Dr. Sorenmo: I realized that this was an underserved population of dogs that we could do something good for by establishing the pet shelter program at Penn. And that's where it started. And, you know, it was easy to get funding for it because it's a very compelling story that people like to help dogs and they like to help dogs in need. And if there is a benefit that you can actually learn about breast cancer. Then it's a double positive.
Dr. Venable: Welcome to the Veterinary Cancer Pioneers Podcast, the show where we delve into the groundbreaking work of veterinary professionals who are dedicated to advancing the field of veterinary oncology. I'm your host, Dr. Rachel Venable, and I'm thrilled to embark on this journey with you. This episode is produced and brought to you by ImpriMed, pioneers in an AI-driven precision medicine for veterinary oncology. ImpriMed’s personalized prediction Profile helps you make confident treatment decisions for canine lymphoma and leukemia patients by predicting how your patient will respond to multiple chemotherapy protocol options. Learn more at imprimedicine.com. That is imprimedicine.com.
Dr. Venable: Hello and welcome to the podcast. Today we have a really interesting guest Dr. Karin Sorenmo. I'm really interested to dive more into her story. So she is a professor emeritus of oncology at the University of Pennsylvania School of Veterinary Medicine, and she's the co-founder and medical director of Lesley's Place, a nonprofit that provides cancer care for homeless dogs. And just a really revolutionary idea on not just helping animals, but also learning more about cancer and comparative oncology. So really fascinating. I think we're going to hear a lot of really great information today, and just excited to dive into her journey from years in academia to her current work and making a difference for both pets and people through her nonprofit. So, Dr. Sorenmo, thank you so much for being with us today.
Dr. Sorenmo: Oh, thank you for having me. And I'm excited to talk about my favorite topic, mammary tumors and estrogen. And I am excited to share my story about how I ended up where I am today.
Dr. Venable: And that's fantastic because I really want to learn more as well. And just to start, I always like to start at the beginning. What got you into veterinary medicine or certainly oncology and mammary tumors?
Dr. Sorenmo: Well, you know, starting all the way in the beginning, I, my background is a little different. You hear that? I yeah, I still have a little accent. I’m Norwegian. I was born on that very small island in the northern part of Norway, just slightly south of the polar circle. But I knew early on that I wanted to be a veterinarian, but I wanted to be like a country animal doctor. And my hero was the country animal doctor. Come to the island with this brown bag to take care of the cows. So that's what I want to do. So I went to veterinary school in Oslo, and I got my degree. And when I graduated, I thought I would do a large animal country practice. And I did that a little bit.
And then I decided to move back closer to home, and I ended up at all places, meat inspection, which is a little different than what I thought I would do. And, you know, clearly it was not what I'd been. The boss wanted to do. So I started to kind of look at what I could do because I wanted to practice medicine. And, even back then it was the saying that everything is better and bigger in America. And I found out that you could actually specialize in small animal medicine in the American veterinary education system. So I decided I'm going to apply to that. And I applied for my internship in Gainesville, Florida, and I think I was both scared and shocked, but I was accepted. But, you know, I had to go and that really changed the trajectory of the rest of my career because it just opened up a whole different view of veterinary medicine and what it could be. Just learning from professors who were so good in medicine and caring for really sick, complex animals. So when I was finished with my internship, I thought, oh, I know we're told that I can go home to Norway and work, as you know, an internist in small animal medicine.
So I went back and, you know, it's one of those things with learning and knowledge when you know very little, you know, you think you know it all, and then you'll learn a little bit more. And then the doors start opening, recognizing the vast amount of knowledge out there that you still need to lock in order to be back here at Penn.
So I decided I needed to learn. And one of the things that frustrated me when I practice in arts law was how we treated animals with tumors, you know, and I know sometimes it stung still here that, you know, it's a tumor. Yes. Let's send it to surgery. Or let's see if it grows and then we'll send it is so great. And that really didn't seem right to me. So I decided, well, if I want to specialize, it's got to be in oncology. So I applied to Penn for the silliest reasons of all, and that was that it was closest in Norway than the other places. That's it. So I ended up again back in the U.S., I really never left. I spent my entire academic career, mostly at the University of Pennsylvania, and I never really looked back. I think it landed me where I wanted to be.
Dr. Venable: It's really interesting and I love how you saw a need. And so you just really went for it and was like, this is this is where we need some help here. So I think that's great. And you do a lot of work with mammary carcinoma, you know, breast cancer basically with people. And so what got you interested into that area specifically?
Dr. Sorenmo: It started with a retrospective study like so many things in veterinary medicine. So I wrote a paper on the effect and timing of various rectum spaying in dogs with mammoth tumors, because I thought that dogs that had money to invest, they should benefit from having some kind of hormonal deprivation, because we know that hormones drive the development of these tumors.
So when my paper was the first one that actually found that that actually could be beneficial, it received a lot of criticism. There was a lack of strong opinions. I think it's one of those things that when the data is weak, their opinions are stronger. So it's true. And so I decided that, well, in order to prove that this is real, you have to do a good study. You have to do a prospective randomized trial. But that was impossible to do here in this country because you're not working in universities. Most of the dogs that came in to see us, the vet, spayed dogs that were spayed at an early age, you rarely saw mammary tumors there. But it's different in Europe and it's different in Norway.
Dogs are typically not spayed there, so you do see a lot of mammary tumors. So I got funded by Morris Animal Foundation and we traveled back to Oslo. I took my whole family, including my surgeon husband who came, which was a very convenient pairing because he did all of the service while we were in Oslo. And that was kind of at the beginning. And, you know, from that study and the data we collected there, my research had continued to build on that. So that was my beginning diving into memory tumors and the hormonal association.
Dr. Venable: And why would you say in your, especially Norway, that dogs aren't spayed? You know, in the U.S.? I remember even as a kid, I don't know if you remember the show The Price Is Right, the Bob Barker at the end would always say, spay and neuter your pets. You know, it was a big campaign in the US, I think, to really help with the pet population. But why is that not the same in Europe?
Dr. Sorenmo: I think the main reason why that campaign is so strong and so important here in the U.S. is that pet overpopulation is a problem, and that it's not the case in Norway. It really wasn't. So there wasn't a big drive to advocate early castration or ovariectomy for that reason, it seems to me that the decreased risk of mammary tumor was almost like a positive side effect from that initial intent of preventing pet overpopulation. So since it's not the problem in Norway, it's never really an issue. And it's also more about, I think, attitude about how to treat animals and not to create them, you know, manipulate them and change them to our convenience, you know, so that dogs should not be spayed just because it's easier for us to manage them. You see what I mean? It's it's that so it's still like that and it's still up when they pick a population. So it's more of a societal issue. I think the particular population that you're dealing with.
Dr. Venable: Okay. Yeah. It is because it is more challenging. Certainly having an intact female dog, you know, there's more involved with that than if they're neutered. And as I mentioned early in the intro, about Lesley's place. And so I kind of want to talk about that with, you know, because a lot of those dogs are intact. Can you tell everybody what Leslie's Places.
Dr. Sorenmo: Right. So when, you know, we returned back to Norway, back to Penn, we wanted to build on the findings that we discovered, based on so much of the data we collected in Norway. And I wanted to continue to work in mammary tumors. But again, the problem was the case population. It didn't exist. But I also had a more mental clarity, I think. And I ask my colleague at Penn, she was the head of shelter animal medicine. I asked them, like, what about the shelter dogs? Are they spayed? And they said, no. And I said, you said mammal tumors and said, “Oh, yeah, a lot of them.” And I realized that this was an underserved population of dogs that you could do something good for. By establishing the pet shelter program at Penn. And that's where it started. And, you know, it was easy to get funding for it because it's a very compelling story that people like to help dogs and they like to help dogs in need. And if there is a benefit that you can actually learn about breast cancer, then it's a double positive.
So the background for Lesley’s Place was really the Penn Program. But when I retired from Penn I wasn't finished with veterinary medicine. It's like I've done it for so long. It's, you know, it was pretty sad not to do it anymore. And my husband retired around this same time. And a few years earlier we lost Leslie to breast cancer.
And Leslie was my colleague at the time. So she was an extraordinary veterinarian. And she thought, you know, let's start a program named after her, do a nonprofit. We did a lot with self funding, and the name is Lesley’s Place. So that she can still be a philanthropist. I think she would like it.
Dr. Venable: Right, that's such an amazing story. And I'm so sorry to hear that Leslie passed, but I think it's amazing that you named this nonprofit in her honor so that that is really special.
Dr. Sorenmo: Thank you.
Dr. Venable: And with this nonprofit and even just your earlier work, too, what is some of the major differences you would say in mammary cancer, especially between un-spayed and spayed female dogs?
Dr. Sorenmo: It's the frequency. Clearly it's a frequency. That's it. So it used to be, you know, accepted that to spay a dog early, you decrease the risk from tumors. But it was also one of those things that, you know, if you spay a dog in mammary tumors, it really didn't make a difference. So that late spaying and hormonal therapy at a later stage in life didn't really affect the outcome of the mammary tumors, to which didn't quite make sense.
And I think the first retrospective proved that. And it's all of the other studies that we have done now. We have shown that this is actually true in dogs as well, that hormonal therapy later in life and a dog has developed mammary tumors. It can do several good things. It can prevent new tumors in other glands, which is very common. Actually 60 to 70% of the dogs, if you leave them intact, they will develop new tumors in other glands. But if you spared them, you cut that risk in half. And that is the same with both benign tumors as well as malignant tumors.
If you spay that dog as well, you can actually decrease or delay the onset of metastatic disease. So that is very similar to what you see in women. Hormonal therapy is still one of the most effective treatments in women with postmenopausal ER-positive breast cancer, and it has been like this for 30 or 40 years now. So the dog is similar to women in many situations, and we still learn so much from human breast cancer that we can apply to the dogs.
Dr. Venable: It is very interesting because I certainly remember learning, you know, if you spay them younger, like if they haven't had a heat cycle yet, the likelihood of them getting mammary cancer goes down. Now, some of that as far as when to spay dogs has changed. I've noticed in the last few years people are waiting longer. What are your thoughts on waiting till the dog is older? Have you noticed or are we seen… I know you said if they're intact in general, we see more mammary tumors, but what about the people that are waiting until they're dogs a year, maybe two years old, before getting them spayed? Do you notice if there's any difference with developing mammary cancer?
Dr. Sorenmo: I think that this idea of waiting a little bit is influenced by observations that dogs that are spayed early, they may have a higher risk of more aggressive tumors, such as hemangiosarcomas, lymphomas, osteosarcomas in certain breeds. So I think the recommendation regarding spaying depends on a few different things, like what is the risk for mammary tumors to us versus what is the risk for these other more fatal tumors.
And you know, the reality is that mammary tumors for the most part is a disease that if it's detected early and the tumors are small, they can be cured. And they can also be detected by their own right. You flip them over, you feel them, you know, with hemangiosarcoma it’s all different. You know, splenic hemangiosarcoma. The owners may not have any idea what's going on with their dog before they have an abdominal bleed, and by that time it is the fatal disease in most cases. Same thing with osteosarcoma. It's highly metastatic. Amputation helps for a little bit. And so mammary tumors are different.
It's also breed differences in, you know, smaller dogs. If you look at the epidemiology in the mammary tumors you see that a lot of the mammary tumors are at high risk breeds are smaller dogs.
So with the larger dogs that you see hemangio, osteo, lymphoma and they are the larger dogs that don't have a lot of mammary tumors. So you can, you know, be a little bit more, I think specific in your recommendations and say, well, you know, if you have a small dog and if you have an older who is somehow unable to monitor the mammary glands because, you know, people have different abilities and maybe they say, well, you know, I don't want to risk it, I want it spay my dog early.
I think that's a big, simple decision. But if you have a larger dog, maybe delay a little bit. I don't know when is the right time, you know, whether two years or four years or never, I don't know. But I think these are questions that I think would help owners make informed decisions about if or when to spay their dogs, depending on their ability to monitor and the kind of dog they have.
Dr. Venable: And makes a lot of sense really. You know, like you said, mammary tumors. A lot of times they are easier to detect, certainly more so than some of those other cancers. And so it is interesting how things are shifting a little bit from, you know, before we would always say usually before six months, you know, to get them neutered.
And, and now I'm definitely seeing, you know, dogs getting older stay more intact. You know, the other thing that was interesting, like you mentioned earlier about hormones, you know, we didn't used to think that was such an issue in dogs. But now it is. But I would say that I don't typically see too often where we use hormone therapy as a treatment in dogs. Is that something that you think needs to shift, or have you found in your research, like maybe we should look at more actual hormone therapy?
Dr. Sorenmo: Well hormone treatment, I think, is ovariectomy as hormonal treatment. It's hormonal deprivation. So basically it achieves the same effect as using anti-hormones or anti-receptors in women with breast cancer. We use tamoxifen to block receptors. So that issue then is not triggering. You know cellular proliferation and malignant transformation. So removing the ovaries removes a big source of hormones for estrogen. And now I'm thinking maybe also progesterone. The two of them play together here. So hormonal therapy, you know, can be many different things. It can be medical or it can be surgical. And for dogs, people have tried tamoxifen in dogs and it's not clearly tolerated. You see pyometra, stump pyometra as well. So it's not necessarily an effective way to go. But removing the ovaries is clearly an effective way to go. So I think you can use that instead of medical therapy.
Dr. Venable: You know, mammary tumors also just seem to be very diverse, right? You have some that, like you said, removing the ovaries or doing a spay can help prevent other tumors. But then sometimes we see these in spayed dogs, dogs that were spayed when they were younger, and they have more aggressive disease. What would you say, even just about how challenging that can be in itself amongst pathologists and clinicians and things?
Dr. Sorenmo: You know, I hope that the take-home message from the meeting we both went to is how complicated it really is. And I think the more you dig into it, the more you appreciate the complexity and the diversity. And it starts with the pathologists. Mammary tumors, there are so many subtypes, and you have to have pathologists who really understand mammary tumors in dogs in order to get a good, useful diagnosis.
And then on top of it, different continents, like in South America, they use a different classification system compared to the system that we are used to from Goldsmith, Pena, Zeppelinl. And secondly, they use the system that I’m used to. So when I read papers from South America, I don’t know what to do about it. I don’t know how to implement the findings in my decision-making because it’s so different.
So it’s like speaking in different languages. So it starts there. But when you’re talking about the tumors that we see here and the different types and the subtypes and the grades, I think that good mammary pathologists are typically in agreement when it comes to the more aggressive tumors. I think where pathologists sometimes disagree is those very early-stage or early transitional tumors that transition from adenoma, a benign tumor, to a low-grade carcinoma. That’s where it gets tricky, and it can be complicated. But you can always say, well, it’s just an academic issue because they’re low grade, so they’re not going to behave aggressively anyway. But the aggressive ones are a challenge for us because we really don’t have effective therapy to offer to the dogs that you don’t think will respond to hormonal deprivation. So that is just something we need to get going. We need to figure out what drugs to use and how to treat them.
Dr. Venable: Yes, and I think it’s so important what you said about the different classification systems because before we talked at the conference, I didn’t realize that South America was using a different system than North America. I didn’t realize they were using a different thing. And so that’s really interesting to think about. When you read through a lot of these studies, it’s not a side-by-side comparison. And so it does make it challenging because I agree, I feel like it’s challenging to know how to treat some of these mammary tumors in general, especially the aggressive ones, as you mentioned. What is the best treatment? Or sometimes, when do you start treatment? I find that can be challenging. With some of these dogs, do they need therapy yet or not?
What, I guess, in your practice, are there certain features where you really decide that, okay, this dog definitely does need more than just surgery or being spayed, versus surgery and being spayed should be sufficient?
Dr. Sorenmo: In the shelter program, we are not in the position to offer systemic chemotherapy for these dogs. We can offer nonsteroidals sometimes, which may have some benefit in some of the aggressive tumors, because we are a shelter program and we don’t have the resources and the staff. And we don’t really want to put these dogs through chemotherapy, especially when we don’t have good data that it will make a difference for them.
I know that veterinarians all over America give chemotherapy for these high-risk tumors because they feel that without it they are going to die from metastases. But the data we know is very weak and inconsistent. And I think some of it may be because of the way the studies are conducted, that they are too small, retrospective, and not really well-controlled studies.
So we still lean on that and say, “Oh, it may help, but we don’t really have the data.” So the shelter dogs get follow-up, and the fosters are often advised and told, your dog has a high-risk tumor, and you can read that based on the biopsies, so you can prognosticate them pretty well. And say this dog is not likely to do well long term, and if you’re interested in getting more treatment for your dog, you can go to an oncologist. But this is beyond what we can provide. Most owners don’t go for it. They elect not to, and I understand. It’s a very different commitment beyond the one they were already taking by fostering these dogs.
Dr. Venable: Sure. And especially if you’re adopting or fostering a dog that has cancer, I just commend those people for taking on those pets. And I think it’s great that you’re able to do surgery and give those pets another opportunity, another chance. And I definitely understand some clients not wanting to do chemo or just feeling nervous about all of that. What about hormone options? Have you found, or is there anything exciting maybe on the frontier for some of those dogs that have been spayed? I know we just talked about tamoxifen and spaying. Is there any other hormone or anything else like that, or maybe targeted therapies, that you think are on the forefront or exciting?
Dr. Sorenmo: I don’t know anything that has been published that I can use to answer that question. And I think that here in the U.S., most university academic institutions don’t have the caseload to actually test it out either. But in hormonal therapy, then we get into the estrogen paradox, which is really looking at how estrogen is not just a bad cop. It can also be a good cop.
And the fact that we have found that dogs that have high estrogen after surgery, they do better than the dogs that have low estrogen. Actually, some of the data that I presented at the meeting, and more data that we have collected from Leslie’s Place now, show that it’s a very different pattern between dogs that continue to have elevated estrogen and increasingly elevated estrogen after surgery.
They don’t develop metastases, whereas the dogs that have maybe lower estrogen and don’t have that elevation, they develop metastases very, very quickly. So this idea that I had too was that I would test out aromatase inhibitors, since they didn’t tolerate tamoxifen, and that would be the ideal option here. I tested it out maybe a few years back and tried to see if I could drop estrogen in these dogs, but it didn’t budge. But there’s something different for the dog. I think it’s almost like the biology in the dog knew better than I did, and it didn’t go down, which I think is a good thing because the dogs that maintain elevated estrogen.. So that brings us back to how estrogen works to drive breast cancer. And it seems like some of the findings, and looking at all the bits and pieces of the puzzle, suggest that it works differently when it is by itself versus when it is working together with progesterone.
So an intact dog that is at high risk is more prone to develop breast cancer, but a dog that has high estrogen with removed ovaries, meaning that the progesterones are not there, they actually benefit from having high estrogen. And that brings us to that dream of complex activation and inactivation that I think is so fascinating. Maybe, you know, I would love to be able to test this out in dogs with mammary tumors that have low estrogen to see if the progesterone is low, you can change the outcome.
Because, you know, in the 50s, high estrogen was actually used to treat women with metastatic breast cancer. And it had the same response rate in those women with metastatic breast cancer as tamoxifen has. So either feeding the estrogen or blocking the estrogen had the same effect. I mean, these days people do not use it because of the fear that it may enhance cancer progression, because they do not know when it is going to be working in their favor or when it is going to drive more cancer to develop.
And since they have other drugs to achieve the anticancer effect that they want, they stay away from it. But it is very interesting what we have seen in dogs. It is clear that it is a very complex story. And I think that we can learn so much from the dog by looking at the dogs after surgery and looking at where the hormone levels go and how they are trending, because it all makes sense when you put all the pieces together. And that is what is so fascinating about the biology of breast cancer.
Dr. Venable: It does seem confusing because on one hand, it is like no, estrogen is bad, it causes it. But then, on the other hand, if they have high estrogen, it treats metastatic disease. Yeah, it is confusing. And I agree, it would be nice to get a study to better tease out what is happening there. And as you mentioned, there really are some links between dog mammary cancer and human breast cancer. What are some other insights that you have seen, especially looking at the two of these as a comparative model?
Dr. Sorenmo: Well, you know, I think that veterinarians are very excited about spontaneous tumors in dogs being models for the same cancers in people. And I think that we are being heard, but we are not being heard well enough. And with breast cancer, I think that the information stream typically goes one way. We look at what they do in humans with breast cancer and apply it to the dog. Very little then goes the other way. But I do think some of the differences between dogs and people can actually be used to provide a different light on the problem and provide research opportunities. So in dogs, you see so many dogs that are older and intact. They do not have just one, maybe two. They have multiple tumors. I have seen dogs from shelters that had tumors in all of their glands and multiple tumors within glands. And what is fascinating with them is one of the things that we published on earlier, which is the progression from benign to malignant, and that the dog can serve as such a good natural model for breast carcinogenesis because you can study how it happens in one dog with multiple tumors at different stages of malignant transformation.
And if you collect tissues from all of those tumors in one dog, you can compare the dog to itself, basically. You do not compare it to another dog that also has tumors, because genetically they might be different. They are all different. But if you collect it from the same dog, you can clean out all that background. So I think that is just a unique model that we have not necessarily used enough. And the other thing is the estrogen paradox, the fact that estrogen can work both ways. Again, because cycles are so different in the dog than in women, where dogs have longer periods of not cycling, maybe estrus twice a year or something like that. So maybe it is cleaner, and easier to tease out what is what in the dog. So I am excited about learning more from dogs. That is why I continue to do this.
Dr. Venable: And I think there is so much we can learn. So I think that it is fantastic that you really have roadmaps and plans on what to do. And speaking of that, you have been working with some researchers in Florida on sequencing mammary tumors and looking at different genomic studies. Have you guys found anything interesting there so far?
Dr. Sorenmo: Well, we have published one paper, and that actually started out of Princeton, because that is where the collaboration started, looking at the molecular modeling of breast cancer and looking at dog models and exactly what they did. So we published that several years ago now, which showed that in dogs that have histologically benign tumors, you do see a lot of molecular dysregulation, specifically at the RNA level, even when they are benign. So that, I think, in itself is very interesting. Florida has all of my tumor tissues right now, and I am hopeful that we can learn more through that kind of research. But like with so many things these days, funding is a major obstacle. So we have not been able to move forward with the sequencing that we wanted to do to learn more from those samples. Because the good thing with the samples is that it is not just the samples. We have the clinical data. We know what happens to these dogs, the outcomes, the developments they had. So without that information, molecular sequencing is not so useful. But if you have it all together, that is what you can do.
Dr. Venable: Right, exactly. You do need the whole puzzle, not just one little piece.
Dr. Sorenmo: Right.
Dr. Venable: To switch gears and go back to Lesley’s Place, I think that is just such a cool thing that you are doing there. And I am sure you have seen all kinds of situations and stories. Do you have a couple stories that you can think of where these dogs maybe had bad tumors but were able to go to a good home?
Dr. Sorenmo: I first want to say something about the fosters here, because they are a story in themselves. Without the fosters, and the fosters’ willingness to take these dogs home with tumors and an uncertain future, and provide a home for them, and then bring them back for the follow-ups, if we didn’t have that, we would not be able to do this work. They are the nicest, the most generous people you can ever meet. So when it comes to stories, it is hard to pick because so many of them come to us with nothing. They have been found on the street, debilitated, neglected, hungry, and you know nothing about them. But there are some that you know more about, and I think one of the dogs that we just lost, even though it is a sad ending, her story is still wonderful, because it sheds light on the suffering these dogs go through, but also the healing they receive when people care for them and give them hope. There is this rescue. They drive down south and they have connections, and they work with a lot of puppy mill people who overbreed dogs. They breed them to the grave because the puppies are valuable, and then when the dogs get sick, they are discarded. They do not get care.
So they drove down there from New Jersey with their truck, picked up a whole flock of dogs, Cavalier King Charles Spaniels, can you imagine, and they drove them up. One of them they brought to us, and she was a Cavalier, so she had pretty severe heart disease. She had oral abscesses. She had a really large tumor. And she was quite a challenge for us because none of us wants to have a dog die during surgery when we are trying to remove a tumor.
We got her a cardiology consult. I usually do not aspirate mammary tumors because I do not necessarily trust it, and I also think it is a dynamic disease. So even though it might be benign today, things change all the time in these tumors, and there is transformation. But I did aspirate her tumor because I wanted to know whether we needed to rush or not, and they said cytologically it was a benign tumor. So we had time to stabilize the heart disease and let her have her puppies. Of course, the puppies were stillborn, but she was placed in the most wonderful family, and she just loved them. And they loved her. It was funny because when they came in with her, her eyes were locked on her foster mom. She would not let go. She was the sweetest little girl.
And after she had the puppies and her heart was beating and doing better, it was like she was saying, it is now or never, we need to take her to surgery. So we did. And the tumor was malignant at this point. She recovered spectacularly. She went home and did well for almost a year until her heart gave up.
So it is one of those stories. It is never just beautiful. It has a little hurt and hardship and sadness in it. But I think that is what this is about. It is not always going to end well, but in the meantime, we can do something right for dogs.
Dr. Venable: Right. And it sounded like she was just so happy to have a real home.
Dr. Sorenmo: Yes.
Dr. Venable: And, you know, with some of those puppy mills, I am from the Midwest, and there are a lot of puppy mills in the Midwest. It is sad. I think the general public just has no idea when they buy these puppies for thousands of dollars. Some of these dogs are expensive, and I think they just do not understand where it is all coming from.
Dr. Sorenmo: Right. It is.
Dr. Venable: But I do love that story. That is a really sweet story. And one thing I am curious about, I know as you mentioned, doing aspirates and cytology is not always a good representation of what the tumor will actually be under the microscope on histology. But how long of a period was it, roughly, from when you did the aspirate where it did not look that aggressive to when you removed it and it was aggressive?
Dr. Sorenmo: It was probably five months, maybe six months.
Dr. Venable: Do you think it transformed?
Dr. Sorenmo: I do not know. Cytology gives you such a small sample of the tumor. And we know that even histologically there can be quite a bit of heterogeneity within sections. It depends on where in the tumor you get it from. And the other thing is that pathologists sometimes have a hard time differentiating between a low-grade carcinoma and a benign adenoma. That transition is hard to capture and agree upon. So I just find it hard to believe that cytology can be that useful. That tumor did grow, though, so I told the owners to keep an eye on the size. But sometimes when you say that without giving more specific instructions, it can be difficult because they see the tumor every day, so they do not notice gradual changes. But that tumor grew about two to three centimeters over that time. So it did grow. So I do not know if it was wrong cytology or a tumor that transformed over time.
Dr. Venable: It is really interesting. And like we have been saying quite a bit on this podcast, it keeps changing. These mammary tumors are complex. It is not as simple as yes or no. Or if you get this answer, you go this way. If you get that answer, you go this way. It certainly is confusing. Whenever I see mammary tumors in practice, I usually double-check the literature because it is not really clear, especially with some of these more complicated cases, what the best route is. What is something you would like to see change maybe even worldwide on how we diagnose, classify, or treat these mammary tumors?
Dr. Sorenmo: I think the first step is to have people who see these tumors more commonly. The pathologists from Italy, Dr. Sopoli and the pathologist from Brazil, Dr. Casali, work together to see if there is a way of presenting the data on histology two ways, or a translation, so that you could understand reporting regardless of where you are in the world and what kind of classification system you are used to. So I think it starts there. I think the other thing is that we need to do good trials. We need to select dogs that are at risk and agree upon what criteria constitute a risk for metastasis, and use those dogs and do randomized prospective trials, and use the same endpoints so that you measure the same thing. Then you can look at all the cases that you have collected together and have enough power to have an answer that everybody can rely on and that will be useful. We do not really have any system for that at this point. I think the conference started a conversation, and I think that is where it has to start, and increase awareness of how complicated it is. My communication with the members of the panel afterward has been only positive. Everybody is excited. So I think it is a start, but there is a lot of work that needs to be done.
Dr. Venable: I think you have definitely done a great job. I agree that the conversation really got started at the conference. And people like myself, who were not even aware of some of these differences, I think that really brought it to the forefront. I am glad to hear that the panelists are all encouraged and talking. So I am hopeful too. I hope we can get a better classification system or more agreement so we can further figure this out in research. And like you mentioned, getting some good clinical trials and agreeing up front on inclusion criteria and everything, I agree. I think that sounds great. And I certainly hope anyone looking for research projects sees that as a great one to take on.
Dr. Sorenmo, I am so glad that you were on this podcast with me today. It was so interesting hearing all the different things about mammary tumors and just the complexity, and the stories behind Lesley’s Place and what you are seeing. The final question I always like to ask people is, who is another guest that you would recommend for this podcast?
Dr. Sorenmo: Maybe, since we talked so much about pathology, what about inviting a pathologist? I think that would be very useful. A mammary tumor pathologist obviously comes to mind for me. But Dr. Zappoli, you heard her speak at the conference. She is an excellent speaker, and this is one of her areas of expertise. I think she has such a good grasp of the situation.
I would love to hear Dr. Goldschmidt being interviewed. He is retired now, for ten years, but he was my pathologist at Penn for so long. Without him, I could not do the work, because like you said, pathology can be so inconsistent. He is one of the forefathers of mammary tumor pathology.
The other person who would be interesting is Dr. Lily Duda. I worked with Lily forever since I started back at Penn. She is a radiation oncologist, but she also has a master’s in ethics, and it is an area that is close to her heart. She is very eloquent. She has strong and clear opinions, and I think it would be interesting to see how she sees how things are done from the ethical point of view, because it is maybe something to consider these days where things are expensive and tests are expensive, and what do you really need to do.
Dr. Venable: Those are all really good suggestions because we have not had a pathologist on, so I think that would be a great one, just to get their take on what they are seeing. And then also ethics, we have not done that either. But that is a great conversation because when you look at different aspects of the world, even with mammary tumors, I have found that when people euthanize is different based on different cultures. I talked with a group in Japan, and they usually do not euthanize a lot of their patients. Their clients will often pursue a natural death. Versus some people in Europe or Northern Europe, where they say people will sometimes euthanize sooner. So I think ethics would be a really interesting talk. And also what you brought up about costs, and different opinions on whether you should treat your pets for chronic diseases or diseases that are not curable in general. So ethics would be a really interesting talk. I did not even realize there was a degree in that. That is really fascinating to me.
Dr. Sorenmo: Right. I do not know if it was specifically veterinary, but it was in ethics in medicine. But as a veterinarian, she made it apply to her field of work. I do not know if there is anybody else like her who does that.
Dr. Venable: No, that is awesome. Those are really interesting and good choices. The other thing I would want to bring up for people is whether there is a good way for people to contact you, maybe about Lesley’s Place. Do you have a website or something, like if people do know of any dogs that maybe need help, or mammary tumors, is there a good way to reach you?
Dr. Sorenmo: I do get people reaching out via the website. My email is there, and there is also an email on the website that people can use. The website is www.lesleysplace.org.
Dr. Venable: Perfect. Well, that is awesome. And I just love the work you are doing, and I hope that it continues. I am really excited to see what you find, and we will certainly keep an eye on what you are up to. So again, thank you, Dr. Sorenmo, so much for being on this podcast.
Dr. Sorenmo: Thank you for having me.
Dr. Venable: Well, that's it for this episode of the Veterinary Cancer Pioneers podcast. If you enjoyed this episode and gained valuable insight, we would be so grateful if you could share our podcast with your friends and colleagues. And it would be even more wonderful if you want to give us a five-star rating, positive review, or any kind of feedback on Apple Podcasts or wherever you listen. The Veterinary Cancer Pioneers Podcast is presented to you by ImpriMed.