Fred Hutch Legacy Insiders

Summer 2024

Loyal supporters and their advisors are helping to accelerate discoveries that prevent, treat, and overcome cancer and infectious disease. We invite you to learn about the innovation their support makes possible.

Donor spotlight: the family of Priscila Martins-Read

Honoring a powerful teacher, wife and mother with contributions that “can help millions.”

Dale and Priscilla

“The ability of one gift to help millions is no greater anywhere than when you support Fred Hutch,” said dedicated donor Dale Read from his home in Vancouver, Washington.

For Dale, his late wife, Priscila Martins-Read, and their children, donating to Fred Hutch Cancer Center was always “the right thing to do.” The family’s commitment grew out of their personal experience, values and compassion for others.

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When she received a breast cancer diagnosis in 2012, Priscila came to Fred Hutch for a consultation and, when her cancer recurred twice, for treatment and additional consultation. “The professionalism, respect, care and attention we received at every visit was exemplary,” Dale said. Inspired by the power and potential of research, the Reads made their first gift to Fred Hutch using a qualified charitable distribution, which allowed them to give generously while enjoying tax benefits.

After Priscila’s passing in 2020, Dale decided to include Fred Hutch in his estate planning as a way to honor her achievements by helping others.

“Priscila was born and raised in Brazil,” Dale said. After arriving in the United States, she became fluent in English and served for more than 30 years as a faculty member and English-language teacher at Clark College in Vancouver. During her tenure, she empowered thousands of refugees, immigrants and exchange students with language skills and encouragement. In 2009, the college honored Priscila with its Exceptional Faculty Award. “She was an incredible person, life partner and mother,” Dale said, “and she was an amazing teacher. In fact, some of her students, who came to the U.S. speaking only their native language, became published authors in English.”

Today, Dale and Priscila’s family, including their children and grandchildren, remain close, gathering often from their homes in Washington, Idaho and New Mexico. A semi-retired lawyer, Dale is also an avid reader of many subjects, including history, geology and astronomy; has written articles for two major law reviews; and is a passionate admirer of the national parks — a love that Priscila shared.

On behalf of his family, Dale also continues to make generous donations to Fred Hutch. Contributions that support the organization’s greatest needs — whether through estate planning, qualified charitable distributions, donations or another mechanism — have a special role, said Dale. “If there’s a research project that is close to a threshold and a little more money will push it over into a clinical trial or a discovery, then the sooner we can start that chain, the more people can benefit.”

“Each donor has their own priorities,” Dale said. “But for me, the impact of a gift to Fred Hutch in terms of benefitting an uncountable number of people is immeasurable. There is no other charitable recipient that offers that level of promise.”
— By Laura Anderson

There are many ways to give to Fred Hutch. To learn more about how you can provide an outright gift, make a legacy gift through your estate, or give through a donor advised fund (DAF) or IRA, contact us at 206.667.3396 or at plannedgiving@fredhutch.org.

Colorectal cancer risk and red and processed meat

Large analysis shows high meat consumption bumps risk by as much as 40%, identifies two genetic variants that increase risk even more

Meat Consumption

People worried about colorectal cancer may want to put those hot dogs and hamburgers on hold this summer.

New research from a Fred Hutch Cancer Center collaboration with USC Norris Comprehensive Cancer Center and published last month in the journal Cancer Epidemiology, Biomarkers & Prevention, quantifies the risk posed by eating red or processed meat. The collaboration also found two genetic mutations that, for those carrying them, make eating red and processed meat even more hazardous.

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Colorectal cancer is the third-most common cancer and the second leading cause of cancer death worldwide. According to estimates from the National Cancer Institute, more than 150K people in the U.S. will be diagnosed in 2024 with colorectal cancer and more than 53,000 people will die of it. Genome-wide association studies, many conducted by Fred Hutch, have reported over 200 genetic variants associated with colorectal cancer risk. Research has also shown that consuming red and processed meat is a known risk factor.

Fred Hutch molecular and genetic epidemiologist Ulrike (Riki) Peters, PhD, MPH, one of the principal investigators of this study, said by conducting a genome-wide gene-environment, or more specifically in this case, a gene-diet interaction analysis, they hoped to identify genetic variants that either increase or ameliorate risk for these cancers.

“We know that not everyone who eats bacon almost every day will develop colorectal cancer,” Peters said. “So we want to understand if the genetic background may play a role here.”

More meat, more risk

The research team started by pooling participants from a collection of 27 studies, analyzing genetic data from around 30,000 colorectal cancer patients and approximately 39,000 healthy controls, all of European ancestry (the non-inclusive ancestry is also one of the study’s limitations).

Cancer patient data was gleaned from three studies, the Genetics and Epidemiology of Colorectal Cancer Consortium, housed at Fred Hutch; the Colorectal Cancer Transdisciplinary Study and the Colon Cancer Family Registry. A questionnaire determined frequency of red and processed meat intake. Red meat was defined as beef, pork and lamb; processed meat included bacon, sausage, lunch/deli meat and hot dogs.

In addition to diet, the researchers looked at a number of different data points including age, amount of food intake, obesity or being overweight and other factors. Peters said their results showed that older adults, those who were obese and those who ate more calories on a daily basis, were at a greater risk for developing the disease.

Ditto for those who ate more meat.

“Participants with the highest intake of red meat had a 30% increased risk of colorectal cancer and those with the highest intake of processed meat had a 40% increased risk,” said Peters, who holds the Fred Hutch 40th Anniversary Endowed Chair. “But this is an overall increased risk. Due to genetic variability, the risk can be higher in some people.”

That variability is exactly what the researchers dug into next.

Some people are more susceptible to CRC risk

After generating data on more than seven million gene variants within the study participants’ genomes, the research team conducted a gene-environment interaction analysis.

They used a standard statistical analysis approach to identify one single-nucleotide polymorphism, or SNP, in chromosome 8 near the HAS2 gene, present in two thirds of the population. This gene variant upped the risk of colorectal cancer risk by 38% for those who consumed high amounts of red and processed meat.

They then used a novel two-step approach to identify pattern between meat consumption and colorectal cancer risk and discovered another SNP in chromosome 18, part of the SMAD7 gene, which is responsible for regulating a protein linked to iron metabolism. The researchers believe this variant also increased the risk of colorectal cancer, possibly by altering the way the body processes iron.

“These findings suggest that there’s a subset of the population that faces an even higher risk of colorectal cancer if they eat red or processed meat,” Peters said.

This study builds on years of research by Peters and her team, including a recent study which found that obesity and alcohol consumption were strongly correlated with colorectal cancers in people under age 50.

Funding for this study was provided by the National Cancer Institute and National Institutes of Health.

Diane Mapes is a staff writer at Fred Hutchinson Cancer Center. She has written extensively about health issues for NBC News, TODAY, CNN, MSN, Seattle Magazine and other publications. A breast cancer survivor, she blogs at doublewhammied.com and tweets @double_whammied. Email her at dmapes@fredhutch.org. Just diagnosed and need information and resources? Visit our Patient Care page.

Are you interested in reprinting or republishing this story? Be our guest! We want to help connect people with the information they need. We just ask that you link back to the original article, preserve the author’s byline and refrain from making edits that alter the original context. Questions? Email us at communications@fredhutch.org

Coping in the aftermath of a cancer diagnosis

10 tips and coping strategies from a Fred Hutch social psychologist and researcher

Receiving a cancer diagnosis can be one of the most stressful, pivotal moments in an individual’s life. During my over decade-long career as a social psychologist and health communication researcher, I have been told repeatedly that the words “you have cancer” often create immensely negative emotions such as overwhelm, fear, anger, stress or even depression. These emotional reactions are normal and part of most patients’ experience — but there are ways to find support. With May being Mental Health Awareness Month, it is critical to raise awareness for patients and those supporting them.

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One major challenge is that patients’ experiences of these negative emotions can make it hard to process all the information their oncologist presents to them. Prior research shows that when cancer patients’ difficult emotions (such as fear, anxiety and worry) are too high, it can hinder their ability to engage in cancer treatment decision-making. This is problematic because this is occurring at the beginning of treatment when rapid-fire decision making must occur to determine next steps in treatment.

So, how do you cope with the aftermath of a cancer diagnosis? Read on to learn how to find support and allow yourself to engage in treatment decision-making in an informed way.

Coping with a recent cancer diagnosis

Due to the overwhelming stress and strain — emotionally, mentally and physically — of receiving a cancer diagnosis and undergoing treatment, it is so important to be sure that you are provided with support. Below are some tips on ways to begin dealing with the reality of a cancer diagnosis and seek out the support you might need:

  1. Express how you are truly feeling. An essential part of coping with challenging emotions is to first label and acknowledge them. If you find yourself feeling fearful, anxious, sad and/or depressed, begin to label those emotions. Often, in the face of a cancer diagnosis, patients feel the need to be brave and put on a strong face for those around them. But this may not be in line with the reality of how you feel. Find safe spaces and places (support groups, counselor, spiritual leader) to express how you are truly feeling.
  2. Find the right people to support you. Walking through a cancer diagnosis and treatment often requires a lot of support — both practical and emotional. If you are able, begin to make a list of the people in your life who can provide practical support, such as getting you to and from the hospital, assisting with meals or watching your kids or pets. Then think of who you turn to for emotional support. Reach out to these people for help. To make it less overwhelming, you can also designate one person in each category to reach out on your behalf to others in order to get you the practical and emotional support that you need without you doing all of the delegation work. If you do not have a source of support, there are many people on your oncology team ready to support you such as psychologists, chaplains and social workers. These individuals are focused on ensuring you, the patient, feel supported with all of your practical, emotional and mental health needs.
  3. Get help (if needed) in communicating your cancer diagnosis. A common challenge recently diagnosed cancer patients face is the immense exhaustion and burden of communicating their diagnosis with friends and family. First, remember that you are not obligated to communicate your diagnosis to anyone. But, for those with whom you do want to communicate, consider asking some of your close friends or family to lift that burden off you and communicate it on your behalf. This way, everyone is informed and can provide support (encouraging notes, meals for you, etc.) without you having to go through the draining process of telling everyone yourself.
  4. Find something that you love (and are able) to do during treatment. Many patients report that something that helps them get through their cancer treatment is engaging in something very simple that they are realistically able to do. This could be watching your favorite shows, reading a poem a day or having your pet come in for a daily cuddle (when at home). The key is to pick something that soothes you and brings you joy but that is manageable while undergoing various treatments such as radiation or chemotherapy, or recovering from surgery. And remember that being flexible and taking days off when the side effects are too severe is crucial!
  5. Take each day one step at a time. Feelings of overwhelm are very commonly reported by cancer patients, especially when they are first diagnosed. There are often a lot of decisions to make, a lot of treatments to undergo, and all of this is happening while you are processing that you have cancer. If things feel like they are a blur to you, know that is normal and it’s OK to take one step forward at a time and not think too far into the future. Center yourself each morning on what appointments or choices you have to make that day rather than zooming too far ahead. This can help reduce the amount of overwhelm and allow you to focus on each step of treatment as it comes.

Tips for appointments and decision-making in early stages of cancer treatment

Experiencing challenging emotions is not only difficult, it can interfere with your treatment decision-making and your communication with your oncologist. Good communication with your oncologist is so important that it’s linked to both being satisfied with your communication with your oncologist and your psychological outcomes (such as anxiety and depression). Below are some tips for how to optimize your appointments with your oncologist in the early stages of treatment decision-making:

  1. If possible, bring someone with you to your appointments. As mentioned, recall of information can be poor if your challenging emotions like fear or anxiety are too high. That’s why, if possible, it is very helpful to bring someone like a friend or family member to your appointments. This way, you have another person present to both hear and recall information as well as to ask questions. If that person lives out of town, ask your oncologist if you can use FaceTime or another phone-based technology to virtually bring the person to your appointment. It is often good to pick someone who you feel will be an advocate for you during those appointments. Another key tip to remember is that if English is not your preferred language, you can always request a medical interpreter. Even if you speak English but feel more comfortable in another language, you can request this service to ensure you feel confident in understanding what your oncologist is saying to you.
  2. Write out your questions ahead of your appointment. Patients’ minds are often swimming with questions and concerns, but these can be forgotten or overlooked at the actual appointment. By bringing a list of questions, either written down on paper or typed into your phone, you can ensure that your oncologist looks at your questions and helps you prioritize what should be addressed during your appointment that day.
  3. Let your oncologist know if and where you are researching information. My prior research has shown that often, patients are looking up information about their cancer (treatment, prognosis, etc.) but failing to tell their oncologist where they got that information from fear of embarrassment. However, it is best to be honest with your oncologist about where you are seeking and finding information. This builds trust between you and your oncologist and helps them inform you more clearly about that information. In most cases, oncologists respond very positively to patients sharing this information and can best help guide and inform you to the details of your specific cancer diagnosis in a way that information online may not be able. Use this as an opportunity to gain from your oncologist’s expertise to help guide you through the information you are finding.
  4. Ask about any procedures or decisions that should (or can) be made before starting cancer treatment. A common issue that can negatively affect a patient’s future is overlooking important procedures, such as fertility preservation, that can only happen prior to starting cancer treatment. Although most oncologists discuss fertility loss as a side effect of cancer treatment, research shows that few provide information to their patients about preserving their fertility. This means that patients lose the chance to engage in fertility preservation. If you are of childbearing age and this is of priority to you, you may want to inquire about this possibility with your oncologist. If you are a Fred Hutch patient, ask about the Oncoreproduction Clinic. Additionally, ask your oncologist if there are any other medical procedures you should know about or consider prior to starting treatment.
  5. Ask your oncologist to outline (if possible) a roadmap of your treatment plan and/or get patient navigation support. Something newly diagnosed cancer patients commonly report is how overwhelming and confusing the cancer treatment ahead of them is. There can be multiple steps in your cancer treatment and care which include surgery, radiation and chemotherapy but very little clear guidance. Ask your oncologist or someone on your care team to create a roadmap for you of what lies ahead if you find that beneficial. You can also request to be connected with a patient navigator if the clinic where you are being treated has one. Patients report that patient navigation is extremely beneficial. It has been shown to help provide emotional support and assistance with information needs, problem-solving and the logistical aspects of coordinating their cancer care.

The aftermath of dealing with a cancer diagnosis can be an emotional time, full of uncertainty and a long, winding confusing path. But there are resources to help you every step of the way, and finding and seeking out good support and having clear communication with your oncologist can help you, just as they have helped many other patients in your shoes.

Megan J. Shen, PhD, is a social psychologist and health communication researcher. She is an associate professor in the Clinical Research Division at Fred Hutch and an adjunct associate professor of Populations Health Sciences at Weill Cornell Medical College. Her research interests include health care communication and decision-making; end-of-life care; advance care planning, palliative care, health equity and grief.

Are you interested in reprinting or republishing this story? Be our guest! We want to help connect people with the information they need. We just ask that you link back to the original article, preserve the author’s byline and refrain from making edits that alter the original context. Questions? Email us at communications@fredhutch.org

Targeted new approach and computational tools reveal lung cancer subtypes hiding in patterns in cell-free DNA

Innovative strategy a step toward liquid biopsy to detect, monitor aggressive small cell lung cancer

Big-picture patterns of DNA packaging, gene activation and mutations could hold the information needed to develop a blood-based biopsy for small cell lung cancer patients, according to new work published by scientists at Fred Hutch Cancer Center in the journal Science Advances.

The multidisciplinary team showed that they could use cell-free tumor DNA in blood samples to distinguish between SCLC and non-small cell lung cancer, as well as different subtypes of SCLC, using innovative computational methods that reveal patterns in the activation status of hundreds to thousands of genes.

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“There is a deep need for blood-based assays that define subtypes in small cell lung cancer,” said Fred Hutch SCLC researcher David MacPherson, PhD, who co-led the work with Fred Hutch computational biologist Gavin Ha, PhD.

Much of tumor behavior is governed by which genes are turned on, or transcribed, regardless of whether they are mutated. Scientists have defined several signature patterns of gene activation in SCLC, and these subtypes may respond differently to treatment and harbor different treatment vulnerabilities. Patients need tests that can monitor their disease, detect when it transforms into a different lung cancer type, and identify potential treatment targets even when standard biopsies aren’t an option.

The new methods are a step toward such assays, MacPherson said.

Most clinical circulating tumor DNA assays focus on changes to DNA sequences, but the Fred Hutch team built an assay that reveals gene activity and regulation status in tumors using a snippet of cell-free DNA.

“Our approach demonstrates that a full-featured circulating tumor DNA assay has the potential to classify clinical subtypes driven by transcriptional programs,” Ha said.

This approach is especially important for SCLC and other tumors without DNA sequence information that can inform treatment decisions, he said.

“This assay expands the boundaries for potentially using circulating tumor DNA to improve treatment selection and cancer management,” Ha said.

SCLC: aggressive and changeable

SCLC is an aggressive disease that is prone to metastasize, or spread. About 238,340 people were diagnosed with lung cancer in the U.S. in 2023, and about 14% of them had small cell lung cancer. Most patients are diagnosed with late-stage disease, and the percent of people who are alive five years after diagnosis can be as low as 6%.

Most cases respond well to chemotherapy, but the disease almost always recurs. In recent years, doctors have extended patients’ lifespan by adding immune checkpoint inhibitors, a type of immunotherapy, but they’re not cures. Researchers like MacPherson are working to develop SCLC-targeted therapies, but it’s not easy.

“For a lot of cancer types, the distinct ‘flavors’ of the cancer types are driven by gene mutations,” MacPherson said.

In NSCLC, a mutation in the EGFR gene drives some tumors and can be targeted with a specific inhibitor.

“In SCLC, we don’t really have that,” he said. Instead, in each “flavor” or subtype, a key protein orchestrates a distinct large-scale gene expression program. This makes it hard to pinpoint individual targets with therapeutic potential.

These different gene expression patterns already have important implications for patients. For example, one SCLC subtype is linked to better responses to immunotherapy, which doesn’t work for every patient. And sometimes patients diagnosed with NSCLC find that their tumors evade treatment by evolving into SCLC.

“There’s a deep need for blood-based assays to define these subtypes in small cell lung cancer patients,” MacPherson said.

Such an assay could help oncologists tailor SCLC treatment when new, targeted strategies reach the clinic. They could also help doctors monitor patients for recurrence or detect when a patient’s disease has switched from NSCLC to SCLC, which will change their prognosis and will dictate a new treatment strategy.

Liquid biopsies are gaining attention as potentially quicker, less invasive and cheaper alternatives to standard biopsies. SCLC tumors release a lot of DNA into the blood, which could be used as biopsy material, MacPherson said.

But developing blood-based cell-free DNA tests is tricky. First, cell-free DNA doesn’t float in long, easy-to-sequence strings. It’s made up of small snippets that must be reassembled like a multimillion-piece jigsaw puzzle. Secondly, most of the DNA in our blood is from healthy cells, even in patients with large tumors. To top it off, most of the DNA in cancer cells is the same as the DNA from healthy cells.

To parse out the tumor DNA and discover its important information, Joe Hiatt, MD, PhD, a research associate in MacPherson’s lab teamed up with Anna-Lisa Doebley, PhD, while she was an MD/PhD student in Ha’s lab. (Doebley conducted the research portion of her graduate work with Ha and is currently finishing her MD at the University of Washington School of Medicine.) Ha and his group specialize in developing computational approaches to re-assemble the DNA jigsaw and find informative patterns in circulating tumor DNA.

Ha doesn’t focus on mutations in individual genes. Instead, he looks at larger patterns, particularly of DNA packaging, which can tell him about which genes are turned on (transcribed) and turned off (silenced).

The most basic unit of DNA packaging is a wheel-shaped protein complex called the nucleosome. DNA strands wrap around nucleosomes like yarn around a spool. The more nucleosomes in a section of DNA, the tighter the packaging and the more “silent” the gene region is. Looser areas where genes are turned on have fewer nucleosomes.

When DNA is released by cells (both cancerous and healthy) into the blood, nucleosomes protect it. The snippets of DNA floating in our blood reflect the regions with more protective nucleosomes. Ha has developed methods, called nucleosome profiling, to glean gene expression patterns from nucleosome-protected snippets of DNA in blood.

So Doebley and Hiatt decided to develop a targeted strategy to discover them. The team looked at regions of DNA called transcription start sites, or TSSs, where the “reading” of genes starts.

Transcription is orchestrated by transcription factors, a wide-ranging group of proteins that help turn genes on and off. The team suspected that the different genetic programs used by the different SCLC subtypes would be reflected in different patterns of DNA packaging at these genes’ start sites — and that these patterns could be found in circulating tumor DNA.

Cell-free tumor DNA reveals lung cancer types

To give themselves a leg up, Hiatt and Doebley started with preclinical models in which cell-free tumor DNA is easier to sift out from DNA released by healthy cells: patient-derived xenograft models, or PDXs.

In PDX models, tumor tissue taken from patients is implanted into mice. This means that all the tumor DNA circulating in the blood of a PDX mouse is of human origin.

The team drew from eight NSCLC PDX models and 20 SCLC PDX models (including one from a patient whose tumor had transformed from NSCLC to SCLC) to draw from. The team had detailed molecular information about each tumor.

“They had ground truth about activation of transcription factors, expression of all genes, and how we can correlate that with the TSS [transcription start site] signal,” MacPherson said.

They created a focused sequencing strategy to detect DNA from relevant regions, and Doebley built her probabilistic models by tailoring Ha’s team’s nucleosome profiling methods to this targeted panel. She formulated probabilistic models that account for the fact that the amount of tumor DNA in blood plasma can vary, and which accurately estimate the fraction of each SCLC subtype even when in samples with 5% tumor DNA.

Doebley and Ha built one model to predict likelihood that cell-free DNA came from an NSCLC or an SCLC tumor. The second model distinguished different SCLC subtypes.

All told, the predictive models examined more than 13,000 transcription start sites and more than 1,000 transcription factor binding sites. The assays captured the sequences of nearly 850 genes.

Doebley and Hiatt then tested the models against cell-free DNA in patient samples to see how they fared in a more clinically relevant context.

They found that their computational model was very good at predicting whether DNA had come from an NSCLC or SCLC tumor, suggesting that their approach has potential for detecting when a patient’s tumor transforms from NSCLC to SCLC, MacPherson said.

The model that predicted SCLC subtype performed well, but was hampered by the limited selection of subtypes in the patient samples. Certain subtypes were well represented, but one SCLC subtype was not included in the cohort.

Validating and refining

Though preliminary, the results show that liquid biopsies based on large-scale patterns in DNA packaging have potential as tools to monitor SCLC, MacPherson said.

The team is working toward further refining and validating their models to improve and expand their predictive capabilities. They will likely be able to winnow down the key TSSs, transcription factor binding sites and mutations to a smaller, but equally informative panel.

“It was remarkable to us that only a smaller set of informative genomic regions was needed for our computational models,” Ha said. “This has implications for more cost-effective and easier translation into the clinic.”

The refined panel will be tested against larger, more comprehensive sets of patient samples, including more from patients whose tumors change from NSCLC to SCLC.

“The other future direction is to broaden the types of phenotypes that we want to try to capture with this assay,” MacPherson said.

This would allow them to do more than merely assign patient SCLC tumors to particular subsets, he said. The team may be able to use the patterns in cell-free tumor DNA to qualities that oncologists could use to someday direct a patient’s treatment, like targets for therapies like antibody-drug conjugates or genetically engineered immune cells.

The investigators also want to link the patterns they’ve detected to clinical responses, which will also help tailor treatment regimens in the future.

The approach has implications for other tumor types as well, Ha and MacPherson noted.

“This was the first study to comprehensively assay thousands of [gene transcription] start sites. An important conclusion from our paper is that cell-free DNA contains information about the activation of a lot of these sites,” MacPherson said.

This information will likely be as important and informative for other tumors as it is for SCLC.

In the short term, MacPherson envisions similar assays being used to improve clinical trials, helping identify patients who are the best candidate for a new therapy, or giving researchers information about why certain patients respond and others do not. He’s also interested in discovering whether a similar assay could be used to detect at the molecular level tumors that are responding positively to treatment even if the response may not yet be clinically apparent.

“A clinical assay is our ultimate goal, and the next steps of our research directions are focused on that,” MacPherson said.

This work was supported by the National Institutes of Health, the Kuni Foundation and the Conquer Cancer Foundation.

Sabrina Richards, a staff writer at Fred Hutchinson Cancer Center, has written about scientific research and the environment for The Scientist and OnEarth Magazine. She has a PhD in immunology from the University of Washington, an MA in journalism and an advanced certificate from the Science, Health and Environmental Reporting Program at New York University. Reach her at srichar2@fredhutch.org.
Are you interested in reprinting or republishing this story? Be our guest! We want to help connect people with the information they need. We just ask that you link back to the original article, preserve the author’s byline and refrain from making edits that alter the original context. Questions? Email us at communications@fredhutch.org

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What does a unique gift like this actually do? By making a gift to Fred Hutch in your will or trust, or by naming us as beneficiary on one of your financial or investment accounts, you contribute to:

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