Doctors, patients focus on preventing cancerRhonda McCartt was in shock when a mammogram and biopsy revealed precancerous cells in her breast. In the past, such a diagnosis would have been a signal to wait and worry, with close monitoring to see whether the cells became cancerous. These days, as doctors detect potential cancers earlier, they’re also trying to stop cancer before it starts.
By: Nancy Churnin, The Dallas Morning News
DALLAS — Rhonda McCartt was in shock when a mammogram and biopsy revealed precancerous cells in her breast.
In the past, such a diagnosis would have been a signal to wait and worry, with close monitoring to see whether the cells became cancerous. These days, as doctors detect potential cancers earlier, they’re also trying to stop cancer before it starts.
Which is why Dr. David Euhus, professor of surgical oncology at UT Southwestern Medical Center, immediately put McCartt on Tamoxifen. The drug, which interferes with the activity of estrogen, has been used for more than 30 years to treat breast cancer and has been used to reduce the risk of breast cancer in high-risk women for the last 10. Despite the sickness she felt in the first few months of taking the drug, McCartt, 48, of St. Paul, Texas, near Wylie, says it was worth it.
“I feel really good on it now. It’s not bothering me at all,” McCartt says. “And it’s given me peace of mind.”
That’s the kind of relief that doctors are seeking with an increasingly preventive approach of early detection and medications, says Dr. Therese Bevers, medical director of the cancer prevention clinic at M.D. Anderson Cancer Center in Houston. Bevers was personally involved in the study that showed the cancer-prevention properties of Tamoxifen and Raloxifene, which had previously been used primarily to counter osteoporosis.
“I do think we’ve come a huge way in the past 10 years,” Bevers says, noting that recent breakthroughs in preventing cancer include Gardasil and Cervarix, vaccinations that reduce a woman’s chance of getting certain types of papillomavirus, which can lead to cervical cancer. She also recommends that women get tested for HPV when they get their Pap smears. Pap smears test for premalignant and malignant activity in the cervix, while HPV screenings can catch cellular changes at an earlier stage, she explains. If the HPV is positive, that means a woman is at higher risk.
“The world of cancer prevention is exploding,” Bevers says. “There is a great deal of investigation. One study is looking at a cholesterol medication, and others are looking at anti-inflammatory drugs to see if they will reduce the development of colon polyps.”
This preventive focus reflects a fresh approach to cancer — a pre-emptive strike instead of a retaliatory war. The reasoning is that in many cases, by the time cancer is detected, it is too late to save the patient. The odds improve greatly if doctors can stop cells or tumors from developing into cancer or remove cancer-prone tissue before problems start.
Bevers says that M.D. Anderson has released new guidelines for identifying people with a high risk of developing cancer so that they can receive more sophisticated tests, such as genetic testing, which could indicate early intervention.
In the case of breast cancer, that might mean a preventive removal of cancer-prone tissue.
Michaela King-Klose, 33, of Dallas was at high risk because she has a sister, grandmother and great-aunt with breast cancer and she had recently had cancer on her ovaries and appendix. She opted for a prophylactic double mastectomy.
King-Klose liked that the surgery would reduce her odds of getting breast cancer to less than 5 percent, she says. She wasn’t willing to wait around and worry about what seemed inevitable to her.
“I had just had a baby in July of ‘08,” she says. “I have three young boys under the age of 10. I have to live for them.”
The next best thing to stopping cancer before it starts is detecting it early before it spreads.
Dermatologists such as Dr. Melissa Costner at Texas Health Presbyterian Hospital Dallas pay special attention to patients who have more than 30 moles or multiple pigmented lesions or who have a history of childhood sunburns or exposure to tanning beds because of their greater risk of skin cancer.
Costner routinely uses magnifying tools that allow her to catch things that she might miss with the naked eye.
“I’ve caught a melanoma or two that I wouldn’t have otherwise seen, using this polarized magnified light,” she says.
Just as movies are moving to 3-D, so is medical technology. Dr. Rassa Shahidzadeh, a gastroenterologist with Dallas Diagnostic Association on the Baylor Plano medical staff, uses a thin, 6,000-pixel fiber-optic diagnostic tool called a Spyglass that allows him a look into the bile duct and diagnose potential problems in the bile duct, pancreas and liver without an abdominal incision.
“There are bile duct tumors that are benign that can become cancerous,” he says.
“The big problem with bile duct, pancreatic and liver tumors is that if they’re imbedded deep in the tissue, just getting a diagnosis through surgery or needle biopsy can run the risk of complications and spreading or seeding of cancers. And sometimes by the time you diagnose them through conventional means, they are too late to treat.”
Dr. Katherine Hall, a radiologist and medical director of the Women’s Diagnostic and Breast Center at Presbyterian, is doing clinical trials with a new 3-D mammography machine. The technology, called tomosynthesis, is not yet approved by the FDA, but it holds promise for catching breast cancer in women with dense breast tissue, Hall says.
McCartt illustrates the importance of all people getting properly screened no matter their level of risk or, in her case, the seeming absence of it. McCartt had no family history of cancer, had stayed fit and had eaten a healthy diet.
She is grateful that her pre-cancerous cells were identified and the problem could be curbed before it started to grow.
“I’m a fine example of the importance of getting your annual mammogram,” she says. “If I hadn’t gone, I don’t know what would have happened.”
There is a clear correlation between obesity and cancer, according to a November report by the American Institute for Cancer Research. It went so far as to link excess body weight to more than 100,000 cancers in the U.S. annually.
Researchers from the American Cancer Society cited this connection as far back as 2003.
In fact, the only issue in doubt among most experts is why.
Some say increased weight causes an increase in the amount of hormones, such as estrogen, or an increase in low-grade inflammation in the body, both of which are theorized to increase cancer risk.
Dr. David Euhus, professor of surgical oncology at UT Southwestern Medical Center and director of the Cancer Genetics and Risk Assessment Program at the Simmons Cancer Center, believes the true culprit is insulin resistance, which increases with weight gain and a sedentary lifestyle.
“Breast cancer risk increases in the years prior to a diagnosis of diabetes,” says Euhus, who is working with researchers at UT Southwestern to explore his ideas. “Women with higher levels of circulating insulin have higher breast cancer rates.”
Euhus is examining medicines such as Metformin, which heightens insulin sensitivity, as possible cancer preventives.
His preferred prescription, which he gives to all his patients, is a healthy lifestyle, he says.
“Losing weight can decrease breast cancer risk. We need to come up with more effective weight-loss strategies.”