Special Advertising Section: Cancer Care in Dallas
Some of the finest genetic testing clinics, groundbreaking research, clinical trials, and medical care in the world are all well within your reach. When you’re in for the fight of your life, Dallas is clearly a great place to do battle.
Americans’ risk of losing the battle against cancer continues to decline, and survival rates for many types of cancer are improving. In fact, fewer than half of the people diagnosed with cancer today will die of the disease.
While it may seem like “everyone you know” is getting cancer, the reason for this misperception is actually a positive one—earlier detection. As word spreads that the single best way to survive this disease is to catch in its earliest stages, more people are talking to their doctors about life-saving screenings, genetic testing, and lifestyle changes that can reduce their risks.
During the past 15 years, there has been a 70 percent decrease in the mortality of cancer, thanks to greater public awareness and increased screenings. Dallas’ growing medical community is not only prolonging, but saving, more lives of patients with cancer, thanks to faster and more effective treatments, up-to-the-minute technology, targeted therapies, and improved surgery outcomes. Some of the finest genetic testing clinics, groundbreaking research, clinical trials, and medical care in the world are all well within your reach. When you’re in for the fight of your life, Dallas is clearly a great place to do battle.
LIFE SAVER: Genetic Testing
Arlington native and Midlothian resident Abigail Ellyson, 36, didn’t give much thought about her risk of getting cancer. She led a healthy lifestyle and didn’t engage in risky lifestyle behaviors commonly linked to the disease. One afternoon, while playing with her young son at home, he accidentally elbowed her in the chest area. What Ellyson thought was a resulting injury to her breast actually turned out to be much more. When the painful lump in her breast didn’t go away on its own, she made an appointment with her Ob/Gyn to have it examined. The doctor ordered a mammogram, and the result led to three different biopsies. “The doctor called back and said I had breast cancer,” Ellyson says. “I was only 36. It didn’t seem possible.”
Because Ellyson was diagnosed with breast cancer at such a young age, her doctor recommended genetic testing. Research shows that breast cancer in your 30s is more of a sign that it’s genetic than two people in the same family having it. If Ellyson tested positive for a breast cancer gene, the chances of breast or other forms of cancer returning after even the most aggressive treatment would be much higher. “I made the decision prior to testing that I wanted to take the least invasive treatment possible,” Ellyson says. “The tumor was very small, and it was caught early and hadn’t spread. But after I got the results of the genetic testing, I changed my mind.”
Ellyson was tested for a genetic link to cancer through the Hereditary Cancer Risk Assessment Program at Texas Oncology-Baylor Charles A. Sammons Cancer Center. Prior to the simple blood test, genetic counselors spent time with her to discuss what a positive result would mean. Not only would it indicate that the cancer would more than likely come back, even with aggressive treatment such as radiation and chemotherapy, it would also mean that other family members, including her children, may also be at risk. She was tested for two common mutated cancer genes, BRCA-1 and BRCA-2, and the results were positive. “You don’t know how you’ll react until it happens to you,” she says. “I thought about my kids – ages 6, 4, and 2. I wanted to live to see them graduate, get married, and have children. I didn’t want to keep dealing with cancer coming back year after year. I wanted to be done with it so I chose a double mastectomy with breast reconstruction.”
Since her surgery last July, Ellyson has spent a lot of time educating herself about other risks of cancer outside of the genetic link. Now that she has hopefully eliminated that risk, she also wants to eliminate other environmental and lifestyle risks associated with cancer. “I thought I lived a relatively healthy lifestyle, but realized that a lot of things we eat and our lifestyle habits also play a role,” she says. “I have reduced my sugar intake, which has been proven to feed cancer cells, and I exercise more. I’m also using what I’ve learned to educate my children about cancer since, more than likely, they run the risk of getting cancer, too.”
Genetic testing for cancer is the analysis of human DNA to detect inheritable disease-related gene mutations that may increase the risk of certain cancers. It provides an in-depth cancer risk assessment for individuals with a significant personal and/or family history of cancer. While you don’t inherit cancer, you can inherit a higher risk for developing it. Although a small percentage of cancers are from inherited gene mutations, genetic testing identifies an individual’s risk for certain types of cancer.
Testing provides early detection and the opportunity not only to reduce the risk of cancer, but also to save lives. Detecting cancer early is one of the most important things people can do to protect their health and significantly increase the chances of successful outcomes. When a gene mutation or change occurs, genes do not function correctly, and a greater risk of cancer is inherited. The testing process includes the following steps:
Medical History: A person first completes a personal and family medical history, along with a counseling session.
Testing: A blood sample is analyzed, looking for a change or mutation in the gene. While the lab test is very complex, only this blood sample is needed.
Counseling: Following the testing, the person receives comprehensive counseling based on the results of his or her test. For those who are found to have a gene mutation and a higher risk of cancer, options for next steps are discussed.
Next Steps: Options can include closer medical surveillance, drug/hormone therapy for prevention, or surgery. Genetic counseling and testing provides them with the tools to make informed decisions.
Dr. Srinivasu Moparty with Texas Oncology-Methodist Charlton Cancer Center says between five and 10 percent of people with breast and ovarian cancer in Texas have an inherited gene mutation linked to cancer, particularly for the BRCA-1 and BRCA-2 mutations. “Testing positive for the mutation if you don’t already have cancer doesn’t necessarily mean you will get cancer,” he says. “It means that you have a much higher risk – anywhere between 55 to 85 percent higher – of getting cancer before age 70. In the case of breast cancer, if you choose to remove both breasts, you reduce that risk to five percent. Since there are no proven effective screning tests for ovarian cancer, I recommend that a mutation-positive woman who is done with child bearing consider an oophorectomy. Another advantage of knowing about your risk is the ability to get advanced cancer screens. For instance, you’ll qualify for a breast MRI in addition to mammograms and will also start getting screened at an earlier age.”
Dr. David Euhus, director of the Mary L. Brown Breast Cancer Genetics and Risk Assessment Program at UT Southwestern Medical Center, has revolutionized cancer risk assessment by creating a software program used by clinicians at cancer centers worldwide. UT Southwestern’s cancer genetics clinic is one of the largest programs in the nation and is the only research-based clinical program in Dallas and Fort Worth to offer testing and counseling for all identified types of cancer. There are about 30 different genes associated with increased cancer risk which the clinic tests, including pediatric cancers. Because of its level of expertise, the clinic’s staff has been recruited to partner with the state health department in launching a major advertising campaign aimed at improving awareness of genetic services. Many people assume that if an immediate family member or other close relative has cancer, their risk for inheriting any kind of cancer themselves is automatically increased. Not true, says Linda Robinson, the senior counselor with UT Southwestern’s cancer genetics clinic.
“Just because cancer is in your family doesn’t mean it’s genetic,” she says. “Shared environmental conditions, for example, can explain the recurrence of cancer in families.”
Only genetic testing can reveal whether a person has an inherited tendency to develop a particular cancer, she says. A positive result means earlier preventive screenings and more aggressive management. Certain medications can also target genetically based cancers, which can dramatically improve a patient’s chances for survival.
Robinson counsels patients who are undergoing genetic testing so that they know their options and how to emotionally prepare if the result comes back positive. She says patients usually deal with a cancer diagnosis better if they go into it with a set plan. Genetic testing isn’t necessary for everyone, but is highly recommended for those with a strong family history or anyone who is diagnosed with cancer at a young age.
“For every one person who tests positive with the gene, we can find on average four other family members with the gene,” Robinson says. “For me, this is the true beauty of genetic testing. You’re able to provide yourself and other family members with the gift of early detection and peace of mind.”
UT Southwestern’s cancer genetics clinics sees more than 1,000 patients a year, and about 20 percent of patients will test positive for a cancer predisposition gene. UT Southwestern can also test for colon, kidney, and thyroid cancers as well as melanoma but the results aren’t as straightforward. “Every year, new genes are discovered that can tell you your risk of cancer based on test results and family history and ancestry,” Robinson says. “In some instances, we can tell patients what probably caused the cancer in their family and trace the gene in the family history. It’s like putting together the pieces of a very important puzzle.”
While diet, lifestyle, and environmental factors all play a role in a woman’s risk for developing breast cancer, mutations in certain genes can significantly increase her risk for breast cancer. Texas Health Presbyterian Hospital Dallas offers a genetic testing service aimed at identifying two of the gene mutations can be the strongest indicators of a woman’s risk for breast and ovarian cancer.
“What’s important to know is that if you have this gene mutation, it’s likely that you could develop breast or ovarian cancer even if you’re doing all the right things by exercising and eating right and not smoking,” said Dr. Becky Althaus, Ph.D., a genetic counselor at Texas Health Dallas. “Women are still at risk for breast cancer if they don’t have the gene mutation, but having the mutation should put them on high alert.”
Women who carry this mutation of the BRCA-1 or BRCA-2 gene are offered enrollment in the high-risk breast cancer surveillance program at Texas Health Dallas. “Along with age and personal and family medical history, genetic testing can help a woman and her physician better assess the risk of developing cancer,” says Dr. Kandice Kilbride, a breast cancer surgeon at Texas Health Dallas. “With this information, each woman and her physician can proactively create a prevention plan and take steps to reduce the likelihood of developing cancer or detect the cancer early.”
The Texas Health Dallas genetic testing program also offers genetic tests for colon and uterine cancer. “It’s important to remember that even with these advanced tests, we don’t have all the answers,” said Dr. Jaya Juturi, chief of oncology at Texas Health Dallas. “These tests only tell us part of the story. These tests are but one effective tool we have to better fight this devastating disease.”
A mutation of the “normal” BRCA-01 or BRCA- 2 gene can predispose a woman to breast cancer — increasing her risk of developing the disease by up to 87 percent or a second primary breast cancer to 64 percent. The genetic test for breast cancer is done with a simple blood test. Before the test, a genetics counselor meets with each woman to discuss her risk factors and to review her personal and family history and look for any other significant risk factors. It may be determined that a genetic test isn’t necessary for some women. Once the lab analysis is complete, each woman meets again with the genetics counselor to discuss the results and possible health implictions. Persons who may benefit from genetic testing include personal or family history of breast cancer diagnosed before the age of 50; ovarian cancer at any age; male breast cancer; bilateral breast cancer; and being of Ashkenazi Jewish heritage. While genes can be a factor in whether someone gets cancer or any other disease, it’s only a piece of the puzzle, Dr. Althaus says. BRCA mutations only account for five to 10 percent of breast cancers. Other risk factors, like personal medical history and lifestyle, play a role.
“But it’s a critical piece of the puzzle,” Dr. Althaus says. “Having the knowledge that they’re high-risk has enabled many of my patients to detect breast cancers at early stages when there were no symptoms.”
Texas Health Presbyterian Hospital Dallas has begun a clinical trial to test whether a new advancement in breast imaging — 3D digital mammography — can accurately detect breast cancers.
Standard mammography is a two-dimensional X-ray of the breast, relying on the contrast of tumors and adjacent normal breast tissue. However, in women with dense breast tissue, deadly tumors can hide in the shadows of overlapping breast tissue. A new imaging technology, called breast tomosynthesis, removes tissue overlap by taking pictures of the breast in layers, generating 15 discrete images of the breast from different angles. The computer system uses these images to mathematically create a tomogram, showing the tissue as three dimensional layers.
“Currently, breast MRI is the gold standard for women with a suspected case of breast cancer or with a very high risk for the disease,” Dr. Kilbride says. “Some studies have suggested that women with dense breast tissue are at higher risk of developing breast cancer. The goal is simple: to find a better way to check for breast cancer in women with breasts too dense for today’s mammograms.”
Texas Health Dallas was one of the first medical centers in the region to offer breast MRI to patients with suspected cases of breast
cancer or with elevated risk factors. But this technology as a screening tool is limited to those women at highest risk for the disease, according to guidelines of the American Cancer Society.
Texas Health Dallas researchers are investigating whether breast tomosynthesis is as effective as MRI in detecting breast cancer in high risk women.
If this proves true, Texas Health Dallas may be able to offer this technology to a broader range of women, including those with dense breasts. A tomogram, or 3D mammogram, takes less than a minute. Today, the technology is only available through enrollment in a clinical trial at Texas Health Dallas or one of a handful of other medical centers around the country. For more information about the tomosynthesis clinical trial, call Texas Health Dallas at 214-345-8324.
Four Ways You Can Prevent Cancer:
This year, more than 97,000 Texans will receive a new cancer diagnosis; in Dallas County specifically, experts estimate that 8,042 new cases of cancer will be reported this year. According to a recent study by the World Cancer Research Fund and American Institute for Cancer Research, one in three common cancers (such as breast, colon, and skin cancers) may be preventable by altering several of your lifestyle habits.
While researchers believe that some cancers develop from factors outside of one’s control, such as environmental and genetic links, a large number of cancers and other diseases may be preventable. Dr. Jairo Olivares of Texas Oncology-Garland says that about 35 percent of all cancer deaths in the U.S. may be preventable by an alteration in lifestyle habits and by employing healthy living strategies. In fact, Texas Oncology suggests four strategies improve your overall health while protecting against cancer. “Cancer is a multi-faceted disease,” Dr. Olivares says. “You can’t focus on one way to treat it or pinpoint just one reason you have it. There are many factors to take into account.”
Eat right. Adopting a healthy lifestyle that includes a well-balanced diet full of nutrients that lower the risk of disease is important for overall well-being and critical to both preventing and fighting cancer. Eating certain types of foods can actually bolster cancer defenses and reduce risk. Fortunately, eating to prevent cancer can also help maintain a healthy weight, as studies have shown that being overweight or obese can increase cancer risk.
One of the healthiest ways to reduce calories is to limit the intake of sugars, saturated fats, trans fats, and alcohol, and to include more healthy foods like nutrient-packed produce. The American Cancer recommends substituting whole grains for refined or processed grains; limiting processed and red meats, foods preserved with salt, and fat; no more than one alcoholic drink daily for women and two for men; at least five servings of fruits and vegetables daily (dark, leafy greens and a variety of seasonal fruits and vegetables including broccoli, cauliflower, cabbage, and berries); and drinking plenty of water every day.
Get regular cancer screenings. Screening exams allow cancers to be diagnosed at the earliest stages and treated when treatment will be the most
effective. The screening guidelines (see right) offer recommended timing for specific ages, genders, and cancers. Texas Oncology, the American Cancer Society, and the National Cancer Institute all recommend these guidelines.
Get moving. “Being overweight and obesity is becoming an epidemic in this country,” Dr. Olivares says. “In fact, diseases that are caused by poor diet and lack of physical activity are killing more people in this country than smoking. Exercise plays a critical role in preventing and reversing many health issues, such as heart disease and diabetes. It can also prevent cancer.”
During exercise you get more oxygen into the cells in your body because you’re breathing more and releasing endorphins. “Cancer cells don’t like oxygen—they thrive in a poor oxygen environment,” Dr. Olivares says. “The oxygen clears the toxins and keeps the cells healthy and functioning properly.”
• Experts suggest 25 to 30 percent of several major cancers may be attributed to obesity or lack of physical activity.
• Up to 18,000 breast cancer deaths per year in women age 50 and older could be avoided by maintaining a body mass index lower than 25.
• More than half a million people die from cancer each year in the U.S., and up to one third of these cancer cases are linked to poor nutrition, lack of exercise, and excess weight.
• Being overweight can increase the risk of cancer by causing a higher production of horm-ones, including insulin, which may stimulate cancer growth.
Practice sun safety. More than one million cases of skin cancer will be reported in the United States this year alone. In fact, Texas ranked third in
the nation last year for reported incidence of melanoma, the most deadly form of skin cancer, and one in three Texans will develop skin cancer over the course of his or her lifetime. There are several types of skin cancer, but melanoma is the most deadly. Basal cell and squamous cell
carcinomas are highly curable if caught early.
Experts recommend avoiding heavy UV light exposure as well as sunlamps and tanning beds, which emit UV radiation. The most common warning sign of skin cancer is a change in the surface of the skin. It is important to have any mole that has changed checked by a dermatologist. The type of treatment for any skin cancer, including melanoma, depends on how large the cancer is, its type, and where it is found on the body.
Oral Cancer will result in approximately 8,000 U.S. death this year, with an estimated 35,000 Americans diagnosed this year with the disease. In fact, one person dies from oral caner every hour daily. “One-third of oral cancers occur in the pharynx, and most often in people over 40, affecting twice as men as women,” says Dr. Lee Fitzgerald, a general and cosmetic dentist in Plano. When found early, oral cancer has an 80 to 90 percent survival rate. However, the majority of oral cancers are found at a later stage which accounts for a high death rate of about 45 percent within five years of diagnosis or a lifetime disfiguration. “The first, simplest step to take is to ask for an oral cancer screening at your next regular dental visit,” Dr. Fitzgerald says. To learn more about oral cancer, visit www.fightoralcancer.org.
Ovarian cancer is known as the silent cancer because it one of the few types of cancers that is rarely linked to any specific cause and because it is most often caught in its latest stage, thus the high mortality rate. About 10 percent of ovarian cancer cases diagnosed each year are patients with a family history. However, women who have a personal history of breast, colon, and uterine cancers have an increased risk of developing ovarian cancer. It is the leading cause of death amongst gynecologic cancers–approximately one woman in 55 develops some form of ovarian cancer in her lifetime. When caught early, ovarian cancer has a greater chance of being cured. However, only 25 percent of all cases are diagnosed at Stage I. About 70 percent of the cases are diagnosed after the cancer has spread. Dr. Alan Munoz is a gynecologic oncologist in practice in the Dallas area. He treats female cancer patients for ovarian, endometrial, and cervical cancer, among others. “I tell my patients that the best thing they can do is to never let a year go by without a pelvic examination,” Dr. Munoz says. “When ovarian cancer is detected early, there is a much greater chance for a cure. However, because symptoms are so vague and there is no screening, most of my patients come to me at stage three. Research is underway to develop effective screenings so that the cancer is caught early, which will save lives.”
Lung cancer kills more than 160,000 people in the United States each year and is responsible for more than a quarter of all cancer-related deaths in the U.S. each year. Lung cancer is often perceived as a man’s disease but is an extremely common and lethal cancer in women. Lung cancer often behaves differently in women than in men and therefore may need be treated differently in some cases. Currently, no specific screening technologies are available, and studies show that most cases have no genetic link. Although patients with lung cancer can look forward to a prolonged life with appropriate treatment, in most cases, a cure is not a realistic option. The National Lung Cancer Partnership (www.nationallungcancerpartnership.org) is a group of doctors, researchers, patient advocates, and lung cancer survivors working to improve treatments for lung cancer patients. Dr. Joan Schiller is president of the National Lung Cancer Partnership and the deputy director of Simmons Comprehensive Cancer Center and division director of Hematology/Oncology at UT Southwestern. She has made it her mission to educate the public about it. “Lung cancer occurs in both non-smokers and smokers, men and women, young and old,” Dr. Schiller says. “It is an under-funded and poorly understood disease.”
Early Detection Resource
Southwest Diagnostic Center for Molecular Imaging:
Southwest Diagnostic Center for Molecular Imaging (SWDCMI) provides the most advanced diagnostic imaging technology, exemplary service to health care providers, and unsurpassed, compassionate patient care.
SWDCMI specializes in PET/CT scansa medical imaging tool which assists physicians in detecting diseases such as cancer. PET/CT scans produce digital images that can identify many forms of cancer and distinguish between benign and malignant disorders. A PET/CT scan can generally detect abnormalities in cellular activity before there is any anatomical change.
PET/CT represents an advanced level of diagnostic imaging for oncology. PET detects metabolic signals in the body, while CT provides a detailed image of anatomy, revealing the location, size, and shape of cellular activity. This can help physicians pinpoint the source of cancer and help determine if the cancer has spread to other parts of the body. PET/CT can show the extent of disease (staging), assist your physician with starting and monitoring treatment, and can show the effectiveness of therapy.
Early detection is important in the treatment and management of diseases, including cancer. Earlier diagnosis, accurate staging and localization, and precise treatment and monitoring are some of the benefits of PET/CT. With the technologically advanced images that SWDCMI provides, patients are given a better chance at a good outcome and can avoid unnecessary procedures. A PET/CT image also provides early detection of the recurrence of cancer, revealing tumors that might otherwise be obscured by scar tissue resulting from previous surgery and radiation therapy, particularly in the head and neck.
SWDCMI offers convenient hours, same day appointments with a medical review, 24-hour report turnaround time, and verification of insurance benefits. SWDCMI participates in numerous clinical trials, such as the National Oncology PET Registry (NOPR) for Medicare beneficiaries.
For more information about PET/CT, call SWDCMI at 214-345-8300 or visit www.swdcmi.com.
Women should begin checking their breasts for lumps every month and have a clinical breast exam every 1-3 years.
Women with an increased risk of breast cancer should discuss beginning screenings earlier with their doctors.
All women should have a Pap smear to screen for cervical cancer at least once every year beginning at age 21 or approximately three years after a woman begins having sexual intercourse, whichever comes first, regardless of whether they have received the HPV vaccine.
Women should have a clinical breast exam and Pap smear every 1-3 years.
Women in their 30s with three consecutive normal Pap smears may limit screenings to every two or three years.
Women with an unusually high lifetime risk for breast cancer associated with defined genetic profiles should consider MRI screening.
Women age 40 and older should begin having an annual mammogram.
Women should continue to have an annual clinical breast exam, Pap smear, and if recommended, an MRI screening.
Men with a high risk of prostate cancer (African American men and those with a family history of the disease) should begin screenings at 45.
Men with even higher risk of prostate cancer should begin testing at age 40.
Men and women with increased risk factors for colorectal cancer should discuss beginning screenings earlier than the normal age 50 with their doctors.
Women should continue to have an annual clinical breast exam, mammogram, Pap smear, and if recommended by their doctor, an MRI screening
Beginning at age 50, both men and women should begin screening for colorectal cancer with one of the options below:
a. Annual fecal occult blood tests or fecal immunochemical tests, which can detect small amounts of blood in stool samples, along with a flexible sigmoidos- copy every five years.
b. Every five years, a flexible sigmoidoscopy for polyps or a double contrast barium enema.