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Southwest Life Health And the West is History Community Travel

Avoid cancer by knowing your risks

Understanding your genetic, environmental threats a good start
A radiologist uses a magnifying glass to check mammograms for breast cancer. Ten percent of breast cancer is hereditary, and you can assess your risk in part by looking at family history.

When it comes to causes of death, cancer looms large – not just statistically, but also in the modern American imagination.

Whereas heart disease – another leading killer – seems increasingly beatable, in the last decade, cancer has taken on the glum luster of a pervasive and fatal certainty, where diagnoses beget patients’ courageous vows to fight on in the face of an indubitable death sentence.

The sheer length – and ease of mentally assembling – a list of celebrities dead by cancer speaks for itself: Farah Fawcett (anal); Ted Kennedy (brain); Audre Lorde (liver); Anne Bancroft (uterine); Jackie Onassis (lymphatic); Babe Ruth (nasopharyngeal); Alistair Cooke (lung and bone); Eva Perón (cervical).

Such is the gloom surrounding cancer that last January just after the New Year, George Johnson, author of The Cancer Chronicles, tried to write a more encouraging interpretation of recent cancer news in an article in The New York Times; its courageous if perhaps counterproductive title was, “Why Everyone Seems to Have Cancer.”

For Durango residents, if not Times’ readers, cautious optimism about cancer was made more possible after a recent lecture by Randi Rycroft, who has worked for the Colorado Department of Public Health and Environment for more than 25 years. She spoke at Fort Lewis College as part of the Life-Long Learning Lecture Series.

Every year, cancer kills about 7,300 Coloradans. But, there’s a bright spot: Right now, she said, there are 200,000 cancer survivors in Colorado, who, thanks to effective diagnoses and care, live on having beaten the disease for now.

Statistics tell local, state story

Rycroft said nationally and statewide, the data public-health officials had managed to gather about cancer was staggering.

Though statistics and data-collection are often dry topics, Rycroft held the audience rapt as she walked through the vast reams of information the Colorado Central Cancer Registry has amassed about cancer cases over the last three decades.

She said hospitals and clinicians have been required by statute to report every cancer case across the state since 1988 and every case in the Denver-metro area since 1979.

The CCCR collects not just information about the type of cancer, but also treatment – whether treatment was successful and if the cancer reappeared.

It also collects demographic data – age, race, sex and area, meaning public-health officials can infer whether or not certain regions, for instance, La Plata County, have higher cancer rates than others.

Buried in the spreadsheets is mixed news for La Plata County.

From 2007 to 2009, the rate at which La Plata County residents developed cancers of the of oral cavity, cervix, uteri, breast, pharynx, lungs and bronchus were roughly equal to the rate at which Coloradans were diagnosed with those cancers statewide.

But in that time period, La Plata County men got prostate and urinary bladder cancer at a significantly higher rate than did men across Colorado. On the other hand, men in La Plata County got colon cancer at a significantly lesser rate than their brothers across the state.

The news was less good for women in La Plata County, who developed melanomas of the skin at significantly higher rates than their Colorado sisters.

Genetics, socioeconomics

Rycroft said from a public-health perspective, such statistics are vital to combating cancer going forward.

She said one of the “very new areas that we’re getting engaged in is genomics work. Given the characteristics that we’ve collected in our data, we’ll be able to identify people who may be at increased genetic risk for some cancers,” she said.

Detecting people who may be at increased risk will be helpful, she said, as then public-health officials can “make sure this person got all of the screenings and referrals they need. Hopefully, this will ensure people don’t fall through the cracks if they’re at heightened risk for cancer or cancer recurrence,” she said.

She said across the state, people in areas that suffer little poverty survive cancer at much higher rates than do people living in areas with lots of poverty.

She said the socioeconomic factor often determines not just whether people are diagnosed quickly, but also whether they have access to the kind of care they need.

“What you notice from the data, almost regardless of the stage of the disease and what kind of cancer it is, those in the wealthiest areas of the state are surviving better than those in the poorer areas of the state,” she said.

Three types of cancer

Elena Strait, a genetic counselor with the Hereditary Cancer Service who specializes in genetic oncology, said there are three types of cancer: sporadic, hereditary and a combination of the two.

Sporadic cancer is mostly about the environment, she said; for instance, smoking and being exposed to radiation increase your chances of cancer.

Some kinds of cancer, on the other hand, are directly caused by one’s genetic inheritance.

Then there are “familial inheritance” cancers that, like diabetes, aren’t caused by a single gene, though they seem to be brought about by some combination of one’s genetic inheritance and life experience.

When it comes to hereditary cancers, there’s a lot you can do to figure out if you’re at risk, she said.

“Many relatives affected in many generations,” she said. “Diagnosis usually happens at a younger age, meaning under 50; sometimes there are two or more cancers in a single person, and I’m not talking about a breast cancer that metastasizes to the lung. I am talking about two or more primary cancers – for instance, breast cancer and a uterine cancer, starting in two different sites altogether.”

She said, for example, 10 percent of breast cancer is hereditary.

“Within that, there are a variety of different genes,” she said. “The gene BRAC2 causes 30 percent of breast cancers – for instance, Angelina Jolie’s type. But we don’t yet know everything about hereditary breast cancers. Unknown genes cause 20 percent of breast cancers – we don’t know what they are yet.”

She said American women in general have a 12 percent lifetime risk of breast cancer.

“But is your risk higher because your grandmother got diagnosed with breast cancer aged 75? No!” she said. “Your grandmother’s cancer was likely sporadic – caused by factors like aging. Whereas if you had many more family members who’d gotten breast cancer, especially if they were young when they were diagnosed, or if any of them were men – you would then want to do a family history to determine whether you are at increased risk.”

Knowledge dispels myth

Strait said there are a lot of myths surrounding breast cancer: “For instance, only women get breast cancer, or only your mother’s family history matters with breast cancer. In fact, half the mutation carriers are men!”

She said sometimes “finding out that your family history makes you high risk for cancer can cause anxiety. But ‘There’s nothing I can do about it’ isn’t a good reason not to find out because there are things you can do about it.”

She pointed to Jolie, who last year wrote a New York Times op-ed about the steps she’d taken after learning that she had hereditary ovarian cancer syndrome.

“There’s hope,” she said.

cmcallister@durangoherald.com



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