PATIENT RESOURCES

“I don’t have cancer in my family, how did I get it?” While genetics plays a role, almost 45% of cancers are preventable. This may seem like a high number but there are actually many things that you can do to decrease your risk. Some risk factors such as genetics and advancing age (greater than 55) are not preventable unless you have found Ponce De Leon’s fountain of youth.

So what to do?  Lifestyle change! These changes can actually help in decreasing the mutation rate of your genes so that you decrease the risk. The number one risk factor but the hardest to eradicate is cigarette smoke. The overall death rate has decreased by 31 % over the peak death rate in the 20^th C primarily because of the decrease in smoking by the general population. It is alarming to see young people picking up the habit. If you smoke STOP NOW! It is never too late.

Excessive dietary consumption including alcohol leads to obesity which is also associated with an increase in certain types of cancer and mixed with cigarettes increases the risk. Adding physical inactivity amplifies the risk further. Diets that limit red and processed meats and highly refined foods like pasta, white rice, white bread are helpful. A plant based diet will give your body the antioxidants it needs to maintain health. This in conjunction with less sitting will decrease your overall body weight and decrease your risk.  A combination of aerobic and strength exercises will help you achieve your ideal body weight goal. Use sunblock to decrease your skin cancer risk while exercising outside.

Viruses are also a cause of many cancers; namely HPV or human papilloma virus. The HPV vaccination has been found to greatly decrease the HPV related cancers like cervix cancer. The target audience for the vaccination are adolescents.

The other proactive thing one can do is take advantage of screenings. Mammography, Colonoscopy, certain blood tests like PSA as well as low dose CT lung screening can help find a precancerous or early stage disease,  most likely making it more curable. Self-examination is also an important tool that should not be ignored.

Make an appointment with your primary care provider for a wellness check to include the screening tests that are appropriate for you. They can also teach you the correct way in which to perform self -examinations.

Changing your lifestyle and partnering with your PCP are the first steps to help in preventing Cancer! It is never too late!
 

Lawrence P. Menache

Radiation Oncologist

Christus St. Francis Cabrini Cancer Center.

In 2021 it is estimated that there will be 27,880 new cancer cases in Louisiana, 4,020 will be female breast cancer with 670 deaths.  It is the most commonly diagnosed cancer in women and the 2ND highest cause of cancer deaths in women. October was designated breast cancer awareness month in 1985 to help lower these statistics by raising awareness and promoting mammograms. The use of mammography leading to early detection has improved survival from Breast Cancer. It is for this reason that women have been encouraged to get their yearly mammogram. 

Who should get a mammogram? The American Cancer Society recommends that women should get their 1st mammogram between the ages of 40-44 and then annually through 55. After 55, you may continue annual screening or transition to every other year as long as life expectancy is 10+ years. I advocate women continue annual screening mammography. Women who are high risk may want to start at an earlier age. This is a conversation to have with your physician.

What are the risk factors? Risk factors come in two types, those we can do something about and those we cannot. Family history of breast cancer and other cancers carried on the breast cancer gene BRCA 1 & 2, high breast tissue density, high dose radiation to the chest at a young age, being childless, first child after the age of 30, high natural levels of estrogen and testosterone, increasing age and being female (1% male breast cases). Modifiable risk factors include weight gain after age 18, use of hormone replacement therapy, high alcohol consumption and physical inactivity. Breast feeding for one year will decrease your risk. 

How do we treat breast cancer? The treatment for this disease has evolved and improved over the years. Not all women require the same treatment. Usually included after biopsy is a surgical procedure, lumpectomy or mastectomy. Chemotherapy, radiation therapy, hormonal therapy or immunotherapy are individually selected for the patient. 

The good news is that breast cancer deaths have decreased over the last 30 years. 

EARLY DETECTION LEADS TO A CURE!

Lawrence P. Menache, M. D.

Radiation Oncologist

Cabrini Center for Cancer Care

Lung cancer is the second highest type of lung cancer diagnosed in both men and women but it is the number 1 cause of death from cancer in both sexes in the US. Louisiana will see approximately 3900 new cases and approximately 2400 deaths from lung cancer in 2021. Fortunately, the death rate continues on a downward trend! This is due to several reasons.

Lung cancer risk factors: They can be broken up into 2 categories. Those you can do something about and those over which you have no control. In the first group are tobacco smoke, second-hand smoke, asbestos exposure and other workplace exposures like uranium, chemicals and diesel exhaust. There is even an increased risk with smoking and taking large amounts of beta carotene supplements. Men who smoke have a 23 times greater chance of getting Lung cancer than those who don’t, Women’s risk is 13 times more. In the second group are included previous radiation to the lungs(not as common now as it was in the past), air pollution, family history of lung cancer/your genetic make-up. There are a few other things that might increase your risk but the data is not conclusive such as smoking marijuana, E-cigarettes and talcum powder. 

Prevent Lung Cancer: The number one preventable cause is tobacco smoke. Therefore stay away from all types of tobacco. This will have the greatest impact. Your family physician has the tools to help you stop smoking.  Everyone can stop regardless of how much they smoke. I have seen it in my practice! Avoiding exposure to workplace chemicals is encouraged and always use the proper protection especially with asbestos.

Screening tests: One of the reasons that the death rate is going down is that early detection has improved. Lung Cancer CT screening helps catch the disease at an early stage when it is more curable with surgery or stereotactic radiotherapy.  You qualify for this if you are:

50-80 years old in good health and

Currently smoke or quit in the last 15 years and

20 pack year history of smoking( number of packs per day  x years smoked)

Why is the death rate and diagnosis decreasing? Apart from early detection, recent decreased rate of smoking in both men and women have helped. Also in patients with advanced-stage cancer have benefitted from new radiotherapy techniques as well as new agents like immunotherapies, i.e. Keytruda. 

November is the month of the great American Smoke Out.  So, if you smoke STOP!
 

Lawrence P, Menache

Radiation Oncologist

BREAST CANCER: Is it Hereditary?

In 2021 it is estimated that there will be 27,880 new cancer cases in Louisiana, 4,020 will be female breast cancer with 670 deaths. 1% will be in men. It is the most commonly diagnosed cancer in women The 2ND highest cause of cancer deaths in women. October was designated breast cancer awareness month in 1985 to help lower these statistics by raising awareness and promoting mammograms. The use of mammography leading to early detection has improved survival. The 5 year survival rate for stage 1 breast cancer is 100%. Yearly mammograms are the single most important thing that YOU can do to increase your survival from breast cancer.

Very often I have heard that “we don’t have breast cancer in my family.” Yet we are told a family history of breast cancer is very important. Women over the age of 55 as well as those with a close family relative with breast cancer are at the highest risk for developing breast cancer.  So, if you have breast cancer how can you tell if it is hereditary. There is a study that looks at a patient’s DNA for BRCA1 and 2 gene mutations.  Only 5 -10 % of breast cancers are hereditary and carry the BRCA 1 or 2 genetic mutation.  A patient with one of these genetic mutations is at high risk for Breast cancer a well as for other associated cancers such as ovarian cancer. By the time you are 80, the risk of breast cancer is 80% if you carry the gene mutation. This genetic mutation can affect how your body safeguards and repairs your DNA and increases your risk of breast cancer.

When you are diagnosed with breast cancer you will be screened to see if you have any of the associated risk factors that could indicate a higher probability of having the BRCA 1 or 2 mutation. These include if the breast cancer patient has:

A history of breast cancer at a young age.

A history of cancer in both breasts

A history of ovarian cancer

Triple negative breast cancer at age 60 or younger

Ashkenazi (Eastern European ) Jewish origin

Or if there is a family history of:

Breast cancer under the age of 50

Bilateral breast cancer

Ovarian cancer

A known relative with the BRCA 1 or 2 mutation

Male breast cancer

If you do not fall into one of these risk factors, then your risk of carrying the BRCA 1 or 2 gene mutation is low and you will not be recommended to have the genetic testing done. If you test positive for the mutation then other family members may be tested as well. Not all family members will carry the gene. A positive test may have treatment implications as well and these need to be discussed with your physician. A genetic counselor can help with making decisions regarding testing for mutations associated with Cancer.

January is Cervical Cancer Awareness month. The fight against cervical cancer is one that has been rewarding with increased prevention, detection and treatments resulting in decreased incidence and deaths. In Louisiana, 240 new cases will be diagnosed in 2021 and the death rate is not even considered in the top 10 cancer causes of death! Why is this?

The number one reason is the development of the pap smear. This test which requires a pelvic exam can detect abnormal cells in the cervix before they become cancerous and can be treated. This single test has changed the face of this disease in the last 50 years. It is recommended that a pap be performed between the ages of 21-65 every 3 years if the cervix is still in place. 

A more recent test is the addition of Human Papilloma Virus (HPV) detection as over 90% of cases are due to HPV. You can extend your screening test out to every 5 years if HPV is added to the pap test. Most recently the HPV vaccine given to females under the age of 17 reduces the risk of cervical cancer in later years. 

The most common symptoms of cervical cancer are vaginal bleeding between menstrual cycles or prolonged menstrual bleeds, pain with intercourse, or abnormal discharge.

Treatment for cervical cancer has also progressed. The pre-cancerous and early stages are usually treated with a radical hysterectomy by a GYN Oncologist and no further treatment is required.  Locally advanced disease is treated today very effectively with the combination of radiotherapy and chemotherapy. The radiation is given in two parts, first the external beam for about 5 weeks and then followed with a series of radioactive implants which directly delivers the radiation to the cervix cancer. Prior to the 1990s, the implant required that the patient stay isolated in the hospital for 3 days. Today the development of high dose rate after loading equipment allows the patient to receive the implant as a one day out-patient procedure each time. The chemo consists of low dose Cisplatnum given once per week along with the external beam part of the radiation. In cases that present with advanced or metastatic disease chemotherapy is the main treatment modality. 

Despite these advances this disease can be very aggressive and unfortunately not all get their cancer screening in a timely fashion if at all. Survival rates are impacted by screening and access to screening. Strict adherence to the screening guidelines clearly leads to early detection and increased cure.

Lawrence P. Menache, M. D.
Radiation Oncologist
Christus Cabrini Cancer Center. 

Doc, when are we going to have a cure for cancer?

This is the most frequent question I have had in my 30 years of practice! I think the answer comes from first understanding the definition of cancer:

Cancer refers to any one of a large number of diseases characterized by the development of abnormal cells that divide uncontrollably and have the ability to infiltrate and destroy normal body tissue. Cancer often has the ability to spread throughout your body.

We also must define cure. To be cured means to eliminate all traces of cancer cells from the body and it won’t come back.

Remission is another term often used: few to no signs of cancer cells in the body while a complete remission means there aren’t any detectable signs or symptoms of cancer cells.

An important concept to grasp is that cancer is really a series of diseases with a common thread, that of uncontrolled division of certain cells in the body. Thus, each type of cancer has its particular characteristics.  Lung cancer is very different from ovarian cancer which is different from breast cancer. Each type of cancer has its own risk factors, both genetic and environmental.  We are having a better understanding of what “sets off” cells in the body to start to divide uncontrollably. We are not always sure what are all the risk factors for each individual cancer. Each type of cancer does not respond to the same treatment. Some are cured by surgery alone or in combination with other agents like chemotherapy, immunotherapy and radiation therapy. In some surgery is not really part of the treatment plan. Some cancer such as certain types of brain tumors have a propensity to come back despite all treatments while others are easily eradicated with little risk of recurrence. 

New therapies are being developed and explored directed toward each type of cancer cell, these include the development of new chemotherapy agents, immunotherapy agents, vaccines, gene therapy or editing, monoclonal antibodies as well as other techniques. Advances in the research arena continue to improve outcomes for many cancer diagnoses.

In Summary, there will never be a single cure for cancer because cancer is so many diseases bundled up into one word. Do not despair as there are cures available today that were not available 10 years ago and this list will only continue to get longer with time as each cancer is explored and studied. Progress is being made with a goal for a cure for all cancers!

Lawrence Menache, M.D.
Radiation Oncologist
Christus Cabrini Cancer Center