Columbus Monthly: Health Matters Special Section (March 2022)

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KICKING CANCER TO THE CURB Doctors weigh in on the best methods for preventing and spotting cancer.

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By Nicholas Youngblood

MARCH 2022 COLUMBUS MONTHLY

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PUBLIC HEALTH LITERACY has become more important than ever in recent years, and the pandemic has exposed weak points in health messaging and treatment access.

That’s especially true for furtive conditions such as cancer, says Dr. David Cohn, chief medical officer and director of gynecologic cancer research at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute.

“If you have incredible, incredible technology and access to the best prevention and treatment strategies, that’s great. But if you don’t get them out to the people who need them, then you’re not doing a service to the community,” Cohn says.

Cancer is the second leading cause of death in the United States. Although modern advances in prevention, detection and treatment have given doctors powerful ammunition in the fight against cancer, they can’t do it alone. Cancer specialists at OSUCCC– James agree that a well-informed public is an essential component.

Stopping Cancer Before It Starts “The best type of cancer to have is the one that you never get,” says Cohn. Prevention relies on avoiding risk factors and building healthy habits from a young age.

In Cohn’s specialty, this means getting a human papillomavirus (HPV) vaccina-

tion. Cervical cancer originates from the contraction of a virus, and infection with HPV is a requirement for the development of most types of cervical cancers, Cohn says, meaning vaccination can provide significant protection. But people with a cervix aren’t the only ones at risk: HPV can also lead to cancers of the head, neck, penis and anus.

Despite this, fewer than half of young adults have received one or more doses of HPV vac-

cination, and just 22 percent have completed the vaccine series, according to the Centers for Disease Control. Cohn says these numbers are improving, however, and eligibility for the vaccine has been extended to age 26, after which a doctor should be consulted.

Another important preventive measure is maintaining good overall health. Cohn says obesity is an important factor in the development of many kinds of cancer. Smoking, drinking, malnutrition and overexposure to ultraviolet rays also contribute to cancer risk. Dr. David Carbone, director of the Thoracic Oncology Center at OSUCCC– James, says the jury is still out on vaping and e-cigarettes, but it’s best to avoid inhaling any strange chemicals.

“Your lungs are very fragile organs,” Carbone says. “They’re designed to exchange oxygen and CO2 with the environment. So they have to have a very thin membrane that allows that kind of gas exchange, and those cells are very sensitive to toxins.”

Carbone says another lesser-known risk factor for lung cancer is radon exposure.

Radon is a naturally occurring radioactive gas that can accumulate in indoor areas, and Carbone says Ohio has one of the highest radon levels in the country. Modern weatherproofing in homes can actually exacerbate radon exposure, so the CDC recommends testing one’s home for radon and hiring a professional to deal with unsafe levels.

Early Detection is Key Cancer can occur even in those who take the utmost precautions. For example, Carbone

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says 20 percent of lung cancers occur in people who have never smoked. That’s why regular visits to a primary care physician and adherence to cancer screening guidelines are essential to detecting cancer in its early stages, when treatment is most effective.

Risk of cancer increases with age. The exception is cervical cancer, for which the CDC recommends Pap tests every three years beginning at age 21 and HPV tests every five years after age 30. Cohn says it is one of the easiest screening processes with the most immediate benefits. “[Although] there may be discomfort associated with getting a Pap test, or having a gynecologic examination or a colonoscopy, those in many ways are substantially less invasive, less risky and less harmful or hurtful compared to … aggressive cancer treatment,” he says.

People with breasts should also know how their breasts normally look and feel so they will notice any abnormalities. Dr. Amy Kerger, a breast imager at Ohio State’s Stefanie Spielman Comprehensive Breast Center, says many people experience some changes throughout their menstrual cycle and as they age, but discomfort, lumps, swelling or redness should be reported to a physician.

Individuals in their 40s begin to see an increased risk of many cancers. Kerger recommends those with breasts should receive a screening mammogram annually starting at age 40. In addition, everyone over 45 should talk to their doctor about regular colorectal cancer screenings, which typically involve stool samples or colonoscopies.

Carbone says people 50 or older with at least 20 pack-years of smoking are eligible for lung cancer screening. A pack-year is defined as smoking one pack of cigarettes per day for one year. Smoking two packs per day, an individual would have 20 pack-years of smoking after just 10 years.

Carbone says it was difficult in the past to detect lung cancer until it had spread to other parts of the body, by which point it is much deadlier. However, recent developments in CT scanning allow a patient to be screened noninvasively with no prep in just 15 seconds.

Still, Carbone says only 5 percent of eligible people get lung cancer screening.

Evaluating Genetic Risk Factors General screening guidelines apply to those with an average risk of cancer, but some people are more vulnerable than others. One way of determining baseline risk is through genetic testing.

Leigha Senter, a licensed genetic counselor who has specialized in cancer

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The Impact of Self-Advocacy Columbus has quickly become a hub of cancer research and treatment, and many doctors and patients alike have worked hard to make that happen. One such person was Dr. Lori Gill Grennan.

Grennan was a family practice physician who began to experience symptoms of mastitis, a breast infection, after giving birth to her second child in 2009. When the usual course of antibiotics didn’t work, she pushed to get more testing. Even after a mammogram and ultrasound, doctors found nothing unusual, but Grennan continued to self-advocate. She wrote her own referral to a breast specialist, and after a biopsy she was diagnosed with Stage 4 inflammatory breast cancer. The prognosis was grim, and her sister Karen Kent says it was clear Grennan was living on borrowed time.

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IBC is a rare and highly aggressive form of breast cancer that Kerger, a close friend of Grennan, describes as “No lump, still cancer.” At the time of Grennan’s diagnosis, the best facility for IBC treatment was in Texas, so Grennan had to pick up her family and move to access treatment and buy herself more time.

In the time between her diagnosis and her death in 2013, Grennan did extensive advocacy work and fundraising with the IBC Network. Much of the proceeds went directly to the Stefanie Spielman Center, dedicated in 2011, which provides a full continuum

of care for every stage of patients’ breast cancer journeys.

“Lori was such a humble, selfless person.

She knew the money she was raising was not going to save her, because it was just going to be too late. But she wanted to make an impact,” says Kent, who has continued her sister’s advocacy work.

The center is one of many powerful resources for fighting cancer right here in Columbus, but the first step is advocating for one’s own health. “If something doesn’t feel right, don’t dismiss it,” Kent says. “You take charge of your own health.”

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genetics at OSUCCC–James for nearly 20 years, says genetic testing has become an essential tool in doctors’ arsenals. “Anybody who has a family history of cancer should ask their health care provider if the cancers in their family raise any red flags from a hereditary perspective,” she adds.

Although only 10 to 15 percent of cancers are hereditary, Senter says genetics are extremely helpful in preparing for those that are. Mutations in BRCA genes, for example, can mean the difference between a 12 percent risk of breast cancer and a 60 percent risk. “What we do to reduce that risk and promote early detection looks quite different at a 60 percent level of risk versus a 12 percent level of risk,” she says. Other genetically influenced cancers include those of the ovaries, pancreas, colon and prostate.

Senter understands many people are anxious about receiving unpleasant news from a genetic screening. “It’s one thing to say ‘Knowledge is power. I want to know everything,’ but there may be times in your life where that knowledge becomes a burden because you’re sort of waiting for the other shoe to drop all of the time,” she says. “We really do try to arm people who are undergoing genetic testing with the tools that they need to at least feel like they’re doing something about it.”

Advances in detection and treatment ensure that cancer is not an inevitability for those with a high-risk genetic profile.

Genetic testing can even inform oncologists about the best methods of treatment should cancer arise. Senter says testing has also become cheaper and more widely covered by insurance.