Special Sections - Cancer Prevention 2019

CANCER

OCTOBER 2019

Prevention

Eat well. Stay active. Be vigilant.

INSIDE How to prevent cancer

Page 4 ++Eating to avoid cancer, page 5 ++Asian mango chicken wraps recipe, page 5 ++The power of cancer screenings, page 8

Risk factors for breast cancer Turning the tide in cancer care

Page 9 ++Breast, cervical & colon health programs, page 7 ++Harvest of Hope, page 10

Page 10 ++Cancer support groups, page 2 ++Treatments for lymphedema, page 11

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CANCER

Prevention

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Peninsula Daily News & Sequim Gazette

OCTOBER 2019  3

HOW TO ‘PREVENT’ CANCER

Proactive lifestyle choices & routine screenings make a difference

By Dr. Kristin Puhl Researchers know more about cancer than ever before, but what is really understood about how to prevent it?

The answer to that is complicated because cancer isn’t just one disease — it’s an umbrella that covers many different diseases that can affect any part of the body.

What all cancers have in common, however, is that they involve a change in the way cells grow. Normal cells will grow and divide to make new cells in predictable, orderly ways. Cancer cells deviate from that pattern and can begin to distribute a damaged “pattern” to more of the body — making it harder to treat as it grows and spreads.

Different forms of cancer carry varying levels of risk. Risk depends on whether the cancers are likely to spread, and how dangerous they are where they developed.

Some will never spread, but already are in a dangerous area, such as the throat; some are not dangerous where they first develop, but will spread to vulnerable areas of the body, such as the brain.

Can cancer really be prevented?

The causes of cancer help address questions about preventing cancer.

Researchers are far from understanding all the interactions that cause cancer, but they have identified many factors that cause cell damage, the first step that starts cells down the road to becoming cancerous.

Smoking causes cancer ­— lungs and bladder are both at risk.

Alcohol consumption can cause changes in cells that line the stomach and liver, putting drinkers at risk for more than one form of cancer.

Human papillomavirus (HPV) is a very common family of viruses to which most people eventually will be exposed.

It is normally killed off by your immune system, but in a small group of people it manages to survive and cause diseases, from simple warts, to cervical, penile, anal or throat cancer.

Diet appears to have a significant impact on cancer risk. People who eat diets rich in fresh fruits and vegetables and low in processed foods are at lower risk for several diseases, including cancer.

Cancer researchers have found that cancer occurs less frequently in people who exercise regularly, as well.

It appears that moderate and regular exercise supercharges the immune system. It boosts adrenaline, certain immune cells (natural killer cells) and other chemicals, creating a cancerkilling slurry that radically slows the growth of cancerous cells and sometimes completely eliminates them.

Although there are certainly factors you cannot change, living a healthy lifestyle will reduce your overall risk.

If you follow up with routine cancer screenings, your chances of catching any cancers that manage to elude your immune system while they are easy to treat go up significantly.

Routine tests & screenings The value of tests and screenings cannot be dismissed as essential tools in preventing cancer. Using these powerful diagnostics, your primary care provider is in an excellent position to help you understand your personal cancer risks and what you can do to help prevent cancer.

There are some tests that are so useful, doctors recommend them to a wide variety of people.

These are “screening tests” — tests that can detect diseases in early stages.

R E G U LAR SCRE

ENING

Your age, gender, lifestyle habits, family history and history of other diseases help identify which cancers you are at risk for. Using this information, your doctor can perform the appropriate screening tests, heading off the diseases before they advance.

In the event you do get cancer, early detection makes it more likely the disease can be successfully repressed.

Cervical cancer is a prominent concern for women. The screening test for cervical cancer is called a Pap smear.

Current standards recommend a Pap smear every three years for women, beginning at age 21.

If pre-cancerous cells are found on a Pap smear, the doctor may recommend more frequent checks or, if necessary, treatments.

Cervical cancer is most often caused

by HPV, which has a powerful new vaccine. In fact, HPV vaccination has helped drive a huge decrease in the number of cases among young people, literally preventing cancer.

Cancer of the colon or rectum affects many people, and the good news is that there are multiple ways to look out for it. It’s usually a slow-growing cancer, so catching it early (before symptoms appear) can make a life-saving difference.

Screening for colon cancer is recommended starting at age 50 and every 10 years following. Colonoscopy is the gold standard screening test for growths in the colon that may become cancerous.

An alternative, the FIT (fecal immunochemical test), also known as a fecal occult blood test, identifies any trace blood in one’s stool, an indication that cancer may be present.

‘Prevent’ continued on page 8 »

The lifestyle you choose can lower cancer risk You can safeguard your health better with proactive life choices than with any medication or screening test.

Eat a varied diet rich in plant-based foods, minimize alcohol consumption, exercise moderately several days a week and quit tobacco products (which also can decrease your risk of heart attack and stroke).

4 OCTOBER 2019

Peninsula Daily News & Sequim Gazette

Cancer Prevention

EATING TO AVOID CANCER Asian mango chicken wraps Healthy doesn’t have to mean bland. These chicken wraps are sure to delight your taste buds.

INGREDIENTS

2 ripe mangos, peeled, pitted and diced You can substitute sweet local fruits, such as peaches, or even use cooked sweet potato.

1 ½ cups chopped roasted chicken breast 2 green onions, sliced 2 tablespoons fresh basil, chopped ½ red bell pepper, chopped 1 ½ cups Savoy or Napa cabbage, shredded 2 medium carrots, grated 1/3 cup fat-free cream cheese 3 tablespoons natural unsalted creamy peanut butter

A healthy diet may help you lower your risk of cancer Research shows that almost half of cancer diagnoses and deaths are preventable if you make healthy lifestyle choices, such as eating a healthy diet.

But with so much information in the news about cancer-causing agents in our food, how do we know what we should be eating?

“A good rule of thumb when you go grocery shopping is to focus on the outside areas of the store,” Michael Lessor, registered dietitian at Olympic Medical Center said. “That’s where you’ll find fruits, vegetables and non-processed foods. The inside aisles of the grocery store typically contain items with a lot

of processed and refined ingredients, which lack nutrition and can potentially lead to cancer.”

Cancer risk can increase because of excessive weight gain or obesity, which is often related to consuming processed foods. Fat can surround a person’s organs and lead to things like fatty liver disease, cirrhosis of the liver and eventually liver cancer. Processed foods can cause an inflammatory response in cells, which over time can increase the risk of cancers of the small intestine, esophagus and colon.

2 teaspoons low-sodium soy sauce 4 8-inch whole wheat tortillas

NUTRITION INFORMATION Makes 4 servings Calories: 440 Total fat: 12g Saturated fat: 3g Sodium: 570mg

Carbohydrates: 57g Dietary fiber: 9g Protein: 29g Cholesterol: 50mg

Source: Produce for Better Health Foundation courtesy of “What’s Cooking? USDA Mixing Bowl.”

Content provided by Olympic Medical Center.

Content provided by Olympic Medical Center.

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Check ingredients and reject any with added oils or preservatives.

DIRECTIONS

• 1. Place mangos, chicken, onion, fresh basil, red bell pepper, cabbage and carrots in a mixing bowl and toss until well-mixed.

• 2. In a small bowl, whisk together cream cheese, peanut butter and soy sauce.

• 3. To assemble: Lay out tortillas on a flat surface. On each tortilla, spread ¼ of the cream cheese mixture and top with mango, vegetable and chicken mix. Roll up tightly, tucking in ends of tortilla. Secure with toothpicks.

• 4. To serve, cut each wrap in half.

• 5. If not serving immediately, refrigerate. These wraps keep well overnight.

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Peninsula Daily News & Sequim Gazette

OCTOBER 2019 5

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By Olympic Peninsula Community Clinic A local program provides help for women and men who are lower-income, uninsured and need breast, cervical or colon health screenings. If you meet the qualifications of age, income and insurance status, you will be able to access free of charge screening services.

To improve access to breast and cervical cancer screening, Congress passed the Breast and Cervical Cancer Mortality Prevention Act in 1990, which directed the Centers for Disease Control (CDC) to create the Breast and Cervical Health Program (BCHP). Finding cancers early can save lives, and Congress believed that every individual should be able to access recommended cancer screenings.

The BCHP began delivering free of charge women’s breast and cervical health care services in Clallam County in 2001. Colon health care was added to the program (changing the acronym to BCCHP) in 2006 and includes screening for men.

The qualifications for the BCCHP are three-fold:

• Age: 40-64 for breast and cervical, 35-39 for breast symptoms and 50-64 for colon, or before 50 if meets family history criteria • Income: at or below 250% of the federal poverty level or 300% for breast care only • Insurance status: none, high deductible or does not have Medicare B

There are also new “special consideration” situations for women under 40: screening pap smears and cervical cancer treatment for women 21-39 and breast screening for women under 40 who are medically documented to be at increased risk for breast cancer.

All screening and diagnostic services are free of charge, including cancer treatment, for breast and cervical care. Screenings for colon care are covered (diagnostics are not covered) and the program would help the client find charity care programs for treatment if screenings result in a cancer diagnosis.

To date, the BCCHP in Clallam County has enrolled over 3,300 people who would not have been able to access screenings if not for these free of charge services. This program has provided thousands of clinical breast exams, screening mammograms, Pap smears/HPV tests and diagnostic services for the breast and cervix. It has provided breast cancer treatment for 58 women and cervical cancer treatment for 26 women. The program has provided colon screenings for 330 people, 138 of whom received colonoscopy procedures. There were no colon cancer diagnoses.

King County is the BCCHP prime contractor for the Olympic Peninsula region. The local program is coordinated from the Olympic Peninsula Community Clinic in Port Angeles. It also is available in Forks and Port Townsend. You are welcome to call 360-452-2012 to discuss your qualifications and how best to get your health care needs met.

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Peninsula Daily News & Sequim Gazette

OCTOBER 2019 7

« ‘Prevent’ from page 4

The FIT must be done more frequently than colonoscopies, since it only detects growths that may already be problematic.

Skin cancer is the most common cancer in the U.S. and, fortunately, often is curable with treatments when caught early.

A thorough, visual skin cancer screening can be done by your general practitioner or a dermatologist, which is the best way to catch cancers of the skin early.

Lung cancer is most likely to affect people who have smoked — the more one has smoked, the higher the risk. For people 55 and older who have smoked in the past, even if you’ve quit, your primary care provider should be consulted as to whether a lung cancer screening is right for you. They may recommend a scan of your chest to screen for any suspicious growths in your lungs.

Researchers don’t yet understand all the reasons cancers occur, but there are many steps you can take to decrease your risk.

Through exercising, eating a healthy diet with many fresh fruits and vegetables and few pre-processed foods, quitting tobacco products and limiting alcohol, you can confidently lower your cancer risk. Then, increase your prevention power by asking your healthcare provider about the cancer screening tests that can help you live a longer, healthier life.

Dr. Kristin Puhl grew up in Port Angeles and is now a physician in the Rural Residency Training Program at North Olympic Healthcare Network (NOHN) in Port Angeles.

The power of routine cancer screenings Early detection is key to effective cancer treatment

Recommended screenings can detect precancerous changes or early-stage cancers, providing the best chance for successful treatment. Knowing at what age and how often to have certain preventive screenings is an important piece of early detection, according to Marcia Limoges, RN, BSN, OCN, an Olympic Medical Cancer Center nurse.

Most cancers don’t cause any symptoms in early stages. Who should be screened?

TYPE OF WHO SHOULD CANCER BE SCREENED? RISK FACTORS

Lung

Quit smoking.

Infection by the human papillomavirus (HPV), commonly spread through sexual activity

Ages 21–29: Pap test every three years (if results are normal)

Both boys and girls can begin receiving the HPV vaccine as early as 9 years old. Adults up to age 45 can also receive the HPV vaccine.**

Being overweight, especially after menopause

Ages 40–44: (optional) annual mammogram

Stay physically active with regular exercise.

Ages 75+ if in good health Drinking two or more with a life expectancy of alcoholic beverages per 10 years or more day

Ages 45–54: annual mammograms

Maintain a healthy weight and diet.

Ages 55+: mammograms at least every other year as long as the life expectancy is at least 10 years.**

Limit alcohol consumption.

Men and women

Being overweight

Ages 45–75

Eating a low-fiber diet with few fruits and vegetables

Age 45: baseline colonoscopy,* repeat colonoscopy every 10 years (if results are normal)

Maintain a healthy weight and diet.

Smoking tobacco

Ages 55–80

Second-hand smoke exposure

Who have smoked at least one pack a day for 30 years, two packs for 15 years, three packs a day for 10 years, currently smoke or it has been less than 15 years since quitting Ages 21–65

Women Ages 40–74

Avoid tobacco smoke.

Radon gas or asbestos exposure Family history of lung cancer

Cervical

Colon

PREVENTION

Age 55+: low dose CT scan once a year

Men and women

Women

Breast

SCREENING

High intake of red meat or processed meats, such as hot dogs

Ages 30–65: Pap test every three years (if both HPV and Pap tests are done and both results are negative, may wait five years between screenings)

Stay physically active.

Having an inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis * According to the American Cancer Society **According to the U.S. Food and Drug Administration Content provided by Olympic Medical Cancer Center

8 OCTOBER 2019

Peninsula Daily News & Sequim Gazette

Cancer Prevention

RISK FACTORS FOR BREAST CANCER Take action to improve your chances of staying healthy

By Kay C. Hobbs, RN Approximately 270,000 women in the United States are diagnosed with breast cancer each year. However, not all women have the same risk of developing breast cancer during their lifetime. Studies have shown that certain factors (called risk factors) increase the likelihood that a woman will develop breast cancer.

Many risk factors associated with breast cancer cannot be changed, but some can be modified.

The presence of breast cancer risk factors does not mean that cancer will occur. Instead, risk factors help identify women who will benefit the most from screening or other preventive measures. It’s also important to remember that breast cancer can occur with no identifiable risk factors. Women should work with their medical care providers to determine their own personal risk of breast cancer based on their own circumstances.

Breast cancer risk factors are divided into nonmodifiable and modifiable risk factors. Nonmodifable factors cannot be changed and include our age and gender. Modifiable factors can typically be changed to reduce the risk of developing breast cancer.

Cosmetic implants, electromagnetic fields, electric blankets and hair dyes are not associated with breast cancer risk.

Modifiable risk factors for breast cancer

• Limit alcohol intake.

• Maintain a healthy weight.

• Limit night shift work.

• Adopt a physically active lifestyle. This should include 150 minutes of weekly moderateintensity activity, 75 minutes of weekly vigorous-intensity activity (or some physical activity above one’s usual routine), in addition to limiting sedentary activity.

If you believe you are at a high risk of developing breast cancer, talk with your health care provider.

Based on your nonmodifiable risk factors, your provider may recommend options such as genetic counseling.

Genetic counselors provide expertise in the use of genetic testing and other measures for risk reduction.

• Exposure to hormones: Long-term use of combined oral estrogen-progesterone (five years or more) increases a woman’s risk of breast cancer.

• Pregnancy and breastfeeding: some studies suggest that women who have given birth multiple times are less likely to develop breast cancer later in life. Other studies show this only holds true for women who started having children at a younger age. Breastfeeding also has been associated with a Kay C. Hobbs, RN, is the nurse coordinator of medical lower risk of developing breast cancer. oncology at the Olympic Medical Cancer Center in Sequim.

• Night shift work: recognized by the International Agency for Research on Cancer and the World Health Organization as a probable cause. The primary reason remains under study but may be tied to the hormone melatonin, which is normally produced at night.

Nonmodifiable risks • Alcohol: Intake as low as three drinks per week for breast cancer can increase risk.

• Gender: Being a woman is the primary risk • Physical activity: Lack of physical activity is factor. Men can develop breast cancer, but it’s about associated with a higher risk.

• Smoking: Both active and passive tobacco smok100 times more common in women. ing is associated with an increased risk, especially • Increasing age: There is a higher risk after age 65. among premenopausal women.

• Family History: Having two or more first-degree relatives with breast cancer who were younger than • Obesity: Weight gain and obesity are associated with an increased risk of post-menopausal breast cancer. age 50 at diagnosis increases one’s risk.

• Diet: some studies have shown that a diet high in • Race/ethnicity: In the U.S., for every fruits and vegetables resulted in a lower risk of breast 100,000 women, there are 124 cases diagnosed. cancer. Eating more than five servings of red meat The rate of breast cancer is lower in black women per week may be associated with an increased risk.

(113 per 100,000), American Indians/Alaska Natives (92 per 100,000) and Hispanic women While there are still a couple risk factors (90 per 100,00). It is lowest in Asian American/ associated with developing breast cancer that Pacific Islanders (82 per 100,000).

• Breast Density: Women whose mammograms you have no control over, such as advancing show many dense areas of tissue have an increased age or family history, you can make lifestyle risk compared with women whose mammograms choices that may reduce your risk. reveal mainly fat tissue.

• Abnormal breast biopsy: Women with a history Participating in regular mammogram screenings is of abnormal breast lumps have an increased risk for highly important, and although it will not reduce your breast cancer. risk of breast cancer, it will significantly decrease your • Age at time that menses starts and at menorisk of dying from it. pause: Both a younger age when menses begins The American Cancer Society recommends that and a later age at onset of menopause increases breast cancer screening begin at age 45. However, risk. This is likely due to the longer overall exposure women with extra risk factors should begin at an to estrogen in a woman’s lifetime. earlier age, typically at age 40.

• Exposure to chemicals or radiation: Exposure The good news about breast cancer prevention is to radiation of the chest at a young age as occurs that there are important lifestyle changes women can with treatment of Hodgkin’s lymphoma or in make to live healthier lives and reduce breast cancer survivors of an atomic bomb or nuclear plant risk factors: accident, is associated with a higher risk of breast • Plan the first birth before age 30. cancer. Chemicals such as PCBs and pesticides such • Breastfeed for at least six months.

• Avoid or limit the use of menopausal hormone as DDT have been investigated but are not clearly therapy. associated with increased risk.

Cancer Prevention

Peninsula Daily News & Sequim Gazette

OCTOBER 2019 9

TURNING THE TIDE

Targeted therapies are changing the face of cancer care

By Olympic Medical Center Many healthcare professionals would agree that we are experiencing one of the most exciting times in oncology. Surgeries continue to become less invasive and more accurate, and emerging innovations in radiation, drug therapy and immunotherapy continue to open more avenues than ever before for virtually all types of cancer.

“Cancer care is constantly changing in both large and small ways as we come to better understand each disease, as well as better understand how we can best leverage the tools we now have to screen, diagnose and treat each patient,” said Patrick Jewell, MD, radiation oncologist and medical director of Olympic Medical Cancer Center (OMCC).

The rundown on advances in radiation

As surgeries for cancer become increasingly precise, so, too, do radiation treatments.

“Radiation technologies and treatments continue to become more refined and accurate, helping to further ensure that only cancerous cells are targeted during treatment,” Jewell said.

To achieve this, the radiation oncology team at OMCC uses the Varian TrueBeam, the most advanced linear accelerator available (a state-of-the-art device that delivers ultraprecise radiation treatments).

“This machine can perform the full scope of radiation treatments, from ‘simple,’ lower-dose treatments for alleviating cancer symptoms, such as pain, to

high-dose, pinpointed ones for destroying cancerous tumors,” Jewell said.

What does that ultimately mean for patients? Better cure rates and less toxicity.

“Patients battling cancer stand to enjoy a better quality of life than ever before, not only while receiving treatment, but after as well,” Jewell said.

Olympic Medical Cancer Center offers both radiation and chemotherapy under one roof, making treatment more convenient for Peninsula residents. To learn more, call 360-683-9895.

Harvest of Hope

Innovative drug & immunotherapies In addition to improved radiation therapies, drug and immunotherapies also have come a long way in recent years.

“There have been a number of exciting changes in cancer treatment — especially for hematology [blood] cancers,” said Kevin Weeks, DO, medical oncologist at OMCC. “The most important being the highly targeted drug and immunotherapies now available to patients.”

Immunotherapies unlock the ability of the body’s immune cells to recognize and attack cancer cells.

Targeted drugs, on the other hand, prevent cancer growth by exploiting cancer cells’ gene mutations. As these therapies continue to improve, we can better and more precisely treat different cancers.

“While these therapies don’t work for every person or every cancer, when they do work, they’re very powerful,” Weeks said. “We have more tools than ever before to make the body stronger and help it more effectively fight cancer. OMCC has invested well in cancer care to meet our community’s ever-changing needs, so you don’t have to leave your hometown community to receive world-class cancer care.”

Wine & Dinner Gala Guy Cole Event Center in Sequim Saturday, Oct. 12 at 5:30 p.m.

Olympic Medical Center Foundation, in conjunction with Seattle Cancer Care Alliance, will present the annual Harvest of Hope Wine & Dinner Gala The 17th annual gala will raise funds for local cancer patients being treated at Olympic Medical Cancer Center through the provision of services, programs and equipment.

The evening will feature well known local chef Kathryn Kitts from The Sweet Beginning Café.

Harbinger Winery from Port Angeles will be the wine served for the event, featuring many of their awardwinning wines.

EVENT DETAILS

• Cocktails begin at 6 p.m.

• Dinner will be served at 6:45 p.m.

Attendees will have an opportunity to help raise funds through the purchase of raffle tickets or live auction items. Sample live auction items include: • • • •

A Safari trip for two to South Africa An autographed guitar from Bono A variety of “instant” wine cellars Brew lessons and dinner at Barhop Brewery in Port Angeles • A one week vacation in a one bedroom condo in Los Cabos, Mexico For more information on the wine & dinner gala, please call the OMC Foundation at 360-417-7144.

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10 OCTOBER 2019

Peninsula Daily News & Sequim Gazette

Cancer Prevention

Treatments for lymphedema

By Karen Rushby, PT, CLT-LANA

A common side effect of cancer removal

When someone has one or more lymph nodes removed and/or receives radia-

certified lymphedema therapist When cancerous cells have grown

tion treatments, they should inspect

surgeries — particularly

into the lymph nodes, a surgeon may

that area daily for any swelling, which

breast cancer removal

remove not only the tumor itself, but

can happen days, weeks, months or

also these nodes. Removing lymph

— is lymphedema,

nodes affects the body’s ability to drain fluid from its tissues, resulting

which causes swelling,

in lymphedema, which can cause

most commonly in

extreme discomfort, hardening of the skin, recurring infections and reduced

the arms. At Olympic

range of motion.

Medical Center,

Lymphedema therapists initiate

certified lymphedema

treatment by taking a patient’s medi-

therapists provide

area itself. They also educate patients

cal history and evaluating the swollen

specialized therapy to those dealing with the effects of lymphedema.

-

even decades later.

Boosting Health & Well-Being Physical therapists not only assess lymphedema and restore normal range of motion after surgery and radiation, but also give helpful exercise guidelines as you return to normal activities after your cancer treatment.

For more information on

on why the swelling occurs, how fluid

lymphedema therapy treatments

moves in the body and available treat-

at Olympic Medical Center, call

ment methods so patients can learn

360-417-7728 in Port Angeles or

how to manage symptoms at home.

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Did you know....

SHERWOOD ASSISTED LIVING OFFERS:

* 24-Hour Professional Nursing Staff * Levels of Care * Secure Units for the Memory Impaired * Wide Range of Services * Adult Day & Respite Care * Activities 7 Days a Week * Locally Owned and Operated

Sherwood Assisted Living... where quality of care is our top priority.

360.683.3348

www.sherwoodassistedliving.com Cancer Prevention

9A2417053

550 W. Hendrickson Rd., Sequim, WA 98382

9A2404247

Assisted Living with a Difference!

SOUPS • SANDWICHES • SMOOTHIES PREMIUM MEATS • LOCAL PRODUCE CHEESE • BULK FOODS / HERBS / SOAPS GROCERIES • HEALTH & BEAUTY SUPPLEMENTS • GIFTS BEER, WINE & SPIRITS Plastic Bag Free

Peninsula Daily News & Sequim Gazette

FAMILY OWNED AND OPERATED SINCE 1975 200 W. 1ST • DOWNTOWN PORT ANGELES • 360 452-7175 OPEN DAILY 8 - 8 • www.countryairemarket.com

OCTOBER 2019 11

World-Class Cancer Care, Close to Home You don’t have to leave the North Olympic Peninsula to get exceptional cancer care. Olympic Medical Cancer Center in Sequim offers comprehensive, patient-centered care using the most advanced technology available.

Our team provides diagnostic evaluation, treatment and follow up care, while ensuring that cancer patients and their families have access to support services for their physical, psychological, emotional and spiritual needs.

We are accredited by the American College of Surgeons Commission on Cancer and affiliated with Seattle Cancer Care Alliance. To learn more, please visit www.olympicmedical.org or call (360) 683-9895.