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creating hope JUNE 2012

Know the code

Genetics program offers new insights into screening for and treating cancer BY JAKE POINIER


he Human Genome Project was completed in 2003, but The University of Texas MD Anderson Cancer Center in Houston had begun integrating genetics into care plans for cancer patients in the mid 1990s, when two breast cancer genes, BRCA1 and BRCA2, were discovered. With other cancer genes subsequently identified, the understanding of the relationship between cancer and our genetic code has continued to progress—with implications for screenings as well as treatment. The longstanding work in genetics in Houston is now benefitting patients in Arizona at Banner MD Anderson Cancer Center. “There are primarily two populations of patients we see in our clinic,” said April O’Connor, a certified genetic counselor and the genetics program coordinator of the Banner MD Anderson Clinical Cancer Genetics Program in Gilbert. “Those who currently have cancer, and those who are healthy but concerned about their cancer risk.” The clinic’s goal is to determine whether there is a hereditary predisposition to a patient’s cancer—which occurs in about 5 to 10 percent of cases—or if it is sporadic. The distinction is critical: Hereditary cancers may react differently to treatment, and be

April O’Connor is a genetic counselor in the Clinical Cancer Genetics Program at Banner MD Anderson Cancer Center. She works with people to identify if they have a hereditary predisposition to a specific type of cancer.

INSIDE 3 Breast cancer prevention aided by cutting-

edge technology 4 Comprehensive Breast Cancer Program 5 Ask the expert - Melanoma

6 ‘Cancer has met its match’ 7 Boys susceptible to HPV 8 Events and classes

more aggressive, which could change the protocol for treatment options. “If someone has hereditary breast cancer, they have a much higher chance of recurrence in the other breast, about 40 to 60 percent,” O’Connor said. “If it’s sporadic cancer, then it’s only 2 to 10 percent. It makes a difference in whether you’d consider a prophylactic mastectomy of the other breast, versus just monitoring by screening.”

GENES AND SCREENS Screening protocols for people with a genetic predisposition for breast cancer have changed in recent years as well. Mammograms once a year for individuals over 25, or individualized based on the youngest cancer diagnosis in the family, now can be supplemented every six months with MRI scans for improved detection.


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Colon cancer is another case in which genomics also may affect the screenings. A full colonoscopy will likely take place earlier, around age 20-25, to assess for any polyps or cancers. While genes that cause ovarian cancer are known, diagnosis is more difficult because the ultrasound and blood test screening results are not as definitive, and the tumors are often fast growing.

Although genomics has come a long way in the past two decades, there are still gray areas, since not every cancer-causing gene has been identified. “You’re not always going to get a definitive answer,” said O’Connor. “But even if you learn you’re negative for the most likely gene, you’ve checked something significant off the list of possible causes.”



Prior to any testing, genetic counseling thoroughly examines family and personal history. Taking into account cancer at early age, rare forms such as male breast cancer, or two different types of cancer in the same individual, clinicians look at risk models that indicate the likelihood of a genetic mutation. If testing is performed, the results come in within two to three weeks.

Many patients come to the Clinical Cancer Genetics Program at Banner MD Anderson Cancer Center based on a physician’s referral, but if you have a family history of or are otherwise concerned about your cancer risk, you may self-refer. To speak with a genetic counselor who can help you decide whether testing is appropriate, please call 480-256-6444.

Breast cancer prevention aided

by cutting-edge technology Banner MD Anderson Cancer Center’s comprehensive breast program supports women in breast cancer prevention, diagnosis, treatment and beyond BY MICHELLE TALSMA EVERSON


nnerving. Frightening. Confusing. A breast cancer diagnosis, or even a suspicion of breast cancer, can be all of these things. To help ease the journey, Banner MD Anderson Cancer Center’s comprehensive breast program offers a variety of cutting-edge tools that help women from start to finish.

KEY PREVENTIVE TOOLS Mammograms — which are often recommended for women beginning at age 40 or sooner with a family history — are one of the key preventative tools in the fight against breast cancer. For women seeking a routine mammogram, Vilert Loving, M.D., a boardcertified radiologist who specializes in breast diseases at Banner MD Anderson Cancer Center, says the center offers 3D tomosynthesis — essentially a 3D mammogram. “The 3D tomosynthesis examines the breast from multiple, different viewpoints,” Loving explains. “A normal mammogram looks from two views, while the 3D one shows multiple angles by moving in an arc around the breast.” Loving says that while the 3D tomosynthesis is new technology — the center just started using it last year — they have so far found it most useful for women seeking routine screening

Dr. Vilert Loving stands by the 3D Tomosynthesis equipment. It is the newest imaging technology for screening mammograms.


mammograms and diagnostic mammograms. He adds that the center has the only 3D mammogram he knows about in the East Valley and one of the few in the state.

GOING DIGITAL The center also utilizes digital mammography, which has been shown to have significant advantages for those in their early 40s; and different types of biopsies, including ultrasound guided, stereotactic and MRI, Loving adds. In addition, their MRI unit is at the forefront of early detection technology. “With MRIs, the stronger the magnet, the better the image; we have a 3T magnet where usually it’s a 1.5T magnet or lower,” Loving explains. “The photos are very good; they show better detail

The 3D tomosynthesis examines the breast from multiple, different viewpoints. — Vilert Loving, M.D., Banner MD Anderson Cancer Center radiologist than a mammogram. MRIs are best used for screening of higher risk patients… it’s also used for those who already have cancer to see if the cancer has spread.” If someone suspects breast cancer, Loving recommends starting treatment at Banner MD Anderson’s Undiagnosed Breast Clinic, where the screening and diagnosis process is accelerated. From there, patients can be referred to the correct specialized health professional.

CONTACT US To schedule a screening mammogram, call (480) 543-6900 To schedule an appointment in the Undiagnosed Breast Clinic, call (480) 256-6444


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Comprehensive care for breast cancer patients Banner MD Anderson Cancer Center’s Comprehensive Breast Cancer Program offers women a multidisciplinary approach to breast cancer treatment. “From screening and treatment to support and recovery, our cancer experts walk every step of the journey with our patients,” says Mary Cianfrocca, D.O., F.A.C.P., a medical oncologist and the director of the breast cancer program. “Highly skilled physicians, nurses and staff provide excellent and compassionate medical care, education and support to meet a woman’s needs when faced with a breast cancer diagnosis.” The Comprehensive Breast Cancer Program includes: • Comprehensive screening and diagnostic services including screening mammograms • An Undiagnosed Breast Clinic where women with an abnormal mammogram or breast lump may be referred for a diagnosis. • Surgical care by breast and reconstruction surgeons who specialize in breast surgery • Medical oncology by expert physicians who focus only on breast cancer

• Radiation oncology treatments • Genetic counseling and testing The program also includes many support services to ease the cancer journey. Dr. Cianfrocca says that support services help to “provide better care in the long run.” Some of these services include: • Clinical nurse navigators who assist patients through the system of care • Wellness activities and support groups • The Boutique of Hope, which provides fittings for breast prostheses, wigs, and other personal items. • Lymphedema therapy, which helps to reduce lymphatic swelling during treatment • Palliative care, which assist patients with pain and symptom management • Other unique offerings like dietitians and weight loss programs for breast cancer survivors “The wonderful thing about these support programs is the ability to offer so many diverse services that take care of the whole person,” Dr. Cianfrocca says. To schedule an appointment with a breast cancer specialist, please call (480) 256-6444.

askthe expert Q:


What are the new advances in the treatment of melanoma?


Did you know that one American dies of melanoma almost every hour? Unfortunately, this type of skin cancer continues to be very aggressive. It is estimated that 76,000 people in the US will be diagnosed with melanoma in 2012. The likelihood of getting melanoma has actually increased in the past 30 years, and no one knows exactly why. Increased UV exposures from the sun and indoor tanning have been identified as risk factors for the disease. But there is some good news, too! After about 13 years of not introducing any new drugs to treat melanoma, the FDA approved three new ones in 2011. Melanoma has been particularly difficult to treat because it’s resistant to chemotherapy, which generally takes a “kill all” approach toward cells. But all three new drugs take a different strategy by using the immune system or genetic changes in the cancer cells. Two of the drugs are for patients with advanced stages of the disease, and the other is intended to prevent the recurrence of melanoma in patients who’ve had the melanoma surgically removed. The first one, ipilimumab, is given intravenously and is designed to stimulate the immune system, which will then attack the cancer cells. A minority of patients with advanced melanoma had a prolonged benefit from this drug than was measured in years. The problem is that it has unique side effects as a result of overstimulation of the immune system. Some of these

Banner MD Anderson physicians Dr. Mark Gimbel, (left) surgical oncologist, and Dr. Jade Homsi, medical oncologist, specialize in the diagnosis and treatment of melanoma. They work as a team to provide a multidisciplinary approach to treating the disease. are: severe diarrhea; inflammation of the liver; and a change in the body’s normal hormone levels. The second new drug available is called peginterferon alfa-2b, which is given as shots in the skin rather than intravenously. It also stimulates the immune system and has an effect on the blood supply to the cancer cells. The drug is for patients who have had a melanoma removed and is designed to reduce the chances of the melanoma returning. Its side effects are more manageable than those of ipilimumab, but can include nausea, body ache, and fever. Lastly, the third drug is vemurafenib, and it’s given orally. This drug works in a very smart way because it targets a mutation in a protein called B-raf in the cancer cells. Approximately

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50 percent of melanoma patients have this type of mutation which makes the drug work only in half of melanoma patients. Vemurafenib has shown to improve survival rates of melanoma patients with manageable side effects. There are some very promising new drugs currently under investigation in clinical trials, so there could be more progress soon. In the meantime, melanoma continues to be a very aggressive disease and we need to enforce and focus on prevention and early detection as the best way to fight this disease. Here are a few recommendations: • Wear sunscreen daily • Wear a hat when outside • Avoid tanning beds and prolonged sun exposure • Do self-skin exam regularly • See a dermatologist on a regular basis, especially if there is a history of melanoma in your family or you have a lot of moles.


‘Cancer has met its match’ Community responds to raise funds for cancer research, services


ancer care, treatment and prevention require much more than a new facility. They require the latest medical technologies, expansive treatment and support programs, ongoing research efforts and staffing capable of delivering the excellence in patient care for which Banner Health is so well known. Banner MD Anderson Cancer Center’s promise is to deliver customized, comprehensive and compassionate care for every patient. Banner Health Foundation is committed to helping Banner MD Anderson fulfill that promise. While Banner Health funded the cost of bricks and mortar of the state-of-the-art facility, many essential elements of the project must be funded by the generosity of those who support Banner’s mission to make a difference in people’s lives through excellent patient care. Banner Health Foundation’s Cancer Has Met Its Match campaign continues to raise funds for screenings and prevention services, patient and family support programs, research and much more. Generous contributions have been received from individuals, corporations and foundations that recognize the value of Banner MD

Anderson to this community have responded to the call for support.

HOW YOU CAN GIVE BACK Gift of Gratitude: We invite you to express your gratitude toward a particular doctor or caregiver with a gift that honors the individual who made a difference to you or your friend or family member.

MEMORIAL OR TRIBUTE GIVING: Make a contribution in memory of a loved one or celebrate a birthday or other event or milestone with a gift to Banner MD Anderson through Banner Health Foundation.

STEPS OF HOPE GARDEN PROJECT: Leave your legacy by purchasing a personalized tile or plaque for the Healing Courtyard at Banner MD Anderson. Purchased tiles will surround the Center’s “Togetherness” sculpture or individual plaques can be placed on or near a selected tree or bench. To learn more about the numerous ways to support Banner MD Anderson or how to get involved in the Cancer Has Met Its Match campaign, please contact Banner Health Foundation at (602) 747-GIVE.

for more info: BANNER MD ANDERSON CANCER CENTER On the campus of Banner Gateway Medical Center U.S. 60 and Higley Road in Gilbert Schedule an appointment: (480) 256-6444


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“As a physician and long-time Valley resident, I understand the impact that giving can make on patients and their families. Banner Health has played an important role in my life and so I chose to make a gift in honor of my late wife, Dr. Judith Pachtman. This gift commemorated her battle against breast cancer and provided help for patients at Banner Desert Medical Center where both she and I practiced. In an exceptional twist of fate, Judy had been treated by Dr. Edgardo Rivera at the University of Texas MD Anderson Cancer Center in Houston. Dr. Rivera is now the medical director at the newlyopened Banner MD Anderson Cancer Center here in Arizona. And so, my connection to Banner has grown even deeper as I look forward to Dr. Rivera and his staff providing the same exceptional service that Judi received to those suffering from cancer right here at home.” –Dr. Michael Pachtman

Boys Susceptible to HPV Vaccine prevents virus that leads to cancer BY MICHAEL FERRARESI


hysicians have their hands full with more than 120 types of human papillomavirus, some of which can lead to cancer.

Recently one HPV vaccine that girls have been receiving for several years was approved for use in boys as well. The vaccine prevents the development of cancers, including cervical, vulvar, vaginal, anal and penile cancers, related to the two most common cancer causing HPV viruses, Types 16 and 18. The vaccine also protects against genital warts related to HPV Types 6 and 11. The U.S. Food and Drug Administration approved the drug for boys and men ages 9-26. Vaccination is also approved for girls and women of the same age group. HPV vaccines “target the HPV types that most commonly cause cervical cancer,”

according to the Centers for Disease Control and Prevention. Exposure to HPV during early teens is a vulnerable time for the developing cervix, says Dr. Diljeet Singh, a gynecologic oncologist and program director of cancer prevention and integrative medicine at Banner MD Anderson Cancer Center in Gilbert. “The HPV vaccine is the result of decades of research and truly is a medical victory,” says Dr. Singh. “This intervention offers us the opportunity to prevent cancers, to prevent precancers and to decrease the worries and procedures that go along with the finding of an abnormal pap smear.” Nearly all of the 12,000 cervical cancers diagnosed in the U.S. each year have been linked to HPV, according to CDC officials.

Dr. Singh, who moved from Chicago to Phoenix in March, previously served as co-director of the ovarian cancer early detection program at Northwestern Memorial Hospital. She said the vaccine was in the news in an unnecessarily controversial way which could distract the public from making the best health decisions for their children. “We can inform people in a way that helps them to make good healthcare decisions,” said Singh. Physicians say that’s all the more reason to encourage vaccinations among teens and young adults. If you are a parent, talk with your child’s physician about HPV vaccinations. Their use can prevent the spread of the HPV virus and thus the diagnosis of many cancers in both women and men.



Events and Classes B

anner MD Anderson Cancer Center offers a variety of classes and support groups to assist cancer survivors and their support teams. These classes are free and open to the public. Classes are held at Banner MD Anderson Cancer Center, 2946 E. Banner Gateway Drive, Gilbert, AZ, 85234.

Wellness Classes Journey to Wellness Group 4 PM, THIRD WEDNESDAY OF EACH MONTH A wellness education group led by a registered dietitian and exercise physiologist that promotes healthy lifestyles. A different topic is discussed every month. Please check our website for topic updates at JUNE: Explore body/mind exercises JULY: Delicious vegetarian dishes AUGUST: Exercises to improve bone health and balance

Monday Morning Meditations 9:30 AM EVERY MONDAY MORNING Take a moment to relax and breathe with us in the Healing Garden or in the Learning Center.

Chair Yoga 10 AM EVERY MONDAY MORNING A calming yoga that stretches our bodies safely while relaxing our minds. Yoga is done sitting in the chair or standing behind the chair for assistance.

Gentle Yoga 4 PM ON EVERY THURSDAY Yoga aimed at releasing the tension in your muscles and mind. Â For questions, contact the Health and Wellness Coordinator at Banner MD Anderson Cancer Center at 480-256-4141.

To schedule an appointment, call 480-256-6444


Banner MD Anderson Creating Hope

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