Banner MD Anderson Power of Prevention Fall 2015

prevention power of

PR E V EN TION • R ESE A RCH • INNOVAT ION

FALL 2015

Waging her battle Breast cancer patient finds strength from friends, family during treatment

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BY KRISTINE BURNETT

ourage takes many forms. For some, it is displayed on the battlefield.

For others, like Mary King of Mesa, courage is revealed when fighting personal battles.

A 52-year-old mother of two sons serving in the United States Armed Forces, King is waging war on an aggressive and fast-growing form of breast cancer: estrogen-receptor-negative (ER-negative) and HER2-positive breast cancer.

Like her sons, she doesn’t view her battle as courageous. Rather, she views it as doing what needs to be done.

“I was diagnosed in October 2014,” King said.

"And thankfully found Banner MD Anderson Cancer Center in Gilbert for a second opinion."

K I N G | 2 →

FOR MORE INFORMATION On the campus of Banner Gateway Medical Center, U.S. 60 and Higley Road in Gilbert Banner MD Anderson Radiation Treatment also available at: Banner Thunderbird Medical Center, 55th Avenue and Thunderbird in Glendale, 602-865-5445 Banner Desert Medical Center, Southern and Dobson in Mesa, 480-412-3808 NEW! Banner Boswell Medical Center, 103rd Avenue and Grand in Sun City, 623-832-4000 To schedule an appointment, call 480-256-6444

Check out our website

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→ FROM THE COVER

“My treatment started with six rounds of intense chemotherapy. Dr. Mary Cianfrocca worked with me to push back one round so I could go see my son receive a medal of valor in February. She knew I needed to be there.”

King’s son, Sgt. Bryan Anderson, an Army Ranger medic, was awarded the Distinguished Service Cross, second only to the Medal of Honor, for his actions in a mission in southern Afghanistan.

Anderson said, “I never thought twice about running to one of those patients.

The guys are basically my family, so when one of them is hurt, and I’m their medic, it’s my job to go make them better.”

FAMILY CONNECTIONS That sense of duty runs in the family.

Before discovering the cancerous lump during a monthly breast self-exam, King cared for her husband while he battled lung cancer.

“I was his only caregiver until hospice,” King shared. “I thought I understood his battle, but now I see just how hard he fought and how much he loved me.”

Sadly, that wasn’t King’s first nor was it her last family experience with cancer.

“I’ve lost six siblings,” she said.

“My sisters to cancer and my brothers to sudden heart attacks.”

Both sisters survived breast cancer before later succumbing to another form of cancer — one to lung cancer and the other to colon cancer.

Despite seemingly insurmountable loss, King is accepting of her diagnosis and her life’s journey: “I lost my husband, brother and mom, and then I was diagnosed with cancer — all within six months. I wasn’t angry with God when I was diagnosed, though I was angry with my mom and sisters for being gone.

I needed a woman to talk to, so I opened My Anxious Moments.”

CONNECTING WITH OTHERS Dedicated to her cancer journey, My Anxious Moments is a closed Facebook page where King can vent, ask questions 2 P OWE R O F PR E V E N T I O N FALL 2 0 1 5

HAVE YOU HAD AN ABNORMAL MAMMOGRAM OR SUSPICIOUS LUMP IN YOUR BREAST? The Undiagnosed Breast Clinic provides answers.

Following an abnormal mammogram or detection of a suspicious lump in the breast, getting answers is paramount. The Undiagnosed Breast Clinic at Banner MD Anderson Cancer Center, a facility recognized by the American College of Radiology as a Breast Imaging Center of Excellence, is dedicated to providing quick answers and timely results.

Whether a woman self-refers or is referred by a physician, most appointments are scheduled to include an initial consultation and all diagnostic testing in one day. Testing may include a diagnostic mammogram, MRI, ultrasound, biopsy or more. Results are given with 48 hours, minimizing the time a woman is left to wait and worry.

If cancer is confirmed, patients meet with a breast cancer team at the center within a few days. The team may include a breast surgeon, medical oncologist, radiation oncologist and other support staff who work together to create an individualized treatment plan for each patient.

To schedule an appointment at the Undiagnosed Breast Clinic, call (480) 256-6444.

and receive support from trusted friends and family.

“It’s like keeping a journal,” she noted. “I can lay it out there and share what I’m going through, no matter how cruddy or great. It’s been a saving grace for me.”

Another saving grace has been her significant other, Richard Harris II, a cancer survivor and cancer widower whom she met in bereavement counseling.

“Having survived throat cancer, he understands what I’m going through — when I’m ‘chemoed’ out and having a bad day,” she said. “He has made this journey easier.”

King says Banner MD Anderson, has also been instrumental in making her journey easier.

“They [Banner MD Anderson] were my second opinion,” she explained. “I can’t say enough about how they introduced me to what I was about to go through.

When I left after meeting them the first day, I felt totally confident and knew I had the right team.”

Leading King’s care team is Mary Cianfrocca, DO, division chief of internal

medicine and director of the breast cancer program at Banner MD Anderson.

“They let me make decisions as we go,” King said.

When, during treatment, a lump was discovered in her other breast, King elected to have a bilateral mastectomy.

“It was difficult to biopsy this breast, like it had been with the first,” she explained.

“I figured something was hiding, so I decided then to have both breasts removed.”

When considering breast reconstruction, King spoke with her sons.

“I told them I wanted to burn my bras and call it a day. I think I’ve earned the right to not wear a bra,” she laughed.

“They were like, ‘Go for it, mom!’”

Liberated from her bras, as she says, King remains in treatment, receiving the drug therapy Herceptin every 21 days.

She is expected to complete treatment

by April 2016.

“I knew from the beginning that this wasn’t a death sentence, but instead another journey I was being put on,” King said, adding:

“It has ups and downs, but you can’t let it get you down.

That’s half the battle. My motto is to live, love, laugh and build memories.” • pp

W

hen it comes to cancer, we at Banner MD Anderson Cancer Center, are ALL IN the fight against cancer — with world-class medicine, unique clinical trials, and a team of experts dedicated to developing a customized treatment plan for each person. We believe in the healing power of a supportive community.

There’s nothing more powerful than knowing we have community behind us, especially during our darkest hours.

That’s where you come in!

Share a message of hope, like the ones included on these pages, and let a patient who is facing cancer know you are all in!

Use the attached postcard to send in your words of support or upload them at WeAreAllIn.com!

These messages will be shared with patients at Banner MD Anderson Cancer Center in Gilbert, as well as our satellite radiation oncology programs in Mesa at Banner Desert in Mesa, Banner Thunderbird in Glendale and Banner Boswell in Sun City.

• pp

BannerMDAnderson.com 3

BREAST CANCER

CERVICAL CANCER

COLORECTAL CANCER

“Breast cancer screening is important because regular screening detects cancers at their earlier stages, leading to improved chances for curing the disease,” said Dr. Vilert Loving, Breast Radiologist. “At earlier stages, treatment tends to be less complex, with smaller surgeries and the potential to avoid chemotherapy.”

Routine Pap tests are critical to catching cervical cancer early. “If a patient has an abnormal Pap test, the physician will do further evaluation, which will change the screening interval,” Dr. Matthew Schlumbrecht, Gynecologic Oncologist, said.

“If a patient has a hysterectomy, she should discuss the need for Pap screening based on her Pap history and the pathology from surgery with her doctor.”

“Colorectal cancer screening is unique because it represents a way that we can both diagnose and potentially treat cancerous and pre-cancerous lesions at an early stage,” Dr. Warren Tseng, Surgical Oncologist, said. “Many of these lesions, if diagnosed early, can be removed endo-scopically at the time of the colonoscopy.”

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RISK FACTORS • Strong family history of breast cancer • History of radiation treatment to the chest • Genetic mutation, including an abnormality in the BRCA 1 or BRCA 2 genes, CDH1, Bannayan-RileyRuvalcaba Syndrome

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RISK FACTORS • History of severe cervical dysplasia • Persistent HPV infection after age 30 • History of organ transplant recipients

• History of lobular carcinoma in situ

• Immune system-suppressive medication use

SCREENING RECOMMENDATIONS

• History of HIV

• Age 20 to 39: Clinical breast exam every one to three years • Age 40 to 75: Clinical breast exam and mammogram every year.

SCHEDULE AN APPOINTMENT • Call (480) 543-6900 to schedule an appointment at our Women's Imaging Center.

• Family history of colorectal cancer or pre-cancerous polyps • Personal history or family history of Familial Adenomatous Polyposis • Personal history or family history of Hereditary Nonpolyposis Colorectal Cancer • Inflammatory bowel disease

SCREENING RECOMMENDATIONS

• Age 50 or older: Follow ONE of these screening options:

• Age 21 to 29: Pap test every three years

• Colonoscopy every 10 years

SCHEDULE AN APPOINTMENT • Call (602) 230-2273 (CARE) or visit BannerHealth.com/ 230CARE to find a gynecologist and schedule a Pap test.

4 P OWE R O F PR E V E N T I O N FA LL 2015

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BY DEBRA GELBART

• Personal history of precancerous colon polyps

SCREENING RECOMMENDATIONS

• Age 65 or older: If you’ve had no unusual tests in the previous 10 years, talk to your doctor.

Cancer screenin before you be

RISK FACTORS

• Diethylstilbestrol (DES) exposure before birth

• Age 30 to 64: Pap and HPV test every five years, or Pap test every three years

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• Virtual colonoscopy every five years • Fecal Occult Blood Test every year Your doctor can help you decide if you should continue screening after age 75. Banner MD Anderson doesn’t recommend screening for adults after age 85.

ENDOMETRIAL (UTERINE) CANCER

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LIVER CANCER

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Endometrial cancer screening is recommended only for women at increased risk, Dr. Matthew Schlumbrecht, Gynecologic Oncologist, said.

Liver cancer screenin recommended only f at increased risk. “Sc important for early detect a nd for consideration of o can be potentially curative surgical resection or liver Dr. Madappa Kundrand Oncologist, said.

RISK FACTORS

RISK FACTORS

• Diagnosed with or family history of Lynch syndrome

• Chronic hepatitis C infe

• Obesity

• Inherited metabolic dise including: – Hemochromatosis – Alpha-1 antitrypsin de – Glycogen storage dise – Prophyria cutanea tar – Tryosinemia

• Unbalanced estrogen levels • History of polycystic ovary syndrome

SCREENING RECOMMENDATIONS If you’ve been diagnosed with or have a family history of Lynch syndrome, follow this schedule: • Transvaginal ultrasound every year

• Primary biliary cirrhosis

• Autoimmune hepatitis

• Non-alcoholic fatty liver (NAFLD)

SCREENING RECOMMENDATIONS • Liver ultrasound every

SCHEDULE AN APPOINTMENT

• Endometrial biopsy every year

• Alpha-fetoprotein (AFP every six months

• Call (602) 230-2273 (CARE) or visit BannerHealth.com/ 230CARE to find a gastroenterologist and schedule a colonoscopy.

SCHEDULE AN APPOINTMENT

SCHEDULE AN APPOINTMENT

• Talk to your gynecologist to schedule a transvaginal ultrasound or an endometrial biopsy.

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LUNG CANCER

OVARIAN CANCER

Lung cancer screening is recommended only for adults at high risk. “Lung cancer screening is important, because it can save your life if you have an early stage lung cancer,” said Dr. Boris Nareav, Medical Oncologist.

“If lung cancer is found early, in many cases no chemotherapy or radiation will be needed. Therefore, a patient will be spared side effects of these intense treatments.”

Ovarian cancer screening is recommended only for women at increased or high risk. If you’re at high risk, Dr. Matthew Schlumbrecht, Gynecologic Oncologist, recommends contacting your gynecologist.

RISK FACTORS

• Lynch syndrome

• Between the ages of 55 and 74

• Family history of breast and ovarian cancer

• Current smoker (or former smoker who quit in the past 15 years)

SCREENING RECOMMENDATIONS

• Smoking one pack/ day for 30 years or two packs/day for 15 years

• Transvaginal ultrasound every six to 12 months

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SCREENING RECOMMENDATIONS

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RISK FACTORS • BRCA1 or BRCA2 mutations • Suspected risk of BRCA1 or BRCA2 mutations • One close relative with ovarian cancer who has a suspected BRCA1 or BRCA2 mutation

• CA 125 blood test every six to 12 months

• Low-dose CT

• If you have BRCA1 or BRCA2 mutations, you should get these exams every six months.

SCHEDULE AN APPOINTMENT

SCHEDULE AN APPOINTMENT

• Call (480) 543-6900 to schedule a low-dose CT lung screening test at Banner MD Anderson.

• Call your gynecologist to schedule an ultrasound or blood test if you have any risk factors.

PROSTATE CANCER

SKIN CANCER

“Most specialists recommend annual PSA screening in most patients starting at age 50, and sooner in certain high risk populations,” Dr. Rachit Kumar, Radiation Oncologist, said. “Digital rectal exams (DRE) allow your doctor to check the prostate for signs that are suspicious of cancer. Like the PSA, most men should have this done annually.

Certain aggressive prostate cancers may have a low PSA level, but signs concerning for disease on the DRE.”

Skin cancer screening is easy to do and is not invasive. It entails having a professional evaluate your skin from head to toe (including your hair and the soles of your feet). Talk to your doctor if you see or feel something suspicious, have a sore that doesn’t heal, or see a change in a mole or freckle.

“Skin cancer screening is so important because all skin cancers can be cured if identified and treated at an early stage,” said Dr. Mark Gimbel, Surgical Oncologist.

“The best way to identify early cancers is to undergo regular screening — and even more frequently if you have any risk factors for skin cancer.”

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RISK FACTORS • Family history (especially father, brother, son) of prostate cancer • African-American

SCREENING RECOMMENDATIONS Starting at age 40, discuss screening risks and benefits with your doctor. The screening recommendations below apply to most men: Age 50 to 75: • Discuss screening risks and benefits with a health care provider • Digital rectal exam every year, if you choose to be screened • Prostate-specific antigen (PSA) blood test every year, if you choose to be screened For those older than 76: • Talk to your doctor to determine if screening is still necessary. Banner MD Anderson doesn’t recommend screening for men age 85 or older.

The screening recommendations below apply to men at increased risk for prostate cancer: Age 40 to 75 • Discuss screening risks and benefits with a health care provider • Digital rectal exam every year starting age 45, if you choose to be screened • Prostate-specific antigen (PSA) blood test every year starting at age 45.

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RISK FACTORS • Having red hair, freckles, or more than 50 moles • Genetic syndromes that make you sun-sensitive • Family history of melanoma • Environmental exposures, such as excessive sun exposure, tanning bed use, or blistering sunburn(s) • Personal pre-cancerous conditions such as actinic keratosis or unusual moles • Personal skin cancer history of basal and squamous cell cancer • Prior treatment for other cancers, immuno-suppressive treatment, or radiation treatment

SCREENING RECOMMENDATIONS • Always be on the lookout for moles, spots or bumps that change or grow.

• Get a full-body skin cancer screening exam every year if you identify with one or more of the items listed above.

SCHEDULE AN APPOINTMENT • If you have risk factors, or any signs or symptoms of melanoma, your doctor will probably refer you to a dermatologist.

BannerMDAnderson.com 5

FOUNDATION

Giving back

Cancer patient makes legacy gift to support Banner MD Anderson

A

cancer diagnosis prompts many patients to take stock of their lives and consider their legacy. For some, that leads to a decision to make a philanthropic gift to benefit future cancer patients. John Charles Hardison is one such person.

Through a lot of hard work and a little luck, he is in a position to make a big difference in prostate cancer care.

Raised on a cotton farm in Buckeye, Ariz., John Charles Hardison was put to work driving a tractor at age 8 and, until he retired in 2008, spent his life working up to 18 hours a day. Now, he owns homes in three states and spends his time traveling the world.

“The harder I worked, the luckier I seemed to get,” Hardison says. “With each job, I walked away with a great deal of business knowledge and experience that was invaluable in my future. Hard work was sort of my college.”

Hardison estimates he has held up to 30 different jobs, often two at a time. But eventually he landed in the water and wastewater treatment industry and found his niche.

At age 30, he started his own business serving that industry in Oklahoma. Hardison spent the next 28 years creating and running several companies and developing new products, including six that were patented. His clients included PepsiCo, the U.S. military and the Chickasaw Nation.

A STROKE OF BAD LUCK Just after his 49th birthday, Hardison received a stroke of bad luck in the form of a prostate cancer diagnosis. He had surgery at The University of Texas MD Anderson Cancer Center in Houston, and his PSA tests remained clear for 4 1/2 years.

Then one night he got a call from his surgeon.

“When I answered the call and heard who it was, I almost fell on the floor,” recalls Hardison. “I knew this would not be good news.”

He returned to MD Anderson and underwent 35 doses of radiation. But it had no effect on his heightened PSA count. Next he began hormone therapy, traveling frequently to Houston from Arizona, California and Oklahoma. It was during this period that Hardison noticed an advertisement for Banner MD Anderson Cancer Center in Gilbert and decided to transfer his treatment there due to its more-convenient location. During one visit, he expressed interest in supporting the cancer center with a legacy gift.

6 P OWE R O F PR E V E N T I O N FALL 2 0 1 5

Subsequently, Hardison established a charitable remainder unitrust, one of many planned-giving options that make it easy to donate assets to nonprofit organizations. He plans to donate virtually all of his assets upon his death to prostate cancer research, with Banner MD Anderson among the selected beneficiaries.

“My goal is to encourage other people who have been fortunate in life to think about leaving a legacy.”

— John Charles Hardison

THE GETTING IS IN THE GIVING After about seven years, Hardison’s cancer stopped responding to the hormone therapy. He had a second surgery and is currently undergoing chemotherapy.

But he knows his cancer is incurable at this point and his time is limited.

“When you’re told you have cancer and it’s not curable, your brain and your emotions go through quite a ride,” he says. “When my time comes, I’m going to donate everything I’ve got to cancer treatment.

I’ve lived with that in my heart and my mind for quite some time.”

Hardison says his philosophy has always been that “the getting is in the giving.”

“My goal is to encourage other people who have been fortunate in life to think about leaving a legacy,” says Hardison. “Whether it’s for Alzheimer’s disease or cancer, give something back for society.” • pp

GARDEN OF HOPE COMMEMORATES BENEFACTOR If you ever visit Banner MD Anderson Cancer Center in Gilbert make sure to spend some time in the John C. Hardison Garden of Hope. Featuring desert landscaping and artistic elements to symbolize the cancer journey, the Garden of Hope offers quiet spaces for reflection and celebration.

Banner recently commemorated Hardison for his significant legacy gift to establish a prostate cancer research fund by naming the garden for him.

The garden comprises three areas signifying the stages of the cancer journey: • Waterfall: Decorative water walls provide a tranquil environment symbolic of the beginning of the cancer journey.

• Boulders: Stepping stones and boulders represent the challenges patients and their families face as they traverse the cancer journey.

• Serenity: A narrow doorway represents hope and victory at the end of treatment. A sculpture made of three stones symbolizes the cancer survivor and the family and friends who made the journey together.

PREVENTION

Is your body trying to tell you something?

The signs and symptoms that shouldn’t be ignored B Y M E G H A N N F I N N S E P U LV E D A

Y

ou know your body better than anyone, but do you know how to recognize symptoms that could mean something is wrong? Subtle clues might just be your body’s way of telling you that a medical condition or disease is present. That’s why it’s important to listen to your body, trust your intuition and know when to see your doctor.

NOTICEABLE CHANGES Fever. Cough. Chest pains. These are all normal symptoms of the common cold.

Usually harmless, these symptoms often go away on their own with plenty of fluid and rest. However, if they linger, it might mean that something else is going on.

“People have a certain awareness of their own body and there may be noticeable changes they just can’t explain,” said Santosh Rao, M.D., medical director of integrative medicine at the James M. Cox Foundation Center for Cancer Prevention and Integrative Oncology at Banner MD Anderson Cancer Center in Gilbert. “If someone is uncomfortable or if there are any new or concerning symptoms, a doctor’s appointment should not be put off.”

Unexplained weight loss, fatigue, fever, loss of appetite, night sweats, pain, coughing and headaches should trigger a visit to the doctor.

“These symptoms may not always be specific but they will likely prompt screening tests, imaging or lab work to further evaluate,” Rao said.

Other more concerning symptoms, such as changes in bowel habits, sores that do not heal, white patches inside the mouth or unusual bleeding, should be evaluated by a doctor as soon as possible.

PATIENT BACKGROUND During an exam, a physician will want your complete patient history, includ-

ing the frequency and severity of the symptom(s) to help determine the next steps in the care plan. A cough, for example, can sometimes be alarming because it might not be diagnosed correctly, which could delay testing and possibly treatment for weeks or even months.

“There are so many different scenarios that become factors in the medical decisions for treatment,” Rao said. “The age of the patient, prior illnesses, and the likelihood of something serious like cancer are all part of the thought process that usually determines the level of concern.”

The suspicion for cancer is higher in an older population, although it can occur in younger patients as well.

“A lump in the breast would likely lead to an ultrasound or breast MRI to screen for breast cancer, but it also could be nothing to worry about,” Rao said.

IMPORTANCE OF EARLY DETECTION Annual wellness visits and preventive routine screenings can lead to early diagnosis and treatment, which ultimately could result in better outcomes.

“There are specific tests available to check for certain diseases when suspicion arises,” Rao said. “As doctors, it is our job to determine what kind of test we should run and how many need to be done to find out what is going on,” Rao said.

A cancer-related check-up for adults should include health counseling and, depending on a person’s age and sex, exams for cancers of the thyroid, oral cavity, skin, lymph nodes, testes, ovaries, breast, prostate and colon/rectum, according to the American Cancer Society. “We have to think about cancer as a real possibility,” Rao said. “These screenings stop giving cancer a huge head start.” • pp BannerMDAnderson.com 7

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NUTRITION

Autumn vegetables pack cancer-prevention punch

BY BRIAN SODOMA

B

uying vegetables when they’re in season is great for a budget, but getting a sweet deal on some of nature’s biggest cancer fighters makes for an even better value. This fall, Christi Kirk, registered dietitian at Banner MD Anderson Cancer Center in Gilbert, suggests you load your plate with these veggies, which are full of anti-cancer phytochemicals.

GO CRUCIFEROUS Broccoli, cauliflower and Brussels sprouts are fall vegetables containing indoles and glucosinolates, compounds that are particularly helpful for breast cancer prevention.

But watch overcooking, which can bring a bitter taste and zap these important nutrients. “These vegetables are best steamed … you don’t want to boil them,” Kirk explains.

SQUASH CANCER Pumpkin, acorn squash, Chayote squash and butternut squash are fall vegetables with high levels of soluble fiber, which is great for blood sugar control and c holesterol reduction and has long been tied to reducing the risk of colon cancer.

Easy preparation makes them even more attractive. “These can all be cut in half and baked in the oven,” Kirk adds.

SALAD ADDITIONS, ROOTS The link between obesity and cancer has been a prominent area of research for some time. To help maintain weight,

8 P OWE R O F PR E V E N T I O N FALL 2 0 1 5

add waistline-friendly endives such as radicchio and Swiss chard to any salad. The cabbage-looking radicchio gives a slightly spicy taste to dishes. Swiss chard is a leafy green and an excellent source of magnesium and vitamins A and C. “With all these you’re talking about a low-calorie, low sodium food that helps you feel full,” Kirk says.

Kirk also recommends eating root vegetables such as sweet potatoes and turnips, which are high in antioxidants and bring color diversity to a plate.

“A lot of meals miss those deep orange foods. … The different colors bring different phytochemicals and health benefits,” Kirk notes.

A HEALTHY TAST

Prep Time: 30 Serves: 4

CHRISTI KIRK

Plant-based eating can keep you healthy

Y AUTUMN TREA T: MASHED SW

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minutes

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