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6 HEALTHY LIFE CANCER August 28-29, 2013
OHSU oncologist Joshi Alumkal is more
optimistic than Leaf about the future of tar-
geted cancer therapy. He acknowledges that
most cancers are much more complex than
CML, but he’s buoyed by advances that are
allowing doctors to quickly and cheaply ana-
lyze the genetic components of each pa-
tient’s cancer.
He envisions a not far-off future where
surgeons remove a small section of a pa-
tient’s cancer, grow it in the lab to learn
which cell abnormalities are driving the
cancer, and develop drugs to remove those
drivers.
“We have the tools to tackle this prob-
lem like we’ve never had before,” Alumkal
says.
Without these tools and the growing un-
derstanding of just how complex cancers
can be, Alumkal says, scientists really
weren’t prepared to go into battle against
the disease.
“We’ve been trying to fight this war with
the lights off,” Alumkal says.
Alumkal’s optimistic vision of the future
is based on the successful fight against HIV
and AIDS. When Alumkal was in medical
school in the mid-90s hospitals were full of
people dying of AIDS, he says,
and there was only one drug used to fight
the disease. Eventually researchers learned
there were many drivers of the virus and
developed drug cocktails to target those ab-
normalities.
He expects to eventually see cocktails
of several low-dose cancer drugs shutting
down key molecular pathways without
harming other cells. Those drugs could
keep cancer patients in remission for
decades.
And when they arrive, Alumkal says, suc-
cess against cancer may not be measured in
terms of cures. Someday, say Alumkal and
others, we may view cancer as a chronic dis-
ease such as AIDS or even diabetes — pre-
ventable to a high degree and manageable
for those afflicted.
“We have to view cancer as a continuous
struggle,” Alumkel says.
Providence’s Urba is taking a similar view.
While OHSU’s Knight Cancer Institute is
primarily focused on targeted therapies,
Providence Cancer Center’s focus is immu-
notherapy.
Immunotherapy could include vaccines
such as those available for cervical cancer,
but more widely, Urba says, it will be used to
help manage and treat cancers. Cancer cells
are continually mutating, making them hard
to target, he says. Targeted drugs combined
with therapy that can encourage the body’s
immune system to join in the cancer-cell kill-
ing effort might yield real benefits, accord-
ing to Urba.
But real cancer prevention, Urba says, will
have to involve patient choices.
“To me, the biggest obstacle we have to
overcome is ourselves,” he says. “So many of
the cancers we get are self-induced.”
Smoking, drinking and obesity have all
been linked to higher rates of cancer, Urba
points out. Which raises a question — Are
people willing to take control of their own
cancer risks rather than wait for research-
ers to come up with cures? Even if it means
fundamental lifestyle changes?
Dr. Nathalie Johnson, Legacy Cancer In-
stitute’s medical director, thinks they are, if
they can be properly educated about how
their choices affect their odds of getting can-
cer. And, she adds enviromental pollutants
such as the chemicals in some shampoos
and pesticides to the list of choices that have
to be made. People, she says, will need to
find ways to lower their exposures to a host
of substances.
“A lot of people are not really aware of
what are in all the products they use,”
she says.
■ From page 5
By RAYMOND RENDLEMAN
Pamplin Media Group
Genetic testing that showed Angeli-
na Jolie had an 87 percent chance
of getting breast cancer and a 50
percent chance for ovarian cancer
is now available in the Portland area.
After finding that she, too, is
BRCA-positive, 35-year-old
Sweet Home resident April
Seward is scheduled on Sept.
17 for her own double-mastec-
tomy intended to prevent can-
cer before it appears. After her
breast reconstructions, assum-
ing counseling doesn’t change
her mind, she’s then planning
to undergo a hysterectomy.
“After watching my mom
and my sister going though
with it after breast-cancer di-
agnoses, and since I’ve fin-
ished having children, it was
an easy decision,” Seward said.
Double-covered through her husband’s and
her own workplace health plans, a test that
usually retails for thousands of dollars cost
Seward only $30 out of pocket. Chromosomal
testing cost significantly more for Seward’s
sister, Tigard resident Cheryl Pacino, whose
insurer did not provide the discount for rela-
tives who had already tested positive.
“When you’re 36 years old, you’re not
thinking about breast cancer, so it was dev-
astating to get the diagnosis,” said Pacino,
now 37, who is recovering from a double
mastectomy.
“But also having an oopherectomy was
the hardest part for me, even though I had
already finished having kids, because hav-
ing your ovaries removed sends you into in-
stant menopause,” Pacino said.
Pacino, who has three chil-
dren (11, 3 and 2), had been
pregnant and was nursing her
son when she first found a lump
in her breast. But she thought it
was from breast-feeding, so she
put off getting a mammogram.
When she found time to get a
mammogram, it came back at
an ominous “Level 5,” and a bi-
opsy came back confirming an
aggressive “Stage 3” cancer.
“I actually did end up having
family history, once I started
looking, through my grandfa-
ther’s side,” she said.
Paul Dorsey, Legacy Cancer Institute’s
cancer genetic counselor, helped Pacino
and Seward through their decisions. Such
services are available at Legacy’s Meridian
Park Breast Health Center in Tualatin and
at Legacy Medical Group Surgical Oncolo-
gy next to Good Samaritan Hospital in
Northwest Portland.
“Your first line of defense against cancer
is these genes that protect you, and then
your immune system is the final defense
before medical intervention is needed,”
Dorsey said.
He offered various risk factors to keep in
mind and to discuss further with your
health professional:
■ Genetic — Three generations with mul-
tiple people per generation who have had
cancer.
■ Bilateral — both ovaries, both breasts,
both lungs.
■ Multifocal — two types of cancer
■ Historic — cancers showing up 10 to 20
years earlier than usual.
■ racial — Ashkenazi Jews, French Cana-
dians and Scandinavians have about a 1 in
40 risk of carrying the gene.
“If you do start triggering these algo-
rithms, then we start asking more and more
questions to assess risk,” Dorsey said.
But in the current issue of the Journal of
the American Medical Association, a group
of physicians encouraged new policies to
reduce chances for overdiagnosis and over-
treatment, while maintaining early-detec-
tion strategies as a major contributor to de-
creasing mortality and locally advanced
disease.
“Although no physician has the intention
to overtreat or overdiagnose cancer,
screening and patient awareness have in-
creased the chance of identifying a spec-
trum of cancers, some of which are not life
threatening,” they wrote.
Dorsey acknowledged that imaging has
gotten so good that it’s often detected be-
nign cancers that immune systems could
take care of on their own.
“But who’s going to wait for the let’s-wait-
and-see study?” he asked. “So most women
are going to say, ‘Let’s take care of it.’”
Supreme Court justices recently ruled
that isolated human genes cannot be pat-
ented, a partial defeat for Myriad Genetics,
a company with patents on the so-called
BRCA1 and BRCA2 genes that allowed
them to gouge people on testing prices.
Myriad has been charging more than
$4,000 for testing just those two genes, but
now — for $3,300 at the University of Wash-
ington — you can find out about all 41
known cancer genes.
“It’s an interesting time right now be-
cause the Supreme Court has removed the
patents for genes, and now these panels are
coming up that allow the testing all at
once,” Dorsey said.
With a son who’s 12 and a daughter who’s
9, Seward is “more worried about my kids
now.”
“I wish that the testing was more avail-
able, because I would have never tested for
this unless I had the cancer,” Pacino said.
How to find out if you have the ‘cancer gene’
■ Legacy Health becomes local
provider of chromosomal testing
SUBMITTED PHOTO
From left, sisters Cheryl Pacino and April Seward. “When you’re
36 years old,
you’re not
thinking about
breast cancer,
so it was
devastating to
get the
diagnosis.”
— Cheryl Pacino