Transcription:
Cancer Biomarkers and Early Cancer Detection

Melanie Cole (Host):  Sometimes hereditary or genetic factors can increase your risk for cancer. City of Hope’s cancer screening and prevention program is designed to help you understand more about your personal cancer risks and armed with this knowledge you can learn how to minimize you risk and stop cancer from developing. My guest today is Dr. Victoria Seewaldt. She’s the Ruth Ziegler Professor and Chair of the Department of Population Sciences at City of Hope.  Welcome to the show, Dr. Vickie. Let’s talk about early detection because I think everybody wants to know “can we catch cancer early so that I have a better chance of living a long, high quality of life”.  Tell us what’s going on in the world of early detection.

Dr. Victoria Seewaldt (Guest):  I think that we’re making some progress but there’s more progress to be made. Right now, at this time, we think about cancer as one size fits all when we do our screenings. We tell, “Everybody go get your mammogram once a year” and for some women, we recommend things like MRI. What’s happening now is that there is a recognition that we have different types of breast cancers and we really need to individualize how we screen for breast cancer in a particular women. One size fits all doesn’t really work.  

Melanie: It certainly doesn’t. We all hear about getting our mammograms or, if you have dense breast tissue, maybe going for 3-D or an ultrasound after. What else can we do? We learn about colonoscopies. Tell us what else, Dr. Vickie, we can do for early detection.

Dr. Vickie:  I think we need to go and take another look at breast self-examination.  This is a cheap, easy tool that every woman could do. Unfortunately, I think we have taught it incorrectly and the data that was generated saying that breast self-exam didn’t provide any benefits was generated in China in 1989. I think that, first of all, we need to simplify our breast self-exam so it isn’t so scary. Secondly, I think we need to redo the trials but in the context of U.S. medicine. What we teach in our clinic – and this is what we would like to take to national trials – is instead of a woman using her fingertips, which are really sensitive, just use the flat hand. What we tell women is, “Give your breast a high five” because what happens is, when a woman touches her breast with her fingertips she gets all kinds of information. She gets all of the ligaments, the lumps and bumps. If you go with your flat hand you can actually do a very good job in finding lumps but it averages out all the stuff that makes the exam really difficult. We also think that the connection with your physician is paramount. A lot of times, women will find lumps and nobody will listen to them. We want to develop a trial which automatically gets a woman scheduled for an ultrasound if she finds a lump so there isn’t that lack of communication.

Melanie:  Do you want women to lie down while they’re doing that or be sitting up? What position? That’s one of the best tips I’ve heard in a very long time to “give yourself a high five and use a flat hand”. Should we be lying down or sitting up?

Dr. Vickie:  I think that either position is okay. What we try to do is reframe the breast self-examination. Breast self-examination is not finding the micro mini little bit in the breast. That’s for imaging. That’s for your mammogram and your breast MRI. What breast self-examination, I think, does very well--and has done very successfully in our clinic – is it finds the fast growing cancers, the interval cancers, that occur between screening. We tell women do it like you’re brushing your teeth. Put your bra on. Don’t make this a cancer-finding expedition. Just say, “I’m brushing my teeth. I’m putting my bra on.” Do it in whatever position feels comfortable. You can even do it with your clothes on, with your bra on. Usually, cancer lumps that are growing rapidly are easily found by the woman. It’s figuring out what’s normal that’s really difficult for us as women. So, if you do a flat hand in whatever position makes you happy with your clothes on, that really can be very helpful in finding the fast growing cancers but filtering out all of the normal stuff that’s part of a normal woman’s breast.

Melanie:  That’s really great information. Now, tell us a little bit about prevention. Are there certain bits of advice that you give, doing what you do for a living and in the Department of Population Sciences, seeing the statistics and what people do, what is your advice for prevention?  

Dr. Vickie: I think first of all, women in my clinic tell me something which is very important – we’re not just breasts. As a woman, I’ll tell you I’m not just breasts. I’m a whole person. Prevention has got to make the whole woman healthy. One of the things that we focus on is exercise. Exercise has been shown to be effective in preventing breast cancer recurrence, preventing the initiation of breast cancer and also is important in preventing Alzheimer’s disease, cardiovascular disease, stroke. We think exercise is whole woman medicine. We also screen for something called “insulin resistance”. In the past, what we did is we waited for women to develop diabetes. Diabetes is where the pancreas burns out. We treated diabetes very different than we treated heart disease. With heart disease, we do prevention. The equivalent of what we’re doing with diabetes is we’re saying, “We’ll just wait until somebody has a heart attack and they have heart failure and then we’ll treat it.” Nowadays, the American Diabetes Association has become a lot more proactive. What they try to do is identify women who are pre-diabetic so the pancreas can be treated and the woman doesn’t develop diabetes. What that involves is a three step approach. What the woman does is, she’s identified as having an increased hemoglobin A1C. That’s just the normal thing you do at your doctor’s office. If a woman has a hemoglobin A1C of greater than 5.7 or less than 6.3, then she’s pre-diabetic. In that case a woman is given Metformin, which is a drug to help control blood sugar. It’s a very cheap drug. It’s used universally. It can be used during pregnancy. It helps women breast feed. And then, try to design a diet that’s lower in carbs. That doesn’t mean you have to do a 19 carb Atkins diet, but just to be able to reduce some of the sugar sources that you have in your diet and also just to do some walking. This is the three-prong approach. The reason that treatment of insulin resistance is so important is when a woman becomes insulin resistant, when she eats, what happens is you get this huge spike in insulin and insulin makes you hungry. What happens is the woman, instead of feeling full when she eats, wants to keep on eating and eating and eating. I became insulin resistant and my thought was, “I’m not full. I’m starving. I want to eat the tablecloth. I just want to eat everything.” It wasn’t a matter of will power, it was just that I was getting this huge insulin spike. The other thing that happens if you have huge insulin spikes is, it starts to burn out the pancreas because it’s working too hard. Also, it becomes impossible for the woman to break down her fat sources. Using Metformin helps a woman to break down fat and also helps to end these really huge insulin surges. I think what’s being proposed right now by the American Diabetes Association is really important but it’s also cancer fighting because insulin is the thing that stimulates a lot of the bad cells in the breast to become worse. Insulin will make cancers aggressive but we also think it plays a role in starting cancers.

Melanie:  People hear the words “immunotherapy” and “treatment” and they hear “genetics” and “genomics”. Now, we’re hearing the word “biomarkers”. What does that mean and how does that help us detect cancer earlier?

Dr. Vickie:  Biomarkers are proteins or messenger RNA, so different components that make the building block of cells that are used to test cells to figure out how bad or not bad they are. When a pathologist looks at cells under the microscope, they can look at kind of how they look but they don’t know what their biology is. They don’t know if they have nice benign biology – meaning that the cells will just sit there and not do anything--or they don’t know if the cells have really aggressive biology. We know that there are some cancers with aggressive biology and some that will just kind of sit there. The same is true for some of the early changes in the breast. What biomarkers help us do is start to sort out what cells have the bad biology and have the potential to turn into something bad and what do not. This is important particularly with things like DCIS—ductal carcinoma in situ or atypias--some of the early pre-cancerous legions. We know that some we over treat – we do too much surgery, too much radiation and we know that maybe some we undertreat. This is going to help us sort out who are the bad actors and who are the ones that we don’t have to be so aggressive with.

Melanie:  Wow, such great information. Absolutely fascinating and, in just the last minute here, Dr. Vickie, give your best advice for early detection of cancer and what you really want people to know and what you tell patients every day and why they should come to City of Hope for their care.

Dr. Vickie:  I think the first thing is keep your body healthy and the second is don’t miss your screening appointments.

Melanie:  That’s very good advice. What about City of Hope? Tell us about your team.

Dr. Vickie:  City of Hope is awesome. I love being here. There’s a huge group of very kind and decent people who are dedicated to making people healthy. We have geneticists. We have surgeons. Everybody is there acting to help women. I think everybody here sees the woman as a whole person. We look at the whole body, the spirit, the mind and we look at the family as well. I’m just very excited to be here and part of the City of Hope team.

Melanie:  Thank you so much, Dr. Vickie for being with us. I applaud all the great work that you do at City of Hope. You’re listening to City of Hope Radio and for more information you can go to CityofHope.org. That’s CityofHope.org. This is Melanie Cole. Thanks so much for listening.