Summer 2007

On the trail of a needless killer

Easy to prevent and easy to detect, colon cancer is highly curable when found early, yet it is the second leading cause of cancer deaths. Center researchers are leading efforts to create easier screening tests, understand the benefits of diet and exercise, customize treatment, and encourage people to take action to prevent colon cancer.

By Colleen Steelquist and Stephanie Cartier

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Sandi Thompson's father was diagnosed with colon cancer at age 54 and died after three cancer recurrences. Her uncle died of colon cancer, too. Her brother succumbed to pancreatic cancer. Her sister survived a cancerous tumor.


Dr. Bill Grady, right, in the lab with Dr. Jun Haeng Lee
Nine years ago, at 52, the normally energetic Sandi started having trouble climbing stairs. A visit to her doctor revealed severe anemia caused by internal bleeding from cancer in her colon.

Sandi was successfully treated, but then cancer struck again in her daughter. The 34-year-old became extremely anemic during a pregnancy and complained of pain in her side. Three weeks after giving birth, she not only had a newborn but also newly diagnosed colon cancer. "I never, ever dreamed that my youngest child would have this," said Thompson. "I had always considered colon cancer an old man's disease."

The cluster of cancer episodes experienced by the Thompson clan was an indicator of a cancer-family syndrome, in which an unusually large number of blood relatives develop certain cancers, typically at an early age. About 5 percent of all colon-cancer cases occur in these families, yet it's estimated that only one person in 10 in this high-risk situation is getting appropriate colon-cancer screening and monitoring.

Dr. Bill Grady is working to change that. Grady, a leading cancer geneticist at Fred Hutchinson Cancer Research Center and gastroenterologist at the Seattle Cancer Care Alliance, is working to develop easy genetic tests to detect colon cancer in individuals not just for high-risk people, but for anyone. And through a specialized clinic at the SCCA, he helps people like Sandi make sure they take the right steps to screen for and prevent colon cancer.

Attacking colon cancer on many fronts

Grady's work is one of many facets of the Hutchinson Center's war on colon cancer, the second most frequent cancer killer in the United States. The Center's colon-cancer research ranges from genetic screening tests to the impact of diet and exercise to customized treatment. And because prevention and screening methods are so effective at saving lives, Center scientists have helped shape public policy to support colon-cancer screening.

One of the most frustrating aspects of colon cancer is that it is remarkably easy to prevent and treat in its early stages, yet it claims so many lives. Current colon-cancer screening tests like sigmoidoscopies and colonoscopies are very effective, but they're also invasive, causing many people to avoid what can be a potentially lifesaving procedure.

If simple tests using blood, urine or stool samples were developed, people would likely be screened more frequently and consistently. Grady believes creating better tests is one way to increase colon-cancer survival. He's doing research in his lab in hopes of identifying molecular markers to create such tests. "The success rates of treating advanced colon cancer now, unfortunately, are not very high," Grady said. "I believe we have the potential to do better. I'd like to play a role in that process and usher in the new generations of prevention and treatment."

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Diet and exercise: keys to avoiding colon cancer

It's estimated that about 60 percent of colon-cancer risk stems from environmental and lifestyle factors. It's known, for example, that a diet heavy with red meat, but low in fiber, fruit and vegetables, can raise risk of developing the disease.


Dr. Polly Newcomb
Public Health Services
Dr. Polly Newcomb, head of the Center's Cancer Prevention Program, uses human populations as her "laboratory," looking for links between colon cancer and its possible triggers, from diet and lifestyle to environmental and genetic factors. She's looked at how factors possibly affect risk, like smoking, body weight, oral contraceptives, calcium and vitamin D supplements, and even how often people snack and eat meals.

Newcomb helps lead the Seattle Colon Cancer Family Registry, one of six sites worldwide to study genetic and environmental factors in colon cancer. Through interviews and examination of lab specimens, the research team is comparing thousands of colon-cancer patients with their relatives to better understand why certain people develop cancer while others remain healthy. This resource will fuel many future research studies, including searches for molecular markers that could lead to earlier and better screening tests.

Dr. Anne McTiernan, a world leader in the relationship between exercise and cancer risk, recently found that regular, moderate-to-vigorous aerobic exercise significantly reduces a risk factor associated with the formation of colon polyps and colon cancer in men.

In the study, as little as four hours of weekly exercise decreased actively dividing cells that can eventually form colon polyps. While most polyps are benign, over time some types can become malignant.

"I think that this study really underscores the new activity recommendations from the United States Department of Agriculture and the Institute of Medicine, both of which advise people to exercise an hour a day, six days a week for weight control and general health," McTiernan said.

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Customized colon-cancer treatment

Dr. Neli Ulrich, an internationally recognized colon-cancer researcher, is studying ways to customize colon-cancer patients' treatment to fit their needs. "There is really no good scientific data to give patients guidance on what they should do after they've been diagnosed with colon cancer and how to improve their well-being and chances of survival," Ulrich said. "Every person's body is different."


Dr. Neli Ulrich
Public Health Sciences Division
She is leading the first study to take a comprehensive look at the various factors that can determine the outcome of a colon-cancer diagnosis. Under the ColoCare Consortium study, cancer patients submit blood and tumor samples over time, and answer questions about lifestyle, environment, diet and exercise. With this data, the researchers hope to pinpoint the best course of treatment for individuals.

Ulrich led an earlier study that showed physical activity can lower a person's risk of developing cancer and increase the rate of survival, possibly because exercise reduces inflammation, a suspected culprit behind many chronic diseases. Recent studies show a blood marker of inflammation is a risk factor for colon cancer.

To further understand this relationship, Ulrich is co-leading a major Hutchinson Center study looking at the effect of a yearlong exercise program, a reduced-calorie diet or a combination of the two on blood markers of cancer development. The study tracks hormone levels and markers of inflammation, as well as DNA damage and DNA-repair capacity. DNA repair is an essential mechanism for protecting cells from becoming cancerous.

The bottom line: prevention

For Dr. Scott Ramsey, frustration was the launch pad for a new health-care model. As a physician and prominent advocate for colon-cancer screening, he was tired of only treating disease and not having time to test and counsel his patients so they can prevent disease and stay healthy.

To better tip the scales in favor of avoiding illness, Ramsey now directs the Cancer Prevention Clinic, launched last year by the Hutchinson Center and the Seattle Cancer Care Alliance. Unique in the Northwest, the clinic directly links the Center's research in cancer prevention and early detection with clinical care. It offers personalized cancer screening and prevention services and gives patients a chance to take part in research studies aimed at warding off cancer or spotting it at its earliest stages, when cure rates are highest.

"I want to spend time helping people prevent cancer in the first place," said Ramsey, who, in his dual role as a health economist, evaluates cost effectiveness and quality of life factors for various testing, screening and treatment approaches for cancer. Part bean counter, part doctor, he understands the costs of unchecked cancer in people's lives and on the bottom line.

Part of his research includes examining the cost-effectiveness of genetic screening for colon cancer. His plans are to develop genetic screening guidelines to help primary care physicians advise their patients.

Ramsey and other Hutchinson Center researchers have been instrumental in helping to shape public-policy changes to support colon-cancer screening efforts (see article below). Because screening is such an effective prevention measure and life saver, Ramsey likens it to dental checkups. "Dental insurance pays for preventive services to keep teeth healthy. Why can't medical insurance pay for services that keep people cancer-free?" he said. "If there's one thing that mitigates colon cancer, it's screening."

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Colon-cancer screening: an ounce of prevention

Anita Mitchell, a busy mother of three, had just turned 41 when she was diagnosed with advanced colon cancer. Cancer that began in her colon had already spread. Her doctors removed 18 inches of her colon, 14 lymph nodes and one ovary before beginning chemotherapy to attack seven inoperable liver tumors and other cancer cells possibly lurking in her body. It required more than a year of surgeries and treatment, but today Mitchell's cancer is gone.


Anita Mitchell
Mitchell's father died of colon cancer and, because of her family history, she now knows she should have been screened when she was in her early 30s. Since her colon-cancer diagnosis, Mitchell has become a strong advocate for early detection from knowing family history to promoting early testing for those at risk.

If colon cancer is found early and treated, there's a 90 percent survival rate. That's the good news. The bad? Because many people are not getting tested, only 39 percent of cases are diagnosed at this early stage when treatment is most successful. When colon cancer spreads, it usually goes to lymph nodes or to the liver or lungs. Once that happens, patients have a less than 10 percent chance of surviving five years.

The Hutchinson Center staunchly supports early detection and prevention. This year, with urging from Center doctors and patients, the Washington Legislature passed a law that requires health insurers to cover colon-cancer screening in Washington for those over 50 or at high risk. When Gov. Christine Gregoire signed the legislation, Washington joined 18 other states that have similar laws.

"This law removes the financial barrier for those individuals who are covered by insurance, so they can have equal access to highly accurate screening tests," said Dr. Polly Newcomb, head of the Center's Cancer Prevention Program. "While the Center is at the forefront of looking for new methods to find cancer earlier, a large part of what we do is encourage people to use the tests we already know are effective."


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