Dr. Rachel Yung wants to be unemployed. As clinical director of breast cancer prevention and wellness at Seattle Cancer Care Alliance (SCCA), here’s what she really means: She wants to reduce the number of people diagnosed with cancer. For those who do develop cancer, she wants to minimize the amount of treatment they need. “I would love to be out of a job,” says Yung, a medical oncologist. “I think most oncologists feel this way.”
Treating disease is the primary focus at a major cancer treatment center such as SCCA. But there’s a growing emphasis on prevention as genetic testing for cancer-predisposing mutations becomes more common. National Cancer Prevention Month, marked each February, offers an opportunity to highlight the six SCCA clinics that focus on thwarting cancer in the first place: breast/ovarian cancer, gastrointestinal cancer, prostate cancer, pancreatic cancer, lung cancer and hematological cancers.
The network of prevention clinics is unique in the Seattle area as is its multidisciplinary approach to care. Early each morning, providers meet for a case conference in which they discuss each patient on the schedule that day. Patients meet with a doctor, a genetic counselor and a registered dietitian to discuss their specific risk and steps they can take to lower it. Nutrition services are free of charge.
“Everyone chimes in,” says Mercy Laurino, a genetic counselor who manages the genetic counseling component of SCCA’s prevention programs. “There are no other prevention clinics in the area that are designed like this.”
People at higher risk of cancer include those with known genetic mutations, a family history of cancer, those who engage in high-risk behaviors such as smoking. In the case of 12 different cancers, being overweight or obese is also a risk factor, which is why SCCA’s team of 10 registered dietitians are an integral component of the prevention clinics. Rates of certain cancers are going up as people become obese at younger ages, says Kerry McMillen, who supervises medical nutrition therapy at SCCA.
“You can’t change your genetic makeup, but you can change what you eat and how much you exercise,” she says. “As a nation, we often miss the boat. We aren’t as focused on prevention as we could be. When we end up with disease, we are left to question if this could have been prevented with healthy diet and lifestyle.”
Reaching out to the community
Prevention services cast a wide net at SCCA, touching individuals and community providers. Consider breast density, a risk factor for developing breast cancer. On Jan. 1, new legislation took effect in Washington requiring that women be notified of their breast density as determined by mammograms; women with dense breasts are more difficult to image for cancer and more likely to develop cancer. “We are trying to build tighter relationships with community doctors to encourage them to use us as a resource since primary care providers will be the first to get notification of breast density,” says Yung.
Density is just one risk factor, though, so SCCA is also holding community events to educate community providers about other risk factors including family history, alcohol, obesity and how old a woman was when she welcomed her first child. “We want to be a resource,” says Yung.
When counseling patients in clinic about prevention, Yung and her colleagues consider whether medications such as hormone or endocrine therapy and/or increased screening are warranted, taking into account genetic mutations and family history of cancer. After patients are seen in the prevention clinic, some are followed in SCCA’s women’s wellness clinic.
Dr. Teri Brentnall runs SCCA’s pancreatic cancer surveillance program, the first of its kind in the U.S., and is one of two doctors seeing patients at SCCA’s gastrointestinal (GI) cancer prevention clinic. A detailed family history helps her sort out what may be underlying disease in a family with multiple cases of GI cancer. Analyzing genetic mutations is important too. BRCA1 and BRCA2, for example, are commonly thought of as breast cancer gene mutations that also predispose a woman to develop ovarian cancer, but they increase risk of pancreatic cancer as well.
“We assess a patient’s global risk for cancer,” says Brentnall. “We include all cancers in our assessment. Just because you have a genetic susceptibility to cancer doesn’t mean you have to get cancer. Our whole program is built around preventing cancer through surveillance.”
