Although the terms “genetic” and “genomic” are often used interchangeably, they are actually very different. Learning more about the differences between them can help clear up some of the confusion we often see related to hereditary genes linked to developing cancer.
Genetic Testing
Genetics usually refers to the study of specific, individual genes and whether they are passed from one generation to the next. Cancer researchers have studied hereditary gene mutations (changes) that can play a role in the development of cancer.
Genetic tests are medical tests that look for certain inherited gene mutations. This allows the genetic counselor to understand if the person being assessed is at a higher risk for developing certain kinds of cancers – such as breast cancer, ovarian cancer, colon cancer, prostate cancer, or others.
People who go through genetic testing do not necessarily have cancer – now or in the past. A genetic counselor will help you decide if genetic testing could give you potential benefits, and if there is even a suggested family history that would make genetic testing worthwhile.
The presence of one or more of the following may suggest a hereditary cancer syndrome could be present and the patient or their family members may want to talk to a genetic counselor about conducting genetic tests.
Cancer that was diagnosed at an unusually young age
Several different types of cancer that have occurred independently in the same person
Cancer that has developed in both organs in a set of paired organs, such as both kidneys or both breasts
Several close blood relatives that have the same type of cancer (for example, a mother, daughter, and sisters with breast cancer)
Unusual cases of a specific cancer type (for example, breast cancer in a man)
The presence of birth defects, such as certain noncancerous (benign) skin growths or skeletal abnormalities, that are known to be associated with inherited cancer syndromes
Being a member of a racial/ethnic group that is known to have an increased chance of having a certain hereditary cancer syndrome and having one or more of the above features as well
Genomic Testing
Genomics refers to an organism’s entire genetic makeup (DNA), which is called a genome. In cancer patients, genomics addresses all the genes within the cancer, and how they’re interrelated within the cancer. This can determine more about how the cancer will behave.
With genomic testing, the genomic makeup of abnormalities, or mutations, within the cancerous tissue can be identified. This means that genomic testing is used for patients that have been diagnosed with cancer, versus genetic testing which is routinely used as a precaution for someone who has not been diagnosed with cancer, or in a patient with cancer to help prevent future cancers.
If the cancer care team can understand the genetic abnormalities that could be driving the cancer’s growth, they can often determine how aggressive the cancer is or whether it is likely to spread to other parts of the body or if the cancer has an actionable mutation, which is an abnormality in the genetics of the tumor cells for which there is either an FDA approved targeted agent or one that is currently in trial or part of a future trial. Where a DNA change or a genetic mutation is detected in a patient’s tumor, and genomic testing could be a valuable tool in helping your oncologist understand how well your cancer could be expected to respond to treatment. There are many new targeted therapies currently being invented, almost on a daily basis. Only cancers with certain targets respond to specific agents.
How Genetic and Genomic Testing Impact Cancer Care
Even though these types of tests are different, they can both have a positive impact on a patient’s cancer care and/or on a family’s ability to screen more carefully for cancers that have a hereditary link.
Understanding the genetic risks of a patient can help physicians detect cancer early when treatment is most effective as well as implement strategies that can help patients prevent or reduce their risk of developing cancer.
Understanding the genomic profile of a patient’s cancerous tumor allows physicians to administer a more precise (targeted) treatment if one is available.
Genetic and genomic testing is not for everyone. It is important to talk with your doctor or a genetic counselor to determine if you would be a good candidate for either type of testing. Arizona Oncology offers a High Risk Cancer Program to our patients who qualify.
Receiving an abnormal report on your screening mammogram can be scary, but it doesn’t mean you have cancer. It doesn’t even necessarily mean that you require a biopsy. In this blog post we take an in-depth look at what it means to receive an abnormal mammogram result, and what the next steps might look like.
What does “abnormal” mean on a mammogram report?
There are several reasons why your report might be abnormal.
· The images were unclear or missed some part of your breast tissue
· There is an area that appears different from other parts of your breast
· Imaging detected a suspicious-looking mass or calcifications
Additional testing may cause patients to worry, and the mammogram technicians try to avoid the need for it by being as thorough as possible during initial scans. But in some cases questions do arise, and additional imaging can verify that findings are benign or that there is indeed something concerning that needs to be followed up on.
It may comfort you to know that fewer than one in 10 women who are called back for additional testing are found to have cancer in their breast.
What Happens During Follow-up?
If the radiologist calls you back because of abnormal screening mammogram results, the next step is usually a diagnostic mammogram. The radiologist will guide the technician in capturing specific breast images, ensuring comprehensive coverage. You may also undergo a breast ultrasound or a breast MRI (magnetic resonance imaging) for a more detailed picture. MRIs can detect subtle changes that might elude detection in mammograms or ultrasounds. In the majority of cases, when the area in question is compressed and more closely scrutinized, it is no longer suspicious looking and is not found to be cancerous.
What are the next steps if the area continues to appear suspicious?
If suspicions persist, a biopsy will be performed. This still doesn’t mean you have cancer—the majority of biopsy results are negative. Nevertheless, a biopsy and subsequent analysis are the only way to rule out or confirm cancer.
What do the Results Mean?
It helps to understand your results and how your doctor interprets them. The Breast Imaging Reporting and Data System (BI-RADS) is used to describe what is found on a mammogram. A zero-to-six categorization helps doctors use a common language to describe findings:
Category 0: Incomplete. The radiologist requires clarification. Additional imaging tests are needed, typically a diagnostic mammogram with spot compression and/or different views. The radiologist may request previous mammogram results to compare to the new results. An ultrasound or MRI may be requested.
Category 1: Negative. Nothing new or abnormal was found. Breasts are symmetrical with no distinguishable masses, abnormal structures, or suspicious calcifications. Calcifications are deposits of calcium seen but not felt in the breast tissue. Microcalcifications are tiny calcifications that can become cancerous. They require additional testing as they can become cancerous. Macrocalcifications are larger, coarser areas of calcium commonly found in women over the age of 50. They are the natural result of aging, past breast injury, or buildup that occurs over time.
Category 2: Benign or non-cancerous finding. This is also a negative test, however it is categorized differently because the radiologist records and describes the findings for doctors who will be looking at the report in the future. Recorded findings may be benign calcifications, masses, lymph nodes, or any changes from prior procedures.
Category 3: Probably benign. A finding in this category has no more than a two percent chance of being cancerous. The finding is not expected to change over time but can’t definitively be labeled as benign. Repeat imaging within six to 12 months and regularly thereafter is recommended until the finding is determined to be stable, usually over a period of two years. Category 4: Suspicious or abnormal finding. This finding may not be cancer, but it could be. A surgical biopsy (removal of a small sample of breast tissue) is recommended. There are three subcategories of suspicious or abnormal findings:
4A: Low likelihood of cancer (between two and 10% chance)
4B: Moderate likelihood of cancer (between a 10% and 50% chance)
4C: High likelihood of cancer (between a 50% and 95% chance)
Category 5: Highly suggestive of a malignancy. Your doctor believes this finding is cancer. It looks like cancer and has at least a 95% chance of being cancer. A biopsy is very strongly recommended.
Category 6: Known malignancy proven by biopsy. This describes a finding that has already been determined to be cancerous. At this category level, imaging is being used to monitor the patient’s response to treatment.
What role does breast density play?
Dense breast tissue has a high composition of glandular and fibrous connective tissue and a relatively low percentage of fatty tissue, which can make mammograms more difficult to interpret. Dense breasts are common, and almost half of all women over 40 have them.
Women with dense breasts may be asked to return for follow-up testing more often than women with fatty breasts.
There are four BI-RADS breast density categories:
Category A: Least dense
Category B: Scattered areas of dense tissue
Category C: More density (heterogeneous density)
Category D: Extremely dense
If your breast tissues are in Category C or D, ask your doctor about whether additional testing is recommended.
The Wait
Waiting for additional results can be unnerving, but most follow-up tests show normal tissue or a benign condition. Try not to worry. Talking with loved ones or other women who have had screenings or biopsies can be helpful. And always speak with your doctor if you have any questions about your findings or screening/testing recommendations.
What is the American Cancer Society’s Great American Smokeout? It’s an annual event, held the third Thursday of every November, a date on which smokers nationwide are asked to give up smoking. Quitting for just one day helps you take action toward a healthier life, and reduce your lung cancer risk.
Each year, the Great American Smokeout calls attention to the deaths, lung cancer diagnoses and other chronic diseases that smoking causes, and how to prevent them. As a result of this event, there have been actions taken towards reducing the health impacts that smoking can have on smokers and non-smokers including:
Many states and local governments have banned smoking in restaurants, public spaces, and workplaces.
Increased taxes on cigarettes
Limiting of cigarette advertisements and product placements.
Each of these elements is reason enough to hold the Great American Smokeout. However, the event also helps smokers to make a plan to quit smoking and serves as an access point to information on the many tools that are available to help you eliminate the habit from your life. Of course, quitting isn’t easy. And it’s hard to do it alone. But, you don’t have to.
Ways to Quit Smoking
Get help from stop-smoking support groups
Seek Counseling
Enlist the support of family members and friends
Utilize available nicotine replacement products and/or prescription medicine designed to reduce the craving for tobacco
Follow stop-smoking guidebooks
Use stop-smoking phone support hotlines
Join online support groups
Combining at least two of these practices supports works better than using just one alone, and some people may find it best to use as many as four.
But while quitting smoking may be a challenge, you’ll find that eliminating smoking from your life offers a wide array of health benefits, too, some of which you may feel almost immediately.
Just 12 hours after you quit smoking, the level of carbon monoxide in your blood drops to normal.
Timeline of Health Benefits When you Quit Smoking
20 minutes: Within 20 minutes of stopping smoking, your heart rate and blood pressure will drop.
12 hours: In half a day, the level of carbon monoxide in your blood drops to normal.
1 to 9 months: Your shortness of breath and coughing decreases.
2 to 3 months: Your circulation improves and lung function increases.
12 months: One year after you quit smoking, your risk of a heart attack dramatically drops. Excess risk of coronary heart disease will be half of someone who continues to smoke.
2-5 years: Your risk of stroke can drop to that of a non-smoker.
5 years: As time goes on, your health benefits will continue to increase. According to the U.S. Surgeon General’s Report and the World Health Organization, after five years tobacco-free, the risk of mouth cancer, throat cancer, bladder cancer, and esophageal cancer is cut in half. The risk of women developing cervical cancer drops to that of a non-smoker.
10 years: Your risk of dying from lung cancer falls to half the risk of a person still smoking; the risk of pancreatic cancer and cancer of the larynx – your voice box – also decreases.
15 years: Your risk of coronary heart disease is now that of a non-smoker.
Quitting tobacco also results in other health benefits: the risk of diabetes is lowered and your blood vessels, heart, and lungs all work more effectively. Smokers live 10 years less than non-smokers, but by quitting smoking before age 40, your risk of dying from diseases related to smoking decreases by a whopping 90%!
Convinced?
Want to participate in the Great American Smokeout? Here’s how: take that all important step toward a much healthier life by making a plan to quit smoking on November 21st. If you are local to Arizona, Ashline is Arizona’s smoker helpline which provides free guidance to help your quit using tobacco. The program includes counseling sessions, educational materials, and a 24-hour helpline. Their 24/7 toll-free number is 1-800-55-66-222. If you are not local, most states have a similar program.
On October 27th, 2023, we held the ribbon-cutting for our brand-new facility in Prescott. Located at 5430 Landmark Lane, this 23,000 square foot practice will provide chemotherapy, diagnostic imaging, genomic testing, and more in one location. By expanding the current Prescott office with this brand-new facility, our aim is to bring advanced cancer treatment closer to patients’ homes and support systems. And we’re so excited to show it to you!
Here’s a view of the building from the outside. The project was realized through the collaboration of NexCore Group with McKesson and US Oncology.
And here’s the reception area, all decked out for our ribbon-cutting event. This will be the waiting area for patients and their families and caregivers.
There was also a delicious spread and music. That’s guitarist Michael Lucarelli.
Guests were able to tour the inside of the facility with its open-concept infusion area and large windows for a brighter, more expansive feel. The new facility will include a 36-chair infusion area, 17 medical and radiation oncology exam rooms, a PET-CT imaging room, brand new Mobile PET/CT, and an outdoor patio space. Future additions will include two linear accelerators for external beam radiation treatments and HDR.
During our event, a number of community members and stakeholders spoke to the crowd. From left to right, speakers included Emcee John Manning, Branch Manager of PNC Bank, Prescott Mayor Phil Goode, Dr. Hamarneh, McKesson Senior Vice President and General Manager of Practice Management Chad Warnick, and NexCore Senior Vice President of Design and Construction Rob Stieg.
Dr. Hamarneh thanked everyone involved for their role in the opening of this new center, which he described as “not just the completion of a building but a profound commitment to the health and well-being of the Prescott community.”
“I want to take a moment to express our gratitude to the architects, engineers, construction workers, and everyone who braved the Northern Arizona elements and worked tirelessly to build this remarkable facility. Your dedication and hard work have not only resulted in a state-of-the-art building but a sanctuary of care and support during one of life’s most challenging journeys,” he said.
“And to the incredible staff who will walk through these doors daily, I want to offer you this:
You are the heart and soul of this institution. Your tireless efforts and dedication, day in and day out, will make the Prescott Cancer Center a place of comfort and strength for our patients,” Dr. Hamarneh continued.
Some of those staff were here at the event, along with Dr. Hamarneh’s family and many patients and members of the community.
Radiation oncologist, Dr. Robert Gin made an appearance, too! And so did the Prescott Regulators’ “Shady Ladies.”
Then it was time to cut the ribbon.
Dr. Hamarneh gets ready…
And there it goes!
We closed out the evening under a gorgeous Northern Arizona sky.
It is our hope and wish that this new facility helps to make cancer care accessible to patients and their families in the Prescott area. This building will not only alleviate the burden of travel but also foster a supportive and collaborative environment for patients throughout their cancer journey. It is another step in our journey to help Arizonians thrive with and beyond cancer.
Head and neck cancers are a group of cancers that originate from the base of skull to the clavicles. It comprises diverse diagnoses of cancers that begin in the sinuses, throat, mouth, salivary glands, and larynx. Cancers in this region have a variety of causes including use of alcohol and tobacco. Head and neck cancers often present as a lump or sore that does not go away. It can be painful or painless. In some cases, the mass can cause difficulty swallowing or even breathing and may cause a hoarse voice. There are many non-malignant causes of these symptoms and concerned patients should be evaluated by a physician or dentist.
Diagnosis
A biopsy is necessary for the definitive diagnosis of cancer and provides information about the cancer which can inform treatment decisions. Once a diagnosis has been made, careful examination is undertaken to determine the extent (or stage) of the cancer. The staging process can include examination under anesthesia, various imaging modalities, and laboratory studies. The result of staging is our best determination of the local extent of the tumor (T stage), the extent of involvement of regional lymph nodes (N stage), and whether the cancer has spread distantly through the blood to other organs (M stage).
Treatment Options
Treatment options for cancers of the head and neck include surgery, radiotherapy, or systemic therapy (including chemotherapy, immunotherapy, or other targeted drug therapy). Patients may receive one, two, or a combination of all three treatment modalities. Ultimately, treatment recommendations are dependent on the goal of therapy, the site of origin, the biology of the cancer, and the stage.
Surgery is often employed when we believe that all malignant tissue can be safely separated from healthy tissue. Radiation therapy uses the fact that healthy tissue is able to repair small amounts of radiation damage while cancer cells cannot. As such, we are able to deliver repeated radiation doses to eliminate cancer cells from tissue that is not easily removed by a surgeon. Chemotherapy is used in low doses to augment radiation therapy or as monotherapy in the treatment of metastatic disease.
A rising number of patients are being diagnosed with head and neck cancers associated with human papilloma virus (HPV) infection. Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. There is no cure for HPV but the majority clear infection. It is not clear why some can get rid of HPV infection, while others cannot. A few high-risk strains, primarily HPV-16, can cause persistent infection and ultimately lead to malignancy.
HPV is associated with head and neck, cervical, vaginal, vulvar and anal cancers. The risk factors for HPV-associated head and neck cancers are similar to cervical cancers—multiple sexual partners, a younger age for the first sexual encounter, oral sex and genital warts. Prophylactic HPV vaccines can prevent infections and thus resultant tumors from HPV vaccine viruses. However, the vaccine is only effective if given before infection occurs. Thus, HPV vaccination is recommended in early adolescence before sexual exposure.
The incidence of HPV-associated head and neck cancers has been increasing over the years. HPV-positive head and neck cancers, particularly arising in the base of the tongue and in the tonsillar region, are typically seen in younger people without significant alcohol or tobacco abuse. These tumors behave aggressively with earlier and more extensive lymph node involvement. However, the prognosis of HPV-positive head and neck cancers is significantly better compared to HPV-negative cancers. This is attributed to the different biology of HPV-positive cancers.
Multiple clinical trials are currently underway to optimize treatments for HPV-positive head and neck cancers, with an emphasis on treatment de-escalation to minimize long term treatment related complications without compromising efficacy and prognosis.
Cancer researchers from Johns Hopkins have concluded that some patients may develop colon cancer due to two specific digestive bacteria that form a film on the colon. According to the study paper, which was published December 2015 in Science magazine, these two types of bacteria invade the protective mucous layer of the colon and create a small ecosystem, including nutrients the bacteria need to survive, causing chronic inflammation and subsequent DNA damage that supports tumor formation. These findings also seem to add to the growing evidence that gut bacteria is more influential on our immune system than we may realize.
The two bacteria the doctors found are known as Bacteroides fragilis and Escherichia coli (or E. coli). The B. fragilis strain, called ETBF, appears to cause inflammation in the colon, while the E. coli strain causes DNA mutations.
Also, the bacteria was linked to patients without a family history of colon cancer. Cancers such as these–where there is no genetic tie–are known as sporadic cancers. Only 5-10% of cancers are considered heredity, meaning the remaining 90-95% are considered sporadic.
What does this mean for colon cancer treatment?
Knowing that the presence of these bacteria may put someone at a higher risk of developing colon cancer may make it possible to screen earlier and monitor those who are found to have them in their digestive tract. Determining whether both of these bacteria are present may require only a simple and painless stool test.
Better Strategies to Reduce the Risk of Colon Cancer
While it’s impossible to completely eliminate these bacteria, there are things you can do to reduce the likelihood that this combination of bacteria will grow in your colon. Two strategies that may help reduce the risk of developing colon cancer in the future may include:
Targeted antibiotics and probiotics. Both of these are two possibilities that could be beneficial in promoting healthy bacteria to chase away the harmful bacteria in the colon. Since antibiotics can damage both good and bad bacteria, taking a probiotic with it can help replenish the good bacteria and restore balance to your system. Probiotics can also be taken even if you are not taking an antibiotic. It is always best to talk with a qualified professional before adding a probiotic to your regimen.
Eating a diet rich with gut healing properties. Certain foods can be helpful in reducing the risk of colon cancer and other types of cancers as well. Gut-healing foods typically fall under two categories: probiotic foods and prebiotic foods.
Probiotic foods – Contain live bacteria, and include foods such as plain, low-fat yogurt (preferably organic), kefir (a yogurt-like drink), kombucha tea, and fermented vegetables like sauerkraut and kimchi.
Prebiotic foods – Feed the bacteria in your gut so they can grow and repopulate, include whole grains, oatmeal, soy beans, garlic, fruits and vegetables (like bananas, onions, and asparagus).
Currently, colonoscopies are the standard of care for monitoring the formation of precancerous tumors, called polyps. According to the study, however, adding a stool analysis to the screening process could provide an opportunity for an earlier and less-invasive way to intervene before the bacteria take over the colon. Although this isn’t a cure, it will make an impact on how colon cancer is detected.
