His and Hers Cancer Awareness
Alaska is rich in resources for screening and testing
Breast Cancer Detection Center of Alaska’s traveling mobile mammography truck. The side is adorned with “A Clinical Approach” by Barbara Lavallee. The nonprofit provides services throughout the state, including in Southeast.
© Breast Cancer Detection Center of Alaska
There is no such thing as a “good” cancer, an “easy” cancer, or a “safe” cancer. But reproductive cancers can be especially devastating, perhaps because they strike at such an integral part of one’s personal identity. They also pose a particular challenge to people who, for cultural, logistical, financial, or personal reasons, don’t participate in the screenings that could save their lives.
The numbers are hard to face: “Cancer has been the leading cause of death since 1993,” explains Julia Thorsness, program coordinator for the Comprehensive Cancer Control Program, which is working toward the vision of a cancer-free Alaska. One in four deaths in the state is from cancer, with breast cancer being the most commonly diagnosed and a non-reproductive cancer—lung cancer—as the most frequently fatal, followed by colorectal, pancreas, breast, and prostate cancers.
In most cases, Alaska’s rates for cancer diagnoses are about the same as the national average. But upon a closer look at the state statistics, Alaska Native populations have significantly higher rates of occurrence than the state’s average for several cancers: lung, colorectal, and cervical. The one outlier to that trend is prostate cancer; the Alaska Native rate of diagnosis is about half of the state’s average rate.
“There’s lots of conversation about [what causes those high rates],” Thorsness says. “But unfortunately we don’t know why.” Although she praised the Alaska Native Tribal Health Consortium’s work to provide medical care in rural communities, there’s no doubt that living in a remote community makes access to screening and treatment more difficult.
“Because of our geography and many folks living far from medical care in a lot of pockets of Alaska, people are less likely to get screened. Because of the lack of screening we tend to see more advanced cancers sometimes, particularly in the Native populations,” explains Dr. Larry Daugherty, radiation oncologist at Alaska Cancer Treatment Center.
Cultural factors can come into play too. Sierra Winegarner, program director of Let Every Woman Know, an Anchorage nonprofit that educates women about gynecologic cancers and supports those with a diagnosis, points out that research has shown similarly elevated rates of cervical cancer diagnosis in other areas where there may be a cultural hesitancy toward participating in screening tests. “Cervical cancer is actually a preventable disease, thanks to pap smears and the HPV vaccine,” she says. (Several types of HPV or human papilloma virus can cause cervical cancer.)
Body Knowledge Equals Health
Getting people to participate in screening is one of the biggest hurdles to catching any cancer early—which exponentially increases the odds of beating it. Undergoing appropriate screenings, understanding possible symptoms, and responding proactively make up the three-pronged path to early detection and relatively easy treatment for reproductive cancers.
If it seems like the recommendations for “best” screening practices are constantly changing, that’s because they are. Nobody’s going to dispute the usefulness of monthly breast self-exams, and many doctors even recommend monthly testicular self-exams for men. But when it comes to when to get a mammogram and whether to get a PSA test at all, patients often feel trapped in the middle of a constant tug of war between constantly updated research, doctor’s advice, and recommendations from various advocacy groups.
The recommendations for screening tests provide a place to start. And for those wondering if preventative exams are covered under the Affordable Healthcare Act, the answer is generally yes for people with health insurance that falls under Affordable Care Act rules; and for those policies the full set of eighteen preventive benefits available to everybody, plus some that are specific to women and children, are available at healthcare.gov/preventive-care-benefits.
Silent Killers: Gynecologic Cancer
Some cancers, especially gynecologic cancers, are missing from the list of screening tests. That’s because other than pap smears to detect cervical cancer, there are no true screening tests for gynecologic cancers.
“If you’re having symptoms [of another cancer] we can do a CAT scan, an ultrasound, a lab draw,” Winegarner explains. “But usually we won’t know until we go in for surgery and remove the mass if it’s even cancerous.” That makes it more important than ever to stay alert to out-of-place symptoms that might otherwise seem normal, such as gas, spotting, or abdominal discomfort, and be willing to bring them to the attention of a trusted doctor.
“Gynecologic cancers are generally so hard to catch for a woman because so many of our symptoms of gynecologic cancers are disguised as things that we’re used to happening to our bodies,” Winegarner says. Telling the difference between normal body variations and cancer symptoms may be especially difficult for women going through menopause, who think a little bleeding or a little pain is normal. “They write it off as changes that women experience in their bodies, and so often they are signs that something is terribly wrong.”
Again, the key is to have a good relationship with a medical provider so that if anything at all abnormal persists for more than two weeks—even if just a minor itch, discoloration, pain, or un-specific feeling—they can address those concerns. A good resource can be found online at leteverywomanknow.org/resources/be-down-there-aware.
“The point that I try to be most emphatic about is just how important it is to be proactive about your own health, being your own advocate,” explains Winegarner. “Oftentimes gynecologic cancers are caught very late, and that’s what makes them so deadly.” Being willing to speak up could save a life.
To Test or Not to Test?
With as critical as it is for patients to be proactive about their own health, can one have too much information? For example, although mutations of the BRCA1 and BRCA2 genes can leave women vulnerable to hereditary breast and ovarian cancers (with Angelina Jolie’s being the highest-profile case), many doctors don’t recommend genetic screening unless there are demonstrated risk factors. “The vast majority of cancers are not genetic,” explains Daugherty. “It’s only about 5 percent that are. So we don’t recommend genetic testing for every woman that gets diagnosed with breast cancer.”
In a similar vein, because prostate cancer often (but not always) grows slowly and often (but not always) happens to older men, there’s a fierce tug of war over whether and why the prostate-specific antigen or PSA blood test should be used. Some cancer survivors feel fiercely that they were saved by test results that alerted them to the presence of cancer; others feel that the treatment can be worse than the disease, and they’d rather not know.
“We do more of a push toward informed decision making,” Thorsness explains of the Comprehensive Cancer Control Program’s stance. “We say, if you’re going to get screened, what are you going to do with that information?”
What about the Men?
Men can develop breast cancer too, although the American Cancer Society calculates their risk of doing so at about one hundred times less common than for women, with a lifetime risk of about one in one thousand.
“The most common cancer among men is prostate cancer,” says Daugherty, who treats both men and women in his clinic. “One in six men will be diagnosed with prostate cancer in his lifetime.” With that said, many (but not all) prostate cancers affect older men, and many (but not all) of them grow slowly, which feeds into that tug-of-war about whether testing is really necessary.
Again, the best way to cut through this uncertainty, and the conflicting recommendations and personal stories, is for patients to take any concerns to a trusted medical provider who can discuss the options best suited to that patient’s particular family history and lifestyle.
As common as prostate cancer is, the most lethal cancer among men is actually lung cancer—and again, Alaska Native populations have more than their share. The state’s rate of lung cancer (66.1 per 100,000 people) is about the same as the nationwide rate of 64.3, but the rate amongst Alaska Native populations is 90.7 per 100,000 people.
The biggest known risk factor for lung cancer is smoking. Although there are no screening tests for the general population, those with a history of heavy smoking can receive CAT scans to help catch any signs of cancer early.
“If we can catch a cancer early, most often it’s going to be curable,” Daugherty says.
The Cost of Cancer
It’s hard to quantify the financial toll of reproductive cancers, although the Agency for Healthcare Research and Quality estimated the direct medical costs of cancer—treatment only—at $88.7 billion in 2011.
That said, it may come as a pleasant surprise to locals that, at the very least, Alaska cancer patients don’t have to shell out a fortune in airfare to get access to top-tier treatment. Large clinics such as the Alaska Women’s Cancer Care Center and the Alaska Cancer Treatment Center offer access to the latest research studies and clinical trials; those same clinics have attracted top physicians, including two fellowship-trained, board-certified gynecologic oncologists at the Alaska Women’s Cancer Care Center, a specialty so rare that there are less than a thousand practitioners in the country.
Most clinics also work with patients in various ways to help them avoid the best care possible—whether by providing social workers to help patients track down financial support or offering free genetic counseling (at the Providence Cancer Care Center) and providing chemical drug sensitivity testing of cancerous tissues at no charge to the patient (through Alaska Women’s Cancer Care Center).
The emotional cost of cancer is, of course, impossible to quantify. Not just patients are affected, but also the close friends and family that care for them. Yet as difficult as it can be to watch a loved one hurt, these people are far from helpless. Often, it’s the small things—staying engaged, being willing to listen, and helping them take care of everyday tasks that improve their quality of life—that make the biggest difference to the patient.
That sort of support may be especially important for single men, says Daugherty. That’s because studies have shown that married men tend to survive cancer much better than their single counterparts—presumably because their wives are an important part of their support network.
“We know that men who are married tend to do better from a cancer treatment standpoint, and I think that that’s just because they have a spouse who is taking care of their nutrition, looking after them, making sure they make it to their appointments,” explains Daugherty. So for men who are single or widowed, it’s important for them to have a support network of some kind, whether it’s a friend coming to appointments to help write things down or family bringing meals over.
Friends, family, and loved ones can help fill that gap—for any gender—by stepping in to help out. Affinityfilms, Inc. produced a documentary film called “Survive & Thrive.” Although it’s geared toward those whose loved one has received a cancer diagnosis, it’s an excellent resource for any cancer diagnosis.
“Everyone’s natural inclination is to want to help,” explains Winegarner. The best advice in the world boils down to simple things that are nonetheless easy to lose or forget in the shock of a diagnosis: Be there. Let them know they’re loved. Tell them positive stories about friends or family members who have beaten the disease. Help them meet their own everyday needs. Above all, listen and make time to engage beyond the basic, mechanical inquiry of “How are you today?”
Finally, those supporting someone with a cancer diagnosis should also remember to form their own support network. “I think a lot of times, the people who are loved ones ... don’t want to admit they need help. They want to be the one providing help,” Winegarner says.
Lisa Maloney is an Anchorage-based freelance writer.
(When) Should You Be Screened?
The following guidelines give a rough idea of how and when those without any cancer symptoms should receive preventative screenings. For those who have extra risk factors or show any questionable symptoms, a trusted physician can help choose the appropriate screening and diagnostic tests.
“It depends on which national guidelines you look at,” says Dr. Larry Daugherty, radiation oncologist at Alaska Cancer Treatment Center. But most oncological associations, he explains, still recommend a baseline mammogram at forty, then tailored recommendations—often, a regular screening mammogram every year—after that.
Pap smears provide an excellent tool for early detection of cervical cancer. The American Cancer Society recommends that women receive Pap smears every three years starting at age twenty-one and continuing until age sixty-five. Starting at age thirty, the American Cancer Society suggests the option of pairing Pap smears with an HPV test every five years. Physicians may suggest more frequent screenings for women in high-risk populations or lifestyles.
The American Cancer Society recommends screening starting at age fifty; test options include flexible sigmoidoscopy, colonoscopy, or yearly stool tests. For Alaska Native populations, testing should begin at age forty.
The American Cancer Society doesn’t recommend lung cancer screening in healthy people at average risk. However, screening may be appropriate for those fifty-five or older with a heavy smoking habit and fairly good health.
“In general the screening answer [for prostate cancer] is ‘no,’ but it’s not as easy as that. It’s always a discussion between patient and doctor,” says Daugherty. If screening is done, it’s usually recommended starting at age fifty (or age forty-five for African Americans or men whose father or brother had prostate cancer at age sixty-five, per the American Cancer Society).
Resources for Cancer Treatment in Alaska
Gone are the days of having to fly out of state to receive cancer treatment. Nowadays, Alaska cancer care providers offer a full array of services, from free genetic counseling to top-tier physicians and participation in the latest clinical trials. The following resources are for any patient—or loved one—to start looking for support.
Alaska Cancer Care Alliance
alaskacancercarealliance.org; 2801 DeBarr Road, Suite C-414, Anchorage; 907-264-1500
The Alaska Cancer Care Alliance, located inside Alaska Regional’s Cancer Care Center, brings together providers and agencies to support patients and their families. It’s one of the best resources for finding support groups for both men and women.
Alaska Cancer Treatment Center
akmedicalspecialties.com; 188 W. Northern Lights Boulevard, Suite 800, Anchorage; 907-276-2083
This comprehensive treatment center offers everything from radiation to massage therapy, with a naturopathic oncologist working along the allopathic-trained staff. The Alaska Cancer Treatment Center is also a designated research center participating in phase I, II, and some phase III studies.
Alaska Native Tribal Health Consortium’s Comprehensive Cancer Control Program
anthc.org/chs/crs/cancer; 3900 Ambassador Drive, Suite 401, Anchorage; email@example.com
The Alaska Native Tribal Health Consortium Comprehensive Cancer Control Program works to make Alaska Natives cancer-free by providing access to comprehensive, integrated prevention, screening, treatment, support, and education.
Alaska Regional Cancer Care Center
alaskaregional.com/service/cancer-care-center; 2801 DeBarr Road, Suite C-414, Anchorage; 907-264-1431
Alaska Regional’s cancer resource center helps guide outpatient cancer patients toward the best treatment and education. They also assist physicians in following research protocols, maintain a library with computer access, and provide two robots in the hospital surgical suites to help surgeons make more accurate, less invasive surgeries.
Alaska Women’s Cancer Care
alaskawomenscancercare.com; 3851 Piper Street, U264, Anchorage; 907-562-4673
Home to two fellowship-trained, board-certified gynecologic oncologists, Alaska Women’s Cancer Care provides comprehensive treatment and support for all gynecologic cancers, including access to clinical trials. The team of doctors also works very hard to provide treatment, regardless of the patient’s ability to pay.
American Cancer Society
cancer.org; 3851 Piper Street, U240, Anchorage; 907-277-8610
The American Cancer Society is one of the most widely recognized nonprofits that supports those with cancer diagnoses and their loved ones. A great source of information, referrals to other services, support groups, and help for basic needs like transportation and lodging.
Breast Cancer Detection Center
bcdcofalaska.org; 1905 Cowles St., Fairbanks; 907-479-3909, 800-464-4577
BCDC Mission: To increase awareness of the survivability of breast cancer and the benefits of early detection by delivering screening services and educational programs throughout the state of Alaska. Founded in 1976, BCDC offers traveling mobile mammography and education services, including to remote communities on and off the road system.
Interior Alaska Cancer Association
interioralaskacancer.org; Fairbanks; 907-374-0974
The Interior Alaska Cancer Association is a nonprofit organization that helps cancer patients and their families, and educates the community about cancer-related issues. The Association helps physicians and members in the Interior fight cancer by providing support groups, financial assistance, and resource guidance for those who have cancer.
J. Michael Carroll Cancer Center
bannerhealth.com; 1650 Cowles St., Fairbanks; 907-458-5380
Fairbanks Memorial Hospital’s cancer care center provides patients and their families access to expert care and support close to home. The center offers cancer diagnosis, treatment, medical oncology, radiation, prevention, clinical trials, a patient library, and support groups. It has been designated a Community Cancer Program by the American College of Surgeons Commission on Cancer.
Katmai Oncology Group
katmaioncology.com; 3851 Piper St., Anchorage; 907-562-0321; 247 N Fireweed St., Soldotna; 907-262-1310
Katmai Oncology Group provides cancer treatment with a compassionate care philosophy. Katmai is QOPI certified oncology practice in Alaska, and affiliated with Seattle Cancer Care Alliance. The group has six board-certified oncologists, six oncology-specialized ANPs, infusion-certified nurses, and support staff to lend support and guidance on a range of integrative care specialties and services.
Let Every Woman Know
leteverywomanknow.org; 3851 Piper Street, U264, Anchorage
This Anchorage nonprofit, run by many of the same people behind Alaska Women’s Cancer Care, focuses on raising awareness, educating, and supporting women living with gynecologic cancers everywhere in Alaska.
Midnight Sun Oncology
midnightsunoncology.com; 2490 S Woodworth Loop # 499, Palmer; 907-746-7771
Mat-Su Regional Medical Center based. Provides care for people with cancer and blood disorders who live in the Mat-Su Valley, and provides care in Homer at South Peninsula Hospital. Facilities include a clinic, lab, chemotherapy infusion room, and a caring staff.
Providence Cancer Center
alaska.providence.org; 3851 Piper Street, U Tower; 907-212-6870
Providence Hospital’s cancer care center provides access to a comprehensive suite of treatments, including radiation, chemotherapy, surgery, and clinical research, along with free genetic counseling, care navigators, and other support services.
Southeast Radiation Oncology Center
southeastradiation.com; 1701 Salmon Creek Lane, Juneau; 907-568-5762
Residents of Juneau and Southeast Alaska are served by the Southeast Radiation Oncology Center, which offers state-of-the-art radiation therapy and cancer care navigation support services.
This article first appeared in the October 2015 print edition of Alaska Business Monthly.