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Why a Pap Smear Might Not Catch All Cervical Cancers

Most women are familiar with the Pap smear, also known as the pap test. Most of us are also aware that the main goal of the Pap smear is to identify cancerous or abnormal cells that may turn into cancer after collecting them from the lining of the cervix. However, based on findings recently published in the International Journal of Cancer, Pap smears may not be the most reliable way to pinpoint cancer types that can often be harder to detect.

According to Kevin Ault, MD, an associate professor of obstetrics and gynecology at Emory’s School of Medicine and Winship Cancer Institute, the Pap smear is not always effective in the diagnosis of adenocarcinoma. Ault came to this conclusion after conducting a post-hoc analysis of Gardasil vaccine trials. Adenocarcinoma is a type of cervical cancer that begins significantly far up the cervical canal, an area that often is not sampled when a Pap smear is conducted.

Andenocarcinoma is the second most common type of cervical cancer, accounting for about 20 percent of all cervical cancer cases. While the overall incidence rate of cervical cancer is on the decline, Ault reports the proportion of andenocarcinoma cervical cancer is rising.

As the 8th most common type of cancer in American women, more than 12,000 new cases of invasive cervical cancer are diagnosed each year. Scientists believe that pre-invasive cervical cancer may develop over a period of months or years after the cervix is infected with the sexually transmitted HPV.

A leading expert and pioneer in the field of human papilloma virus (HPV), Ault suggests women might seek an HPV and Pap test at the same time. Why? A positive HPV test may be an indicator for early stages of adenocarcinoma cervical cancer that can’t be determined via a standard Pap test.

High-Impact Donation Helps the Fight Against Breast Cancer

Winship Cancer Institute of Emory UniversityIf you’ve been following our cancer blog, you’ve probably seen some of our efforts to keep breast cancer awareness going not just in October, which is Breast Cancer Awareness Month, but year round. The Winship Cancer Insitute of Emory University just received a truly generous gift that will make that fight, and the fight against breast cancer on the whole, a whole lot easier.

The Wilbur and Hilda Glenn Family Foundation has generously committed $5 million to the Winship Cancer Institute. The commitment will name the Glenn Family Breast Program at Winship, establishing a fund to support patient care, research, education and community outreach.

More than 200,000 women in the U.S. will be newly diagnosed with breast cancer this year, and one in eight women will be diagnosed with breast cancer in her lifetime. The gift bestowed upon Winship from the Glenn Foundation will allow the cancer treatment team at the Winship Cancer Institute to further advance results in the research and treatment of breast cancer.

Some of the initiatives in place to achieve this expansion of breast cancer research and treatment include:

  • A Strengthened Effort in Breast Cancer Biobanking: expand and strengthen breast cancer tumor banking efforts at the Winship Cancer Institute and leverage collaborations with the Avon Comprehensive Breast Center at Grady and Emory University Midtown Hospital.  This will make Winship’s breast cancer tissue bank among the most robust in the nation and will ensure full integration of patient outcomes.
  • High Risk Breast Cancer Care:  Building on its strength in assessing women at high risk for breast cancer or disease recurrence and its history of collaboration with other cancer centers, Winship will expand its multi-disciplinary approach to screen and care for more women.
  • Seed Grants:  Building on the success of the established Glenn Scholars program, these seed grants will support young investigators in their research in four critical areas: new therapeutics, early detection, health disparities and imaging.
  • Clinical Trials:  The Glenn Foundation grant will contribute to new clinical trials, including novel treatment trials such as those targeting women with high-risk breast cancer, such as triple negative disease and those women who currently lack access to quality breast health care and treatment.
  • Survivorship:  The gift will strengthen Winship’s survivorship program to include an online database to match patients and caregivers with trained peer partners who offer support and guidance throughout treatment.
  • Community Access:  Winship will build a stronger coordinated community outreach program to enhance access to cancer screening and early detection services throughout and beyond metro Atlanta.

We thank the Glenn Foundation for the very generous gift and look forward to seeing lots of great developments in the research and treatment of breast cancer from the Winship Cancer Institute.

Full Court Press Against Breast Cancer

PINK gameEvery year, Georgia Tech’s women’s basketball team hosts a PINK game to raise awareness for breast cancer. This year, Tech is teaming up with the Emory Breast Center and Winship Cancer Institute of Emory University to honor breast cancer survivors at the game.

This year’s PINK game is a home game match-up between Georgia Tech (25) and NC State. Tip-off will take place at 5pm on Sunday, February 13, and the game will be broadcast on ESPN2. To keep breast cancer awareness top of mind, Tech’s Ramblin’ Wreck women basketball players will wear pink jerseys for the game and will enter the arena by running through a typical tunnel, made up of not-so-typical participants*. Breast cancer survivors from around Georgia will form the tunnel to welcome the team to their home stadium.

So why should you care? One in 8 women will be diagnosed with breast cancer in her lifetime. That’s why we ask that you join Emory and Georgia Tech as we wage a “full court press” against the disease and raise awareness about the importance of screening mammography and understanding breast cancer risk.

*We are still recruiting breast cancer survivors to form the team’s tunnel! As an honoree, survivors will receive a free ticket to the game and a pink Emory Breast Center t-shirt to wear on game day. It is not a requirement that participating survivors have been treated at Winship at Emory.

Please join us for this special event. You can register by calling 404-778-7777 or visit www.emoryhealthcare.org/pink for more information.

Have You Scheduled Your Pap Test?

Sharmila Makhija, MDJanuary is Cervical Health Awareness Month – a time to highlight issues related to cervical cancer, HPV disease and the importance of early detection. It’s also a time to celebrate all of the wonderful progress that has been made in the United States over the last four decades to diagnose, prevent and treat the disease. Cervical cancer is now almost 100% preventable and curable if detected early.

Cervical cancer is a slow-growing cancer that forms in tissues of the cervix (the organ connecting the uterus and vagina), generally with no symptoms unless it has progressed to more advanced stages. It was once the leading cause of cancer death for women in the US, but has seen a dramatic decline in incidence and mortality rates because of regular screening programs, the cervical cancer vaccine and improved treatment options.

In the U.S., the cause of the majority of cervical cancers is linked to two particular high-risk types of the human papilloma virus (HPV), types 16 and 18. Since HPV is passed from person to person through sexual contact, most men and women will become infected at some point in their lives and fortunately most infections clear up on their own. But when a woman has a persistence of one of the high-risk HPV types and it causes pre-cancerous changes of the cervix, she may need treatment of these pre-cancer changes and closer follow-up with her doctor.

The single most important thing a woman can do is to have a regular Pap test as part of a routine pelvic exam. Not only does the Pap test identify cancer cells but also abnormal cells that are pre-cancerous and could lead to cervical cancer. Early detection means treatment, such as surgery, radiation therapy or chemotherapy, is more likely to be effective.

Vaccines have been developed in recent years to prevent acquiring the high-risk HPV infection, essentially stopping cervical cancer before even the first step can begin. The vaccines are recommended for girls, ages 11 and 12, allowing the immune system to be activated before a girl is likely to be exposed to HPV.

Researchers have also been developing surgical techniques to cure localized cancers while preserving as much normal tissue as possible. Dr. Peter Rossi and I are currently conducting a study at the Winship Cancer Institute of Emory University, researching how much actual radiation is delivered against cervical tumors. This type of “GPS” for the body is being evaluated in order to deliver radiation more accurately and targeted directly to the cancerous tissue. If successful, the effectiveness of radiation treatment may be improved and more importantly, unwanted side effects may be reduced.

Any woman can get cervical cancer, but it occurs more often in African-American and Hispanic women than in non-Hispanic white women. Those who are most at risk for the disease, though, are women who do not have regular checkups that include Pap tests. So, talk to your doctor today and schedule a Pap test. It could save your life.

Dr. Makhija is Director Gynecologic Oncology and Associate Professor of Gynecology and Obstetrics. Her research interests include chemo-resistance in ovarian cancer and the development of novel, targeted therapeutics including monoclonal antibodies and gene therapies for ovarian cancer. Additional research interests include the extension of cervical cancer clinical trials to under-served women, particularly in India, as well as education and participation in the HIV Prevention Trials Network. She has published numerous peer-reviewed scientific papers and review articles in journals such as International Journal of Oncology, American Journal of Obstetrics and Gynecology, Oncogene, and Women’s Oncology Review.

Can Fruits and Vegetables Really Fight Cancer?

Just one more reason why healthy eating should be one of your resolutions this year!

fruit vegetables cancer preventionDid you know that…

  • Broccoli has preventative properties related to prostate and breast cancer?
  • Lycopene found in tomatoes, guava and even watermelon can help fight cancer?
  • Compounds found in soy and legumes are known for their anti-cancer power?

While the power of food related to cancer has only been evaluated over the past few decades, the knowledge of the medicinal properties of food date back 6,000 years when Chinese emperors used soy for its curative power.

Back in the 1980s, when only a handful of researchers were exploring how specific foods may prevent cancer, Omer Kucuk, MD, was one of those researchers. Today a professor of hematology and medical oncology at Emory Winship, Kucuk focuses on food’s effect on cancer prevention and treatment, as well as its effect on other diseases such as osteoporosis.

Many foods, particularly fruits, vegetables and legumes, contain bioactive compounds that display potent anticancer activities, says Kucuk. For example, evidence exists that specific food compounds such as soy isoflavones and curcumin can increase the effectiveness of chemotherapy and radiation therapy in patients with advanced prostate cancer.

What’s more, many nutritional compounds used for therapy or disease prevention can be taken as part of a routine diet and have little if any side effects, explains Kucuk. “The tomato carotenoid lycopene has cancer-preventing properties. People can get enough lycopene by eating tomato paste and tomato sauce, which is very rich in lycopene. So, if people ate a couple of ounces of tomato paste a day as part of a regular diet, they would eat enough to get all the benefits,” Kucuk says.

To hear Kucuk’s own words about these food compounds, listen to his podcast on the topic. Subscribe to Emory’s Sound Science for more podcasts from our Emory doctors.

New Blood Test Aids in Early Cancer Detection

Winship at Emory’s Dr. Suresh Ramalingam explains the test and what it means for cancer detection and treatment.

Suresh Ramalingam, MDYou may have heard in news headlines this week about the ability to detect a single cancer cell among billions of healthy cells. This may be possible via a new blood test (under development) that may someday help detect cancer earlier.

For tumors located in organs such as the lung, prostate, colon and breast, access to tumor tissue is only possible with a biopsy. This requires an invasive procedure, which in certain situations involves surgical intervention. It has been known for sometime that tumors shed their cancer cells that can be found in the circulating blood stream. However, the tumor cells are a significant minority in number compared to normal blood cells. Identifying the tumor cells among billions of normal cells has been a major challenge. Currently, it is possible with sophisticated techniques to identify such cells and count them. The number of circulating tumor cells has been linked to survival outcomes in some studies. Now researchers are trying to not only count, but collect these tumor cells and then conduct molecular testing.

Such an advance would have tremendous implications for cancer research and treatment. First of all, it may not be necessary to obtain tumor biopsies if adequate number of cells can be identified in the peripheral blood. It will be possible then, to administer this test during the course of a patient’s treatment to learn how a tumor is changing, because they do change as treatment progresses. It would also be possible to diagnose cancer early as part of screening strategies for patients at risk for developing certain cancers.

So how does this test work and what does it do? The test uses a microchip resembling a lab slide covered in 78,000 tiny posts. Those posts are coated with antibodies that attract and bind to tumor cells like glue. A patient’s blood sample, about a teaspoon full, is forced across the chip. The cancer cells stick, and a stain makes them glow so researchers can capture them for study.

For patients, care-givers and researchers this is very exciting news. However, this technology is just entering the early stages of testing and will have to go through several studies before it can be applied in routine practice. A number of important research questions will still have to be answered regarding the utility of circulating tumor cells, even if the test proves to be successful.

It is important to emphasize that while the new technology is exciting, it is possibly years away from practical application. If you have questions on this new blood test, please leave them in the comments below.

When it Comes to Cancer, Beauty is More than Skin Deep

Elizabeth Goodman shares her experience at Winship’s Radiance Boutique

Emory Radiance Boutique“The most beautiful things in the world cannot be seen or even touched; they must be felt with the heart.” This quote by Helen Keller perfectly describes The Radiance Boutique at Winship Cancer Institute of Emory University, which offers up a feeling of beauty that is much more than skin deep and is most definitely felt with the heart. This boutique is no place to find overpriced designer clothing or useless knick-knacks; it is stocked to the brim with wigs, compression garments, and mastectomy bras and prostheses to heal beyond a medical level.

As the Boutique coordinator and certified professional I spend my days measuring, fitting and offering garments to men and women of all ages to help them maintain their dignity and find hope for normalcy on their journey toward recovery. Being present for such an emotional transition in these patients’ lives gives me the opportunity to be more like a guide and a counselor than a salesperson, offering advice on getting through these difficult times and armed with an arsenal of items to help our patients along the way.

Unfortunately, I am no stranger to the heartbreak of cancer. My father was diagnosed with and treated at Winship for lung cancer. Although he lost his battle with cancer in August 2003, my experience with my dad allows me to connect and empathize with our patients and their families as they are going through their experience. My passion for health care and patient interaction led me into this field. Every day allows me the opportunity to use my expertise of the health care industry and my product knowledge of all kinds of prosthetics. At the boutique we provide a wide range of products, including:

Wigs

Most frequently associated with the boutique is our huge variety of wigs. Between synthetic, real hair and customized, the boutique offers the best wigs found in the country. The wigs are made from real hair and can be brushed and styled like natural hair.

The patient’s cap size is measured, and hair is ordered to match the natural hair. After treatment has begun, the patient can go to a hair dresser, have his or her hair shaved off, and then have the wig styled the same way the natural hair was styled. Of course, if the patient would rather change hair style or color, there are several wigs in stock at the boutique ranging in texture, fit, color and cut.

Compression Garments

Compression sleeves and socks are fashioned to provide the perfect amount of constriction on different parts of the leg or arm to increase circulation. For patients suffering from vascular problems, compression garments can be immensely helpful.

Mastectomy Bras and Prostheses

Many patients come for help after having mastectomies during battles with breast cancer. With forms in all sorts of shapes, sizes and colors, our products go a long way in making these women feel beautiful again. The prostheses also can prevent irreversible back problems that often persist from the weight of unevenly carrying only one breast. I often meet with women in pre-surgery consultations show and discuss options available to them after lumpectomies, reconstruction and mastectomies. A commonly requested item is a post-surgical camisole, which features drain pouches for immediate use after such a surgery. They look like tank tops and blend comfortably into any patient’s wardrobe.

The Radiance Boutique is open to patients Monday through Friday from 9:30 a.m. to 3:30 p.m. and is located in the Patient and Family Resource Center at Winship Cancer Institute. For more information or to set up an appointment, call us at 404-778-1264.

Could Space Travel Cause Lung Cancer in Astronauts?

Researchers are launching a new cancer research initiative – literally. NASA partners with Emory & MCG

NASA has awarded a team of investigators from both the Winship Cancer Institute of Emory University and the Medical College of Georgia $7.6 million over five years to study how a component of space radiation may induce lung cancer.

The award establishes a NASA Specialized Center of Research (NSCOR), consisting of a team of scientists with complementary skills who work closely together to solve a set of research questions. Ya Wang, PhD, professor of radiation oncology at Emory University School of Medicine and Winship Cancer Institute, is director of the NSCOR at Emory.

Interplanetary space travel could expose astronauts to conditions where they are chronically subject to types of radiation not normally encountered on earth. One of these radiation types is high energy charged particles (HZE), which results in complex damage to DNA and a broader stress response by the affected cells and tissues.

There is no epidemiological data for human exposure to HZE particles, although some estimates have been made studying uranium miners and Japanese atomic bomb survivors. Animal experiments show that HZE particle exposure induces more tumors than other forms of radiation such as X-rays or gamma rays.

Because it is a leading form of cancer, lung cancer can be expected to be prominent among increased risks from radiation even though astronauts do not smoke. However, the risk for astronauts remains unclear because the dose of HZE astronauts are expected to receive is very low.

The Emory-MCG researchers will probe whether the broader stress response induced by HZE particles amplifies cancer risk. Investigators will collaborate with physicists at Brookhaven National Laboratory to gather information on HZE’s effects. Individual projects include the study of how cells repair DNA damage induced by HZE particles, how HZE particles generate oxidative stress, and how they trigger regulatory changes in DNA known as methylation.

“The information generated by this project will be critical for estimating risks and establishing countermeasures for cancers associated with long term space travel. In addition, new insights into cancer resulting from all types of radiation exposure, including those found on earth, are likely to emerge from this project,” concludes Dr. Paul Doetsch, PhD, professor of radiation oncology and biochemistry, and associate director of Emory’s NSCOR.

Wear Purple to Show Your Support, November is Pancreatic Cancer Awareness Month

Pancreatic CancerLung cancer gets a lot of attention during November, but did you know that November is also Pancreatic Cancer Awareness Month?

If you’ve seen a lot of people wearing purple this month, they’re doing it to raise awareness for pancreatic cancer, the fourth leading cancer killer in the United States. The color represents more than 32,000 Americans who will be diagnosed with the disease this year and almost as many who will die because of it by year’s end.

Pancreatic cancer affects the pancreas, an organ located in the abdomen that helps to make enzymes for food digestion. Pancreatic cancer is difficult to detect because the symptoms such as weight loss, fatigue, and abdominal discomfort are vague and associated with many other illnesses. When the pancreas produces too much insulin, other symptoms such as chills, diarrhea, general feelings of weakness, and muscle spasms may also be experienced. But these symptoms rarely occur in the early stages of the disease and they set in gradually, causing it to go untreated and producing devastatingly low survival rates.

If a doctor suspects pancreatic cancer, imaging tests may be done to gain a better view of the pancreas. But according to Charles Staley, MD, chief of surgical oncology at Emory University School of Medicine and the Winship Cancer Institute, “Pancreatic tumors are difficult to image because they don’t show up very well on CT scans and MRI.”

In an effort to diagnose and treat pancreatic cancer in its earlier states, Emory researchers have tested a molecule that specifically binds pancreatic cancer cells to tiny “nanoparticles” made of iron oxide. The iron makes the particles clearly visible under magnetic resonance imaging (MRI). If the tumor can be imaged better, radiation or chemotherapy may be able to be put into these particles to deliver them directly to the tumor. This could eventually mean higher survival rates.

There is no proven way to prevent pancreatic cancer, but researchers have identified several risk factors. Smokers are two to three time more likely to develop pancreatic cancer than non-smokers and African-Americans are diagnosed more frequently than other races. Increased age, diabetes, chronic pancreatitis and a family history of pancreatic cancer are also common risk factors.

To hear more from Dr. Staley on how he treats patients with rare cancers, listen to his podcast.

You can also visit the Winship Cancer Institute’s website to get more resources on pancreatic cancer, including its diagnosis and treatment.

Can a CT Scan Save 32,000 Lives? The Answer May be ‘Yes’

Lung CT ScanWhat if there were a way for 32,000 of the 160,000 lives lost each year related to cigarette smoking to be saved? There may just be. Findings from a recent study show the risk of dying from lung cancer could be reduced by 20 percent by use of a low-dose helical computed tomography (CT) scan. In other words, this type of CT screening could save over 30,000 lives a year.

Lung cancer is the leading cause of cancer-related deaths, and as such, cancer research and treatment experts are constantly looking for ways to reduce the pervasive nature of the disease. The National Cancer Institute (NCI) launched the multi-center National Lung Screening Trial (NLST) in 2002. The trial compared two ways of detecting lung cancer using low dose helical (spiral) CT vs a standard chest X-Ray. Part of this research study was actually led at Emory by radiologist and researcher Dr. Kay Vydareny.

The trial aimed to determine the effects of low-dose helical CT scans vs chest X-Rays on lung cancer death rates in high-risk populations. Both chest X-rays and helical CT scans have been used as a means to find lung cancer early, but the effects of these screening techniques on lung cancer mortality rates had not been determined.

Over a 20-month period, more than 53,000 current or former heavy smokers ages 55 to 74 joined NLST at 33 study sites across the United States. In November 2010, the initial findings from NLST were released. The conclusion? Clinical trial participants who received low-dose helical CT scans had a 20 percent lower risk of dying from lung cancer than participants who received standard chest X-rays.

While the benefits of low-dose helical CT scans in the reduction of lung cancer deaths are obvious, not every diagnostic option comes completely risk free. The CT scans can occasionally detect suspicious abnormalities that do not turn out to be lung cancer – known as false positives. Many of these abnormalities are scars from smoking, areas of inflammation or other noncancerous conditions that may require additional testing to determine that they are not harmful. These tests have been known to cause undue anxiety for patients and may sometimes lead to biopsies or surgeries.

“It is certainly an individual’s choice whether they want to be screened for lung cancer with a CT scan if they have no symptoms. However, it is important to make certain that such individuals have complete information and be well-informed before having such a scan. If a patient has symptoms, such as a persistent cough, weight loss, persistent hoarseness or trouble breathing, he or she should see a physician as soon as possible. Often these symptoms are due to something other than lung cancer, but more tests should be performed to make certain,” says Vydareny.

What should a person at high-risk for lung cancer do? The answer that all physicians agree on is to stop smoking right now, the sooner the better. Or even better … don’t start smoking ever, further reducing the chances of getting cancer or suffering from a stroke or heart attack as well.

“All physicians hope that there will be a test that can screen for early lung cancer and that the dismal prognosis of those with lung cancer will improve. Perhaps it will be screening with CT scans. Perhaps it will be a blood test,” says Vydareny. “That day hopefully will come, but it has not yet arrived. But if you are or have been a heavy smoker, your first step should be to consult your primary care physician to discuss all possible screening options.”

For more information, check out the lung cancer screening clinical trial video below: