Special Section: Health Matters

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How to KO Cancer In health care, as in sports, the best defense often is a good offense.

By Peter Tonguette

MARCH 2020 Columbus Monthly

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Early Detection Dr. Stephen E. Auciello, also of OhioHealth, says that health care in the United States must shift to preventing, rather than simply treating, illnesses.

“I think it’s really important that we focus on our health in advance rather than waiting until we develop a disease,” Auciello says.

“That’s where most of these recommendations are rooted—in either preventing diseases entirely or catching them when they’re early and more treatable.”

Yet, for many Central Ohioans, unpacking the various cancer screening guidelines currently circulating can be overwhelming.

Guidelines often make reference to age and gender, but exceptions are made for those

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patients considered to be more prone to develop a particular form of cancer. Like many patients, you might often feel like asking: Where do I start?

“Screening, I think, is incredibly complex because there are multiple organizations across the country with different thresholds of recommendations,” says Dr. Joseph Hofmeister of Columbus Oncology and Hematology Associates. “This is a very controversial area with lots of opinions.”

Auciello says that primary care physicians are uniquely positioned to assess a patient’s particular screening needs. An approach tailored to the individual, he says, will take into consideration not just age and gender, but also race, ethnicity, family history and consumption of alcohol or tobacco.

“The better we know you as a patient, the more we are going to be able to tailor those recommendations to the individual needs of a patient and the values of that patient,” Auciello says, pointing to the potentially

different screening preferences of younger patients in good health versus older patients in declining health.

Perhaps counterintuitively, patients in the former category, he says, may be better candidates for certain screenings because they are seeking to live as long and healthy a life as possible.

“If a patient is older and maybe not in as good health as they used to be, they may view many of these recommendations with a different lens,” Auciello says. “They may be more focused on maintaining the quality of life that they currently have rather than identifying a disease that may not affect their long-term survival.”

For a majority of patients, though, certain guidelines can be applied more universally.

In the case of breast cancer, Jones says that monthly self-exams are not a bad idea, but also not proven to have real medical benefit.

Medical professionals, by contrast, know precisely what to look for.

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I

n the world of cancer research, the announcement was tantamount to a breaking-news bulletin on cable television or an extra edition of your daily newspaper: In early January, the American Cancer Society made public the news that deaths caused by cancer in the United States declined more dramatically from 2016 to 2017—a total of 2.2 percent—than during any other 12-month span.

According to the ACS, improvements relating to lung cancer are at the center of the sharp drop in overall numbers. Reasons given for the decrease in deaths include declines in tobacco use and better treatments for those who are diagnosed with lung cancer.

But the announcement came with a postscript that is all too easy to gloss over: Rates for other major forms of cancer—including breast, cervical and prostate—have not experienced similar levels of decline.

Such sobering news is a good reminder that, when it comes to cancer, the best offense is a good defense—and a good defense often means proper screening.

Central Ohio physicians say that testing for various types of cancer is bound to make a dent in outcomes for patients.

“I do think it’s making a difference in that we’re finding them earlier, particularly in the breast cancer world,” says Dr. Natalie B. Jones, a surgical oncologist at OhioHealth whose area of focus includes treating breast and skin cancers.

“I don’t know if we have a lot of good, long-term data yet that says whether we’re truly impacting overall survival,” Jones continues. “But I’d like to think that if we’re finding Stage 0 and Stage 1 breast cancer before it’s metastasized, or spread to the lymph nodes, then we are making an impact on overall survival.”

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patient,” says Dr. Kavya Krishna of Columbus Oncology and Hematology Associates, referring to the risk of infection, bleeding and overall stress that goes along with a biopsy. “It has to be a discussion upfront as to what the screening involves and what the consequences are from the screening procedures. … Of course, the benefits of a biopsy outweigh the risks in the right patient in the right clinical scenario.”

Proactive Prevention The only thing better than identifying cancer early on, of course, is preventing it from occurring in the first place. Because of the availability of a vaccine for the human papillomavirus (HPV)—a virus that can contribute to the emergence of cervical cancer—such a reality could be in sight in the decades to come.

“Cervical cancer is one of the most preventable cancers that we have,” says Electra D. Paskett, the director of the Cancer Control Research Program at the Ohio State University Comprehensive Cancer Center. “We actually have, worldwide, a goal to eliminate cervical cancer in the next 50 years or so.”

Doctors pin their hopes on reducing instances of the disease thanks to a combination of HPV vaccines being given to males and females between the ages of 9 and 26, as well as cervical cancer screenings for females between the ages of 21 and 65.

The HPV vaccine, which covers nine versions of a virus that can be spread in over 200 different versions, is most effective in young people around the ages of 11 and 12.

“It has the best impact on the immune system when it’s given to adolescents because the immune system is at its peak,” Paskett says. “We want to vaccinate at that age group so that they are vaccinated before any onset of sexual activity, because sexual activity is the main way to transmit the virus.”

Adults between the ages of 27 and 45 are eligible to be vaccinated, too, but whether they have or haven’t, women should also be screened for cervical cancer through a test meant to spot HPV or a Pap smear, in which cervical cells are extracted and scrutinized for irregularities.

“There might be another strain that for you, as a woman, causes cervical cancer,” Paskett says, also noting that tobacco use, multiple sexual partners and unprotected sex are

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“A clinician doing a clinical breast exam [is] looking for anything that feels worrisome,” she says. “Any new nipple retractions, any palpable adenopathy [swollen lymph nodes]—those are some things that would alert them that maybe that patient needs to be sent on for further work-up and imaging.”

Average-risk women are encouraged to schedule their first mammogram—in which an X-ray offers an inside look at the breast tissue—at age 35; once they celebrate their 40th birthdays, those screenings should happen on an annual basis.

Mammograms are the tests that can identify abnormalities, which can then be biopsied in order to ascertain whether they are cancerous or benign. “If we can identify cancer at an earlier stage, it improves overall survival and prognosis,” Jones says.

Yet before embarking on any test, including a mammogram, a patient and their primary care physician need to be on the same page.

During a mammogram, “there can also be benign things that can be picked up, which may not be clear-cut on imaging and that would need additional investigation, such as biopsy, which tends to add morbidity to the

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Caitlin McTigue

PILATES

Photos: Courtesy Club Pilates

Club Pilates I’m totally new to Pilates. Is there a class for me? Definitely! Pilates is for every body. The great thing about Pilates is that any exercise can be taught and then modified across beginner, intermediate and advanced levels, making the exercise accessible for everyone regardless of their level of physical fitness or any potential limitations due to injury, etc.

the exercise with six major principles in mind: concentration, control, center, flow, precision and breathing. Incorporating these principles into each exercise forces you to use your brain during the movement, fostering a deeper mind/ body connection and a better physical and mental state.

How does being in control of my physical health help me be in control of the rest of my life? Club Pilates’ mantra is “Do Pilates. Do Life.”

Pilates is one of the only exercise routines that focuses on overall body alignment during the workout, lengthening and strengthening every muscle in your body, not just the bulky muscle groups. By building up lean muscle across all major and supporting muscle groups, not just some of them, you not only stand taller and live your daily life with less pain, but also promote stability and strength as you age.

What makes Pilates different from other workouts? The primary goal of Pilates is to make movement more functional, helping you to walk, sit stand, etc. more efficiently in everyday life. In Pilates, not only are you strengthening and toning muscles, you are promoting body alignment, balance and improved movement.

What is the mind/body connection in Pilates all about? Joseph Pilates created

1080 Yard St., Grandview Heights 614-776-0282 4024 Powell Rd., Powell 614-245-0300 5780 N. Hamilton Rd., Unit G, Columbus 614-245-0333 (coming soon) clubpilates.com

What training/experience do your instructors have? Our instructors all have gone through 500+ hours of intense Pilates training. They have extensive anatomical training as well—this is why Pilates is the top recommended exercise routine for injury prevention and rehabilitation.

MARCH 2020 Columbus Monthly

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Whole-Body Health

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among the behaviors that can place individuals in a high-risk category for cervical cancer.

If both tests are done concurrently, women between ages 30 and 65 should be screened every five years; if either test is done on its own, women between 21 and 65 should be screened every three years.

“It is extremely important to still get the screening even if you’ve gotten the HPV vaccine,” says Paskett, who nonetheless stresses the revolutionary importance of the HPV vaccine as a means to end a form of cancer.

“The purpose is to eliminate a cancer, and in this case, cervical cancer,” she says.

Less cut-and-dried are screenings for prostate cancer. Earlier guidelines called for adult males to receive annual digital rectal exams along with a test measuring prostatespecific antigen (PSA) in the blood. Several years ago, Auciello says, the United States Preventative Services Task Force “changed their recommendation to not recommend routine prostate cancer screening.”

The rationale behind the about-face?

“We were finding prostate cancers that did not necessarily impact someone’s quality or length of life,” Auciello says. “The blood test that we use to screen for prostate cancer does not differentiate between cancers that are very aggressive and cancers that are very slow-growing.” The physician notes that more specific diagnoses involve an invasive prostate biopsy, which is done in the dark, as

it were, since it cannot be known ahead of time whether a cancer is fairly innocuous or more serious.

Current guidelines seek a middle ground, with some suggesting that males between ages 45 and 49 receive a test to establish a baseline PSA level. From there, a physician can develop a patient-specific approach. “[If] we see that that is at an acceptable or low level, that would lead us to a check less often, maybe every couple of years,” Auciello says. “If we do see that it’s mildly elevated, that would trigger us to screen more often.”

Screenings for All More universally accepted are guidelines dictating screenings for colon cancer, which males and females are recommended to undergo starting at age 50 and continuing once a decade until age 75. Tests in which a patient’s stool is examined for blood or abnormal DNA have gained in popularity, but colonoscopies—in which a thin, flexible camera allows physicians a peek inside the colon— remains the best test. (Stool-based tests are less expensive, less invasive and lower-risk, but they are considered less comprehensive.)

Either way, the goal is to cut colon cancer off at the pass.

“We’re trying to interrupt the cycle or progression from something like a benign polyp to something more ominous, such as a cancer,” says Dr. Darrell Gray, a gastroen-

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The fight against cancer should be an all-hands-on-deck effort. That means not neglecting lifestyle factors, such as maintaining a healthy diet and avoiding smoking. Another major aspect of wholebody health: proper exercise. There’s a wealth of fitness studio options available in Central Ohio, including a discipline that you may have overlooked. After all, to some observers, Pilates can have an air of exclusivity about it.

The fitness system—which uses seemingly simple movements with the goal of attaining body alignment and strengthening the core—is sometimes thought of as being aimed at the well-heeled.

Caitlin McTigue, who has recently opened two studios in Central Ohio, is familiar with those complaints: “‘Oh, hey, only dancers do this,’ or, ‘Only people with a lot of money can afford this.’ ” She’s heard it all, but insists her studios—Club Pilates, with locations in Grandview Yard and Powell—are different.

“We are for everybody and every body,” says McTigue, whose studios aim to make Pilates more accessible to the general public through more affordable pricing and an emphasis on flexible scheduling for people with overflowing calendars.

“It’s not just, ‘Oh, I can only come at 9 a.m. or 6 p.m. because those are the only two classes you have,’ ” McTigue says. “We have classes 6 a.m. to 8 p.m., seven days a week.”

Club Pilates, which employs instructors from a range of Pilates lineages, offers seven signature class formats as well as private or semi-private training intended for those uncomfortable in a group setting. Private settings may also be best for those who have undergone surgeries or other procedures and need Pilates as part of rehabilitation; special apparatuses are available to safely facilitate recovery.

McTigue, who plans to open four additional Club Pilates locations around Central Ohio, has received an enthusiastic response from Pilates pros and newbies alike. “The feedback has been awesome,” she says.

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terologist and deputy director of the Center for Cancer Health Equity at the Ohio State University Comprehensive Cancer Center. If precancerous growths are found and eliminated, he adds, “I am in essence preventing a cancer from happening.�

Family history—that is, if a first-degree relative, like a father, or multiple second-degree relatives, like grandparents, had a history of colon cancer—can lead to a different pace for screenings. “If a first-degree relative has been diagnosed at less than 60 years of age, we recommend that the patient start screening either at age 40 or 10 years younger at which the cancer in their first-degree relative was diagnosed—whichever comes first,� Gray says.

Inflammatory bowel diseases, obesity and alcohol consumption also play roles in increasing a patient’s risk in developing colon cancer; screenings for African Americans are also recommended to begin earlier, at age 45. “Significant data ‌ suggests that African Americans present with later-stage disease and typically have worse outcomes,â€?

Gray says, pointing to discrimination and wealth inequality as having negative impacts on the utilization of screening and access to treatment among African American patients.

Skin cancer might be assumed to be easy for individuals to keep an eye on at home. After all, one can monitor changes in moles as well as any doctor, right? Wrong. “Skin cancers can develop in locations that you can’t look at yourself every day,� says Jones, including on a person’s back, scalp or hairline. “You would be amazed at how many people are completely shocked and didn’t even know that they had this abnormal-looking skin lesion.�

Some guidelines call for individuals to have a dermatologist examine their skin in full each year. “Most melanoma originates within a mole or a nevus that starts to change color and shape and size, which is then what prompts the biopsy,� Jones says. “Sometimes, it can be a completely new skin lesion that develops in an area where there wasn’t a preexisting mole.�

The decision of whether, and when, a particular cancer screening is right for you is best made in consultation with a doctor.

Fortunately, area physicians find that patient interest in screenings—and the potential benefits they reap—is at a high. “People are spreading the word themselves within their families, within their communities ‌ about the importance of getting screened,â€? Gray says. “I’m also seeing younger individuals ask earlier about screenings or when they should start.â€?

It starts with the very best cancer care for you.

ALL PHYSICIANS ARE BOARD CERTIFIED

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For general cancer information please call OhioHealth’s Cancer Call (614) 566-4321

Tel: (614) 442-3130

810 Jasonway Ave., Columbus, Ohio 43214

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A Bigger Investment in Better Outcomes Facing a cancer diagnosis is hard enough without having to travel to find the care you need. That’s why Mount Carmel is committed to bringing the latest cancer treatment options right here to Central Ohio.

As part of that effort, they recently added cardiothoracic surgeon Dr. Jose Rodriguez to the team. Dr. Rodriguez is widely known for his success using robotic surgery to treat patients with lung cancer.

Vision Of Care More people die each year from lung cancer than from breast, colon, and prostate cancer combined.

So, providing more treatment options for lung cancer patients here in Columbus isn’t a luxury, it’s an imperative. “I came to Mount Carmel because they have the same vision that I do for improving care for lung cancer patients,” says Dr. Rodriguez. “They’re investing in the technology and expertise necessary to improve outcomes.”

Dr. Rodriguez states that robotic surgery has several advantages over traditional types of surgery. “This method of surgery enables us to get a 3-D view of a patient’s tumor and operate with incredible precision,” says Rodriguez. “Patients typically experience less pain, fewer compli-

cations, and shorter hospital stays.

That means they’re able to get back to their lives sooner and feeling better.”

“For anyone facing a lung cancer diagnosis, I’d encourage them to do their homework and find out what treatments are available to them,” says Dr. Rodriguez. “I always tell my patients to get a second opinion and take a good look at the numbers. Look at a surgeon’s complication rate. Look at a surgeon’s conversion rate. Those things make a big difference in how you feel after surgery.”

Advanced Care, Advanced Caring Dr. Rodriguez and his team are part of a program designed to provide patients cancer care that’s

as advanced as it is compassionate.

Mount Carmel’s comprehensive cancer program provides integrated, multidisciplinary care, advanced technologies, and cutting-edge research to prevent, detect, and treat the disease. Each patient is assigned a specially trained Oncology Nurse Navigator who coordinates care before, during, and after treatment.

That caring, comprehensive approach is what drew Dr. Rodriguez to Mount Carmel. “Bringing this level of care to Columbus is exciting because it means I can help more patients have better outcomes and better health,” says Dr. Rodriguez. “That’s what I love most about my job—seeing a patient go home and knowing I’ve helped improve not only their health but their quality of life.”

Dr. Jose Rodriguez

AMAZING THINGS HAPPEN WHERE TECHNOLOGY MEETS COMPASSION. We don’t think patients should have to choose between being treated with the latest technology and being treated with compassion. Which is why Mount Carmel is committed to bringing advanced cancer care to our patients in Central Ohio. Whether it’s through access to clinical trials or providing advanced treatments such as robotic surgery, we care for each of our patients with love, kindness, and a heart for service. That’s how we’re creating better outcomes for cancer patients and their families. To find out more about cancer care at Mount Carmel, visit mountcarmelhealth.com/cancercare.

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