SPRING 2020
Health, Science & Wellness COVER STORY
Life, love and a new baby PAGE 8
How our Liver Tumor Program gave Nicole Leon a second chance after cancer ALSO IN THIS ISSUE PAGE 7
Shin splints or stress fracture? PAGE 15
Closer to you Our new location in River East
Spring 2020
The Forefront
IN THIS ISSUE ON THE COVER
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Cover photo by Robert Kozloff
Nicole Leon was told nothing could be done for a liver tumor. Today, she is cancerfree, married and the mother of a baby boy.
CELIAC DISEASE OR GLUTEN SENSITIVITY?
5
Clearing up confusion about gluten-related disorders.
ASK THE EXPERT
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What women need to know about dense breasts.
3 FULL RECOVERY After our neurovascular team removed a rare lesion from her brain, Olivia Parrillo is back to 100 percent.
READ ONLINE TOP DOCTORS 78 UChicago Medicine physicians were named to Chicago magazine’s 2020 Top Doctors list.
UChicagoMedicine.org/ forefront Nicole Leon, left, Talia B. Baker, MD, (holding baby Baker Leon) and Larry Leon.
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SAVING SONYA
UChicagoMedicine.org/ enewsletter
Thanks to a quick response, Sonya Prowell survived a second heart attack.
The Forefront magazine features stories about life-changing care and breakthroughs in medical research at the University of Chicago Medicine and Biological Sciences. Kenneth S. Polonsky, MD Dean of the University of Chicago Biological Sciences Division and the Pritzker School of Medicine and Executive Vice President for Medical Affairs Sharon O’Keefe President of the University of Chicago Medical Center
VISIT OUR WEBSITE FOR MORE INFORMATION: Adult and children’s care UChicagoMedicine.org Science, health and wellness news
Senior Vice President, Chief Communications and Marketing Officer: William “Skip” Hidlay Editor: Anna Madrzyk Associate Editor: Gretchen Rubin Design: SBDWorks, Inc. Contributing writers
Read The Forefront online at UChicagoMedicine.org/TheForefront Email us at imagine.editor@uchospitals.edu Facebook.com/UChicagoMed Twitter.com/UChicagoMed
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FIT ENOUGH FOR SURGERY?
Physicians ask two questions to determine whether patients are healthy enough to undergo and recover from major non-cardiac surgery: Can they climb a set of stairs? Can they walk two blocks on level ground? A study published in the journal Anesthesiology by University of Chicago Medicine researchers examined whether the answers these questions elicit accurately reflect patients’ fitness levels. “The questions are pretty good at identifying patients who answer yes and have adequate functional capacity,” said anesthesiologist Daniel Rubin, MD. “But for patients who respond no, it’s a coin flip as to whether they are functionally capable.” Rubin and several colleagues are developing an app so physicians can easily conduct the more comprehensive Duke Activity Status Index (DASI) survey and the six-minute walk test, both of which have proven effective for evaluating cardiovascular fitness.
VIOLENCE, SOCIAL ISOLATION LINKED
Exposure to violence can negatively impact a person’s physical and psychosocial health, according to two new studies co-authored by University of Chicago Medicine social epidemiologist Elizabeth L. Tung, MD. The studies were based on in-person surveys of more than 500 adults living in Chicago neighborhoods with high rates of violent crime, and in predominantly racial and ethnic minority groups. One report found that social isolation — a survival strategy in neighborhoods affected by violence — was associated with poor nutrition, not taking medication properly, binge drinking and smoking. A second study looked at exposure to community and police violence and hypervigilance. Chronic hypervigilance — a heightened emotional state of always feeling “on guard” — was more strongly associated with police violence than community violence, and was a risk factor for cardiovascular disease and stroke. The results of both studies were published in the October issue of the policy journal Health Affairs.
The doctor is online UChicago Medicine’s MyChart patient portal now makes it even easier for you to get the care you need with convenient e-visits and online scheduling options. E-visits are available for minor health concerns that may not require a physical exam or testing, including: » Flu-like symptoms » Headache » Back pain » Cough
PRESCRIPTION MEDICATIONS AND SUICIDE RISK
Most suicides occur in patients with a psychiatric disorder, such as depression. Yet many drugs, including antidepressant medications, carry a “black box warning” from the FDA advising of an association with suicidal behavior. This has led to decreased use of these medications despite possible benefits. The University of Chicago’s Center for Health Statistics developed a statistical tool to measure the links between drugs and suicide attempts. A review of 922 prescription medications taken by 146 million patients showed that just 10 drugs were associated with increased suicide attempts. The 44 drugs showing a decrease in suicide risk included a large group of antidepressants that have black box warnings. Robert Gibbons, PhD, lead author of the study in the Harvard Data Science Review, said if these findings are confirmed in clinical trials, physicians will have new pharmacological tools, including drugs to be avoided and drugs that may be protective, to help stem the nation’s suicide epidemic.
» Urinary tract infection (UTI) » Vaginitis (vaginal discharge) To be eligible for an e-visit, you must be at least 18 years of age, located in Illinois and have had an office visit at a participating UChicago Medicine Primary Care Group location within the past three years. Additionally, online scheduling is now available for many UChicago Medicine locations. You can now schedule the following visit types and more through MyChart: » » » »
Urgent/sick visits Annual physicals Well-child and well-woman exams Postpartum follow-ups
To learn more, visit UChicagoMedicine.org/mychart
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For medical emergencies, call 911 or go to your nearest emergency room.
BOUNCING BACK AFTER BRAIN SURGERY While buying lunch in her high school cafeteria, Olivia Parrillo reached for a yogurt. “All of a sudden, something shot through my arm,” she recalled. She collapsed into a seizure that lasted almost five minutes. The 16-year-old was rushed to a nearby hospital, where tests showed a cerebral cavernous malformation (CCM) in her brain. A CCM is a cluster of small blood vessels that form abnormal, bubble-like structures, which can leak, causing seizures, bleeding in the brain, weakness and, in some cases, paralysis. Seeking the best care for their daughter, Tracey and Mike Parrillo, of Oak Brook, reached out to their doctor at the University of Chicago Medicine. He referred them to Issam Awad, MD, an internationally renowned neurosurgeon whose team at UChicago Medicine has seen more CCM patients than any other center in the world. “We were willing to travel to the ends of the earth to get the best care for Olivia,” Tracey said. “But lo and behold, the number one guy in the field was right here in our backyard.”
In addition to being an expert in treating CCM, Awad has been researching the disease for nearly three decades. “Cavernous malformations are relatively rare,” Awad said. “Even a neurosurgeon who specializes in vascular problems of the brain might not see more than five or so cases a year. Our team sees two to three a week.” After meeting with Awad, the family decided surgery was the best option. “Our team has substantial experience operating on the area of the brain where Olivia’s lesion was located,” Awad said. “We knew that removing the lesion would give Olivia the best chance of being seizure-free.” Using innovative brain mapping technology, Awad and his team identified the specific location of the lesion. Rather than shave Olivia’s head for surgery, one of Awad’s team members braided the teen’s hair so that the lesion would be easily accessible. “We made every effort to not only safely and successfully treat Olivia, but to also minimize stress and anxiety,” Awad said. During the three-hour surgery in late February 2018, a team of neurophysiologists mapped Olivia’s brain activity, ensuring everything went smoothly.
| A B O V E | Olivia Parrillo (center) with
her parents, Tracey and Mike
By late April 2018, Olivia was cleared to resume most of her normal activities, including dancing. For four consecutive nights, she performed in her dance studio’s annual showcase. “It was amazing,” Tracey said. “She just had brain surgery, and there she was back on the stage. She had even learned all of the new choreography.” Seven months post-surgery, an MRI showed that Olivia’s brain had fully healed, and an electroencephalogram (EEG) showed no further signs of seizure activity. “I’m back to 100 percent now,” said Olivia, now a high school senior. “It’s funny because sometimes my teachers will say, ‘Come on, this isn’t brain surgery,’ and I’m thinking, ‘I’ve been through that!’” UChicago Medicine’s nationally recognized Comprehensive Stroke Center includes a team of neurologists, neurointensive care specialists, neurosurgeons, neuroradiologists, therapists and social workers providing comprehensive care. To make an appointment, call 1-773-702-6222 or visit UChicagoMedicine.org/Stroke-Center
Cerebral cavernous malformation (CCM) is an underdiagnosed condition that affects more than 1 million Americans. UChicago Medicine was recognized by the Angioma Alliance as the nation’s first Center of Excellence in CCM care. | L E F T | Issam Awad, MD
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Coping with celiac disease
The Bourkes at home, from left: Sean, Clodagh, Niamh and Renee, along with the family’s dog, Rocky
Niamh Bourke’s troubles with food began when she was a baby. Her organic formula made her throw up, and the stomach problems persisted when she started solid foods. She also seemed to be growing slowly, not getting her first tooth until she was 14 months old. An online search convinced Renee Bourke that her youngest daughter might have celiac disease, but the family’s pediatrician was skeptical. When Niamh was 4, things took a turn for the worse.
“She started being sent home from school, screaming with stomach pain,” Renee said. Celiac disease is an inherited autoimmune disease that affects the digestive process. When someone with celiac disease consumes gluten — a protein found in wheat, rye and barley — the immune system attacks the small intestine, stopping the absorption of important nutrients into the body. The only treatment is to avoid all foods containing gluten. Children with celiac disease typically have symptoms such as abdominal pain, diarrhea and weight loss. But some children, as well as some adults, with celiac disease have no symptoms.
| B E L OW | Niamh, 6, and Clodagh, 8, prepare a gluten-free snack.
Gluten is a protein found in wheat, rye and barley — common ingredients in breads, pastas and cereals. But gluten can also turn up in surprising foods, including ice cream, hot dogs and salad dressing.
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“Symptoms of celiac disease can vary. You can have gastrointestinal symptoms and non-gastrointestinal symptoms,” said Ritu Verma, MD, Medical Director of the University of Chicago Medicine Celiac Disease Center. For example, non-GI symptoms may include headaches, short stature, rashes and tooth enamel defects. “That is why it’s truly so difficult to make the official celiac diagnosis.” Niamh was diagnosed in March 2018 at another hospital, but the Northwest Side family wasn’t satisfied with the follow-up care. Renee posted in a Facebook parents’ group asking for suggestions of where to take her daughter for celiac disease care.
“It was continuous replies saying, “It’s worth the drive, go to the University of Chicago,” Renee said. The internationally recognized UChicago Medicine Celiac Disease Center offers expert clinical care for adults and children with celiac disease and conducts groundbreaking research aimed at finding a cure. At UChicago Medicine Comer Children’s Hospital, Niamh’s care team included a physician, nurse and dietitian. “After we come to an official diagnosis, we’re all in the same room, listening to the family, providing education and support,” Verma said.
The team helped the family learn how to manage Niamh’s diagnosis and gluten-free diet. Today, Niamh, now 6, is healthy and thriving. The good news is that for almost all children, the lining of the intestine heals fully after gluten is eliminated from the diet. The Bourkes even consulted with the celiac center experts when they decided to get a dog, and wondered: Would the dog’s food pose a cross-contamination risk? To be safe, Rocky, a German Shepherd mix, eats gluten-free food, too. “We didn’t even think about it until we had to buy dog food,” Renee said, “but we called the office and they helped us figure it out.”
On the horizon RESEARCHERS ARE STUDYING:
» Pills taken before or while eating that would make the small intestine less permeable to gluten or break it down before it reaches the small intestine. » Medication to quench the inflammatory response of the intestine to gluten. Learn more at cureceliacdisease.org
CELIAC DISEASE AFFECTS AT LEAST 1 PERCENT OF AMERICANS, OR NEARLY 3 MILLION PEOPLE IN THE U.S.
Is it celiac disease, or something else? Despite awareness efforts, celiac disease is often confused with other glutenrelated disorders — like non-celiac gluten sensitivity and wheat allergy. While the symptoms may be similar, these distinct medical conditions require different types of care. “When people have symptoms, it’s important that they go to a doctor right away for the proper diagnosis, and not just diagnose it themselves and start a gluten-free diet,” said pediatric gastroenterologist Ritu Verma, MD, Medical Director of the University of Chicago Medicine Celiac Disease Center.
Celiac disease A genetic, autoimmune disease where ingested gluten damages the small intestine. Left untreated, it can lead to other health problems, such as thyroid disorders, low bone density and intestinal
WHAT IT IS:
cancers. Diagnosis requires a screening blood test and small intestine biopsy. SYMPTOMS: They’re extremely varied. Symptoms can be gastrointestinal (diarrhea, abdominal pain, etc.) and nongastrointestinal (chronic headaches, certain rashes, poor growth, etc.), or a person could be asymptomatic.
It involves complete gluten restriction and careful avoidance of cross-contamination. Celiac disease also can run in families, so it’s important that family members be screened.
WHAT SETS IT APART:
Lifelong gluten restriction and follow-up care. A dietitian and medical providers need to assist with information about food choices, reading labels and lifestyle adjustments.
TREATMENT:
Non-celiac gluten sensitivity (NCGS) Gastrointestinal (GI) and nonGI problems related to gluten consumption, but blood tests and biopsies test negative for celiac disease and wheat allergies. WHAT IT IS:
SYMPTOMS: Similar to celiac disease, with GI and non-GI symptoms like abdominal pain, bloating and fatigue.
Blood tests are negative and biopsies are normal, despite
WHAT SETS IT APART: Ritu Verma, MD
eating gluten. Some gluten consumption is OK, up to the level that causes symptoms. People with NCGS don’t have to be as restrictive with gluten and crosscontamination as people with celiac disease do. Identify the threshold amount of gluten causing the symptoms, and remove it from the diet. Symptoms will improve on a gluten-free diet, but it’s still important to meet with a dietitian to avoid vitamin and nutritional deficiencies.
TREATMENT:
Gluten (wheat, rye or barley) allergy An immediate allergic reaction to foods containing wheat, rye or barley.
WHAT IT IS:
Itching, hives, trouble breathing or anaphylaxis (a life-threatening reaction), nausea, abdominal pain, itching, and swelling lips or tongue. SYMPTOMS:
It’s the only gluten-related reaction helped by EpiPens (injectable epinephrine). Patients are treated by allergists rather than gastrointestinal doctors. WHAT SETS IT APART:
Avoidance of allergy-causing food. An EpiPen could be used to stop a severe allergic reaction. Dietitians can help patients remove the problematic gluten from their diet.
TREATMENT:
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Eating and drinking with GERD A diagnosis of gastroesophageal reflux disease (GERD) doesn’t have to stop you from eating many of your favorite foods. Learning how to manage your GERD triggers can help you enjoy food without feeling the sting of acid reflux. “When it comes to what we eat and drink, it is important to remember the saying: everything in moderation,” said Robert Kavitt, MD, MPH, Director of the Center for Esophageal Diseases at the University of Chicago Medicine. GERD is a digestive disorder that occurs when stomach acid flows back into the esophagus — the tube connecting the mouth and stomach. Many people experience mild heartburn once in a while. For a diagnosis of GERD, someone must have mild acid reflux that occurs at least twice a week or severe acid reflux at least once a week. Treatment options include diet and lifestyle changes (including weight loss), medication and, in some cases, surgery.
UChicago Medicine is home to one of the few centers in the U.S. dedicated to diagnosing and treating esophageal disorders, including GERD.
Our experts offer these tips: Eat slowly and don’t overeat. Research has shown that rapid food intake produces more GERD episodes than when people eat more slowly. Eating slowly allows your body time to feel full, which will decrease your chances of overeating. Overeating puts pressure on the lower esophageal sphincter muscle (LES), a ring-like muscle that acts as a valve between the esophagus and stomach. When the LES is weakened, acid can flow back into the esophagus and trigger a GERD episode.
Robert Kavitt, MD, MPH
Avoid eating for three to four hours before bed. It’s more difficult for your food to digest when you’re lying down, so eating earlier and staying upright will allow it time to break down.
Yalini Vigneswaran, MD
Drink more water. Minimize carbonated beverages and alcohol. “Carbonated beverages and alcohol can cause relaxation of the LES muscle and trigger GERD,” said Yalini Vigneswaran, MD, a gastrointestinal surgeon who specializes in esophageal and gastric disorders. “If you drink more water, it will clear the esophagus and reduce reflux.”
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Avoid your triggers. While everyone may have different triggers, a few of the common foods and drinks that can lead to a GERD episode are: » garlic » raw onions » chocolate » red wine » peppermint » citrus fruits Keep your preferred antacid on standby. “Prepare for a potential GERD episode by keeping your over-the-counter antacids or medicine prescribed by your doctor handy,” Vigneswaran said. Don’t be afraid of food. Having GERD doesn’t mean you have to stop dining out or avoid food-centered special occasions. “We want you to be able to enjoy yourself,” Vigneswaran said. “Being mindful of what and how you eat will help you do so.” LEARN MORE
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Do you have shin splints — or a stress fracture? In time for running season, here’s what you need to know about how to prevent and treat these common overuse injuries. Both shin splints and stress fractures are usually caused by training errors and running too much, too quickly, said Brendon Ross, DO, a primary care sports medicine specialist at the University of Chicago Medicine. Poorly fitting footwear, running on hard surfaces, and a lack of flexibility and muscle imbalance also can play a role. The lower leg pain of shin splints is caused by inflammation and micro-tears in muscular attachments and tissue around the shin. A stress fracture is a tiny crack in the bone and usually occurs in the lower leg, hip or foot. In making the diagnosis, Ross starts with a complete history from athletes about their running routine, including mileage, intensity, pace, terrain and footwear, as well as any recent changes in training regimen.
Shin splints This condition — medial tibial stress syndrome, or MTSS — is common among new runners, runners returning to the sport after an extended break and runners who have rapidly increased their mileage and training intensity. Lower leg pain while running, especially at faster speeds. Shin splints don’t
SYMPTOMS:
usually cause pain while walking or during daily, non-running activities. The pain often goes away once running is stopped. Ross starts runners with rest, ice and anti-inflammatory medication for pain. Stretching and low-impact activities that don’t cause pain, like swimming and cycling, can help maintain strength and conditioning. Sometimes, decreasing running frequency, distance and intensity by half can improve symptoms while allowing someone to keep running.
TREATMENT:
Runners should return to their running program slowly, increasing the load by no more than 10 percent per week. Flexibility exercises and strength training are also very important as part of the comprehensive treatment plan and to prevent recurrence.
Stress fractures Stress fractures result from cumulative strain on the bone, without enough time for proper recovery. Eventually, the bone weakens and becomes susceptible to tiny cracks, or stress fractures.
Preventing
shin splints and stress fractures » Don’t do too much, too quickly. If you’re new to running, start with a run/ walk regimen. Consult a physical therapist, coach or personal trainer to set up a smart running program. » Don’t run through pain. » Slowly ramp up your training regimen, adding 10 percent maximum (mileage, intensity) per week. » Cross-train with a focus on strength and resistance training, especially for the core, hips and legs. » Maintain overall flexibility with a good stretching program. » Ice after runs if you are sore, and avoid hard surfaces when possible. » Properly fitting running shoes are essential. Orthotics also may be helpful. » Ensure a well-balanced diet with adequate calorie intake for your activity level and target a healthy body weight.
Pain while running, but over time, runners also will experience pain while walking and doing other activities. If the stress injury is significant, pain may persist at rest, too. Pain is often localized in one spot, rather than spread out over a small area, as with shin splints. SYMPTOMS:
Runners with a stress fracture have to stop running until it heals. To ensure proper healing, Ross often places the runner in a walking boot and may even add crutches. Anti-inflammatory medication is used for pain. After several weeks, runners can gradually return to pain-free activities, while addressing risk factors that may have contributed to the stress fracture. These include a proper diet with enough calories as well as calcium and vitamin D supplementation to optimize bone health.
TREATMENT:
Brendon Ross, DO
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Nicole and Larry Leon with baby Baker
Six months to live. Then a chance for life, love and a baby named Baker.
For two years, Nicole Leon worked out hard six days a week, sweating on an indoor bike trying to lose weight that wouldn’t go away. In October 2016, after a bout of food poisoning sent her to the emergency room, she found out what was wrong: A mass on her liver the size of a football. A biopsy of the tumor came back as hepatocellular cancer, the most common type of liver cancer. At the time, Leon was 32, living in Chicago and enjoying a busy social life and successful career in human resources. Doctors told her she had six months to live. “They said it was so large it had gone over the hepatic artery and that it was inoperable,” she said. “The doctors didn’t know when or why the tumor had started growing, and
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they suggested I go into palliative care.”
liver cancer, bile duct cancer or benign liver tumors.
That answer wasn’t acceptable to Leon, who flew across the country for a second opinion. This time, she was told she had several tumors that couldn’t be surgically removed.
The multidisciplinary team is led by liver specialist Anjana Pillai, MD, and liver transplant surgeon Talia B. Baker, MD.
In January 2017, a friend told Leon about the University of Chicago Medicine’s comprehensive Liver Tumor Program, which brings together medical and surgical liver experts along with cancer specialists to offer personalized care for patients with primary
Leon met with both physicians, who told her surgical removal of the tumor was possible. Baker recommended to Leon’s previous doctor a one-time treatment called radiation embolization to reduce the size of the tumor prior to surgery. Radioactive
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Dr. Baker was the only one in the world willing to operate on me and give me another chance at life.” Talia B. Baker, MD, holds her namesake, Baker Leon.
particles are delivered to the tumor to kill cancer cells and block the blood flow the cancer needs to grow. “We were hopeful that we could do this,” Baker said. “I’ve operated often after liverdirected radiation therapy, and we know that if the liver and the tumor responded well to the treatment, the more likely it is we will be able to successfully remove the entire tumor.” In February 2017, Baker performed an extended hepatectomy, a procedure to remove all of the tumor and more than 80 percent of Leon’s liver. This left about 20 percent of the liver to regenerate. The surgery was a success, and today Leon has close to 100 percent of her liver volume back and normal liver function. “Dr. Baker was the only one in the world willing to operate on me and give me
NICOLE LEON
another chance at life,” Leon said. Baker credits the effective approach to Leon’s care to the collaboration made possible through the Liver Tumor Program, which includes surgeons, hepatologists, medical and radiation oncologists, transplant specialists, interventional radiologists, pain specialists and other experts. The team also includes a research coordinator to enroll patients in clinical trials and a nurse navigator to help with scheduling appointments and coordinating treatment and communication among physicians. “This type of program is rare,” Pillai said. “It’s how we should be treating many of these cancers — in a multidisciplinary fashion — and more centers are leaning toward it.” Two months after her surgery, Nicole became engaged to Larry Leon, who stayed by her side before, during and after the
procedure. In August 2018, the two were married. And last summer, she gave birth to a baby boy after an uncomplicated, but carefully monitored pregnancy. The couple named their son Baker. “Dr. Baker saved my life and allowed me to have a second chance — to get married and start a family and move on,” Leon said. “Baker is our miracle baby. We didn’t even know if I’d be able to get pregnant, and I’m forever grateful to Dr. Baker and her team and UChicago Medicine for taking on my case and allowing me to live.” At a follow-up appointment in August 2019, Leon, then approaching three years cancer-free, brought baby Baker in to meet his namesake and Pillai. “I am honored and grateful that I was able to touch Nicole’s life,” Baker said.
Anjana Pillai, MD, left, and Talia B. Baker, MD, lead the University of Chicago Medicine’s multidisciplinary Liver Tumor Program.
UChicago Medicine Liver Tumor Program HYDE PARK Duchossois Center for Advanced Medicine ORLAND PARK 14290 S. La Grange Road LEARN MORE UChicagoMedicine.org/liver-tumor-clinic MAKE AN APPOINTMENT
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WAYS TO LOWER YOUR RISK FOR CANCER HELP PREVENT CANCER
1. Quit Smoking. Tobacco use increases the risk for many kinds of cancer and other diseases. Quitting smoking can lower your risk for cancer within 5 years. Talk with your doctor about getting help to quit smoking.
2. Vaccinate. The human papillomavirus (HPV) vaccine is recommended for anyone between 9 and 45 years old. It helps prevent multiple kinds of cancer, including cervical, anal, and head and neck. The hepatitis B vaccine helps prevent liver cancer.
3. Protect Yourself from the Sun. Ultraviolet radiation from the sun’s rays can cause skin cancer, including basal and squamous cell carcinomas and melanoma. Use sunscreen with SPF of 30 or higher when outside. Do not use tanning beds and lamps.
4. Exercise. Higher body weight and an inactive lifestyle are associated with increased cancer risk. One to 2 hours of moderate-to-hard physical activity every week can lower your risk, as can losing even a few pounds.
5. Eat Healthy. Studies have linked red and processed meats to colorectal cancer risk. Diets high in vegetables, fruits and whole grains (and low in red and processed meats) are linked with lower colorectal cancer risk.
6. Moderate Alcohol Intake. Alcohol raises the risk for oral, throat, esophageal, liver, breast and colon cancers. Even 3 to 4 drinks a week increase your risk. Make informed decisions about when and how much you drink.
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The possibility of getting cancer is affected by many factors, including age, lifestyle, weight, where you live and your surroundings, and family history. Some things cannot be controlled. However, you can take steps to lower your risk.
CATCH CANCER EARLY 7. Lung Cancer. If you smoke now or you are a former smoker over 55, talk to your doctor about lung cancer screening. People with a history of exposure to secondhand smoke should talk with a doctor about testing.
8. Colorectal Cancer. Yearly testing of a sample of your bowel movement or a colonoscopy every 10 years can catch colorectal cancers and pre-cancers early. Talk to your doctor about getting tested after 45 years of age.
9. Breast Cancer. Talk to your doctor about getting a yearly mammogram if you are a woman over 45. If you have a known BRCA mutation or other factors linked to increased risk, you should start getting a yearly mammogram at age 30.
10. Skin Cancer. Watch your skin for changes. See your doctor if you notice changes in the size, appearance or number of moles you have. A visual test or biopsy from a dermatologist can tell if it is cancer.
11. Cervical Cancer. Every 3 years, women over 21 should have the Pap test. After age 30, women should get both the Pap and the HPV test every 3 to 5 years. Follow up with your doctor about any test result that is not normal.
12. Prostate Cancer. Risk factors for prostate cancer are different for each person based on family history and ethnicity. Men over 45 who are at higher risk should be tested. Men at average risk should talk to their doctor about whether testing is needed.
Are you and your loved ones up to date on cancer screening? Find out about screening options for different types of cancer and how to schedule an appointment by calling 1-855-702-8222. To learn more, visit UChicagoMedicine.org/cancer and cancer.org/healthy
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ASK T HE E XPE R T
Dense breasts and breast cancer: What every woman should know About half of women have dense breasts, which increases the risk for breast cancer — and can make cancer harder to detect. Illinois state law requires patients to be notified when a mammogram indicates they have dense breasts, and insurance companies must cover supplemental screening exams if needed. Still, many women don’t know whether they have dense breasts and how that affects breast cancer screenings. Radiologist Deepa Sheth, MD, who specializes in breast imaging at the University of Chicago Medicine, explains what dense breast tissue means and why it matters. WHAT ARE DENSE BREASTS, AND WHY SHOULD WOMEN KNOW WHETHER THEY HAVE THEM?
Dense breasts have a higher proportion of glandular tissue to fatty tissue. We get worked up about dense breast tissue for two reasons: Having dense breasts inherently increases your risk for breast cancer by two to four times, and the denser your breasts are, the harder it is for radiologists to spot cancer. The reason for this is that dense breasts look white on imaging, as can cancer. So white on white makes it hard for me, as a radiologist, to see through that dense breast tissue to find the cancer. CAN A WOMAN FIGURE OUT ON HER OWN IF SHE HAS DENSE BREASTS — ARE THEY THE SAME AS FIRM BREASTS?
No, and you can’t tell just by feeling. The biggest factors are age and genes: Younger females traditionally have denser breast tissue. After menopause, a woman’s breast density usually decreases, unless she is taking hormone replacement therapy. In addition, genes play an important role in breast density; if your mom had dense breast tissue, you’re more likely to have it.
12 » THE UNIVERSITY OF CHICAGO MEDICINE
HOW DO DENSE BREASTS AFFECT SELF-EXAMS?
Dense breast tissue cannot be felt in a clinical breast exam or in a breast self-exam. But let’s talk about breast self-exams: They’re falling out of vogue and are no longer included in the U.S. Preventive Services Task Force (USPSTF) guidelines. What matters is getting comfortable with what your breasts feel like. No breast feels the same; it’s like a fingerprint. What you’re looking for is a change. If all of a sudden you feel a ball or a mass you’ve never felt before, that’s something you need to bring to the attention of your doctor. IF A WOMAN HAS DENSE BREASTS, WHAT ARE HER OPTIONS FOR BREAST CANCER SCREENING?
The first option is 3D mammography, or tomosynthesis. This imaging creates 1 millimeter “slices” of your breasts, meaning the radiologist can have 90 to 100 images to scroll through and scrutinize for cancer through that dense breast tissue. The second option is automated whole breast ultrasound. For this, you lay comfortably on a bed, ultrasound gel is put on you and a probe is gently moved across each breast for five to 10 minutes. The final option is a breast MRI. For this, you lie on your belly and your breasts fit through circular coils that help pick up the magnetic signal that’s being emitted through your breast tissue to show images on an MRI.
UChicago Medicine locations called SmartCurve paddles hug the breast instead of mashing it into a pancake. The other concern is gadolinium, the contrast agent we inject in patients for breast MRIs. Last year, the FDA discovered patients had gadolinium retention in their brain and bodies, most marked in patients with multiple MRIs. However, the FDA stated that there are no known long-term effects from this retention and deposition. There are now newer contrast agents coming out — one of which is in phase 3 clinical trials here at UChicago Medicine — that are supposed to have no retention and deposition. So, I think these fears are starting to decrease. IF THESE TESTS ARE COVERED BY INSURANCE IN ILLINOIS, WHICH ONE SHOULD YOU GET?
In the era of personalized medicine, we have all these amazing tools, and we want to pick the right one for you. Talk to your radiologist about what would be best. If you already have dense breast tissue documented on a prior mammogram, you should consider getting a 3D mammogram on your next screening and perhaps add an automated whole breast ultrasound or breast MRI to your regimen. The key is to understand your risks and know that there are tools out there to help you.
WHAT ARE SOME OF THE MORE TALKED-ABOUT DRAWBACKS TO THESE DIFFERENT TESTS?
Many women fear how tight their breasts will be squeezed in a mammogram. When we compress the breast, we’re reducing its thickness and, subsequently, the amount of radiation needed to get a good picture. Now, new technology available at
The Forefront | S P R I N G 2 0 2 0
Deepa Sheth, MD
Doctors classify breast density into four categories:
| A B O V E | Lead mammography technologist Giselle Anderson, right,
explains the SmartCurve System in the mammography clinic on UChicago Medicine’s Hyde Park campus.
CLASS A
Almost entirely fatty breast tissue (about 10% of women)
CLASS B
Scattered areas of dense glandular tissue and fibrous connective tissue (about 40% of women)
Making mammograms more comfortable and convenient UChicago Medicine now offers SmartCurve technology, developed by Hologic in partnership with Solis Mammography. This unique technology uses curved compression paddles, shaped like a woman’s breast, and a SmartCurve Breast Stabilization System with 3D imaging. It can be used by the vast majority of women, with the exception of those who have very small or large breasts or certain types of implants. UChicago Medicine has upgraded its mammogram machines to include high-tech 3D models, and SmartCurve paddles have already been added to many of them. They’re in use in the newly renovated mammography clinic in the Duchossois Center for Advanced Medicine (DCAM) in Hyde Park and at UChicago Medicine Orland Park.
CLASS C
Heterogeneously dense breast tissue, with many areas of glandular tissue and fibrous connective tissue (about 40% of women)
CLASS D
Extremely dense breast tissue (about 10% of women)
Women with heterogeneously dense or extremely dense breasts must be notified, and some may need follow-up exams. Sources: UChicago Medicine Department of Radiology images, cancer.gov
SmartCurve System mammograms will be available in spring 2020 at UChicago Medicine’s new River East location. In March 2020, UChicago Medicine Orland Park will open a new Comprehensive Breast Imaging Suite as part of a joint venture with Solis Mammography. The 3,500-square-foot facility plans to offer screening and diagnostic mammography, breast ultrasound and bone density scanning.
To schedule a mammogram, call 1-888-824-0200 U C M C O N N E C T 1 - 8 8 8 - 8 2 4 - 0 2 0 0 | UCHICAGOMEDICINE.ORG » 13
NEWS SHARON O’KEEFE,
President of the University of Chicago Medical Center, was honored with the Woman of Heart Award at the 2020 Chicago Go Red for Women Executive Luncheon. O’Keefe was recognized by the American Heart Association for her outstanding vision, dedication and commitment to the fight against heart disease and stroke.
HONORS
Named to Crain’s Chicago Business’ 2019 Notable Women in Health Care from UChicago Medicine: Cancer researcher MARSHA ROSNER, PHD; food allergy researcher CATHRYN NAGLER, PHD, President and co-founder, ClostraBio; and KRISTA CURELL, Vice President, Risk Management and Patient Safety, and Chief Compliance Officer.
PHYSICIAN SPOTLIGHT The European Society for Medical Oncology honored hematologist-oncologist THOMAS GAJEWSKI, MD, PHD, with the 2019 Immuno-Oncology award acknowledging his groundbreaking work in uncovering why some cancer patients are resistant to immunotherapy and how to restore the anticancer immune response. Anesthesiologist JEROME received the 2019 Excellence in Education Award from the American Society of Anesthesiologists in recognition of his significant contributions to undergraduate and graduate medical education in his specialty.
KLAFTA, MD,
The American Society of Clinical Oncology (ASCO) has elected EVERETT VOKES, MD, as its President for the 2021-22 term and TARA HENDERSON, MD, MPH, to its Board of Directors for the 2020-24 term. Vokes, an internationally renowned expert in head and neck and lung cancer, is Physician-in-Chief at the University of Chicago Medicine. Henderson directs UChicago Medicine’s Childhood Cancer Survivor Center and serves as Director of Survivorship for the UChicago Medicine Comprehensive Cancer Center. The world’s leading organization of its kind, ASCO represents physicians from all cancer subspecialties.
LEADERSHIP
Artificial intelligence software developed by University of Chicago Medicine researchers to help radiologists more accurately diagnose breast cancer made TIME’s list of Best Inventions for 2019. The technology is based on two decades of research by MARYELLEN GIGER, PHD, a pioneer in computer-aided diagnosis. 14 » THE UNIVERSITY OF CHICAGO MEDICINE
RANDY NEISWONGER joined the University of Chicago Medicine as Chief Operating Officer of its Community Health and Hospital Division and Vice President of Operations for Ingalls Memorial Hospital. JEAN VANDER SANDEN, DPT, MS, PT,
is the Executive Director leading the UChicago Medicine and Shirley Ryan AbilityLab alliance.
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NOW ACCEPTING APPOINTMENTS NEW PHYSICIANS Gastrointestinal surgery YALINI VIGNESWARAN, MD, MS
Head and neck surgery BRANDON BAIRD, MD CHRISTOPHER ROXBURY, MD
» Primary care » Women’s care » Specialty care A wide range of procedures will be available in dermatology, plastic and cosmetic surgery, gastroenterology (including minimally invasive weight loss procedures) and minimally invasive gynecologic surgery. Screenings will include 3D mammography using SmartCurve technology for improved comfort and bone density scans.
MOSTAFA EL DAFRAWY, MD
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Ophthalmology PATHIK AMIN, OD MARY QIU, MD Emily Doll, MD
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Psychiatry MOLLY ERICKSON, PHD
» General pediatrics » Neurology and neurosurgery » Pediatric gastroenterology and plastic surgery » Vein clinic and vascular lab To make an appointment, call 1-877-336-5667
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Sonya Prowell, 42, felt pain spreading in her arm and started sweating “like I had just run a race.” Because she had suffered a heart attack eight years earlier, she recognized the symptoms.
Sonya Prowell with Marcus, her 1-year-old grandson
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“Sonya had the procedure within 64 minutes of her arrival to the hospital,” said Trish Martinez, BSN, RN, chest pain coordinator for Ingalls. “The quick actions by the paramedics, along with quickly moving the patient through our emergency room and into the cardiac catheterization lab, were nothing less than stellar. As a result, her cardiac muscle was saved exponentially.” ambulatory_vascular_8.25x10.75.indd 1
Prowell was able to go home after two days in the hospital and soon began working out at the Ingalls cardiac rehabilitation gym. The Calumet Park resident, who cares
for her two grandchildren, recently quit smoking after 22 years. She is determined to adopt a healthier lifestyle with better food choices and regular exercise. “I had a heart attack at 33 and 42 years old,” Prowell said. “You don’t see that every day. But with both heart attacks, I had faith in God. I prayed for my life, and God spared it both times.” Ripple Doshi, MD, is an independent medical practitioner and is not an employee or agent of Ingalls Memorial Hospital or University of Chicago Medical Center (“UChicago Medicine”).
Too weak to stand up, Prowell asked her husband to call 911. “I knew I might not make it to the hospital if we didn’t call an ambulance,” she said. The staff at the University of Chicago Medicine Ingalls Memorial Emergency Department in Harvey quickly assessed Prowell’s condition and transported her to the cardiac catheterization lab. Interventional cardiologist Ripple Doshi, MD, performed a balloon angioplasty to restore blood flow through her arteries. As an American College of Cardiologyaccredited Chest Pain Center, Ingalls Memorial is required to achieve a benchmark of 90 minutes from first medical contact to a balloon inflation when a patient is having a heart attack. 16 » THE UNIVERSITY OF CHICAGO MEDICINE
| A B O V E | Sonya Prowell, center, and her UChicago Medicine Ingalls team: Ripple Doshi, MD, left, Tressa Holmes, RN, Elsa Irwin, RN, Alexis Zivo, RN, and Rob Grobowski, radiology technologist
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HEART OF A
Ivan Moskowitz, MD, PhD
CHILD
Foundation inspires community to support research on pediatric heart defects Imagine holding your newborn and hearing from the pediatrician that your baby has a heart malformation, known as congenital heart disease (CHD). About 40,000 parents in the U.S. will get this news every year. CHD is the most common birth defect, affecting about one in 100 newborns. It occurs when the heart or blood vessels near the heart don’t develop normally during pregnancy. Defects can range from a small hole in the heart to issues with the heart’s muscles or poor connections among the heart’s blood vessels. While some infants with CHD do not have any symptoms, others experience life-threatening conditions, such as heart failure, and some babies die. In other cases, signs and symptoms of CHD may not appear until years after birth. While physicians don’t always know why an infant develops CHD, the condition often runs in families, signifying a genetic cause. At the University of Chicago Medicine, Ivan Moskowitz, MD, PhD, a professor of pediatrics and pathology, is investigating the genetic causes of CHD in an effort to improve diagnosis and
treatment of children born with this condition. Moskowitz and his team are studying signaling pathways in the heart — groups of molecules that travel from one cell to another to control what the receiving cell does during organ development. When a signaling pathway fails, it can lead to serious problems in heart development. That’s why the Heart of a Child Foundation, founded by Rashida and Raghu Mendu, supports his work and is encouraging support from the community. The foundation focuses on advancing research like Moskowitz’s to find the causes of CHD and improve care of children born with heart defects. In concert with Congenital Heart Defect (CHD) Awareness Week in February, the foundation created a Giving Challenge to raise $30,000 from 100 donors in support of Moskowitz’s research. Last year, the Heart of a Child Foundation sponsored a Giving Challenge, pledging a $100,000 donation and encouraging others to support Moskowitz’s research. More than $23,000 was raised from outside support. The foundation’s goal is to raise awareness and advance CHD research that can lead to effective interventions to save children’s lives.
DONATE NOW We are discovering how genes and teams of genes work together within a developing heart.” IVAN M OSKOWITZ , M D, PH D
Join the Heart of a Child Foundation in support of Dr. Moskowitz by making a gift to support promising CHD research at giving.uchicago.edu/chd.
NONPROFIT ORGANIZATION U.S. POSTAGE PAID CAROL STREAM, IL PERMIT NO. 2003
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