Volume 2, Issue 2- Spring/Summer 2002

Americans advised to exercise one hour each day

New dietary guidelines from the Institute of Medicine on fat, protein and carbohydrate intake recommend at least one hour of exercise each day for people who want to stay healthy. This advice doubles the previous recommendation by the surgeon general in 1996 and applies to both adults and children. The committee recommended at least one hour of moderate physical activity daily such as walking, slow swimming, leisurely bicycle riding or golfing without a cart. Recognizing that the lifestyles of many people might make this new goal difficult to achieve, the committee suggested that exercise could be broken up and spread throughout the day.

The dietary guideline also suggested getting 45 percent to 65 percent of calories from carbohydrates (sugars and starches found in foods such as fruit and bread); 20 to 35 percent from fat (meat, dairy products and oils); and 10 to 35 percent from protein (available in meat, eggs, dairy products and some vegetables).

National Academies News, Sept 5, 2002. Report Offers New Eating and Exercise Targets To Reduce Chronic Disease Risk: http://www4.nationalacademies.org/news.nsf/isbn/0309085373?OpenDocument

John D. Potter, MD, PhD	Deb Bowen, PhD	Julie R. Gralow, MD

Hormone Replacement Therapy

As women age and experience the often prolonged and unpleasant effects of menopause, one of the most important and difficult decisions they face is whether or not to take hormone replacement therapy (HRT). In July 2002, new findings were released about one type of postmenopausal hormone therapy that uses estrogen plus progestin (also known as progesterone). The findings offer women important new guidance in considering this type of therapy.

The new findings come from the Women’s Health Initiative (WHI), coordinated from Fred Hutchinson Cancer Research Center in Seattle. WHI is a 15-year study of ways to prevent heart disease, breast and colorectal cancer and osteoporosis in women.

The WHI clinical study which produced the new HRT findings involved 16,608 women, age 50 to 79, with intact uteri, who took either estrogen plus progestin therapy (prescribed under the brand name Prempro) or a placebo (a substance that looks like the real drug but has no biologic effect). The women were enrolled from 40 clinical sites across the country, including Fred Hutchinson Cancer Research Center.

In its most recent review of the study, the WHI Data and Safety Monitoring Board saw an increased risk of breast cancer (in addition to other health problems) in women taking the estrogen plus progestin. Other results from the therapy indicated that this kind of HRT did not protect against heart disease but actually increased risk of heart attacks, stroke and blood clots. Estrogen plus progestin did, however, appear to reduce the risk of colorectal cancer and bone fractures.

How many women were affected?

Only 2.5% of the women in this study experienced these events. These results tell us that during one year, for every 10,000 women taking estrogen plus progestin, we would expect:

• 7 more women with heart attacks. In other words, 37 women taking estrogen plus progestin would have heart attacks compared to 30 women taking placebo.
• 8 more women with strokes.
• 8 more women with breast cancer.
• 18 more women with blood clots.

• 6 fewer colorectal cancers.
• 5 fewer hip fractures.
• Fewer fractures in other bones.

In summary, more women taking estrogen plus progestin had a serious health event than did women taking placebo. It was concluded that estrogen plus progestin does not prevent heart disease and is not beneficial overall.

Because these differences were not greater, the WHI researchers said women who participated in the trial and other women who have taken estrogen and progestin should not be unduly alarmed and urge them to talk with their doctors about their use of this form of HRT.

For more information about study results, please visit the WHI website at: http://www.whi.org.

Disease Rates for Women on Estrogen Plus Progestin or Placebo

Thyroid cancer affects approximately 15,000 women and 5,000 men in the United States each year. It is still not clear why there is a greater incidence of thyroid cancer in women than men, although hormonal influences may be a factor.

The normal function of the thyroid gland is to take up iodine from blood to produce hormones important for regular body function. These hormones primarily regulate metabolism. The thyroid gland is located at the lower part of the front of the neck and is composed of two lobes, one on the right and one on the left.

Thyroid cells normally grow and divide in an orderly way. When this process goes awry, new cells form when the body does not need them and old cells do not die when they should. These extra cells can form a mass of tissue called a growth or a tumor. Most growths are benign and do not spread beyond the thyroid. Occasionally, however, a growth may be malignant. Malignant growths are considered cancerous because they can invade and damage nearby tissues and organs. There are four types of malignant thyroid cancer: papillary, follicular, medullary and anaplastic. Papillary carcinoma is the most common type (75% of thyroid cancer) and is more common in younger people, particularly women. Follicular cell carcinoma is less common (15% of thyroid cancer) and tends to occur in slightly older people. Medullary cell carcinoma is a rare cancer (7% of thyroid cancer) and is sometimes, but not always, hereditary. Rarer still is anaplastic thyroid cancer, which accounts for approximately 3% of thyroid cancer. Thyroid cancer most commonly is diagnosed in people between the ages of 25 and 65.

Thyroid cancer can be hard to detect. In some cases there may be symptoms, including difficulty in swallowing (dysphagia), difficulty in breathing (dyspnoea), and hoarseness of the voice. Often, however, there are no symptoms at all and the disease is found accidentally. Cancer of the thyroid gland is very slow growing and it may be many years before the symptoms become obvious.

The most common cause of thyroid cancer is significant exposure to radiation, either from the environment or as a result of medical treatment where radiation was applied to the head and neck area. Exposure to nuclear radiation can also increase the risk of thyroid cancer quite substantially.

Genetics and family history also play a role in the development of thyroid cancer. For example, although most types of medullary thyroid cancer do not run in families, one type is now known to be inherited and can occur in multiple generations. Hereditary medullary thyroid cancer appears to be caused by a defect in the genetic material (DNA) which leads certain cells in the thyroid gland and parathyroid gland to grow at an increased rate, resulting in tumor formation. In most families with multiple cases of medullary thyroid cancer it is now possible to identify individuals who may be at increased risk of cancer by testing for this gene abnormality, although there currently is no treatment to reverse its effects. People who have a genetic predisposition for certain types of medullary thyroid cancer sometimes choose to have the thyroid gland removed before it has a chance to become cancerous. The decision whether or not to undergo genetic testing is a very individual one and depends very much on personal experience and opinion; the issues are complex and the decision requires careful consideration. Discussing the issues with a genetics professional can be helpful.

Once thyroid cancer has been diagnosed, surgery, followed by radioactive iodine therapy, is most often the first line of treatment. Usually the whole thyroid gland (total thyroidectomy) will need to be removed, although sometimes the removal of only one lobe will be sufficient—the scale of the surgery depends on various factors such as age at diagnosis, size of the lump, and results of other tests. Fortunately, thyroid cancer has a very high survival rate (95% of all thyroid cancer patients achieve long-term survival without reoccurrence).

To learn more about thyroid cancer, ask your doctor or call the Cancer Information Service at 1-800-4-CANCER.

If you need help finding a genetics professional in your area, you can visit the National Society of Genetic Counselors (NSGC) website at http://www.nsgc.org or the Pacific Northwest Regional Genetic Group (PacNoRGG) website at http://mchneighborhood.ichp.edu/pacnorgg/.

The Thyroid Cancer Survivor’s Association (ThyCa) sponsors an annual conference of thyroid cancer survivors. ThyCa’s informational website is http://www.thyca.org.

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The Northwest Cancer Genetics Network (NWCGN) is fortunate to have Dr. Melissa Austin as one of its investigators. Her expertise in genetic epidemiology provides the framework for many interesting research studies in the NWCGN.

Dr. Austin is Professor of Epidemiology in the School of Public Health and Community Medicine and the Director of the Institute for Public Health Genetics (IPHG) at the University of Washington. She is also a faculty member of the Cancer Prevention Research Program at the Fred Hutchinson Cancer Research Center.

In addition to pancreatic cancer and familial cancer syndromes, Dr. Austin's research focuses on the genetic susceptibility to cardiovascular disease and diabetes. She also serves as Director of the Ethical, Legal and Social Implications (ELSI) core of the Center for Ecogenetics and Environmental Health in the UW Department of Environmental Health.

Dr. Austin recently returned from a sabbatical in England with support from the International Atherosclerosis Society and the Department of Epidemiology. During that time, she was an Honorary Visiting Fellow at the University of Cambridge attached to the Public Health Genetics Unit. She was also a Visiting Professor at the Centre for Cardiovascular Genetics at University College London.

We are privileged to have Dr. Austin as a part of our study network and look forward to working with her to answer some fascinating questions about cancer genetics. .

Hundreds of research studies have found that eating fruits and vegetables can help fight cancer, heart disease, and stroke. By eating a minimum of 5 fruits and vegetables per day, you will improve your diet for a longer, healthier life!

Ovarian cancer screening may influence the feelings or quality of life of women at increased genetic risk of ovarian cancer. Several studies have shown that women with a family history of breast or ovarian cancer may have increased levels of emotional distress. For some high risk women participating in a screening program may reduce distress. However, participation in screening could also increase emotional distress in high-risk women because it provides frequent reminders of their high-risk status.

If you are participating in the Ovarian Cancer Early Detection Study (OCEDS), you will be invited to join in this Quality of Life (QOL) survey study. Willing participants are asked to complete a QOL survey every 6 months while in the study to evaluate individual feelings at various times during the screening process.

For those of you not enrolled in the OCEDS study, look for surveys like this in the future. Your feelings and opinions are important to us.

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Ovarian Cancer Early Detection Screening Study Update

The Ovarian Cancer Early Detection Study has been enrolling women for a year now and is progressing on schedule. To date, 137 women in the greater Seattle area are enrolled. The purpose of this study is to determine whether quarterly blood tests and annual ovarian ultrasound can detect ovarian cancer at an early stage in women who are at high-risk for developing this type of cancer. We will continue to approach potentially eligible Northwest Cancer Genetics Network participants for this study in the coming weeks.

You may be eligible for this study if you are over the age of 30 and have a personal and/or family history of breast or ovarian cancer. If you are interested in receiving information about the Ovarian Cancer Early Detection Study or to determine your eligibility, please call 1-800-328-1124.

Thanks to all of you who have shown an interest in participating!

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Avon Foundation Awards $1.25 Million to the Fred Hutchinson Cancer Research Center for the Avon Breast Cancer Immunotherapy Initiative

At the Closing Ceremonies of the Seattle Avon Breast Cancer 3-Day walk, an event which raises money and awareness about breast cancer, the Avon Foundation announced a $1.25 million gift to Fred Hutchinson Cancer Research Center for the Avon Breast Cancer Immunotherapy Research Initiative. The gift will be allocated toward a focused collaborative effort to investigate the immunobiology of breast cancer and to develop immune-based therapies for breast cancer. The initiative will also enhance and expand activities in breast cancer research directed at vaccine development and specific immunotherapy.
http://www.fhcrc.org/news/science/2002/08/11/avon.html

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It's Not About the Bike

It’s Not About the Bike: My Journey Back to Life is a book about the triumph of one man determined to overcome great hardships and come back stronger than ever. The book starts off with an account of the days leading up to and directly following professional bike racer, Lance Armstrong’s, diagnosis with testicular cancer at the age of 25. One of the things that is most impressive about this book is that Lance spares no details when it comes to his illness, treatment or recovery. Armstrong believes that his personal transformation gave him a greater purpose – to be a steward of cancer survivorship. In 1996, he started the Lance Armstrong Foundation (http://www.laf.org/) to benefit cancer research and treatment. Not only has Armstrong survived his cancer to win four consecutive Tour de France Titles (1999-2002), but his foundation has raised over 3 million dollars for cancer research, a triumph for cancer patients the world over.

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Frequently Asked Questions

What is hereditary predisposition?

Where can I get more information about cancer?

You can call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237) and a trained information specialist will answer your questions or send you information at your request.

If you have web access, you can also visit various websites: