“Breast cancer is a very heterogeneous disease,” says radiation oncologist, Janice Kim, MD, MS, who treats breast cancer at Fred Hutchinson Cancer Center. “Not all triple negative breast cancers are the same, not all stage IV breast cancers are the same. It’s more complicated than people think.”
Breast cancer affects more than 200,000 people every year in the U.S. There are many factors that may contribute to breast cancer risk, including genetic factors passed from generation to generation, as well as length of exposure to estrogen. This can include estrogen made within the own body during a person’s fertile years, or estrogen-like products in the environment. “As patients and physicians, we want to know exactly what caused the cancer,” says Kim, “but the truth is, it’s multifactorial. We can’t point to one thing and say: ‘Don’t eat red meat,’ or ‘Don’t drink diet Pepsi.’”
Because breast cancer is so varied, it can make screening recommendations difficult and ever changing. Kim tells her patients to go with their intuition. “If you notice something, get it checked out. We are in tune with our bodies, we know best. Sometimes that means we have to advocate for ourselves and insist on screening even if we fall below the recommended age frame,” she adds.
What Kim really appreciates about working at Fred Hutch is that she has access to many forms of radiation to formulate the best possible treatment plan for each individual. “It allows me to look at each person’s exact expression of the breast cancer, as well as their anatomy, to make a determination on treatment,” says Kim. “Proton therapy has the potential to mitigate long lasting side effects. Only a small amount of radiation to the heart can have detrimental effects on the organ, and that can’t be changed after the fact. If I can spare as much radiation as possible to healthy tissue using protons, then that’s what I will do. If photons can be used more effectively, I will use photons.”
Kim is seeing more breast cancer recurrences, not because the original treatment failed, but because patients are living longer. When she sees patients in their 60s and 70s who were treated in their 40s and early 50s, proton therapy allows her to treat the cancer despite the patients’ previous radiation treatment.
“The proton team is exceptional,” says Kim. “I had one case where the dosimetrist came up with a good plan for reirradiation. However, I needed her to improve it in certain areas. When she gave it back to me, she had exceeded all my expectations. I think that the team is a huge factor in the success of treatment."
"The number one thing I want patients to know is that they need to be comfortable with their team. They should feel good about asking questions, feel supported in their decision making. Medicine is an art as well as a science.”
Kim also encourages patients to join clinical trials. Fred Hutch offers many clinical trials to further our understanding of risk, treatment, screening effectiveness and more, including the RADCOMP trial, which is accepting new participants through the end of the year. Because it is such a large and long-lasting trial, it will give a lot of information about the effectiveness of proton therapy for breast cancer. RADCOMP will follow patients for 10 years or more and will look at long-term outcomes from surveys from both the patient and physician perspectives.
“I tell patients that clinical trials are so important to cancer care. By joining, they help future patients get the best possible treatments. It won’t negatively impact their own care, so I encourage them to ask if they are interested,” says Kim.
Where Kim feels the most need for improvement in health care is in access to medicine by marginalized groups. “I absolutely think there is disparity in care for ethnic minorities, LGPTQ+ populations, but also for people with mental illness. I think Fred Hutch is doing a great job with our commitment to diversity, inclusion and equity, but by the time they get to us, it’s often late in the game. A push to get all patients into care quickly regardless of insurance status, age, race, etc., to increase their chance of a successful outcome should be a priority at every clinic, from family care to cancer care.”
We are excited to have T. Martin Ma, MD, PhD, join our clinical staff at Fred Hutchinson Cancer Center – Proton Therapy. Ma recently moved to Seattle with his family after completing his radiation oncology residency at University of California, Los Angeles. Ma specializes in prostate and other genitourinary as well as gynecological cancers at the proton facility and South Lake Union.
Ma was extensively involved in research during his residency and has been involved in multiple prostate cancer clinical trials. One of his goals is to expand clinical trial options and other leading-edge radiation treatment options at Fred Hutch.
“I’m very excited about the future full potential of proton therapy, such as with the improvement of motion management and potential for proton arc therapy,” says Ma.
Ma earned his PhD in neuroscience before he decided to pursue a medical degree. He studied in a neuroscience lab at the Johns Hopkins University School of Medicine with students in a combined MD/PhD program. Their clinical work intrigued him so he shadowed colleagues to see what it was like to be a physician. Through this experience, he developed a deep appreciation of the direct impact a physician has on their patients and decided to apply to medical school.
“I’ve always been interested in oncology, but I learned about radiation oncology fairly late. I became fascinated by the leading-edge technology as well as the intersection with physics in radiation oncology. I also like that in radiation oncology, you create a customized plan for each patient based on their individual anatomy and disease characteristics.,” says Ma.
During his residency, he worked closely with mentors in genitourinary and gynecological cancers, who greatly impacted his career development. He chose to follow that path in his own practice.
Although not originally from the Pacific Northwest, Ma is no stranger to Washington state. He completed his preliminary medicine internship at UW Medicine and his wife grew up in Olympia, WA.
“It made a lot of sense for me to join the faculty at the University of Washington after graduation and to move my family to Washington state,” says Ma. He is impressed by the tremendous growth UW Medicine had in terms of research and clinical care in recent years under the leadership of Ramesh Rengan, MD, PhD, FASTRO, chair of the radiation oncology department. In conjunction with Fred Hutch, radiation oncologists at UW Medicine can offer proton therapy as a treatment option.
“It’s always beneficial to be able to offer patients a choice of treatments,” says Ma. “Patients often do a lot of research on their own and have settled on protons. I am proud to be able to offer that option. It is incredible to work in a place with access to all the leading-edge radiation delivery modalities.”
Outside of work, Ma, and his wife, Hayley, love spending time outdoors, which includes hiking, camping and mountain climbing. Hayley has conquered half of the top 100 mountaineering peaks in Washington state and first introduced Ma to the wonderful world of mountaineering. They have climbed Mt. Rainier together without a guide, as well as Mt. St. Helens, Mt. Adams and the Dolomites in Italy. On their list of future peaks to summit are Mt. Fuji and Mt. Kilimanjaro.
The couple has two young kids – ages 3 and 7 – who are also being introduced to outdoor pursuits.
Ma is also an FAA-certified commercial UAV (unmanned aerial vehicle) pilot and has been flying both camera and racing drones since 2013, when most people had no idea what they were. While flying drones, he wears augmented reality goggles and can control the devices from up to three miles away. Needless to say, he takes along the drones when mountaineering which is always “the icing on the cake.” Ma draws many parallels between treating cancer patients and flying drones, as “both require a thorough understanding of the technology including its limitations, meticulous planning before execution, and importantly, a sense of humility and respect.”
As the days shorten and the weather turns brisk, you may start to think about warm, nostalgic foods of autumn that provide as many health benefits as they are delicious. This includes these antioxidant-rich fruits and vegetables: pomegranate, cauliflower, kale, sweet potato and apple.
Each of these plants offers a knockout combination of nutrition and cancer-fighting properties and can be prepared in many different delicious ways. Soups can be especially heartening, and they are easy to swallow and digest – plus many soups and be made once and frozen to eat later.
Each of these plants offers a knockout combination of nutrition and cancer-fighting properties and can be prepared in many delicious ways. Soups can be especially hearty and are easy to swallow and digest – plus many soups and be made once and frozen to eat later. Read on for fall recipes from Fred Hutch’s Cook for Your Life.
Let’s start with pomegranates, which are loaded with vitamins C and K, folate, fiber and potassium. They also contain a potential cancer-fighting ingredient called ellagic acid. Pomegranates taste fresh and tart and add a nice balance to both savory and sweet foods. This fall, try this curried quinoa with eggplant and pomegranate recipe. Quinoa can be a great food for cancer patients as it is a complete protein which can help heal the body.
For a velvety soup, try roasted cauliflower and goat cheese soup. It provides the vitamin punch of cauliflower combined with the easier-to-digest benefit of a mild, soft goat cheese. Cauliflower is part of a group of plants called cruciferous vegetables that include broccoli, Brussels sprouts, cabbage and more, which contain high amounts of carotenoids, vitamins C and K, folate, manganese potassium, fiber and phytonutrients known as glucosinolates. Glucosinates may protect cells from DNA damage, inactivate carcinogens and have antiviral and antibacterial effects, though human studies are still ongoing.
In this sweet potato and kale farinata recipe, we combine kale and sweet potatoes for a super healthy and tasty lunch snack. Farinata is an Italian flatbread like an eggless frittata made with chickpea flour. Like cauliflower, kale is also packed with anti-inflammatory nutrients. And for breast-, prostate- and colon-cancer-fighting benefits, you can’t beat sweet potatoes because they are loaded with vitamins A and C, fiber and manganese. Farinata is tasty right out of the oven, or at room temperature as part of a packed lunch. You can also eat wedges of farinata with soup.
And to end on a sweet note, try this fall apple crisp for dessert. Apples may not sound like “superfood,” but they are above average. They contain quercetin, epicatechin, and procyanidin— nutrients that may help prevent or inhibit cancer cell growth. They also have lots of vitamin C and both soluble and insoluble fiber. In this recipe, you also get the anti-inflammatory benefit of cinnamon and the antioxidant power and sweetness of cherries.
The recipes included in this story all adhere to standards established by the Academy of Nutrition and Dietetics. For more recipes and nutrition resources, visit the Cook for Your Life website. Please consult with your care team before making any dietary changes as some foods may not be appropriate for all patients.
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