Like many women in their 40s, Penny Pagels is concerned about breast cancer and gets an annual mammogram. She also wonders whether the fact that her mother had breast cancer means that her own risk is higher than average.
"There are no other cases of cancer in my extended family," said Pagels, program manager of the Center's Science Education Partnership. "But my mom was an only child, and several of her first cousins were adopted, so I don't really know whether I have a higher than normal risk of cancer. I am very interested in getting more information about my risk."
Information for all
Starting tomorrow, a new clinic on the Hutchinson Center campus will help provide answers — as well as ongoing, comprehensive cancer screening and preventive care — that may help Pagels, and others who may be at risk, stay healthy and cancer-free. The Cancer Prevention Clinic, located on the fourth floor of the Seattle Cancer Care Alliance outpatient clinic, will offer state-of-the-art cancer early detection, risk assessment and counseling services for any Western Washington resident. The clinic will also provide individuals with an opportunity to take part in Center research studies aimed at warding off cancer or spotting it at its earliest stages, when cure rates are highest.
"All individuals need information about their cancer risk," said Dr. Scott Ramsey, clinic director and a member of the Public Health Sciences Division. "But cancer screening is generally applied very haphazardly, and the typical annual physical is not always the ideal setting for a full risk assessment. We think there is an unmet demand for high-quality comprehensive cancer screening and have designed a program we believe will be unique among cancer centers."
Statistics show that about one in every two men and one in every three women can expect to develop cancer during his or her lifetime. Yet experts believe that more than two-thirds of all cancer cases could be prevented if individuals would stop smoking, exercise regularly and make other healthy lifestyle choices such as eating a diet rich in fruits and vegetables. Besides providing cancer-screening tests such as mammograms and colonoscopies, the new clinic will include nutritional consultations and refer smokers to an effective program for kicking the habit.
Many individuals with a relative who has had cancer may be worried about their risk of developing that same disease, Ramsey said. "A woman whose father dies of pancreatic cancer may be very concerned about getting the disease herself. Yet in all likelihood, she has a much higher risk of developing breast cancer or if she's a smoker, a higher risk of lung cancer. We'll provide a personalized risk assessment and screening recommendations for each person."
As a physician, Ramsey knows that preventing cancer or diagnosing it early spares patients and their loved ones from a great deal of pain and suffering. As a health-care economist, he is also well aware that cancer prevention and screening make good economic sense.
"Cancer screening and prevention are among the most cost-effective things we can do in the health-care system, yet they are not applied broadly and often not covered by insurance," he said. "We're happy to spend $100,000 on a drug for treating advanced cancer that may not extend life very much, but we are not willing to invest in cancer screening. I want to bring that cost effectiveness to the community as broadly as I can."
The fact that not all insurers cover preventive care means that some individuals seen at the clinic will have to pay out-of-pocket. Individuals do not need a referral from their primary care physician to make an appointment at the clinic.
"We will work very hard to keep barriers as low as they can be," said Marian Johnson, clinic coordinator.
Ramsey's hope is that eventually the clinic may be able to attract funding that would subsidize costs for those unable to afford screening tests. "As a primary care doctor, it's hard to do cancer prevention. We have an acute-care system. I'm hoping the time is right for people to begin thinking about cancer care in a preventive way."
As excited as he is about the opportunity to offer preventive care to the community, Ramsey and colleague Dr. John Potter, director of the PHS Division, are equally excited about the unprecedented opportunity to directly link the Center's outstanding research in cancer prevention and early detection with clinical care. All patients seen at the clinic will be asked for their consent to be contacted for their willingness to participate in future research studies and to donate blood or other biological samples. They also will be invited to join or be referred to appropriate current research studies that may help them reduce their risk of disease.
The Cancer Prevention Clinic is distinct from the Prevention Center, a research facility in the Arnold Building that was established to help scientists investigate the causes, progression, control, treatment and prevention of disease through studies that often involve volunteer participants.
"Traditionally, doctors are trained to focus on diagnosis and treatment," said Potter, "one of the clinic's earliest proponents. However, we have worked over many decades to accumulate data and tools that allow us to think about practical prevention and early detection. It is so gratifying to see that we can integrate what we do in PHS with the clinical programs right on our own campus."
Initially, the clinic will see patients for a half day each Friday but is poised to expand its services as demand increases. In addition to Ramsey, Drs. Matthew Hollon and John Choe, faculty in the University of Washington Department of Medicine, will provide care at the clinic. The clinic also will provide education for general medical and oncology fellows, who will rotate through the clinic.
Ongoing screening opportunities
The clinic will closely link with the other SCCA services that provide risk assessment for individuals of higher-than-average risk for breast, ovarian and gastrointestinal cancers. However, unlike the high-risk clinics, which provide a one-time consultation and recommendations for follow-up care, the Cancer Prevention Clinic will provide ongoing screening — including for those referred by the high-risk clinics.
Ramsey said that the new clinic puts the Center and the SCCA at the forefront of preventive medicine.
"No cancer center comes close to the Hutchinson Center's leadership in terms of prevention science," Ramsey said. "We are thrilled to now have a means to translate all that research into clinical prevention."
To make an appointment, or for general information, contact the SCCA Intake Office at (206) 288-1024, Marian Johnson at (206) 288-6396 or firstname.lastname@example.org, or visit the clinic Web site at www.seattlecca.org.