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Prevention Remains Among Best Options for Eliminating Cancer Occurrence

At the Podium – July 2007

By Graham Colditz, MD, DrPH

More than half of all cancers can be prevented. That fact has been proved repeatedly over the past 30 years, as research into the causes of cancer has shown that people’s lifestyle choices – smoking, inactivity, obesity, unhealthy diet – increase their risk of developing the disease. In addition, routine screenings such as mammography, PSA testing and colonoscopy have demonstrated their effectiveness in catching cancers early, when there is a much greater chance of treatment success. And medications such as tamoxifen and vaccines for the prevention of cervical cancer are examples of pharmacological advances that are and will have far-reaching benefits for women’s health.

As a National Cancer Institute-designated Comprehensive Cancer Center, the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine is committed to developing a program that advances strategies for cancer prevention and control, particularly in the areas of nicotine dependence and smoking cessation; early detection; and cancer communication and intervention. The center’s commitment to this goal was key in my decision to join its faculty last fall. Following more than 20 years in cancer prevention at Harvard University, I saw my new position at Siteman as a chance to go beyond the work I’d been doing to engage in an even more active translation of research into practice. Siteman has enormous strength in basic science research and in understanding disease processes. The challenge is adding ways to identify cancer risks – both for individuals and within whole communities – and changing behavior to lower risk and improve people’s lives.

In the months ahead, we will take a multidimensional approach to achieving these goals. Among our first efforts is the implementation of Your Disease Risk, an interactive assessment tool now available on the Siteman Web site at yourdiseaserisk.wustl.edu. This easy-to-use, informative tool provides users with a personalized assessment of their risk for 12 different types of cancer as well as diabetes, heart disease, osteoporosis and stroke. It also gives tips on what people can do to lower their specific risk. Other information offered includes explanations of a variety of cancers, risk factor definitions, educational materials and suggestions for actions communities may take to reduce risk.

One of our first research endeavors will be investigating ways to build prevention messages into routine care. In conjunction with Siteman’s Joanne Knight Breast Health Center, we are working to conduct a breast cancer risk assessment for every woman undergoing a screening mammogram at the center. Using information from the assessment, we can give referring healthcare providers risk and prevention strategies for their patients along with their mammogram results.

Once the mammography model is established, it may be tailored for use with other screening procedures, such as colonoscopy, and even replicated in the primary-care setting. We envision a time when patients will complete computerized risk assessments, with results delivered directly into their physicians’ medical record system. This would facilitate the delivery of messages about smoking cessation, increased physical activity and weight management without creating additional demands on providers’ time. Eventually, all of these tools will incorporate the assessment of genetic risk, making them an even more accurate resource for patients and physicians alike.

Along with developing aids to assess cancer risk, we also are focusing on expanding our Program for the Elimination of Cancer Disparities (PECaD). Through this program, Siteman strives to build awareness among underserved patients – including minority, rural and immigrant populations – by expanding working partnerships with local community organizations. A five-year, $1.25 million award from the National Cancer Institute’s Community Networks Program is allowing us to fund disparities-based research, train minority researchers and educate Siteman faculty and staff members about healthcare inequalities.

Among our most interesting undertakings is a continuing collaboration between Siteman and Saint Louis University’s School of Public Health, a relationship that has been in place since Siteman’s inception. This consortium allows us to develop research studies that “marry” the advanced biological science and imaging capabilities of Siteman with the School of Public Health’s expertise in cancer risk communication and evidence-based public health practices. This unique alliance greatly enhances our work in advancing prevention and control.

The beauty of all the programs discussed here – as well as other ongoing prevention and control initiatives at Siteman – is their ability to touch thousands of lives in the St. Louis area, the state of Missouri and the Midwest region as a whole. With them, we can improve access to medical care, create education and screening programs, and establish partnerships with communities. It is an exciting challenge – one I look forward to with enthusiasm.

Graham Colditz

Graham Colditz, MD, DrPH, is Niess-Gain Professor and associate director of prevention and control at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine.

You can hear Dr. Colditz as a guest on Cancer Connection, Siteman Cancer Center's podcast series.