The James Cancer-Free World Podcast

Knowing your family’s medical history is important and can save lives. “When we think of family history in terms of cancer genetics [and inherited genetic mutations], we think about a broad spectrum of relatives, more than just your parents and siblings,” said Leigha Senter, MS, CGC, a James licensed genetic counselor. “We ask about grandparents and aunts and uncles and cousins and that can inform us about how likely you have a hereditary predisposition for cancer.” Ohio State and the James have one of the largest and most advanced genetic counseling programs in the country. “We have 12 genetic counselors on the faculty supporting the cancer program and we have genetic counselors who specialize in specific types of cancer,” Senter said. In this episode, Senter discusses the two most common types of inherited genetic mutations that increase the cancer risk: the Breast Cancer gene (BRCA1 and BRCA2) that increases the risk of breast cancer as well as ovarian, pancreas and prostate cancer; and Lynch Syndrome, which increases the risk of colorectal cancer as well as uterine cancer. “The average woman has a 12 percent chance over the course of their lifetime of developing breast cancer,” Senter said. “Those with [BRCA1 and BRCA2] have anywhere from a 50 to 80 percent chance.” Uncovering inherited genetic mutations leads to earlier and more frequent screenings that can detect cancer in its earliest and most treatable stages. In the case of patients with Lynch Syndrome, earlier and more frequent colonoscopies “can actually prevent a cancer from happening,” Senter said. Cascade testing is one of Senter’s specialties. “Someone in every family is always the first to test positive for an inherited genetic mutation,” she said. “The next step is to help them share this information with as many family members as possible. This is cascade testing and is where are real potential to help people is.”

The number of younger patients diagnosed with colorectal cancer is on the rise. “We always used to say at age 50 get your first colorectal screening, and now we’ve dropped that to 45,” said Samuel Akinyeye, MD, an Ohio State gastroenterologist. “And the reason is we’re seeing younger people being diagnosed with colorectal cancer … I’m seeing younger patients in my clinic.” In this episode, Akinyeye discusses several of the reasons for the increase, including the impact of unhealthy diets and sedentary lifestyles, and the role of family history and inherited genetic mutations that increase the risk of colorectal cancer. “We’re eating more processed foods and greasy, fatty foods that are pro-inflammatory,” he said, adding obesity and inflammation increase the risk of cancer. He also talks about the importance of screenings, such as colonoscopies, and how they can reduce the number of colorectal cancer diagnoses and deaths. “Colonoscopies are the gold standard of screening,” Akinyeye said, adding they detect and pre-cancerous polyps that are then removed before they actually become cancerour and spread to other parts of the body. “Screenings save lives,” he said. Knowing your family history and discussing it with your primary care physician is vital. “We have a saying, that family secrets kill families,” Akinyeye said, adding people with a family history of colorectal cancer or even high-risk polyps should start screenings even earlier than 45. “People aren’t getting screened as early as necessary because they’re not aware of their family history.” Inherited genetic mutation, such as Lynch Syndrome, “greatly increase the chances of developing colorectal cancer and other types of cancer,” Akinyeye said.

To kick off Pelotonia 2024 Launch Week, this is a special re-release of episode 155, “The Next Leaps Forward in Cancer Treatment, with Guest Co-Host Raph Pollock.” The new version of this episode now includes an introduction and conclusion from Joe Apgar, Pelotonia CEO. Each of the James scientists and physicians featured in this episode has been funded by Pelotonia. Hearing directly from these individuals about the continued progress, groundbreaking research, and treatment advancements is inspiring as the Pelotonia movement kicks off its 16th year. Pelotonia's cycling events for 2024 are Ride Weekend on August 3-4 and Gravel Day on September 28, 2024. Riders, Volunteers, and Challengers can sign up and commit to continue funding the work of James scientists and physicians like those you will hear from in this episode. Registration for Pelotonia 2024 opens on February 29 at Pelotonia.org/register.

Clinical trials are “the foundation of cancer research and lead to better treatment options and outcomes for patients,” said John Hays, MD, PhD, a James medical oncologist who treat patients with peritoneal cancers. He is also one of the leaders of the James clinical trials office and “at any given time we have between 500 to 600 clinical trial open and we put 1,000 patients a year on clinical trials, which is one of the largest numbers in the country.” In this episode, Hays explained the process of how an idea that begins in the lab (usually a new drug) goes through several different phases before it becomes approved for treatment. “Less than one percent of the Phase 1 clinical trials are ever approved,” he said, adding this is done to ensure patient safety and ensure the new treatment is an advancement over current options. “But, even if they’re not successful, we can learn something we can apply to the next trial.” He also said there is a common misconception that clinical trials are the “last resort” for patients. “It can be at any phase during treatment, from a front-line treatment setting or a later stage,” he said. “In most cases it’s adding something to the standard of care to make the standard of care work better … And, I never present to a patient that you have to do this trial. It’s always their decision and my goal is to help them understand everything, answer their questions and allow them to make the best-informed decision for them.” A new national trend in clinical trials the James is helping to lead is decentralizing the location of the trials in order to reach more patients. “We’re developing clinical trials by James people for patients all over the state and beyond,” Hays said. “We utilize tele-med and work with the patient’s local oncologist. COVID opened our eyes about what we can do from a distance.” Advancing cancer science and bringing new treatment options to patients is what motivates Hays. “We want to be there for our patients and bring them the newest and best options,” he said. “The real joy for me is talking to a patient and giving them the option to participate in a clinical trial and maybe bring them a drug [or treatment option] that isn’t available anywhere else.”

The foods we eat can reduce or increase the risk of developing cancer over the course of a lifetime, according to Fred Tabung, PhD, an assistant professor in the Department of Internal Medicine. “Think of food as medicine,” he said, adding that “what you eat should be enjoyable, but we should also eat in a healthy way to reduce the risk of cancer.” In this episode, Tabung joined with Candice Schreiber, RDN, LS, CSO, a James dietician, to discuss the importance of a healthy diet, including what it entails, how and why what we eat impacts the risk of cancer, and tasty ways to eat healthier. “A plant-focused diet is what I encourage people to eat,” Schreiber said. “It doesn’t have to be vegan or vegetarian, the goal is to fill the majority of your plate with fruits and vegetables and whole grains.” In his James lab, Tabung studies “combinations of food and beverages that effect the metabolism, specifically inflammation and the insulin response,” he said, adding that too much inflammation and insulin can increase the risk of cancer. “High levels of insulin [from consuming too much sugar] can tell the cells to divide when they’re not supposed to divide, and this can lead to cells becoming cancerous.” Red meat, processed meats, such as sausage and hot dogs, as well are highly processed foods chock full of preservatives and sugar increase the risk of cancer. “In these highly processed foods, the nutritious parts are removed … the cancer-fighting parts of the foods have been stripped away,” Tabung said. His lab is involved in a new clinical trial in which women with a high risk of developing breast cancer are placed on a diet designed to reduce the risk. “We’re really excited about this,” he said. Tabung and Schreiber provided numerous tips and suggestions on how to eat healthier. For example, when it comes to beverages, unsweetened coffee and tea are metabolically active and provide healthy nutrients, while diet soda “is metabolically active, but not in a good way,” Tabung said. “My pet peeve is that people often think that healthy food doesn’t taste good, but it absolutely does,” Schreiber said.

The new James mobile lung cancer screening unit is on the road, traveling around the state of Ohio. This is a big step forward because “lung cancer still accounts for more cancer deaths than breast cancer, colon cancer and prostate cancer combined,” said Michael Wert, MD, a James pulmonologist and director of the James lung cancer screening program. “I still see too many patients who haven’t seen a doctor in a while, ignore symptoms and come in so sick that we’ll do a CT scan and find they have really advanced lung cancer.” In this episode, Wert talks about the goals for the screening unit and why it is so vital. Smoking is the primary cause of lung cancer. “The new screening guidelines for lung cancer are that people aged 50 to 80 with a 20-pack-year history should be screened,” Wert said. “This means someone who has smoked a pack a day for 20 years, or two packs a day for 10 years.” Even people who have quit smoking years ago, but had a 20-pack-year history, need to be screened. “Too many people think what I don’t know can’t hurt me, but this isn’t true, but this fear may prevent people from getting screened,” Wert said. Reaching out to underserved communities is vital in reducing cancer deaths. “Right, now, the major screening centers in Ohio are in the big cities,” Wert said. “And the highest risk patients for lung cancer often lives hours away from the nearest screening facility … We’re one of only five or six mobile lung cancer screening units in the country and we’re at the cutting edge of this. So, if you live in a remote area, don’t be discouraged, our mobile lung cancer screening unit will be coming to you one day and don’t let your fears or anxieties of finding an abnormality scare you away. My hope is we’ll take our mobile screening unit to a town and hundreds of cars will be lined up waiting for us.”

Advances in cancer research and treatment are accelerating at a rapid pace. We asked several James scientists and physicians to tell us about an advancement that has them especially excited. Their answers were fascinating and filled with hope. This special episode was co-hosted by Raphael Pollock, MD, PhD, director of the Ohio State Comprehensive Cancer Center. “We’ve recruited more than 200 new members to the cancer center in the past four years, that’s more that most cancer centers in the United States,” Pollock said, adding that collaboration is the key to breakthroughs and “this is the best collaborative environment for cancer research of any place I know of.” Roman Skoracki, medical director of the Stefanie Spielman Comprehensive Breast Center, said the development of advanced chemotherapy and immunotherapy drugs will reduce the need for breast-cancer surgery. “We’re already seeing tremendous responses, to the point that there’s so much shrinkage of the tumor that we’re performing smaller surgical interventions,” he said. Advances in the techniques to genetically engineer a patient’s immune cells to better detect and fight cancer is another big step forward. “One of the benefits of utilizing the immune system is we’re seeing not only good responses, but responses that last a long time because your immune system has a good memory,” said Margaret Gatti-Mays, MD, MPH, a medical oncologist who specializes in immunotherapy. Advances in detecting cancer with sensors and blood draws that can identify the proteins on cancer cells “is coming and I think faster than people realize,” said James Rocco, MD, PhD, chair of the James Head and Neck Oncologic Surgery Division. Detecting new cancers earlier will save lives. Peter Shields, a lung cancer specialist, talked about how research into the use of psychedelics is in the very early stages and “has the potential for a huge impact” in reducing stress and anxiety for cancer patients and helping to improve their quality of life.

The future of cancer care has arrived at Ohio State with the opening of the region’s first proton therapy center.

While there are a handful of cancer hospitals around the globe that offer proton radiation treatment, The James proton therapy center offers the “most advanced proton radiation therapy in the world,” according to Arnab Chakravarti, MD, chair of the department of radiation oncology at The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute.

With advances in care and research, along with the opening of new, state-of-the-art facilities, 2023 was another big year in Ohio State’s work to create a cancer-free world.

“These are really exciting times for our cancer program, as we continue to broaden our facilities and access, and further the innovation of treatments, technologies and expertise that offer tomorrow’s treatments today,” says David Cohn, MD, MBA, interim CEO and chief medical officer of The James Cancer Hospital and Solove Research Institute.

Listen for some of the many cancer care and research highlights from The Ohio State University over the past year.

Better understanding of head and neck tumor causes and progression could help doctors improve personalized treatment for cancer patients.

“How it started and how it evaded the immune system and got into the blood stream provides a wealth of information we can utilize, and gives us more treatment options,” says James Rocco, MD, PhD, a head and neck cancer specialist and chair of the head and neck surgery department at The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute.

Rocco and his collaborators have developed a computational data analytics program called PhylogicNDT, which will evaluate the progression of head and neck cancer tumors caused by the human papillomavirus (HPV), and they believe “the approach can be applied to other types of cancers,” according to Rocco.