The importance of early cancer detection
Traci Luitjohan wasn’t too concerned about the spot on her face, but her family doctor wanted her to get it checked out just in case.
So Luitjohan, of Highland, saw plastic surgeon Ryan Diederich, who also didn’t think much of it. However, they did a biopsy.
It came back positive for spindle cell melanoma — a type of skin cancer — in May 2013.
Diederich, who operates MidAmerica Plastic Surgery in Glen Carbon, performed surgery to remove the cancerous cells. At that time, it was not in the lymph nodes.
But three years later, she had a pain in her hip, which turned out to be cancerous cells attacking a chip in her pelvis.
“When you have melanoma it’s in your system and it just doesn’t attack until something is weak in your body,” Luitjohan said. “It attacked that chip fracture.”
She immediately began treatment with two immunotherapy drugs — opdivo and yervoy — in April of last year.
“That I caught it that early is why all these treatments are working,” Luitjohan said. “This immunotherapy is really, really helping a lot of people.”
Early detection is one of the reasons the cancer death rate has declined 25 percent since 1991, according to statistics released by the American Cancer Society in a report last month. The report titled “Cancer statistics, 2017” was authored by Rebecca L. Siegel, Kimberly D. Miller and Ahmedin Jemal. It also attributes the decrease in cancer death rates to reductions in smoking and advancement in treatments like immunotherapy drugs.
From 1991-2014, the overall cancer death rate dropped 25 percent, which meant 2.1 million fewer cancer deaths, according to statistics released by the American Cancer Society.
The medicine Luitjohan is taking shrunk the tumor on her liver from two centimeters to below one centimeter. She also has some other spots on her liver that doctors think are scar tissue. All will be removed during a surgery she is having on March 1 at Siteman Cancer Center in St. Louis.
“It’s all good news,” she said. “Fingers crossed, the surgery takes care of everything.”
Local doctors including Diederich are encouraged by the new statistics showing a decline in cancer rates.
Diederich serves as president of the Madison County Medical Society. On behalf of the doctors in the group, he released the following statement:
“The physicians of Madison County remain committed to the patients of Southwestern Illinois. With further research, advancements, and the support of our community we are optimistic about these findings and look forward to even greater strides in the future. With proper screening as recommended by your physicians, we can continue to make progress in the fight against cancer.”
The leading type of cancer is breast cancer for women and prostate cancer for men, according to Diederich.
Dr. Jason Lee, a radiation oncologist at the Cancer Treatment Center in Swansea, emphasized the statistics in the American Cancer Society report is from two years ago because of the time it takes to collect data and analyze it.
“It’s probably the best data we have from a public health perspective,” he said.
Lee is encouraged the cancer death rates and the incidents of cancer are “trending in the right direction” — downward.
“That’s a reflection of a number of things. One is detection. Two is screening programs. Three is essentially treatment options, which have become a lot more advanced over the last 10, 20, 30 years,” he said. “If you put that all together you kind of see a global trend toward improvement in cancer outcomes.”
Importance of screenings, early detection
Since she was diagnosed with melanoma, Luitjohan has been spreading awareness throughout her community about the importance of early detection.
“I was very lucky with catching everything early,” she said.
Luitjohan, 56, who was born and raised in Highland, encourages everyone to get screened for skin cancer. “It’s really getting the word around,” she said.
A family member started a Facebook page to raise awareness as well. It can be found at facebook.com/
“It’s important to catch it early,” Luitjohan said of cancer.
Lee said, “If we can find a way to detect cancers early, for the most part, cancers caught early have more favorable outcomes, both in terms of survival and in terms of long-term side effects that patients have.”
He explained that typically early-stage cancers “demand far less aggressive treatment.”
“If we can avoid more aggressive treatments for early stage cancers, then we have done the people a favor, not just from a survival perspective, but also from a toxicity standpoint,” Lee said. “Early detection is critical for that.”
Overall, there’s been improvement in not only early detection but prevention as well, according to Diederich.
“Patients are being more aware of their care and different techniques they can use to prevent cancers,” he said.
It’s hard to beat colonoscopies. Colonoscopies have been found not only for early detection of cancer, but some of these early polyps that could go onto to be cancer are treated.
Ryan Diederich, plastic surgeon
Often times, Diederich said early cancer detection occurs at home or when patients meet with their primary care physicians.
“We are finding that these screening tools have made a substantial improvement,” he said, such as mammograms when appropriate, low-dose CT scans for early detection of lung cancer, regular pap smears and colonoscopies.
“It’s hard to beat colonoscopies. Colonoscopies have been found not only for early detection of cancer, but some of these early polyps that could go onto to be cancer are treated. So not only is it early detection but it’s actually early treatment which can dramatically affect that outcome of that type of cancer.”
There’s some controversy surrounding prostate cancer screenings, according to Lee. In 2012, the United States Preventive Services Task Force came out against routine screening for prostate cancer.
“I think the task force really made the point that early screening while it can detect more cancers doesn’t really necessarily lead to better outcomes,” Lee said. “So it’s a conversation that patients need to have with their primary care doctor on whether or not screening is appropriate for them.”
In his practice, Lee said he’s seeing “more of the later-stage prostate cancer” as there’s been a trend toward less screening.
Colonoscopies, which are recommended to start at age of 50, have lead to better outcomes for colon cancer patients. “More patients survive as a result of that screening program,” Lee said.
One factor that has helped reduce the cancer death rates is the “tremendous decrease in smoking,” Diederich said.
Lung cancer is a common cancer that’s difficult to screen for, according to Lee, who also mentioned the emergence of CT scans as one possible screening method for it. However, it may not be covered by insurance.
“It’s a relatively new thing to consider,” he said. “Not all physicians may be aware that, that’s something that should be considered for patients with some sort of smoking history.”
When used as a screening tool for lung cancer, the CT scan needs to be set up in a particular way, according to Lee.
“Time will tell but if there’s a bigger uptick in that screening program, I think we can potentially make some difference in lung cancer mortality,” Lee said.
Advancement in treatments
Cancer treatments have made “dramatic advances” over the last two decades, according to Diederich, who treats patients who are battling melanoma and breast cancer.
“Melanoma has made amazing leaps and bounds as far as treatment options,” he said, “from immunotherapy to viruses that are actually directed toward the cancer cells have really changed the lives and the outcomes dramatically of melanoma in particular, and many other cancers.”
Five or six years ago, Diederich said, when he had a patient with melanoma, the prognosis was “very bad.”
“We had treatments, but they didn’t work well,” he said. “Now, it’s a whole different story.”
Diederich is encouraged by the outcomes of using immunotherapy drugs as well as directed viruses. “You can make the virus attack only those cancer cells and kill them,” he explained. “There’s been great progress in that.”
Immunotherapy actually takes advantage of the body’s immune system to target cancer cells, according to Lee, which have benefitted melanoma and lung cancer patients, among others.
“I think in the next five or 10 years we are going to see more data emerge about immunotherapy and how beneficial that is,” he said.
There’s emerging data that immuntherapy and radiation actually work together, Lee said. “One makes the other work better,” he said.
I think in the next five or 10 years we are going to see more data emerge about immunotherapy and how beneficial that is.
Dr. Jason Lee, a radiation oncologist at the Cancer Treatment in Swansea
Lee also praised the use of targeted therapies for treating cancer. “The old ways of treating cancer was putting these essential toxins in the body — chemotherapy — to preferentially treat cancer cells above normal cells,” he explained. “But that leads to a host of side affects, and you’re sort of limited by what you can do because of how toxic these treatments can potentially be.
“We are now able to target specific receptors and take advantage of the behavior of tumor cells,” Lee said. “So that we can really target the treatment to the cancer cells, more so than we had been before.”
It’s vital for doctors to keep up with the latest treatment options and monitor statistics released by the American Cancer Society and others.
“There’s constant evolution in the recommendations because of the improvements in care,” Diederich said.
While advancements have been made in the treatment of some cancers, others like lung cancer remain difficult to treat.
“The actual treatment for lung cancer is still very tough,” Lee said. “It’s not come as far along as say the treatment for things like breast cancer and prostate cancer. For lung cancer, in particular, if we can catch those earlier, patients do a lot better.”
Higher death rates for some
The 2017 report from the American Cancer Society highlights the differences in cancer rates based on gender and/or ethnicity. Men have a 20 percent higher rate of cancer and a 40 percent higher mortality rate, according to the report. Black Americans have a 15 percent higher cancer death rate than white Americans, the report states.
“There’s been a longstanding disparity between outcomes and cancer death rates with different ethnic groups,” Diederich said. “Fortunately, we are making progress. This is improving for all groups, which is a wonderful thing.”
However, he said, there’s a lot more that can be done, including better access to care and more resources.
20 percent higher rate of cancer for men
40 percent higher cancer mortality rate for men
Part of the racial disparity is a correlation between race and socioeconomic status, according to Lee. “We know socioeconomic status is one of those things associated with health outcomes,” he said. “That’s probably driven by a number of things — access to healthcare, things like diet and exercise and access to medication.”
There isn’t a “clear answer,” Diederich said, for why the cancer death rate is higher for men.
“More studies need to be done to really understand why there’s these disparities between different groups,” he said.
If you look at the trends, Lee said, “for whatever reason, men tend to get the cancers that are harder to treat. They are just more common in men.” These include pancreatic cancer and lung cancer.
Diederich said the medical community likes to stop cancer when it develops. “But more importantly we want to stop it before it occurs.”
Luitjohan said cancer patients need a big support system of family and friends like she has. The Luitjohan family is well-known is Highland. They own and operate the Oberbeck Grain Company.
“I have so much support — my family, my friends. It’s really overwhelming,” she said.
Reducing your risks
Steps people can take to reduce their cancer risks include:
- Quitting smoking.
- Using sunscreen, which must be reapplied every two hours.
- Eating a healthy diet.
- Exercising regularly.
- Minimal alcohol consumption.
Source: Drs. Ryan Diederich and Jason Lee
2017 cancer projections
New cancer cases
Source: Report from the American Cancer Society titled “Cancer statistics, 2017” authored by Rebecca L. Siegel, Kimberly D. Miller and Ahmedin Jemal.