Dr. Richard A. Van Etten: Cancer


Please welcome to the show Dr Rick van how you doing. Thank you very much Andrew and Brittany I greatly appreciate the opportunity to be able to come and talk to your talk your listeners today. Yeah. Well, thank you for taking the time out of your busy schedule to talk to us. So we're GONNA be talking about obviously cancer and how you can prevent cancer do your best to prevent it. But as I mentioned in the Intro, most likely someone knows someone who's had cancer or they've had cancer themselves even it's pretty it seems like it's touches a lot of people but can you kind of tell me how many people does cancer impact on a yearly basis? Well. Thank you for the question Andrew. The lifetime risk of getting cancer is approaching thirty eight or thirty, nine percent. So more than one in three Americans will get cancer during their lifetime. So that explains what you said that basically almost everybody is either been personally. Involved with cancer knows a close family member or a loved one that's been stricken by cancer. So some of the statistics nationwide in the United States, there's about one point seven million people diagnosed each year with cancer. And they'll be about unfortunately six hundred thousand Americans will die every year of cancer. Here in Orange County it's interesting that cancer has overtaken cart diseases, the number one killer, and as soon gonNA happen nationwide. So a very very. Prevalent disease what kind of has led to what's led to that trajectory? Why is that happening? Well, actually the the the death rate from cancer has been falling and it's been falling significantly over the past fifteen or twenty years, which is a success basically for the research that's gone into it through the National Cancer Institute and other mechanisms. But the fact that cancer is now the number one killer has actually also reflected progress in cardiovascular disease. So doing which used to be the number one killer. So we're doing a better job at preventing. Heart disease through the things that you know about treatment of the risk factors like high lipids, blood pressure, diabetes et CETERA. Right? Interesting. Okay. All right. So we got some work to do on the cancer and Kinda catch up. And, that generally, like I mentioned usually happens through education funding, which we'll talk about in a little bit What types of cancers are the most prevalent today? I know that you specialize are a believe in like blood cancers by what are the most prevalent that people run into so we can talk both about incidents, which is the new diagnosis that we have each year and prevalence, which is the number of people living with the disease at any given time. But the top four in both categories are pretty similar. So there's breast cancer which obviously predominantly affects women but also can affect men. Then there's lung cancer there's prostate cancer which obviously is a male cancer and the last one is colorectal cancer. Those are the big four. Close on their heels are diseases like skin cancer and melanoma that's particularly relevant for Orange County where we have two hundred and eight, hundred, ninety days per year rate. And after that come some blood cancers that I specialize in, which is mainly things like leukemia lymphoma and Myeloma Okay. What kind of leads to these types of cancers occurring out of those top four that you mentioned, what? What's the biggest contributor to people getting? Is it? Is it just genetics you got bad genes or something in your lifestyle or in your the world around you I guess causing it. So they're. Probably, equal contributions both from genetics and from lifestyle. Okay. When I say genetics I mean the cancer is principally in the opinion of a lot of primarily a genetic disease in the cancer cells have acquired mutations that contribute to their malignant or cancerous phenotype, their ability to grow and attack the body. Most of those mutations are acquired in other words they happened just within the cancer cell and they're not inherited. So you don't get them from your mother or your father. Now there are exceptions there are well defined cancer susceptibility syndromes the most the one that may be most familiar to your listeners is the bracket jeans Brca which segregating families particularly people, of Ashkenazi, Jewish descent that are inherited either from your mother or your father, and greatly increase your risk for developing breast cancer or ovarian cancer so that the risk for women who doesn't ever bracken gene mutation is about one about eleven percent or one in nine during your lifetime. If you inherit one of these genes, it's virtually almost everybody will get breast cancer ninety percent risk over your lifetime. So, this cancer susceptibility syndromes are very important the need. For instance when there's a new cancer diagnosis, you need to take a careful family history and in some cases be referred to a genetic counselor to determine whether testing family members is indicated. Yeah. Well, that's interesting that you bring that up because my wife actually we went through that process, and so she was found her mother had breast cancer and through that process they found out, she had the bracket gene Brac to and then and so my wife decided because they kind of give you choice like do you want to get screened? Do you not like you kind of have? Do you want to know more or or like not and stay naive to it I guess and so what I've discovered, we went through it and is interesting out of the split my wife got it and her sister didn't so the fifty, fifty there and. It. Seems like. It's I think my opinion is it's good to know because now they're just more aggressively screening her and is that typically the case when you find out about something like that, you're more your screened even more regularly than the average person should be. That's right. A change basically changes the surveillance. In it not to make it more complicated. But there are some genes like the broncos where the penetrates which means that the chance of actually getting breast cancer. If you have the have, the mutation is very high I think there it's pretty straightforward to decide whether to get screened. Right. There are other mutations that can be inherited that don't increase the risk that much increase it above the background, but it's not nearly as high and there it's more complicated to try to decide what to do about that. But. My advice to your listeners is to seek the advice of a NCI cancer center in a a qualified genetic counselor. Those are the people best qualified to help guide you through that decision making process right? Right. When you're going through like you said they ramp up the screening process if you had the genetic mutation but how does how did we get to discovering these genetic mutations I? It sounds like you kind of have somewhat of a background like you discovered or help discover this protein that was causing leukemia right and. How does that process even work? How do we make these discoveries? How do you make these? Discovery I was involved in is one of these acquired mutations not inherited, but it came about from studies done many many years ago actually nineteen sixty that showed that patients with this particular type of leukemia had an abnormal chromosome in their blood cells. And when to make a very long story short when that was tracked down, it was shown that the chromosome was actually an a Barrett. That was acquired in these cancer cells that lead to the expression of this abnormal protein. And that protein. Hasn't is an enzyme which means that it has a ability to catalyze chemical reactions. Okay and that particular reaction stimulated the growth of those blood cancer cells. So. That led a drug company, which is today is no artis to develop us a drug a small molecule inhibited the action of that protein. And that That drug which has the trade name GLIVEC revolutionized the treatment of that leukemia so that in the past everybody died of this leukemia, unless you had a bone marrow or stem cell transplant. Today everybody takes a drug likely. And most people go into remission and when they do, they have normal age adjusted life expectancy. That's example would that's Therapy likely that can do to cancer right? So does this all come from these discoveries? Does it come from just? Tons of data over decades like this one you're saying, it came from research started in the sixties and this didn't have until the early nineties. Is that right or wealth the the The structure of the protein was discovered. I'm saying Circa Nineteen, eighty-four which I got involved. The drug development efforts took place shortly thereafter I'm and the was FDA approved in two thousand one. So it's been on the market now for almost nineteen years I and there are many many other efforts in other cancers that are parallel parallel that. The thing that's happened today is because of our new technology and the genomics and the ability to determine, for instance, the genome sequence very quickly that's accelerated the progress that we can make. So what took forty years from sixty two to the drug being approved now can be done in a couple of years. Wow. Everything's happening much much faster. That's awesome. That's great news for those of US living right now.

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