Lots of progress against cancer with a long way to go
Jan. 23—For all the progress science and medicine have made against cancer, the disease remains a wicked adversary.
The announcement this month by Christus St. Vincent Regional Medical Center that it would build an $80 million cancer center on its main campus reflects the growing number of cancer cases and the ongoing allocation of resources against it. As the population grows and ages, raw numbers of cancer cases and deaths in New Mexico and the United States continue to creep up.
The diagnosis today generally is far from a death sentence, but the word "cancer" continues to prompt dread.
"It's terrifying," said 80-year-old Ed Wolff, an Albuquerque man who has been treated for one of the many rare, difficult-to-pronounce forms of cancer — Waldenstrom macroglobulinemia — for more than
20 years.
Wolff figures without science and his cancer doctor, Malcolm Purdy, he'd probably be dead by now.
"I know that it kills people, but definitely not as many as it used to," Wolff said of the disease.
He choked up. "I feel I'm alive because of Dr. Purdy."
Purdy, an oncologist with Albuquerque-based Lovelace Health System, called this an incredible time in cancer care. "The medicines that we have now are remarkable," he said. He quoted musician Paul Simon: "These are the days of lasers in the jungle."
Purdy said vaccines against certain cancers are in clinical trials, but he didn't want to oversell their potential. "Buyer beware," he said. "Let's wait for the data."
The odds are surprisingly good — that is, bad — that one will have an intimate encounter with cancer. The American Cancer Society said in an article published this month the chance of acquiring cancer in the U.S. at some point in life is more than 1 in 3.
Patti Watson, who runs an Albuquerque public relations agency, was diagnosed with breast cancer in 2004. The disease was treated with removal of the lump and radiation.
"It's scary," said Watson, 62. "It makes you think about what you are going to do." She wondered if she would have to stop working, worried that her hair would fall out and feared it would affect her relationship with her husband. The answer to each of those was no.
Watson learned the chances of a second bout in her case were slim. But the odds failed her, and breast cancer paid a second visit in 2013. This time, the treatments included a double mastectomy, breast reconstruction and seven years of taking a chemotherapy pill.
Today, she said, she is well, working, still married and grateful. "And I had a really good team of doctors," she said.
Jan Lavin of Las Cruces endured a bout with non-Hodgkin's lymphoma seven years ago and had to do it all over again last year. This time, the chemotherapy regimen made her hair fall out.
"Some of that chemo is tough. It is not for sissies," said Lavin, 84. She said a brother died of cancer at the age of 11 and her mother survived breast cancer.
"So I really was just kind of expecting it, maybe," she said. "It's not a happy story at all, this cancer."
But Dr. Jason A. Call, a radiation oncologist at Memorial Medical Center in Las Cruces, said he has seen progress since moving on from the Mayo Clinic residency program in Minnesota 10 years ago.
And one of the elements scientists and doctors are working on, Call said, is to deliver good results with fewer chemo and radiation treatments, making those regimens less grueling.
The American Cancer Society estimated New Mexico will see 11,030 new cancer cases this year and 1.9 million Americans will suffer new cases. That compares to 1.4 million Americans who were diagnosed 15 years ago, the organization said at the time, including 8,030 New Mexico residents.
This year about 3,830 New Mexico residents and 609,360 Americans are expected to die of cancer, up from 3,270 and 559,650, respectively, in 2007, the Cancer Society reported.
The Cancer Society cautions its yearbooks provide only estimates and that comparing statistics from one year to the next is dicey because they "are model-based and vary from year to year for reasons other than changes in cancer occurrence."
But it also says, "These widely cited projections serve as a basis for research and are also readily understood by the public."
An aging and growing population leads to more cancer cases and deaths in this country, and makes comparing one year to another somewhat deceptive.
The Cancer Society reported the cancer death rate rose during much of the 20th century because of the prevalence of cigarette smoking. Reductions in tobacco use and better early detection of some cancers have led to a decline in the cancer rate from 215 per 100,000 people in 1991 to 146 per 100,000 in 2019.
An improvement in the tools to fight the disease has helped as well. Dr. Bryan Goss, a radiation oncologist with Christus St. Vincent, said major advances have taken place in cancer care.
"Technology has allowed us to do things that we never dreamed of," Goss said last week.
At the same time, he described young mothers fighting breast cancer off and on for years, and he became slightly emotional while talking about those patients. There are good days and bad days for them, good months and bad months, he said, and choosing oncology as a specialty means there are wins and losses.
But just in radiation oncology, Goss said, there have been improvements in recent years that make treatment more effective. For instance, specialists now can "fuse" the image of an MRI with that of a CT scan and gain a clearer view of a tumor.
Goss said the new Christus St. Vincent Cancer Center, expected to be finished in early 2024, also will contain the "next generation" of a form of treatment technology called a linear accelerator, which directs radiation to the tumor with precision.
He and others said genomic testing will enable physicians to more clearly identify the genes involved in a patient's cancer and gain a better idea of how to treat it.
"I think we're getting there," Goss said. "And there will be more and more arrows in our quiver if we discover the weakness the cancer has."
The coming battle
Dr. Bernard Agbemadzo, medical director for Presbyterian Cancer Care, agreed advancements are coming in surgery, radiation and chemotherapy.
Immunotherapies, which have been around commercially for roughly 10 years, have the ability to trigger the immune system in such a way that it goes after the cancer cells and spares healthy cells, he said.
Those therapies, some of which are advertised on television, can extend the lives of patients. "We use the immunotherapies mainly to keep the cancer at bay," he said.
Christus St. Vincent plans to put numerous programs, such as radiation and medical oncology, diagnostic imaging, laboratory services and palliative care under one roof in its 72,000-square-foot cancer center. The hospital's 45,000-square-foot cancer center now is off-site, near St. Francis Drive and Zia Road.
Lillian Montoya, CEO and president of Christus St. Vincent, said the two-story facility will contain plenty of natural light and a staff that is sensitive to how lonely the cancer "journey" can be.
It should be a comfortable place that's easy to get around in, Montoya said, with nooks available for family members to huddle with their loved ones, and for the patient and family to meet with those providing the care. Just as the center will be more than a place, Montoya and others said, the care will consider emotional as well as physical needs.
A center at the hospital, officials said, will enable Christus St. Vincent to start anew.
"We are doing our best to imagine cancer treatment five or 10 years from now," said Genevieve Tarnow, director of the Christus St. Vincent Cancer Center. It's an exciting time in cancer care.
"I feel like it's no longer — and I hate to use the word — it's no longer a death sentence. And it's changing almost daily," she said. "We're actively in clinical trials and finding clinical trials all the time that have a lot of hope for patients."
The foe is formidable. Cancer is the second-leading cause of death, behind heart disease, the Cancer Society says. It is also the second-leading killer among children 1 to 14 years of age, after accidents.
Breast, prostate, lung and colorectal cancers, in that order, are expected to cause the most cases this year, the society reported, with lung, colorectal and pancreatic cancers causing the most deaths.
The tough fight
Agbemadzo said in some cases, the goal is to manage the cancer like a chronic disease, such as diabetes. "We have begun to use the world 'cure' very, very selectively," he said.
Ed Wolff received a kind of plasma exchange infusion for years. Purdy predicted 20 years ago a pill would come along to suppress Wolff's disease, the patient said, and that proved true.
He said he has plenty of other problems, including a lung disease that requires him to be on oxygen 24 hours a day. But he plows on, saying, "I feel great."
Patti Watson's second bout with breast cancer came, naturally, as a shock.
"Oh, no, here we go again," she said to herself. The double mastectomy was rough.
"But I'm fine now and doing well," Watson said. She advised people to stay current with their doctors on cancer screening, because there's no denying the impact the disease can have.
"I lost my father to cancer, I lost my mother to cancer and I lost my aunt to cancer," she said. "Cancer's still a loaded term."
Jan Lavin got through a harsh regimen of chemotherapy in late 2021. She didn't minimize the challenge posed by the disease and the treatment.
"I'm glad I'm doing as well as I am, given what I've gone through," she said. "And you have to put your big-girl britches on ... you've got to be a fighter."
