Center for Cancer Prevention and Wellness Aims to Identify, Prevent Cancer at Earliest Molecular Development

Staff Report From Greenville CEO

Monday, April 1st, 2019

As someone familiar with the devastation of a loved one’s cancer diagnosis, Steve Johnson has long been an advocate for knowing his own risks for developing the disease. So when a genetic test revealed he carried a BRCA1 gene mutation, a high indicator for breast cancer, he suggested his three daughters get tested as well. But when two of the three tested positive for the gene, and subsequent tests revealed one had developed breast cancer at a barely detectable point, knowledge of the family’s risk factors became truly life-saving.

An innovative new initiative at the Prisma Health Cancer Institute aims to help people like the Johnsons identify and manage their risk factors for cancer, examining links between lifestyle, genetics and cancer formation, with the goal of eventually preventing cancer at its earliest molecular development.

The Center for Cancer Prevention and Wellness (CCPW), a first-of-its-kind program, offers a two-fold approach to cancer prevention. First, CCPW aims to reduce an individual’s risk of cancer by offering free wellness screenings and suggested lifestyle modifications to reduce chances of cancer from preventable causes. But more foundationally, CCPW approaches cancer research through the lens of epigenetics, analyzing the way cells are genetically modified through daily behaviors. This approach relies on samples of participants’ genetic information, including blood, urine and cheek swabs, stored for longitudinal study. By pairing real-time information about a participant’s behavioral and environmental risk factors with his or her genetic and molecular composition, CCPW will build a more comprehensive picture of an individual’s predisposition for cancer and gain broader knowledge to inform future cancer research.

For example, when looking at a smoker’s real-time health and wellness information, coupled with his or her genetic profile, researchers hope to be able to pinpoint when a genetic mutation forms due to that smoker’s behavior. CCPW also aims to identify similar relationships between other lifestyle factors, such as poor diet and sedentary lifestyle, and cancer development. The National Cancer Institute estimates that these controllable factors account for up to 70% of cancers.

“We are increasingly successful at treating cancer once identified,” said Larry Gluck, MD, medical director of the Prisma Health Cancer Institute. “However, the molecular change and multiplication of one cell into a visual or palpable sign of cancer takes years. That uncharted middle period, while cancer is developing at a molecular level but undetectable by routine scans and testing, is the critical time to enact interventions that may be able to stop further cancer development. As we collect and study this data from CCPW, we anticipate that we will eventually be able to identify a molecular alteration in its early stages and intercede before cancer truly appears.”

The importance of knowing both your lifestyle risks and your genetic risks is critical, says Sarah Johnson-Taylor, Johnson’s daughter. As an active 31-year-old at the time of diagnosis, Johnson-Taylor was unaware that she was at high risk for breast cancer. Without her father’s genetic testing, which he underwent at Gluck’s recommendation, she still may not have known, as routine mammograms are not recommended until 40.

“I was completely shocked that I had cancer, let alone that we were able to detect and treat it,” said Johnson-Taylor. “If it weren’t for my father’s commitment to learning as much as possible about our family’s risk factors, it’s possible that the outcome could have been very different.”

CCPW participants are empowered to address their own risk factors through a free 90-minute comprehensive wellness assessment. The assessment includes a personal and family health risk analysis as well as a non-invasive body composition analysis that digitally gathers biometric data ranging from weight and blood pressure to percentage of body fat and muscle mass. Blood, urine and cheek swab samples are also collected for bio banking, or long-term storage of molecular material, at the Institute for Translational Oncology Research (ITOR), part of the Cancer Institute. The assessment is performed by dedicated CCPW nursing staff.

Upon completion of the assessment, participants will receive recommendations to reduce their risk of cancer based on health history and behavioral and environmental factors. Recommendations may include lifestyle modifications, such as smoking cessation or weight loss, or may include screening recommendations and referrals, including genetic testing, if needed. Follow-up appointments with recommended specialists may be billed through the participant’s insurance if applicable.

Participants are encouraged to return for annual assessments to monitor health changes and progress towards overall wellness goals, ultimately working to reduce their risk of cancer from preventable causes. Annual assessments are free for all participants.

“It’s becoming exceedingly clear that we are our own first defense against cancer, in many cases,” said Julia Yates, nurse navigator for CCPW. “People may understand that it’s good to exercise and eat healthy, but they may not make the connection between those behaviors and cancer prevention. We want to show people that the small actions they take every day can lead to great health outcomes or serious health consequences, if they aren’t careful.”

CCPW and its population health approach is inspired by the Framingham Heart Study, a longitudinal study begun in Framingham, Mass. in 1948 to identify common factors or characteristics that contribute to cardiovascular disease. Through 70 years of data collection from 14,000 participants, the results of this study have informed much of today’s knowledge about cardiovascular disease and stroke, including knowledge about the detrimental effects of high blood pressure, high cholesterol and smoking.

“The Framingham study was the first population health approach to solving a medical problem, and it was revolutionary for its time,” said Gluck. “Much of the cardiovascular knowledge we now take for granted was a result of that study. We are approaching cancer research from a similar angle with CCPW. We want to help individuals take steps to better themselves, but we also want to identify patterns over time that could demonstrate facts about cancer we don’t even know yet. But in order to accomplish this ambitious goal, we need participation from a broad swath of our community.”

In its inaugural year, participation in CCPW is available to those ages 18 or older from all backgrounds. The more diverse participants are in gender, race and health status, the more telling the data may be in identifying patterns applicable to the community as a whole, said Gluck.

The free program is funded by a $274,000 grant from the Daniel-Mickel Foundation, funds raised from the Cancer Institute Dragon Boat fundraiser, Challenge to Conquer Cancer and contributions of other generous donors.

“The Upstate is lucky to have a program like CCPW now available,” said Johnson. “It’s so important to learn all you can about yourself and your family’s risk before something serious happens. The information you gain can be literally life-saving.”