The Nebraska Medical Center Cancer Center Blog

Better to Bask in the Sun or Live Vitamin D Deficient?

There is little that is more enjoyable than getting out into the sun after a cold and grey winter. The air is fresh, the grass is green and the warm rays of sunshine seem to pull us outside. Our bodies crave the bright light. It is no wonder that light therapy is used in northern latitudes to prevent the wintertime blues known as seasonal affective disorder. We have evolved to need and love the natural light of the sun. It is a valuable source of vitamin D and among populations who live in northern latitudes there is nearly an epidemic of vitamin D deficiency.

Ten minutes of midday sunshine in the summer is equivalent to taking a dose of synthetic vitamin D. It is clear that vitamin D is important for the health of our bones, but additional research suggests vitamin D may be important for the immune system, cardiovascular health and some types of cancer such as colorectal. As with many things in life, you can get too much of a good thing.

Ten minutes of midday sunshine in the summer is equivalent to taking a dose of synthetic vitamin D.

There has been a dramatic rise in skin cancers over the last 30 years. The most common cancers are basal cell carcinoma and squamous cell carcinoma which are slow growing and typically easy to treat. Melanoma on the other hand is rising at a dramatic rate and if it is not diagnosed early it can be very difficult to control. Melanoma typically presents as an abnormal looking mole.

The ABCDE pneumonic has helped health-care providers and patients alike recognize worrisome appearing moles.

• Asymmetry
• Border irregularities
• Color variegation
• Diameter greater than six millimeters
• Evolution in color, shape or size

Worrisome lesions tend to be larger with irregular borders and may have multiple colors. If any lesion changes over time or has a tendency to bleed it should evaluated. Individuals with fair skin tones tend to burn easily and they are at greatest risk of developing melanoma. The lifetime risk of developing melanoma among Caucasians is estimated to have been 1 in 1,500 in 1935 as compared to an estimated risk of 1 in 39 among men and one in 58 among women today. This remarkable change in lifetime risk is not due solely to increased rates of screening and the identification of early and less aggressive lesions.

So how do we balance our need for vitamin D with the risk of developing skin cancer? Is there any evidence that sunscreen prevents skin cancer? It is clear that sun screen is helpful at preventing the more common and typically less life threatening, skin cancers. There are new studies emerging that suggest sunscreen may also be helpful in preventing melanoma. It is believed that the risk from sun exposure comes with intermittent and intense exposures that lead to burns. Individuals who had more than five sunburns in childhood are twice as likely to develop melanoma as an adult.

Unfortunately there is no medical consensus on the optimal amount of time to spend in the sun. It varies by an individual’s skin color, the time of the day, the geographic location, the season of the year and the weather.

The ultraviolet radiation from the sun is divided into UV-A and UV-B. We know that UV-B poses a greater risk for melanoma. Is it safe to get that bronze tan from a tanning bed that uses only UV-A light? There are now multiple studies demonstrating that tanning beds increase an individual’s risk of developing melanoma. In 2009, the World Health Organization classified ultraviolet light from tanning beds as a human carcinogen. This carcinogen was used by one third of women aged 18 to 25 in the United States in 2010. Are we doomed to be deficient in vitamin D if we can’t get our sun? This question has generated a great deal of controversy given the importance of vitamin D to overall health.

Sunscreen effectively blocks the harmful UV-B rays of the sun and an SPF-30 screen can decrease vitamin D production by 95 percent. As with many things in life the balance of adequate sun intake and avoidance of sun damage requires careful consideration. Spending as little as three to six minutes in the sun may be adequate for vitamin D synthesis in fair skinned individuals, but among those who are sensitive to the sun this could lead to a burn. Unfortunately there is no consensus on the optimal amount of time to spend in the sun. It varies by an individual’s skin color, the time of the day, the geographic location, the season of the year and the weather.

The points to take away are that melanoma is on the rise and ultraviolet radiation from the sun is a risk factor. Intermittent and intense sun exposures that cause burns should be avoided. Some direct sun exposure, but not too much, is ideal. The vast majority of time spent in the sun should be done with adequate protection. Among individuals who burn easily, live in northern latitudes or get minimal sun exposure a vitamin D supplement should be considered after discussion with a physician.

Aaron Wieland, MD
Head and Neck Surgical Oncologist
The Nebraska Medical Center

Call 800-922-0000 to make an appointment with Dr. Aaron Wieland. For clinic location and hours use the Find a Physician link.

Bone Marrow Transplant Program Celebrates 30th Year

Since performing the hospital's first bone marrow transplant April 1, 1983, The Nebraska Medical Center has evolved into one of the leading bone marrow and stem cell transplantation centers in the world. Nearly 4,500 transplants have occurred since the program's inception.

Patients from all 50 states and more than a dozen countries across the globe have received bone marrow or stem cell transplants at the hospital. Most of the transplants have been performed on adults. These patients have sought out innovative treatment options for their diagnosis of blood cancer, in particular, lymphoma, leukemia and multiple myeloma. Pediatric transplants normally are performed for patients with more aggressive disease such as acute lymphoblastic leukemia.

Julie Vose, MD

"We have an extraordinary team dedicated to improving cancer treatment and care," says Julie Vose, MD, chief of the Division of Hematology/ Oncology. "Their work has increased survival substantially in patients. Through the efforts of many, people now have access to some of the best cancer treatment in the world right here in Omaha."

The adult transplant program was founded by Kearney, Neb., native, James Armitage, MD. After the adult program was launched, the pediatric transplant program followed in 1987, led by Peter Coccia, MD.

The medical center's expansive cancer research program has been responsible for advancing knowledge and treatments, according to Dr. Vose. Researchers receive funding from a variety of sources, including the National Institutes of Health. They collaborate with some of the top cancer centers in the world, such as MD Anderson Cancer Center, Fred Hutchinson Cancer Center, Dana-Farber Cancer Center, Stanford University, Johns Hopkins University and several European centers.

James Armitage, MD

"We learn through our encounters with patients and our clinical trials," says Dr. Vose. "Our experience not only helps our current patients but also will help future patients five or 10 years down the road. In oncology, everything we do is based on research."

Tawny Roeder is representative of thousands of patients who've benefitted from the medical center's work. It saved her life. In 2008, the Storm Lake, Iowa resident was just finishing nursing school when she was diagnosed with non-Hodgkin lymphoma. She was referred to the medical center for a transplant and moved to Omaha. She received a transplant and ultimately was able to finish nursing school. She now works as a nurse and lymphoma transplant case manager at the medical center – with the same physician who treated her.

Tawny Roeder

"Having the stem cell transplant completely changed my life," Roeder recalls. "I was hopeful that someday I could help and comfort others who were sick. Now, as a transplant nurse, I get to help others through the difficult process every day. Sometimes life's toughest battle turns into an amazing journey with a fulfilling purpose."

Dr. Vose, Roeder and others are looking forward to the construction of a comprehensive cancer center on campus, scheduled to be completed in 2016. "We're excited to take the next step to advance our work for better treatments and improve the quality of life for those with cancer," Dr. Vose says. "It's reassuring to be able to see patients over the years and help them through their illness. There's nothing better than seeing them return to a normal, healthy lifestyle and have time with their families."

For more information on bone marrow and stem cell transplant program at The Nebraska Medical Center, please visit our website.

To make an appointment with a cancer specialist, please visit our Find a Physician tool.

You’re Invited to Shape the Future of Cancer Care

An exciting opportunity exists at The Nebraska Medical Center for cancer survivors, families and caregivers to shape the future of cancer care.

The Patient Family Advisory Council (PFAC) provides a forum where adult cancer patients, their caregivers and families feel comfortable providing feedback related to cancer treatment experiences. Members of the council influence the development and improvement of cancer related services at The Nebraska Medical Center.

The main goal of PFAC is to ensure cancer care and collaboration between caregivers, families and patients at The Nebraska Medical Center exceeds expectations.

Together the council works to address patient, caregiver and family concerns promptly and effectively. The medical center values the input from council members when developing new cancer related services, programs and even facility design.

As the hospital moves forward in planning and designing the new cancer center there will be many opportunities for PFAC members to share their opinions and suggestions.

PFAC membership application is available to anyone in the metro area who has either received cancer treatment, is a family member of a patient or taken on the role of a caregiver for an oncology patient within the past three years.

Requirements for serving on the council will equate to volunteering about 5 hours of time each month. Members are asked to attend meetings, respond with feedback to emails and letters from moderators and participate in cancer center planning activities.

To be considered for membership on the Patient Family Advisory Council please download, print and fill out the membership application. You may choose to return the completed application by email or standard post.

Email Cherie Bennett

The Nebraska Medical Center Cancer Center
Attn: Cherie Bennett
111 N. 175th St
Omaha, NE 68118

For more information on cancer support services at The Nebraska Medical Center, please visit our website.

Brain Tumor Education and Support Group

Wednesday, Feb, 20

The Nebraska Medical Center
University Tower, 3rd floor
Private Dining Rooms 5:30 to 6:30 p.m.

The discussion this month is about managing fatigue and will be facilitated by Ann M. Berger, PhD, RN, AOCNS, FAAN.

Please call 402-559-4420 if you plan to attend.

In the event of severe weather, if Omaha Public Schools (OPS) cancels evening activities, this event will be cancelled.

For more information on cancer support services at The Nebraska Medical Center, please visit our website.

To find a primary care doctor or make an appointment with a cancer specialist, please visit our Find a Physician tool.

The Impact of Cancer on Sexuality – Cancer Survivorship Group

Cancer Survivorship Group
February 5 at 5 p.m.
The Impact of Cancer on Sexuality by Kimberley D. Dockery, MS, PLMHP, PhD Candidate

University Tower, 3rd floor, Private Dining Room C

Please call 402-559-4420 if you plan to attend.

In the event of severe weather, if Omaha Public Schools (OPS) cancels evening activities, this event will be cancelled.

For more information on The Nebraska Medical Center cancer support services, please visit our website.

New Lung Cancer Screening Guidelines Expected to Improve Survival Rates

There is good news in the field of lung cancer.

We now have new guidelines from the National Comprehensive Cancer Network^® (NCCN^®) that were recently published in JNCCN – Journal of the National Comprehensive Cancer Network that recommend that certain high-risk groups can benefit from lung cancer screening with low-dose Computed Tomography (CT) scan. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) guidelines were developed after a study sponsored by the National Cancer Institute and published in the New England Journal of Medicine indicated that screening can reduce lung cancer mortality by 20 percent. I am part of the NCCN Guidelines Panel that developed the NCCN Guidelines^®.

This is very good news because the five-year survival rate for lung cancer is highest when the disease is still localized, but few lung cancers are diagnosed at this early stage. Up until now, about 75 percent of lung cancer cases were found at more advanced stages of the disease – usually stage III or stage IV. Lung cancer found at these stages have a cure rate of 5 percent or lower.

Lung cancers are difficult to diagnose early because most people who develop lung cancer initially lack symptoms that warrant medical attention. It’s not until the disease has progressed, do symptoms such as persistent cough, chest pain, shortness of breath or recurring infections begin to appear.

In addition, common diagnostic tests such as X-rays are inadequate at picking up lung cancer at an early stage. A CT scan, on the other hand, can detect lung cancer nodules in stage IA when the cure rate can be as high as 90 percent or more.

With these new NCCN Guidelines, individuals ages 55 to 74 that have smoked a 30-pack history can be screened and covered by most major insurance companies. A 30-pack history is equivalent to a half pack a day for 60 years, one pack a day for 30 years or two packs a day for 15 years. This applies even to individuals who smoked in their earlier years and have not smoked for many years.

For those people who fall into this high-risk group, they should discuss the pros and cons of being screened with their primary care doctor. If it is decided that a CT is in their best interest and no nodules are found, we would still recommend getting a CT scan every year until age 74. If nodules are found, the patient should be referred to a lung specialist to determine whether they need to be biopsied or watched. About 50 percent of the population will have lung nodules from exposure to things like fungus or respiratory tract infections, but only 2 percent of these individuals will have cancerous nodules.

Determining what should be done if nodules are found is one of the most challenging aspects of this screening. Whether we biopsy the patient will depend on factors such as the size of the nodule and whether the nodule is increasing in size. This is where our expertise comes into play. I am part of a team of specialists at The Nebraska Medical Center who are dedicated to diagnosing and treating lung cancer. Studies show that the chance for long-term survival improves when the medical team involved has a dedicated interest in treating patients with lung cancer.

Lung cancer is the most common cause of cancer deaths in both men and women in the United States and is the most preventable. It causes more deaths in women than breast, cervical, uterine and ovarian cancers combined. I am hopeful that this new screening will help turn those statistics around.

Rudy P. Lackner, MD
Thoracic Surgical Oncologist
The Nebraska Medical Center

Associate Professor of Surgery, University of Nebraska Medical Center

Call 800-922-0000 to make an appointment with Dr. Rudy Lackner. For clinic location and hours use the Find a Physician link.

Meditation Classes for Cancer Patients

Studies have shown that meditation can help reduce stress and increase focus. Patients may experience less of a reaction to pain when engaging in meditation therapy. Meditation classes are held Tuesdays from 6 to 7 p.m. and are open to cancer patients, caregivers, family and staff. Registration is required.

Life Renewal Center

The Life Renewal Center is dedicated to providing all cancer patients a more positive healing experience by supporting their personal and physical needs during treatment and recovery.

The center is located on the 2nd floor of the Village Pointe Cancer Center in west Omaha and is open from 8 a.m. to 4 p.m., Monday through Friday.

Specialty classes are available on designated days in addition to massage services and wig fitting sessions. Visit The Life Renewal Center and learn more about tools to help cancer patients, their caregivers and families cope during this difficult time.

Can French Kissing Cause Cancer?

For a long time, smoking has been clearly linked to causing a variety of cancers including many in the head and neck. However, with improved public awareness campaigns, there has been a decrease in the number of people using tobacco. This has led to a decrease in the number of patients developing most, but not all forms of head and neck cancers.

Medically speaking, the head and neck is divided into different areas:

• Mouth (oral cavity)
• Throat (oropharynx and hypopharynx)
• Voice box (larynx)
• Back of the nose and sinuses (nasopharynx and paranasal sinuses)

One area of the throat that deserves special attention is the oropharynx. This region includes the tonsils and the back of the tongue. Despite decreasing rates of smoking and decreasing rates of head and neck cancer as a whole, there has been a dramatic rise in the number people presenting with cancers of the tonsils and back of tongue.

Research suggests that even open mouth kissing or “French” kissing is a risk factor for passing the virus.

These cancers more often occur in younger individuals who have no history of tobacco or alcohol use. Research over the last 10 to 15 years has revealed that these cancers are associated with infection by the human papillomavirus (HPV). HPV is known to cause cervical cancers in women and is also associated with anal and penile cancers in men. We are now seeing HPV in the majority of cancers of the tonsil and the back of tongue.

Head and neck cancers related to HPV infection are on the rise, but the reason is not clear. Numerous studies have demonstrated that this is a sexually transmitted disease. The risk of developing an HPV associated cancer of the head and neck is related to both the number of sexual partners and the types of sexual behaviors of an individual. Research suggests that even open mouth kissing or “French” kissing is a risk factor for passing the virus.

The rapid rise in HPV associated cancers of the head and neck over the last 10 years may be related to changing cultural attitudes toward oral sex. A recent study published in the Journal of the American Medical Association (JAMA) received well-deserved media attention. The study revealed that 7% of Americans are infected with HPV. In this study men were found to have a higher rate of infection at 10% than women at 4 percent.

The risk of infection was directly related to an individual’s number of sexual partners. There are many different strains of HPV and a small subset have been associated with cancer. The strain most commonly associated with head and neck cancer is HPV-16 and in this study, 1% of the population tested positive for this strain.

There are two silver linings to the story of the emergence of HPV associated head and neck cancers. The first is that these cancers are more treatable than traditional head and neck cancers associated with smoking. Multiple studies have demonstrated significantly improved cure rates. The second is that there are two vaccines for HPV on the market that have been approved for use in males and females. While studies need to be completed to verify that this vaccination is protective for head and neck cancer there is good reason for optimism.

Reference for statiscts in this blog can be found in the following article: Gillison ML, Broutian T, Pickard RK et al. Prevalence of Oral HPV Infection in the United States, 2009-2010. JAMA. 2012;307(7):693-703.

Aaron Wieland, MD
Head and Neck Surgical Oncologist
The Nebraska Medical Center

Call 800-922-0000 to make an appointment with Dr. Aaron Wieland. For clinic location and hours use the Find a Physician link.

Imagine a Cancer-Free Nebraska

In 2010, the theme of the Ambassador of Hope Gala, the Eppley Cancer Center’s biennial fundraiser for cancer research, was ‘Imagine.’ Those in attendance at the Gala were asked to ‘Imagine a cancer-free Nebraska.’ With the construction of the proposed cancer center on The Nebraska Medical Center and University of Nebraska Medical Center (UNMC) campus, a cancer-free Nebraska will be one step closer to reality.

The cancer center will consist of a research tower, a multidisciplinary outpatient clinic and a 108-bed inpatient hospital. These structures, comprising 695,000 square feet dedicated entirely to cancer research and care, will be impressive and state-of-the-art. But what takes place inside the buildings will be even more impressive.

Imagine one place on the campus that is dedicated to only cancer. A convenient, comfortable location where patients can see all cancer care specialists including oncologists, nurses, pharmacists, dieticians and physical therapists, without having to move around the campus. Having cancer care providers in one place will greatly enhance the experience for patients who receive their cancer treatment and care at Nebraska’s only National Cancer Institute (NCI)-designated cancer center.

The integration of all cancer research and care on campus into one location will provide all Nebraskans with a facility they can be proud of.

Imagine cutting-edge cancer research leading to better therapies to treat cancer. In the new cancer center, scientists and physicians will be together under one roof, in state-of-the-art facilities that encourage the exchange of ideas and information. This exchange will lead to new discoveries in the laboratory that will lead to the development of therapies tailored to specifically target each patient’s cancer. We now know cancer is not one disease, but a group of diseases, with different molecular and genetic characteristics. Analyzing each tumor at the molecular level will lead to the best therapy for that patient.

Imagine access to the most current and innovative treatments available, many developed at The Nebraska Medical Center and UNMC, through the translation of cutting-edge cancer research into state-of-of-the-art cancer care.

Imagine more opportunities for developing potentially life-saving clinical trials. This requires that scientists and physicians work side by side, in the same environment, for the benefit of patients. Clinical trials are research studies that test the effectiveness and safety of potential new cancer treatments. Clinical trials represent an important therapeutic option for patients and the opportunity to assist in advancing medical knowledge. Clinical trials of today lead to the standard therapies of tomorrow. In fact, each and every drug being used today to treat cancer in the clinical setting was first studied in clinical trials.

Everyone involved in the care of cancer patients appreciates the many physical changes and emotional stresses that patients experience following their diagnosis and subsequent treatment. The new cancer center will help provide patients with the tools and the support they need to actively manage their recovery. It is not enough to treat the cancer. The entire patient must be the center of therapy. The emotional needs of cancer patients and their families and loved ones cannot be overlooked. A variety of support services, many already available to patients, will be readily available in the new cancer center, helping to provide renewed energy and spirit and improved self-esteem, and help with the journey many face as patients and cancer survivors.

The integration of all cancer research and care on campus into one location will provide all Nebraskans with a facility they can be proud of, and one that will transform the way care is delivered. It will be a model for cancer centers around the world.

Kenneth H. Cowan, MD, PhD
Director, Eppley Cancer Center