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Kitsap Peninsula takes strides to bring newest cancer screening, treatments close to home

Dr. Ronald Reimer, a local veteran oncologist, ponders the changes in cancer survival statistics from when he began his career more than 35 years ago compared to today. In breast cancer alone, the chance of surviving at the time was 50 percent, while today more than 80 percent of patients are expected to be cured. That means as many as 65,000 lives saved every year in the United States.

But when he looks at the reasons for the change, he says there’s really no silver bullet because it wasn’t just one thing that contributed to it — it was a combination of better screening, better technologies and continuous new treatments. He sees that same trend continuing today.

“I think there’s a lot of progress being made. It’s never one thing when you win a war, it’s not one bullet,” he said. “It’s a sustained effort.”

This kind of a sustained effort has been happening not only nationally but also locally, on the Kitsap Peninsula. Working collaboratively or individually, local physicians from various fields are bringing the latest screening methods, treatments and approaches to the community, from the latest clinical trials to state-of-the-art imaging technology that in some cases is not available anywhere else in the state.

One example is cutting-edge, three-dimensional mammography screening at InHealth Imaging in Poulsbo. The technology, called Selenia Dimensions system and manufactured by Hologic, was approved by the Federal Drug Administration in February.

InHealth recently became the first practice in Western United States to offer the service and patients have been coming not only from outside of Kitsap Peninsula, but from outside the state as well. One woman was reported to be traveling from the Philippines just to have this screening for breast cancer, which is the second-leading cause of cancer death in women after lung cancer.

Called breast tomosynthesis, the technology allows radiologists to see a 3D reconstruction of the breast via a series of one-millimeter thick slices.

Dr. Manfred Henne, founder of InHealth Imagining, told the Kitsap Peninsula Business Journal in an earlier interview that he wanted to make tomosynthesis available because missing a breast cancer diagnosis for a radiologist is devastating, and this technology allows for a much more precise diagnosis than traditional mammography.

“I learned over the years it’s not benefitting the patient population to wait on the technology to be widespread,” Henne said. “I don’t want to wait until they ask me to do it, I wanted to bring it to the community now.”

Another example is new MRI technology that became available in March at Olympic Radiology in Bremerton for comprehensive prostate MRI and MRI-guided prostate biopsy. The first of its kind in the state and one of the few on the West Coast, it uses dynamic contrast enhancement and diffusion-weighted imaging that can detect microscopic movements of water molecules and runs the images through a computer analysis.

The computer-aided detection (CAD) allows for diagnosis that may be missed by other tests as well as more precise detection of the cancer’s location and whether it has spread outside of the prostate gland. It also performs more accurate biopsies because it can collect samples in a precise location (compared to ultrasound-guided biopsy that takes random samples in an area).

“We’re pretty excited about this,” said Dr. James Rohlfing, a veteran radiologist with Olympic Radiology. He said the technology had been approved more than a year ago and Dr. John Hedges with Kitsap Urology Associates approached him with the idea of making it available locally after learning about its success in California from a colleague.

Also for prostate cancer — the most prevalent type among men after lung cancer — one new treatment is Provenge, approved last year and delivered at Peninsula Cancer Center in Poulsbo since this April. Administered in an injection form, Provenge is the first immunotherapy for prostate cancer (immunotherapy uses a person’s cells to simulate the immune system and attack a disease). Used in certain cases when other treatments have failed and metastasis has developed, it works by harvesting a person’s immune cells through a blood draw, separating specific white cells and manipulating them, then injecting them back.

“It’s a brand new mechanism for treating prostate cancer, different from traditional methods of treatment,” said Dr. Alex Hsi, co-founder of Peninsula Cancer Center and Peninsula Prostate Institute. He said he hopes to incorporate this treatment into clinical trials for other prostate cancer indicators.

Hsi said in addition to immunotherapy, new treatments becoming available are molecular therapies that inhibit the growth of cancer cells, such as a pill called abiraterone, approved by the FDA this April for late-stage prostate cancer that has failed other treatments. The drug targets a specific protein that contributes to cancer growth.

“We’re seeing the front edge of a wave of new therapies and it’s a very exciting time in cancer treatments because there are a lot of new therapies beyond the traditional methods,” he said.

Clinical trials, used to both fine-tune the use of approved drugs and to test the efficacy of newly developed drugs, also give access to experimental treatments in cases where other treatments have failed the patients. On the Kitsap Peninsula, oncologists from several practices have access to the same major clinical trials available at big healthcare organizations in Seattle.

Reimer said one example of how clinical trials benefit patients is a targeted therapy called Tarceva, developed about six or so years ago for end-stage, non-small-cell lung cancer (the most prevalent type). Because it doesn’t work in all patients, originally the drug was given only after chemotherapy failed but researchers soon realized the therapy worked specifically when a certain gene mutation was present. After new clinical trials, it was shown Tarceva actually worked better before chemotherapy in those cases and now, all patients who are newly diagnosed with advanced non-small-cell lung cancer are tested for the mutation prior to determining a course of treatment.

“It’s not a pleasant drug to take but compared to chemotherapy or death, it’s not a bad drug to take,” Reimer said. “The testing has become a critical part of the decision-making process for one type of lung cancer, and with the epidemic of lung cancer in nonsmokers, it’s a big deal. It’s not a small number of people (who can be affected).”

He said what really makes a difference with regards to the latest screening and treatments, is having them available close to home. Many patients have to work or take care of families even while undergoing treatment, and being able to get the care in their own communities makes a difference in their ability to work or meet other obligations at the same time.

Other new local services that are filling the gaps include a fusion PET/CT scanner. The screening has been offered by Olympic Radiology twice a week in Bremerton via a portable trailer in collaboration with another organization, but an in-house PET/CT machine became available in Poulsbo when the practice opened its second location.

The scanner can better localize and more accurately diagnose many types of cancer as well as identify if cancerous tumor is left after or during treatment. For example, Hodgkin’s lymphoma often leaves a residual mass after treatment and a CT scan could not detect whether the mass was an actual tumor, but the CT combined with the PET allows for that differentiation.

“It’s made a big difference in how patients are treated,” Rohlfing said.

The technology is valued at $2 million, and Olympic Radiology is among the many local health-care organizations that are making those kinds of major investments to bring access to latest technology on the Kitsap Peninsula.

“What’s really cool is that you have that in Kitsap County,” Reimer said. “If you have new technology but have to drive or fly a great distance to access it, it makes it difficult for patients… If we work just a little harder to accommodate people’s needs, it brings great value and having the latest technology (and treatments) available at local level is not just cool — it can make a huge difference, and it makes for better, more personal care.”

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