Laura Shellman shared updates about cancer prevention and detection

Laura Shellman, Family Nurse Practitioner at Sweet Medical Center, addressed the monthly meeting of the local Cancer Support Group. Shellman, who joined the medical center in May, 2016, was trained and worked as a labor and delivery nurse for several years before completing a graduate degree as a Nurse Practitioner from Brigham Young University in 2012. She and her family relocated to the area from Glendive when she joined Sweet Medical Center.

Shellman said she understood about cancer from an academic and professional view and personally. Twelve years ago her mother was diagnosed with lung cancer and died soon after the diagnosis. Her mother was a non-smoker and was seldom exposed to second hand smoke. Later in the presentation, while speaking about lung cancer, Shellman said, "My mother was one of the 10% who developed lung cancer with no connection to tobacco."

Shellman divided her presentation into two parts: strategies to prevent cancer and a discussion of approaches to detect cancer at treatable stages. Much of the presentation about detecting cancer focused on changes in knowledge about when screening was appropriate and when the tests should be done. Shellman noted the key to prevention and detection is to communicate your family history and personal health status so you and your provider can jointly decide about the best type and regularity of cancer screening.

The most effective prevention strategies

Put simply, Shellman said, "Use of tobacco, especially smoking, and poor diet are the major risk factors for cancer." Describing her mother's experience contracting lung cancer, she explained, "My mom was a non-smoker but she was overweight. She avoided going to the doctor because she knew there would be a discussion about her need to lose weight. Not using tobacco and keeping a healthy weight are major factors in cancer prevention."

Shellman summed up several other actions that can help prevent cancer. "Excessive use of alcohol," she said, "increases risk of cancer in the mouth, throat and liver." Another potential problem is the increased use of CT scans (computer tomography scan) that use many X-ray measurements to produce cross sectional images for medical diagnoses. She explained, "There are appropriate times

that CT scans may be necessary, but patients need to be aware that these procedures involve heavy doses of radiation." Minimizing radiation is another good cancer prevention strategy.

Additional precautions, such as applying sun screen to exposed skin and wearing protective clothing to safeguard against ultraviolet rays from the sun, are also helpful in cancer prevention. One interesting challenge involving sunlight is the body's need for Vitamin D, which comes from the sun. Shellman said, "One approach is to use sun block and wear a big hat while taking a Vitamin D supplement." "And," she added, "get sufficient sleep and exercise regularly."

Early detection can often mean successful treatment of cancer

Shellman emphasized the importance of regular medical checkups and follow-ups to changes in one's health status. "The problem with the screenings we have," she added, "is that the standards continually change as new research is done." She then shared some changes that applied to several well known cancer screenings and made the point several times, "when to begin and how often to do a screening should be decided between a patient and their provider. There are variations in each individual's health status that may call for screenings to begin earlier than normal or at shorter intervals that is typical."

Shellman began with the current standards on breast cancer screenings, a procedure that has seen a number of changes in recent years. The current standard per the American Cancer Society is, "women ages 40 to 44 should have the choice to start annual breast cancer screening with mammograms (x-rays of the breast) if they wish to do so. Women age 45 to 54 should get mammograms every year. Women 55 and older should switch to mammograms every 2 years or can continue early screening."

The most effective screening for colon cancer is a colonoscopy, a fairly invasive procedure that involves examining the entire colon and rectal area using a lighted tube. Shellman said starting at age 50 an individual should have a colonoscopy every 10 years. "Or," she said, "a patient might use a FIT kit (fecal immunochemical test) that can be done from home and tests for blood in one's stool. If there's a problem detected, then more rigorous testing can follow."

For many years the standard screen for prostate cancer was the PSA. Shellman said that test produced so many "false positives" that it is not really recommended for men unless the provider and patient feel it is useful. The screen for cervical cancer is now recommended to start at age 21 with a follow up test every three to five years, none after age 65. Unless suggested based on family history, screening for ovarian cancer is not recommended.

Finally, Shellman addressed the cancer that results in the most deaths. Deaths from lung cancer alone out number deaths from all other types of cancer. And 90% of lung cancer is the result of smoking. Fortunately, stopping smoking, better to never start, is one of the most effective strategies to prevent cancer. A smoker who stops reduces their risk of cancer by 80-90% over a period of 10-15 years. While annual lung screening is no longer recommended for the general population, low dose radiation scans are encouraged for smokers over 55 years of age or former smokers who stopped 15 years ago or less. Best advice about preventing lung cancer, don't start smoking....

Shellman fielded a few questions from the audience. One question had to do with the perceived increase in pancreatic cancer. She said, "Unfortunately, pancreatic cancer is hard to detect and there is no good screening process at this time." She also commented on a question about the recently changed standard for identifying people with high blood pressure and added, "it's another example of how the standards change with new research and new information."

Two other staff members from Sweet Medical Center accompanied Shellman to the support group's meeting. Christy Pease, Communications Specialist, and Robert Kelley, a Patient Care Assistant, were introduced during the luncheon.