Network-Summer 2012

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Cigars have long been symbols of power, wealth and success.

And thanks to several regulation loopholes, they may seem an attractive alternative to cigarettes. Yet they contain many harmful, cancer-causing ingredients.

While rising prices and widespread awareness of health risks have led cigarettes into a decline,

“luxurious” fermented cigars have become a profitable product currently unregulated by the U.S. Food and Drug Administration (FDA).

In 2009, an estimated 13.3 million people, more than 5% of the U.S. population older than 12, smoked cigars. Cigarette use, however, declined from 21.1 billion packs sold in 2000 to 17.4 billion in 2007, according to the American Heart Association.

This increased popularity is likely tied to the lower rate at which cigars are taxed, making them less expensive to smoke.

The federal tax on “cigarette alternatives,” such as cigarillos and little cigars, is just a tenth that of cigarettes, allowing even cash-strapped young adults to smoke more cheaply, according to researchers at the Harvard School of Public Health.

“Cigars and cigarillos have become an emerging issue in tobacco control in recent years, in part because of their appeal to young people through lower prices and sweet flavors,” a 2011 study by the

American Journal of Public Health reports.Though cigar users may believe cigarette

alternatives such as smokeless tobacco or filtered cigars are less harmful, each is associated with health risks, including higher risks of developing cancers of the mouth, lung, esophagus and larynx.

The anatomy of a cigarAccording to the National Cancer Institute,

“cigars contain the same toxic and carcinogenic compounds found in cigarettes and are not a safe alternative.”

There are various cigar types and sizes that appeal to a wide array of users, but all cigars share certain characteristics.

Cigar smoke contains as many as 4,000 chemical compounds, more than 40 of which are identified as cancer-causing agents.

Large cigars, which make up nearly 50% of the current market, contain at least one-half ounce of fermented tobacco, the same amount found in an entire pack of cigarettes. They contain more tar and about 400 milligrams of nicotine — nearly 40 times the amount in a cigarette.

Cigars are commonly sold individually and don’t contain a Surgeon General’s warning, instead displaying only the custom label of the producer. Their ingredients are not disclosed to health authorities, and cigar producers aren’t regulated by the FDA.

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Cigars: Behind the smoke screen

By Johnny Rigg

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While the FDA considers extending a 2009 law allowing the agency to oversee tobacco product sales to include cigars, a new bill is moving through Congress attempting to keep cigars from being regulated by the government.

‘I don’t inhale’While inhaling cigarette smoke is linked with the

development of lung cancers, carcinogens in cigars may be absorbed into the bloodstream through the lining of the mouth and throat, causing exposure to tissues throughout the body.

Moments after ignition, cigars fill the smoker’s mouth and throat with a brown coating containing various cancer-causing compounds. Though the smoke released by cigars is harsh and unlikely to be inhaled, its release can still burn or corrode organic tissue.

The thick smoke breaks down cells, forcing the body to repair itself. And repeated exposure to these chemicals and carcinogens may overwhelm the body’s defenses.

“Cigars are designed to be absorbed through the mucosa in the mouth, while cigarettes obviously enter the lungs,” says Joel Dunnington, M.D., professor in the Department of Radiology and longtime anti-tobacco activist. “You’re still at higher risk for developing cancer, at least three or four times higher, than nonsmokers.”

The power of images In 2001, the Federal Trade Commission mandated that cigar

packaging and advertisements include a Surgeon General’s warning. But since most cigars are sold individually, they don’t display any of the required warning labels.

Cigar manufacturers have also significantly increased their marketing efforts, focusing on celebrity endorsements, cigar magazines and publications and product placements in film and television. Though not as obvious as tobacco campaigns of the past, companies use “stealth advertising” to display their products in a positive light.

“When I was a kid, 50% of ads on TV were for cigarettes,” Dunnington says. “After their ads were cut from TV, tobacco companies moved to sports, adding images and broadcasting them around the world. And they began advertising in magazines.”

Cigarette companies were banned from advertising on television and radio in 1971 after overwhelming evidence that their products are harmful to health.

Not coincidentally, various advertising agencies began airing campaigns for little cigars the same year.

“Some cigars are made to look and smoke like cigarettes. They’re taxed at a lower rate and are about three dollars cheaper than, say, a pack of Marlboros®. This is a way for kids to smoke more cheaply,” Dunnington says.

Enticing the public to buy a dangerous product by relying on celebrity endorsements and sidestepping regulations greatly concerns Dunnington.

“I’d like to see all marketing of tobacco products stop,” he says.

Only then, he says, will the association of cigars with glamour and success begin to be replaced with an accurate view of the dangers and health risks they pose.

For more on cigar smoking and tobacco advertising, go to www.mdanderson.org/

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Cigars: Behind the smoke screen continued from page 1

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knew right away to get it checked. “That’s why I caught the colon cancer early.”

‘Kickin’ with Kimberly’ helps family healAlmost from the moment of Kim’s diagnosis with brain

cancer, the family threw themselves into philanthropic efforts. They formed “Kickin’ with Kimberly,” an organization that supports brain cancer research and initiatives to help at-risk children.

The organization has raised more than $73,000 for the Dr. Marnie Rose Foundation, which supports brain cancer research at MD Anderson. Kickin’ for Kimberly also funds soccer camps for kids in underserved neighborhoods.

Richter is also a member of Anderson Network, a patient-to-patient telephone support line. He’s been counseling people affected by cancer informally for years.

“I enjoy people. I like telling my story and listening to others,” he says.

Richter also stays busy with his demanding but rewarding work at Unified Resources, the 25-year-old marketing firm he co-owns.

“Yes,” he laughs. “There’s always the work.”

Terry Richter: This is

what resilience looks like

By Mary Brolley

Terry Richter could be

forgiven for feeling that cancer

has a bullseye on his family.The Houston marketing executive lost his beloved

wife Kimberly to glioblastoma multiforme in 2010. She was 44, and the couple had three children.

Then, just seven months after Kimberly’s death, Richter’s teenage daughter Meredith was diagnosed with and treated for Hodgkin lymphoma.

And last fall, he learned he had colon cancer. He had surgery and chemotherapy, and completed treatment this spring.

But Richter is upbeat as he tells his family’s story. Warmth, good humor and generosity of spirit are evident.

All three Richters were treated at MD Anderson, and he has great respect for the physicians and staff.

He also has special empathy for the newly diagnosed and their families, especially those facing brain cancer.

“You can’t imagine what you’ll end up going through,” he says. “But at MD Anderson, we always felt that the staff cared for us.

“Never did we feel rushed. We understood that everyone else in the waiting room needed care, too — and knew that when it was our turn, it was our turn.”

Genetic testing yields an answerBecause of all the cancer in his family, Richter was recently

tested for Lynch syndrome, an inherited genetic tendency to develop cancer of the digestive tract, particularly the colon and rectum.

Also known as hereditary nonpolyposis colorectal cancer (HNPCC), Lynch syndrome may be inherited if just one parent is a carrier.

The results of the testing — Richter carries the gene — came both as a relief and a call to action. He’ll have frequent colonoscopies to watch for the development of polyps, but feels that knowledge is power.

Another key to his peace of mind is living a balanced life: making time for family, faith, philanthropic work and exercise.

“Running saved my life,” he says. “I eat healthy, and running was pushing me to my limit. So when I started to feel ‘off,’ I

To learn more about Anderson Network, call 713-792-2553 or 800-345-6324 or click on www.mdanderson.org/andersonnetwork. Information on the Kickin’ with Kimberly Richter Foundation is at www.kickinwithkimberly.com.

people profile

Photo: Natalie Hebert Photography

Mitchel, Meredith, Terry and Matthew Richter

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understanding of how the disease starts and spreads at the molecular level may lead to developing more effective treatments.

And understanding the molecular mechanisms of IBC metastasis should help us understand the metastatic processes of non-IBC breast cancers as well.

Have there been treatment advances in IBC?Yes, research has uncovered several potential molecular

therapeutic targets. These molecular mechanisms are known to increase proliferation (rapid reproduction), promote metastasis and contribute to drug resistance in cancer cells. We’re conducting five clinical trials with treatments targeting these mechanisms to determine whether they’ll improve the outcome of patients with IBC.

What spurs you to do research on this rare cancer? My mission is to reduce the suffering brought on by advanced breast cancer. I specialize in metastatic breast cancer and IBC. Unfortunately, most patients die from metastasis. Of course, screening is important to detect breast cancer early, but I felt I needed to do something for those already suffering with aggressive disease. I committed myself to IBC because it’s the most aggressive form of breast cancer. I truly believe that by understanding the molecular processes of IBC metastasis, we’ll also gain knowledge that will help patients suffering from other types of advanced breast cancer.

doctor, doctorFocus on inflammatory breast cancer

We asked Naoto Ueno, M.D., Ph.D.,

professor in the Department of Breast

Medical Oncology and executive director

of the Morgan Welch Inflammatory Breast

Cancer Clinic, to help us understand the

basics of inflammatory breast cancer.

How does inflammatory breast cancer (IBC) differ from other types of breast cancer? Patients with IBC present with red (erythematous), inflamed (engorged) breast tissue. The breast may not have a mass. Thus, looking for a mass — as we do for other types of breast cancer — is often not the best way to detect the disease early.

IBC is the most lethal and aggressive form of breast cancer. Despite progress in the development of treatments, especially combined-modality treatments (using a combination of chemotherapy, surgery and radiation therapy), the long-term outlook for most patients with IBC remains bleak: only 40% to 50% of patients survive at least five years after diagnosis.

In comparison, in non-IBC breast cancer, 5-year survival rates are as high as 60% to 70% for locally advanced cancer.

How rare is it? How many cases does MD Anderson see a year?

IBC represents just 2% to 5% of breast cancer diagnoses, but causes 8% to 10% of breast cancer-related deaths in the United States. We see about 100 cases per year at the Morgan Welch Inflammatory Breast Cancer Clinic.

Why is IBC so aggressive? Is it because it’s usually diagnosed at a late stage?

The high risk of developing distant metastases (disease going to other organs) and lack of effective targeted therapies may partly explain the poor outcomes associated with IBC.

Also, because the disease presents as red, inflamed breast tissue instead of as a mass, it’s often misdiagnosed as a breast infection (mastitis). Patients may then receive prolonged treatment with antibiotics before a correct diagnosis is made.

By the time patients with IBC arrive at our clinic, 30% of them have developed metastases.

This is why there’s an urgent need for more research into the molecular mechanisms of IBC. Improving our

For information about enrolling in clinical trials or becoming a patient at the Morgan Welch Inflammatory Breast Cancer Clinic, please contact Jie Willey at 713-792-3965 or email [email protected].

Naoto Ueno, M.D., Ph.D.

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Commonly used cancer drug eliminates morphine tolerance

Seeing children endure chronic pain associated with cancer treatment inspired Howard Gutstein, M.D., professor in MD Anderson’s Department of Anesthesiology and Perioperative Medicine and Department of Biochemistry and Molecular Biology, to focus his research on pain management. Specifically, he wanted to find the cause of morphine tolerance, which develops over time and makes the drug ineffective for pain relief.

Gutstein and his colleagues found that the cellular process that causes morphine tolerance can be blocked by a reformulated form of imatinib, a drug commonly used to treat certain kinds of leukemia and gastrointestinal tumors. Since imatinib, known by the brand name Gleevec®, is already approved for use in humans, Gutstein hopes soon to translate his findings on the reformulation of the drug through animal studies and Phase I trials in humans.

Blocking tolerance would make lower doses of morphine more effective, also reducing undesirable side effects associated with morphine, including itchiness, nausea and difficulty breathing.

Researchers discover connection between platelet count and cancer

As early as 1867, doctors noticed that cancer patients are at high risk for developing blood clots. Recently, MD Anderson professor Anil Sood, M.D., and colleagues discovered an explanation and a vicious cycle: The body reacts to tumors by producing high amounts of platelets, which then feed tumor growth.

Sood, professor in the Department of Gynecologic Oncology and Reproductive Medicine and the Department of Cancer Biology, found in a Phase I/II clinical trial that treatment of ovarian cancer patients with siltuximab, an antibody to the inflammatory cytokine interleukin-6, sharply reduced platelet counts during a three-week period.

More research is needed to understand the connection and perhaps take advantage of it to treat people. Platelet levels may also serve as biomarkers for detecting ovarian and other cancers.

Two drugs shrink tumors in Ewing’s sarcoma patients

By combining two drugs, researchers shrank tumors in some patients with treatment-resistant Ewing’s sarcoma, a cancer that primarily affects the bones and most often occurs in teens and young adults.

The two drugs address molecular pathways that cause cell growth and survival, abnormal blood vessel growth, and resistance to chemotherapy and radiation.

Lead researcher Aung Naing, M.D., assistant professor in MD Anderson’s Department of Investigational Cancer Therapeutics, says that prior to the Phase I clinical trial, patients were heavily treated and became resistant to most other treatments.

Five of 17 patients with Ewing’s sarcoma responded to the treatment. Their tumors reduced by more than 20%.

When the two drugs, cixutumumab and temsirolimus, were used as single agents, treatment results were mixed. Researchers theorized that combining the drugs would help stave off onset of drug resistance, a common occurrence and major obstacle in cancer treatment.

To learn more about MD Anderson research, visit www.mdanderson.org/newsroom or the Cancer Frontline blog at www2.mdanderson.org/cancerfrontline.

research briefs

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Violinist and cancer survivor Treesa Gold will provide entertainment at the banquet on Sept. 14.

Other keynote speakers are Richard Lee, M.D., medical director of the Integrative Medicine Program, and Shelby Robin, pediatric nurse and cancer survivor.

The Anderson Network, an organization with support and educational services for patients/survivors, their families and caregivers, is a program of the Department of Volunteer Services.

Author, activist Susan Garrett Baker headlines Cancer Survivorship Conference Sept. 14-15

Wife of former secretary of state says her cancer diagnosis was overwhelming, emotional

A Texas ranch girl who went on to travel the world with her husband, James A. Baker III, Susan Garrett Baker will headline MD Anderson’s 24th annual Anderson Network Cancer Survivorship Conference Sept. 14-15 at the Omni Houston Hotel Westside, 13210 Katy Freeway.

In her 2010 autobiography “Passing It On,” Baker gives an honest account of the difficulties of blending two families, the struggles with and joys of her faith, and her activism on the issues of homelessness and parental advisories on record labeling.

Though the book’s manuscript was nearly complete when she was diagnosed with ovarian cancer in 2009, she also explores this aspect of her life, describing chemotherapy that “hit her like a Mack truck,” losing her hair, feeling foggy and hopeless, and “looking death in the eye.”

Her message — “Cancer made me realize how much my daily choices matter” — will kick off the conference, which is open to all who want to learn more about the issues cancer survivors face, meet and share with other survivors, take wellness classes and have fun.

Thanks to MD Anderson, sponsors and individual donors, the cost of the conference is just $50 for early registrants, which includes all meals, activities and self-parking.

Registration is available online until Sept. 7. After that, participants may pay $60 at the door on the day of the conference.

Speakers, breakout sessions, medical panel The conference offers nearly two dozen informative breakout

sessions, including: • risksandbenefitsofvitaminandmineralsupplements

for cancer patients,• managingtreatmentsideeffects,• issuesofyoungadultsurvivors,• thehealingpowerofjournaling,and• makingthemostofyourmedicinesduringcancercare.Members of the popular medical panel will present an

overview of their research and answer questions from the audience. They include Ronald DePinho, M.D., president of MD Anderson; Holly Holmes, M.D., assistant professor in the Department of General Internal Medicine; and Karen Lu, M.D., professor in the Department of Gynecologic Oncology and Reproductive Medicine.

For more information or to register, fill out the form on page 7, check the conference website at www.mdanderson.org/patientconference or call 713-792-2553 or 800-345-6324.

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Scan this QR code to watch pediatric cancer survivor Shelby Robin discuss her cancer journey.

Conference FactsRegistration deadline:Friday, Sept. 7

Registration online:www.mdanderson.org/patientconference

Scholarships:A limited number of scholarships are available for patients and caregivers. To obtain an application, go to www.mdanderson.org/patientconference or call the Anderson Network at 800-345-6324 or 713-792-2553.

Conference location: Omni Houston Hotel Westside, 13210 Katy Freeway, Houston, TX 77079

Hotel rates:The hotel is offering a group room rate of $95 for reservations made by Aug. 30.

For reservations and directions, call 800-THE-OMNI (800-843-6664).

Be sure to mention that you want The University of Texas MD Anderson Cancer Center group rate.

Parking:Self-parking is available at no charge. Valet parking is at your own expense.

PhotographyBy registering, I understand that MD Anderson will be photographing and/or recording the Survivorship Conference and that as a participant in the conference, my image or voice may be included in the photos and/or recordings made by or for MD Anderson. By registering for and/or participating in the conference (1) I irrevocably give permission to MD Anderson to have photographs and audio or audiovisual recordings taken or made of me in connection with the conference activities (the “Media Materials”) and to use, copy, distribute, display, exhibit, and release the Media Materials in connection with any of its business, educational, professional, or fundraising activities; (2) I release MD Anderson and The University of Texas System and their Board of Regents, officers, agents, and employees from any and all liability in connection with the Media Materials; and (3) I waive all rights, interest, or claims for payment or other compensa-tion in connection with any use, copying, distribution, display, exhibition, or release of the Media Materials.

For additional conference information, call the Anderson Network at 800-345-6324 or 713-792-2553, or visit www.mdanderson.org/patientconference.

Cancer Survivorship ConferenceOmni Houston Hotel Westside • Sept. 14-15, 2012

Please complete one registration form per person (you may copy additional forms) and return to:

Cancer Survivorship Conference Office of Conference Services – Unit 1381 UT MD Anderson Cancer Center P.O. Box 301439 Houston, Texas 77230

Name: Last ____________________________ First _______________________________

Address:_____________________________________________________________________

City: __________________________________________ State: _____________________

Zip: __________________ Daytime phone: _____________________________________

Email address: _______________________________________________________________

Registration fee: Registration is $50 until Sept. 7. After that, participants must register at the conference for a late registration fee of $60. Conference fee covers all activities and meals, including self-parking, Friday night banquet, Saturday luncheon and coffee breaks throughout the conference. I will attend/need:

The banquet on Friday night q Yes q No

Vegetarian meals q Yes q No

Breakout sessions: If you’re able to go online, consult the conference agenda at www.mdanderson.org/patient conference. Please choose the number of the breakout session you would like to attend in each cluster on Friday and Saturday and list by number here:

Friday, Cluster 1 ________________________ Friday, Cluster 2 ______________________

Friday, Cluster 3 ________________________ Saturday, Cluster 4 ___________________

Payment information: The registration fee for the conference is $50, which covers only a minimal amount of the cost of the conference. The price is kept low due to the generosity of MD Anderson, corporations and individuals.

Please make checks payable to UT MD Anderson Cancer Center. If you are paying by credit card, check one:

q VISA q MasterCard q American Express

Total amount to be charged: ___________________________________________________

Card number: ________________________________________ Exp. date: ____________

Authorized signature: _________________________________________________________

Those paying by credit card may fax the registration form to 713-794-1724, but an authorized signature must accompany the form.

Conference Registration

I am a

q Patient/Survivor q Caregiver/Family q MD Anderson Volunteer q Other

If you require a wheelchair, oxygen, etc., please plan to bring your own equipment to the conference.For the protection of patients undergoing treatment, children younger than 16 are not allowed.

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The Anderson Network is a program of Volunteer Services at MD Anderson Cancer Center.

Address changes should be sent to: Mary Brolley The University of Texas MD Anderson Cancer Center Communications Office – Unit 700 6900 Fannin St. Houston, TX 77030-3800 Phone: 713-792-0658 Fax: 713-563-9735 Email: [email protected]

Articles and photos may be reprinted with permission.

Susan French, Executive Director, Volunteer Services Debbie Schultz, Assistant Director, Volunteer Services/ Anderson NetworkSara McIntosh, Chair, Anderson Network Mary Brolley, Writer/Editor, NetworkScott Merville, Johnny Rigg, Contributing Writers Gini Reed, Graphic Design

© 2012 The University of Texas MD Anderson Cancer Center

network

The University of Texas

MD Anderson Cancer Center

Communications 600784/18050664 – Unit 700

P.O. Box 301439

Houston, TX 77230-1439

Non-Profit Org.U.S. Postage

PAIDHouston, TexasPermit No. 7052

www.mdanderson.org/networkSave the date: Cancer Survivorship Conference, presented annually by the Anderson Network,

Department of Volunteer Services, is Sept. 14-15.713-792-2553; 800-345-6324

Young adult patients, survivors convene for Cancer180 Survivorship Symposium

They gladly gave up a summer Saturday to learn about issues crucial to them. On Saturday, June 9, 100 young adult patients, survivors, caregivers and friends ages 18 to 39 spoke to and learned from MD Anderson experts who are just as invested as they are in finding answers to questions like: • Whatarethelong-termeffectsofchemotherapy? • HowcanIprotectmyfertilitybefore,duringandaftercancertreatment? • HowdoIgetbackintoschooland/ormycareerafteralengthyabsence? • HowdoIdealwithissuesregardingmychangedbodyimage? • Aretheresupportresourcesspecifictomyagerange? During the lunch break, a panel of young adult survivors shared their stories, fielded questions and were living proof that life goes on after cancer and cancer treatment. This first Houston-area symposium was co-sponsored by MD Anderson, the Leukemia and Lymphoma Society and Novartis Oncology. For more information about Cancer180, a program of Anderson Network, go to www. cancer180.org.