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Prevention: Employee Profiles

Annual Report - 2006-2007

Risky Business

By Mary Jane Schier

Carol Etzel, Ph.D.

Suggestions by graduate school mentors would result in Carol Etzel, Ph.D., coming to M. D. Anderson, where she’s developed a risk model to predict lung cancer.
While she was working on the first of two master’s degrees, a professor encouraged her to change plans from teaching high school math to pursue a career in statistical science. Then, as she was about to receive her Ph.D. from Southern Methodist University in 1999, Etzel’s advisor invited her to accompany him to give a lecture at M. D. Anderson.

“At the last minute, he couldn’t get here, so I delivered his talk,” Etzel remembers. “It turned out to be a life-changing day.”

Immediately after that lecture, she was offered a postdoctoral fellowship in M. D. Anderson’s Department of Epidemiology. Another fellowship followed, and in 2003 she became an assistant professor in the department.

Etzel’s research has involved designing and validating a risk prediction model that estimates individual probability of developing lung cancer.

“Although about 85% of lung cancers occur in current or former smokers, only a fraction of long-term smokers will develop the disease. Nationally, there are about 42 million current smokers and 46 million former smokers, so our challenge is to identify the highest risk subgroups,” Etzel explains.

Her risk model was built with guidance from Margaret R. Spitz, M.D., chair of the Department of Epidemiology. It compiles data about individuals’ age, gender and lifestyle habits, with emphasis on smoking, family history of cancer, medical conditions and workplace exposures.

In a study published last year, Spitz, Etzel and six collaborators evaluated 1,851 lung cancer patients at M. D. Anderson and 2,001 healthy controls from the Houston area. They developed a formula which gives a numerical value that estimates an individual’s risk for lung cancer as low, intermediate or high.

Etzel says the potential public health benefits from using such a model are huge because individuals at high risk could undergo periodic screenings and possibly be enrolled in chemoprevention studies. Soon she’ll debut an Internet site version of the risk model that can be accessed anywhere by health care providers and individuals.

“Not only do I combine my love of math and statistics, but I also feel good about conducting research that may help lots of people,” Etzel says.

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Escape With Your Life

By Mary Jane Schier

Alexander V. Prokhorov, M.D., Ph.D.

Alexander V. Prokhorov, M.D., Ph.D., draws on personal experience in his ingenious efforts to educate youths about the dangers of smoking.
“I once was a heavy smoker who tried many times to quit before I succeeded. Because I understand the addictive power of nicotine, I want to do everything possible to prevent kids from smoking and help them stop if they already use tobacco,” emphasizes Prokhorov, professor in the Department of Behavioral Science.

His latest tobacco prevention and cessation program is an educational video game titled “Escape With Your Life,” which his team developed through a U.S. Department of Defense grant. It was introduced last August for a six-month pilot test at Fort Bend Independent School District’s M.R. Wood Alternative Education Center in Sugar Land, Texas. Students are sent there due to school absenteeism, drug and/or alcohol abuse and other problems that place them at high risk for smoking.

Research shows that as many as 70% of troubled youth use tobacco, often becoming highly addicted in their early teen years, Prokhorov says.

He designed the 30-minute video game and had it built inside an easy-to-move kiosk. Players select different educational paths according to age, gender and ethnicity.

A 15-year-old playing “Escape With Your Life” can hear another teen with bone cancer say, “I didn’t have a choice about getting cancer, but you have a choice about smoking.” One real-life scenario involves an 18-year-old talking about his same-age friend who died from cancer caused by chewing tobacco. Graphic details demonstrate that smoking can “make you sick, miserable and poor.”

Once the pilot project is evaluated, Prokhorov hopes to offer the video game kiosks to YMCA/YWCA centers, neighborhood health clinics, churches and other community centers frequented by high-risk youth.

“Most kids today have access to computers and video games, so we know this is an important way to educate them. Our next step is to develop video games focusing on sun protection, healthy eating and exercise,” he says.

Meanwhile, Prokhorov says he’s delighted that ASPIRE, a multimedia Web-based tobacco prevention and cessation program he developed and tested among 1,600 Texas public school students, is likely to be adopted by all public schools in Arkansas.

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Reducing Weight and Risk

By Mary Jane Schier

Karen Lu, M.D.

As the incidence of endometrial cancer increases, Karen Lu, M.D., is expanding research to identify women at elevated risk and planning ways to prevent it.
“More than 35,000 women in the United States will be diagnosed with endometrial cancer this year, making it the most common cancer of the female reproductive system,” notes Lu, associate professor in M. D. Anderson’s Department of Gynecologic Oncology.

Endometrial cancer often is called uterine cancer since it arises from the endometrium or lining of the uterus. More than 95% of cases occur in women age 40 and older, with incidence peaking between ages 60 and 70. Known risk factors include obesity, which is associated with at least one-half of all cases, plus hypertension, diabetes and use of estrogen-replacement therapy among postmenopausal women.

Lu was senior author on a 2007 report showing that insulin resistance was an independent and inversely associated risk factor for endometrial cancer. In the study, 117 women with endometrial cancer and 238 controls with no history of cancer were evaluated.

“Ours was one of the first studies to look at insulin resistance,” Lu says. “We’ve been working with the Nurses Health Study at Harvard University to confirm our findings and expect the final analysis of 198 pre-diagnosis sera (blood) from women who later developed endometrial cancer and 491 controls to be published in 2008.”

The next step will be an endometrial cancer chemoprevention study, which Lu hopes to initiate within the year. It will be a randomized, open label study involving obese, insulin-resistant women who will take Metformin, a drug that is frequently prescribed for patients with type 2 diabetes.

All of this research has been supported through the $10 million Specialized Programs of Research Excellence (SPORE) grant for uterine cancer, on which Lu is the principal investigator. It’s one of 10 SPOREs awarded to M. D. Anderson by the National Cancer Institute.

“Meanwhile, we must redouble our efforts to motivate obese women to lose weight and to help all women modify known risk factors for endometrial cancer,” Lu emphasizes. “With obesity now an epidemic, we have our work cut out for us.”

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© 2015 The University of Texas MD Anderson Cancer Center