Putting oncologists out of business

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Leigh Pearce: We have a really robust program around cancer research in my team. We study ovarian cancer, we study breast cancer and we study cervical cancer. And these are all diseases that have a big impact on people across Michigan, across the US and across the world. We know that it's actually possible to eradicate cervical cancer now between vaccination for HPV and screening for early detection, which can be with pap smear or with HPV testing. If we had that running in a full scale, everybody getting the guideline concordant care, we could ultimately eradicate cervical cancer.

LP: And that's where I really feel so passionate across all of my research is on disease prevention, cancer prevention. I want to put oncologists out of business. That would be brilliant, and I think they would be okay with that too, because there are other things that we could all be doing.

Narrator: Hello, and welcome to Population Healthy, a podcast from the University of Michigan School of Public Health. Join us as we dig into important health topics, stuff that affects the health of all of us at a population level, from the microscopic to the macroeconomic, the social to the environmental, from cities to neighborhoods, states to countries and around the world.

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Narrator: Leigh Pearce is a professor of epidemiology at the University of Michigan School of Public Health. Her research group studies the causes and prevention of ovarian and breast cancers. She joins us to talk about her work in this area as well as a new large scale research project she's spearheading in the state of Michigan. We asked her how she got started on this path.

LP: When I finished my MPH here at Michigan, I had a number of job offers, which is one of the great things about being at Michigan, the training we receive. And ultimately, I decided to go back home to Los Angeles, and I took up a position at the Los Angeles Gay and Lesbian Center where I ran the largest anonymous HIV testing site in the nation at that time, and also ran their sexually transmitted disease clinic, which was funded by the Los Angeles County Health Department. That was 1995, a really important time in HIV/AIDS and getting to know the community and really having an impact and making services accessible to people was what I would really consider true public health work. That was really exciting. I was an infectious disease epidemiologist, but ultimately took a big turn toward cancer, which is where my career has followed since then.

LP: One of the things that I really learned working in public health in Los Angeles County was about how diseases get reported and how public health follows up with disease reporting. Cancer is, in fact, reportable by law in every single state in the US. So that bridges the infectious disease and cancer path. And the fact that the diseases are reportable both is important for surveillance and disease control, but then also especially with cancer opens up incredible opportunities to carry out research projects in that area.

LP: I started studying ovarian cancer in 1997, and that was a time where there were seminal papers published that really changed our understanding of the disease. It's called ovarian cancer, but it turns out that most ovarian cancers actually start in the fallopian tube. And you can imagine if you're studying a disease and you've been studying the wrong organ that that can create some challenges. And so really now over the last decades, we've had just a sea change in our understanding of the disease, which has really opened up prevention opportunities for the disease that never would've existed if we hadn't had this fundamental shift in understanding.

Narrator: A promising aspect of ovarian cancer in particular is the number of prevention opportunities that have been developed with new ones on the horizon.

LP: We have chemo prevention, meaning drug related prevention, and that's the oral contraceptive pill. So many people don't realize that taking oral contraceptives for five years or more cuts your risk of ovarian cancer in half. So five year survival with ovarian cancer is less than 50%. So if you think about the number of ovarian cancers that are prevented because people take oral contraceptives, that's pretty remarkable. We also have surgical prevention opportunities, which is the removal of the fallopian tubes that can be done in lieu of somebody having a tubal ligation or having their tubes tied, and it seems nearly obliterate your risk of ovarian cancer.

LP: So that's a very exciting piece of work that was published with colleagues in British Columbia where they really showed that in the people who had their fallopian tubes removed, there were no cancers that developed. So we've got chemo prevention, drug prevention, we've got surgical prevention, and now what we're really working toward is what we call precision prevention.

LP: Can we identify the people who are at most risk of the disease and target prevention efforts toward that group? It is far better to never get ovarian cancer than to get it diagnosed early. I guarantee you, if you're in a room of survivors and you ask how many of them would have rather never had to have their cancer treated because they didn't get it, versus wanting their cancer diagnosed earlier, hands down, they will pick to have never gotten it in the first place. And that's really what I'm most passionate about. How many ovarian cancers can we prevent from occurring so that people do not have to go through the experience of having that disease treated? And that goes for the people with ovarian cancer and their loved ones because it is not an easy road to go down.

Narrator: In addition to studying how best to prevent ovarian cancer, Pearce also works with survivors.

LP: We have a large program around studying exceptional survivors, so women who have lived 10 or more years with the most deadly form of the disease, the goal of shifting more people with ovarian cancer into that exceptional survivor group. It's an international project that I lead, and we are trying to tackle this question of exceptional response from an immunologic perspective, a genomic perspective, and an epidemiologic perspective. We also, in Michigan, are just launching SOCIAL, which is Surviving Ovarian Cancer Innovation Advancement in Living Well. And it is a survivor cohort of people with ovarian cancer in our state where we can really understand the impacts of newer treatments, which are very promising, and we can understand lifestyle impacts and also the role of stress and inflammation on cancer, both survival, but also quality of life.

Narrator: A cohort study is one that follows people over time. Researchers put together an initial group or cohort and create a baseline of information about whatever they're studying. Then they follow this group, checking in every few years to gather updates, which brings us to Pearce's most ambitious research project. MI-CARES.

LP: So, MI-CARES is the Michigan Cancer and Research on the Environment Study. And it is an effort across Michigan to get people between the ages of 18 to 49 energized and engaged around understanding the impacts of environmental exposures on cancer risk and other health outcomes. So we know that in Michigan there have been a plethora of environmental catastrophes, and this is dating back to the early 70s when animal feed was poisoned and distributed across Michigan leading to the deaths of many animals, but also the poisoning of Michiganders who ate the meat.

LP: And we know that there are cancer risks associated with having had that exposure. But now we can fast forward and talk about the Flint water crisis. We know that lead exposure can lead to major health issues, particularly for children. We also know that with the Flint water crisis, there was Legionnaires' disease outbreaks and people lost their lives.

LP: We honestly don't know yet what the full extent of health concerns are going to be because of the water crisis. We're actively studying whether or not the exposures are associated with unusual cancer patterns. So that's a major aspect of our work. But with MI-CARES, if people enroll and we follow them through time, we will really be able to understand the full constellation of the health impacts of environmental exposures in Flint and across the rest of Michigan.

LP: Other areas in Michigan have had water contamination such as Benton Harbor. There is widespread environmental injustice across the state through industrial pollution. And then just the air pollution from the cars we drive, for example. MI-CARES will really give us the opportunity to understand how those exposures are affecting our risk. We can study so many different health outcomes in this young group of people. For example, what are the environmental exposures associated with autoimmune disease? 

LP: We can look at other diseases where the incidents, the occurrence is going up and evaluate whether or not that's because of environmental risk factors that we're really only becoming aware of or thinking about now. So in the press recently, there was a lot about microplastics. We all have microplastics floating around in our blood. What does that mean? What are the consequences of that? PFOS, if you're here in Ann Arbor, you can walk down to the Huron River and see the signs, see the foam. What does it mean that we have PFOS in our river? Michigan has the most PFOS sites of any state.

LP: We also want to know about other metals. We want to know about even the personal care products people use. What's in your shampoo? What's in your makeup? What's in the products you put on your hair? So there's new research that's come out that use of chemical hair straighteners is associated with breast and ovarian cancer risk.

LP: We want to get the message out about these findings. We're preparing different communications materials so that Michiganders are aware of these exposures, what the most current up-to-date research is so that everyone can make informed choices.

LP: MI-CARES is a multidisciplinary project. I believe in team science. I've been doing team science since I was a PhD student. You really cannot make use of all the research you're doing if you don't have all the experts at the table. So with MI-CARES, we have colleagues from every department in the School of Public Health as a part of the team. To get 100,000 people into this cohort, we have to use so many different approaches to make the cohort accessible to all. So we have a website where you can join remotely. You never have to see us, never have to talk to us. You can just go online, micares.health and enroll. It's pretty straightforward. However, we know that not everybody has access to a computer or a smartphone. So we are working to make it even more accessible with paper surveys and mailing those to people, taking them to events so that people can enroll that way.

LP: We are out in the community at Farmers' Markets, at health fairs, putting out the word about the cohort study, but also bringing cancer prevention messages to the community. So this is not just a one-sided where researchers give us your information. We want to give back to the community. So we have done health fairs across Michigan. We talk about cancers that you can screen for like cervical cancer, breast cancer, lung cancer, colon cancer, and in some cases, prostate cancer so that we can prevent as many cancers as possible while at the same time telling people about why enrolling in MI-CARE has so much value to the state of Michigan. That's what's so great about this project is it's the whole state. We have the opportunity to understand everything that's going on in Michigan with respect to environmental exposures.

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Narrator: If you're a Michigan resident between the ages of 25 and 44 and would like to help the Michigan cancer and research on the environment study understand the impact of the environment on Michiganders Health, please visit micares.health. That's M-I-C-A-R-E-S.health to find out more. Billing is in our show notes. Thanks for listening to this episode of Population Healthy from the University of Michigan School of Public Health. We're glad you decided to join us and hope you learned something that'll help you improve your own health or make the world a healthier place. If you enjoyed the show, please subscribe or follow this podcast on iTunes, Apple Podcasts, Google Play, Stitcher, Spotify, or wherever you listen to podcasts.

Narrator: Be sure to follow us @umichsph on Twitter, Instagram, and Facebook so you can share your perspectives on the issues we discuss. Learn more from Michigan public health experts and share episodes of the podcast with your friends on social media. You're invited to subscribe to our weekly newsletter to get the latest research news and analysis from the University of Michigan School of Public Health. Visit publichealth.umich.edu/news/newsletter to sign up. You can also check out the show notes on our website, population-healthy.com for more resources on the topics discussed in this episode. We hope you can join us for our next edition where we'll dig in further to public health topics that affect all of us at a population level.

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