ESSENTIA HEALTH CANCER CENTER WEST MARKET - 2018 ANNUAL REPORT

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A NOTE FROM THE CANCER COMMITTEE CHAIR

The Cancer Program Annual Report is a culmination of the efforts of many individuals and services. I would like to express my gratitude to all who have contributed to this effort that not only benefits our oncology program, but more importantly, our patients. This annual report will feature some of the recent enhancements and accomplishments of our program.

It is gratifying to see that cancer treatment as a whole has evolved to a more personalized approach, treating the individual based on more specific information. Genomic, biochemical, and specific individual medical characteristics, and perhaps, most importantly, the patients’ informed wishes all play a vital role in determining the optimal treatment for each patient.

Here at Essentia Health we offer state-of-the art medical and radiation therapies to treat cancer patients. This report highlights how we use stereotactic radiotherapy to target some types of cancer with extreme precision in a short amount of time to maximize the dose to the tumor, while minimizing the dose to normal tissue. Immunotherapy is a relatively new medical treatment which we feature in this report. Immunotherapy drugs activate a patient’s immune system to attack cancer cells. In the last few decades immunotherapy has become an important part of treating some types of cancer.

In addition to proven cancer treatments, clinical research has greatly expanded through our participation in the National Cancer Institute Community Oncology Research Program (NCORP). Moreover, a recent grant through the Minnesota Cancer Clinical Trial Network (MNCCTN) will allow us to expand access to clinical trials to community sites across Minnesota, including Detroit Lakes, Park Rapids and Fosston.

Other endeavors range from installing our own on-site PET scanner which has greatly improved imaging quality and turn-around time for completion of exams, to implementing a tool to screen patients at high risk of developing breast cancer, to expanding oncology outreach to Jamestown, ND. Patients in the Fosston, Park Rapids, Detroit Lakes, and now Jamestown regions have the ability to receive cancer care without going too far from home.

We continue our survivorship clinic and programming, giving patients all the tools and supportive services they need to successfully navigate their cancer journey. We also continue to promote skin, breast and colon cancer awareness and prevention. Our Sun Safety campaign was very successful again, reaching a wider audience than in past years. We also added a new head and neck cancer screening event this year through

collaboration with a local dentist’s office, an event we hope to grow next year.

I have the unique perspective of participating in the evolution of our cancer center since near its inception and have witnessed tremendous changes over the years. I believe that one of the more important distinguishing characteristics of our program from early on has been a commitment to a more personal, individual approach to cancer care as opposed to a one size fits all approach that historically has been adopted by larger institutions with high patient volumes. Our institution has been at the forefront and an early adapter of more effective technologies for improved cancer care.

It is with great pride that we present this 2018 Cancer Program Annual Report

Mark Cooper, MD

Radiation Oncology

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SURVIVORSHIP

At Essentia Health Cancer Center we realize that cancer has the potential to touch every aspect of a cancer survivor’s life. Cancer survivorship begins at the time of cancer diagnosis, and the needs of patients and their loved-ones evolve throughout the diagnostic process, treatment, transition to surveillance, and continued long-term, active surveillance. Our Survivorship program focuses on addressing the

physical, psychological, social, economic, and spiritual impacts of cancer.

After patients have completed the treatment phase of their cancer journey, they are transitioned into the Survivorship Program. At the first visit, a survivorship care plan is provided to the patient, which includes a summary of the treatments

Brittani Boehlke-Fiecke, PA-CHematologist/Oncologist

received, contact information for the providers involved with their care, possible late adverse effects from cancer treatment, healthy living goals, and emotional support resources. During these visits, our emphasis is on addressing and monitoring for long-term and late adverse effects from cancer treatment. Other areas of focus are on prevention and early detection of other cancers and promotion of healthy lifestyle choices. A dedicated Cancer Center social worker, nurse navigator, and dietitian see each patient at their first survivorship visit. They address financial concerns, provide emotional support and resources, coordinate appointments, and discuss weight management and lifestyle modifications.

Integrative health services available to all patients throughout their cancer journey include oncology rehabilitation through the physical, occupational, and speech therapy departments. These specialists concentrate on pain and fatigue management, improvement of endurance, strength, balance, range of motion, and lymphedema therapy. We offer wigs, scarves, beanies,

and wraps through the Cancer Center Accessories of Strength Boutique, donated by the American Cancer Society and community members. Bra and prosthetic fitting are available by appointment, and scheduled through the Cancer Center registration desk.

Self-improvement activities and programs are also offered at the Cancer Center to help patients cope with long-term and late effects of cancer treatment. A Cancer Support Group meets the first Tuesday of every month from 1:00-2:30 pm. The second Wednesday of each month at 2:00 pm is the Look Good Feel Better Program, led by the American Cancer Society in collaboration with the Professional Beauty Association. This program is a free, two hour hands-on workshop to supply and educate women on skin care and makeup, hair and wig styling, and clothing suggestions. Annually, in September, we host the Cancer Journey Conference, an educational day for cancer survivors and their loved ones. We also offer a celebration in June during National Cancer Survivors Month to provide our cancer survivors and their families with food, fellowship, and activities. An Expressive Art Program funded by the Essentia Health Fargo Foundation and Fargo Moorhead Area Foundation is available for survivors to create art projects which promote creativity, emotional expression, and comradery.

Additionally, survivorship care is provided at our satellite clinics in Detroit Lakes, Park Rapids, and Fosston, MN and Jamestown, ND. These sites also have infusion centers, which are staffed daily by nurses. For those patients who must travel a distance for their cancer care, travel and lodging assistance is available through generous donations and fundraising efforts by the Essentia Health Foundation.

Survivorship EventsCancer Survivor Celebration

The Essentia Health Cancer Survivor Celebration provides our cancer survivors and their families and friends with the opportunity to simply celebrate life together. The occasion allows survivors to create lasting memories with those who have supported them during their cancer journey – including the staff at the Essentia Health Cancer Center. Survivors reconnect with those whom they met during their treatments and make new connections.

The 2018 event held at Bonanzaville included live music, family-friendly entertainment, and a short program featuring an Essentia Health Cancer Center physician and a past patient who spoke about her experiences. The Cancer Survivor Celebration is planned again for June 18, 2019 at Bonanzaville in West Fargo, ND.

Cancer Journey Conference The Essentia Health Cancer Journey Conference is a day devoted to educating and empowering cancer survivors and their network of supporters.

This year’s event featured keynote speaker and cancer survivor Ruth Bachman, who spoke about “Growing Through the Narrow Spots.” The day also offered education and information sessions about long-term side effects for cancer survivors, mindfulness, music therapy, and reflexology. Survivors and their care-givers also enjoyed dedicated time to connect and share experiences.

The next Cancer Journey Conference is planned for Tuesday, September 24th, 2019 at the Courtyard by Marriott in Moorhead, MN.

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IMMUNOTHERAPY HELPS KAREN FIGHT LUNG CANCER

In her fight against lung cancer, Karen Lewis feels fortunate to have a promising new treatment: immunotherapy.

Her Essentia Health hematologist/oncologist, Dr. Tadeu Ambros, is pleased to have another treatment proven to help slow the progression of some cancers and even cure others.

Karen is receiving durvalumab (brand name Imfinzi) as part of an intensive course of treatment for advanced non-small-cell lung cancer. Chemotherapy and radiation treatments shrank the tumor in her left lung from 9.5 centimeters to 4.8 centimeters before she began a one-year course of immunotherapy.

Dr. Ambros says Karen had a very large tumor in her left lung that had not spread to her lymph nodes. That’s unusual, he explained, since the probability of cancer cells spreading usually correlates to a tumor’s size. At 9.5 centimeters, or about 3 3/4 inches, Karen’s tumor warranted an intensive and comprehensive treatment plan, Dr. Ambros said.

“Immunotherapy activates a patient’s immune system to attack any cancer that has survived chemotherapy and radiation and eradicate it,” Dr. Ambros explained.

“We want to increase the chance of a cure, and data on immunotherapy is looking that way.”

Karen sees immunotherapy as another step in a journey that

began when she sought help for a lingering cough. “I’d had a cough and had been wheezing for a couple of days, and I knew that was not right,” recalls the 66-year-old resident of Horace, North Dakota.

“I hadn’t had that before and I thought it could be the start of bronchitis.”

Karen made an appointment with Bruce Larson, a physician assistant at the Essentia Health-Lisbon Clinic.

He listened to her chest, noted her history as a former smoker and ordered the CT scan that found a large mass in her left lung near her esophagus. A biopsy confirmed non-small-cell lung cancer.

“All my life, I’ve never been sick,” says Karen, who retired from the Bobcat Company. “One day you’re well and the next day you have lung cancer.”

When she was 17, Karen’s mother died from cancer. “I was just told she had cancer and they did exploratory surgery in her chest and it spread,” she recalls. “When you’re 17, nothing sinks in.”

Karen could not have surgery on her tumor because a pre-op physical showed a closed valve in her heart, a condition she didn’t know she had. She and Dr. Ambros decided on a course of chemotherapy and radiation treatments followed by immunotherapy. Karen says she was fortunate to have very few side effects besides fatigue.

Immunotherapy was only recently approved by the U.S. Food and Drug Administration for her type of cancer. “Dr. Ambros was excited and I was excited,” Karen recalls. “We want to get the tumor down to almost nothing so it won’t come back.”

Karen recalls looking at a CT scan with Dr. Mark Cooper, her Essentia Health radiation oncologist: “I wanted to see the scan. We were both very happy with the progress – there was a hole in the middle of the tumor and it had shrunk.”

“Immunotherapy is a new treatment option that has the potential to prove to be as important as chemotherapy with less side effects,” Dr. Ambros says. “Immunotherapy has cured people. When it works, it lasts much longer than chemotherapy.”

The hematologist/oncologist explains immunotherapy is being prescribed for most lung cancers, kidney cancers and melanoma.

It can also be offered to people with some types of colon, breast and prostate cancers.

Dr. Ambros says he has seen immunotherapy be effective even in a few patients with Stage IV lung cancer that has spread to lymph nodes and other organs. He’s observed tumors that shrank.

“People are back to work and back to their lives because they’ve had positive results with no side effects or minimal side effects,” Dr. Ambros says. “I have one patient who wonders why he needs to come in for his immunotherapy infusions because he’s feeling so good.”

Karen makes regular trips to the Essentia Health Cancer Center in Fargo to receive infusions. “The nurses are so caring and so helpful,’” she says. “If any questions pop into my head, they’re happy to explain. And they’re always checking in, asking if you’re comfortable or they can get you anything.”

Karen says completing her radiation treatments and moving to immunotherapy has made her hopeful.

“Last year, I was getting things in order and I moved from Lisbon to Horace to live next door to my son,” she says. “I’ve accepted that I could die. I go day by day, but I have hope.”

Karen has even found a silver lining: She’s seeing more of her grandchildren, who can now stop by to visit. “It seems I never saw them when I lived 60 miles away in Lisbon,” she says with a smile.

“Immunotherapy has cured people. When it works, it lasts much longer than chemotherapy.”

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COMMUNITY OUTREACH

Education CampaignsSun Safety Poster ContestEssentia health collaborated with the Fargo-Moorhead Youth Commission, area YMCA afterschool programs, and the Dilworth-Glyndon-Felton School District to implement a poster contest for area elementary school-age children. The Youth Commission and YMCA approached the poster contest as a two-week project. During the first week, project leaders provided education, including a sun safety pre-test. In the second week, students made sun safety posters incorporating lessons learned from the first week’s instruction. The school-based contest was advertised via the school newsletter and administered and managed outside of the classroom. Parents gave the education and instructions, and students had a month to complete and submit their posters.

Cancer Center staff, patients, and caregivers judged the poster entries based on originality, creativity, use of sun safety strategies, and quality of artwork. Four Grand Prize winners, one from each local region, were awarded a 2018 family season pass to local area parks’ outdoor swimming pools and the top ten winners from each region received a Sun Safety Kit.

Summer Sun Safety Tips

HELLO SUN!

Artist: Ainsley - Fargo

Sun Safety CampaignA sun safety public service announcement (PSA) campaign was launched the week of May 21st and continued for seven weeks. The PSAs highlighted the importance of using water-resistant, broad-spectrum, sunscreen with an SPF of 30 or higher on days when spending time outside. Other topics included warnings on the dangers of indoor tanning and promoting sunless tanning for special occasions. The PSAs also included attention-getting statistics and facts (e.g. “More people develop skin cancer from indoor tanning than develop lung cancer from smoking.”

Sun Safety Pool Safety Day EventsEssentia Health collaborated with West Fargo, Fargo, Moorhead and Dilworth public pools to provide a sun safety booth at each public pool’s annual pool safety day event. Swimmers were asked to answer sun safety questions before spinning the prize wheel, and sunscreen and sunglasses were given as prizes. This interaction was a great way to spark further conversation with kids and parents.

Breast Cancer Radio Campaign and Fund RaiserFor the second consecutive year, Essentia Health collaborated with the local radio station Big 98.7 during Breast Cancer Awareness Month in October. The radio campaign included live interviews with patients and clinicians, and pre-recorded PSAs. Topics focused on general screening recommendations, information about 3-D mammography, dense breast identification, and lifestyle, environmental, and genetic risk factors for breast cancer.

The campaign also aimed to increase public awareness through a bra donation campaign – “Bras on Big”. Bras donated by the

community were matched with dollars awarded to Essentia Health Fargo Foundation Cancer Fund. Funds raised are used to provide patient support, including transportation assistance, lodging, grocery assistance, and wigs for patients in active cancer treatment.

Screening EventsHead and Neck Cancer Screening Essentia Health collaborated with a local dental office, Dr. B’s Dentistry, and the James Carlson Public Library to offer a head and neck cancer screening event for the Fargo-Moorhead community. Twenty participants were screened, and three persons required follow-up. These three persons were given referral information for local providers and contacted by phone two weeks later to ensure that they had established follow-up care. Head and neck cancer educational material was provided to all participants.

Ada Health Fair Colorectal Cancer Screening In October, community members in Ada, MN participated in a health fair offered by Essentia Health, which included FIT testing for appropriate unscreened individuals (i.e. adults age 50-75 with average risk for colorectal cancer, and not up-to-date on screening). This rural community health fair benefits those who are uninsured or under-insured by offering lab work at a reduced cost. Approximately 200 people attended the event, 29 of whom met colorectal screening criteria and took home FIT tests. Individuals who do not return a FIT test are contacted to encourage completion of the test. Participants with positive results are called to schedule a colonoscopy.

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BREAST CANCER ASSESSMENT IDENTIFIES HIGH RISK PATIENTS

Beginning in early 2018, women undergoing screening mammography at Essentia Health in Fargo are having their lifetime breast cancer risk estimated using the Breast Cancer Risk Assessment Tool (Gail Model). This risk calculator uses simple information including age, race/ethnicity, family history (1st-degree relatives), age at menarche, age at first live birth and other factors to produce estimated 5-year and lifetime risks. According to Dr. Mitch Crider, this information is used to help identify patients that are at increased risk of breast cancer. Depending on specific clinical factors, this

high-risk patient population may benefit from additional evaluations which include annual screening MRI (in addition to annual mammography), focused family history and physical examination, evaluation by a genetic counselor, or evaluation by oncology for risk reduction strategies. To facilitate appropriate additional high-risk evaluation, radiology is referring these patients to a high-risk breast clinic provider who will help the patient in interpreting the results and determining specific next steps.

NEW SERVICES/TECHNOLOGY

TeleSitterEssentia Health Hospital in Fargo now has an option to use TeleSitter for patients that need continuous monitoring. Patients must be redirectable using verbal cues to qualify for this service. TeleSitter can be used on numerous different patients (those at risk for falls, forgetful/confused, suspicious activity, etc.). The TeleSitter Monitor Technician has the capability to observe six patients at a time and can interact with patients via 2-way audio communication. When TeleSitter is in use, there is a sign placed outside of the patient’s room to alert family and visitors about the service. This system does NOT record audio or video, and when cares or

assessments are being completed, there is a privacy option. Since incorporating this system, we have prevented numerous falls!

In-House PET/CTIn mid-June, installation of a new PET/CT scanner at Essentia Health on 32nd Avenue was completed and the first patients were scanned. Having PET/CT in-house has significantly improved scheduling flexibility, turn-around time for completion of exams and imaging quality. Currently, three slots are available daily, Monday through Friday. PET/CT is an important tool in the staging and re-staging of many common malignancies, including lymphoma, melanoma, head & neck, breast, lung, colon and other cancers.

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STEREOTACTIC RADIOTHERAPY OFFERS FASTER, HIGHLY PRECISE TREATMENTS

Stereotactic radiotherapy is a type of external beam radiation therapy that uses a focused beam of radiation to target a well-defined tumor. It allows us to deliver a high dose of sculpted radiation to the tumor in a short amount of time, usually one to five treatments. The goal is to maximize the dose to the tumor, and minimize the dose to normal tissue. In order to provide effective and safe treatment, we utilize detailed imaging, precise/reproducible set-up techniques, computerized four-dimensional (4D) planning, and sophisticated treatment delivery.

Stereotactic radiotherapy is also known as Stereotactic Radiosurgery (SRS) when treating lesions in the brain or spine, or Stereotactic Body Radiotherapy (SBRT) and Stereotactic Ablative Body Radiotherapy (SABR) when treating lesions elsewhere in the body. Not every patient or every cancer is able to be treated in this way. It is generally best for small tumors that can be

accurately pinpointed. Stereotactic radiotherapy is generally very well-tolerated, and has been shown to be very effective.

Extreme precision is necessary to ensure the cancer is getting the prescribed dose, while minimizing the effect on other nearby organs. The patient must be able to hold a certain position and lie completely still. Customized devices are used to accomplish this, such as a face mask or body immobilizer. Also, we must be able to visualize the target and manage any motion that can occur during treatment. This requires advanced technology, appropriate physics support, and clinical expertise by both the physician and the radiation therapists.

At Essentia Cancer Center, lung and prostate are the cancers we treat most often with SBRT/SABR. According to National Comprehensive Cancer Network (NCCN) Guidelines for treatment, SBRT/SABR is recognized as an acceptable mode of

treatment for both of those sites. As you can imagine, there can be considerable motion of lung tumors with respiration. Our technology allows us to capture images during breathing, and perform sophisticated computations to provide 4D data. We are able to visualize and account for the tumor position in each phase of the respiratory cycle. With this information, we are confident of the tumor position and are able to decrease the dose to nearby tissue - such as normal, healthy lung.

One might not think of the prostate as a moving target. But it is! Changes in bladder and rectal filling can affect the location of the prostate. And these changes can occur in the few minutes that the patient is lying on the treatment table. 4D ultrasound monitoring provides live imaging of the target and surrounding anatomy during treatment. If the target moves outside of the allowed threshold, the treatment is stopped and the patient is realigned.

It is truly amazing how far therapeutic radiation has come in the last decade. In both stereotactic and standard treatments, we have made advances that allow for better visualization of the cancer and immobilization of the patient. The end result is highly conformal therapy with exceptional precision. Here at Essentia Health Cancer Center, we are proud to deliver state-of-the art cancer treatment - and are committed to continue doing so in the future.

Joni Buechler-Price, MDRadiation Oncologist

Top 5 Cancer Sites Essentia Health West 2016 vs National Cancer Data Base 2016*

0

5

10

15

20

BREAST LUNG PROSTATE MELANOMA COLON

14%

18%

15%

12%13%

9% 9%

4%

7%6%

Essentia Health NCDB

*2016 is the most recent year data is available from NCDB.

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County names are hidden under each layer.States are only colored white.

CANCER IMMUNOTHERAPY UPDATE

Ersin Selcuk Unal, MD, PhD Hematologist/Oncologist

Today, we are using immunotherapy agents to treat a vast majority of tumors including, but not limited to, malignant melanoma and cancers of the lung, kidney, bladder, colon, head & neck and breast. In carefully selected patients, intravenous administration of these drugs result in long-term, durable disease remission rates. Unlike conventional chemotherapy regimens, a unique feature of immunotherapy is the

continued tumor killing effect even though the treatment is discontinued.

Immunotherapy uses certain parts of a person’s immune system to fight cancer. Some tumor cells resist, or escape, the innate response of the immune system and continue growing, which may result in metastasis. This occurs through a process called immune evasion. Hence, multiple treatment methods were developed to increase the power of the immune system to fight against and eliminate cancer in the field of cancer immunotherapy. Continued scientific and technological innovations have resulted in major breakthroughs in recent years. This is mainly due to the demonstration of the interacting molecules on immune cells and cancer cells resulting in inhibition of T-cell function. The most studied molecules involved in the evasion process are either expressed by the T-cells, such

as CTLA-4 (cytotoxic T-lymphocyte-associated protein 4) and PD-1 (Programmed Death 1) or the tumor cells, such as PD-L1 (Programmed Death Ligand 1). The inhibition of the immune system by the tumor cells are blocked by currently used immunotherapy drugs, which are antibody molecules against CTLA-4, PD1 or PD-L1. In this treatment method, a person’s own immune system cells are stimulated to attack the cancer cells by removing the brakes placed on them by the tumor cells.

Although immunotherapy agents are generally better tolerated than cytotoxic chemotherapy, they do have specific side effect profiles. As expected, the side effect profile of immunotherapy agents occurs mainly due to the increased activity of T-cells. Patients require close clinical and laboratory follow-up during the treatment course since the off-target accelerated inflammatory reaction(s) triggered by immunotherapy may affect normal human tissues such as the lungs, gastrointestinal tract, endocrine organs and skin.

An extensive amount of research is ongoing in the field of immunotherapy and hundreds of clinical trials are in progress. There is a significant need for the development of more accurate biomarkers/predictive factors and the establishment of the optimal use of immunotherapy/chemotherapy combinations. Hopefully, these studies will improve current treatment protocols and further increase high quality, cancer-free lives with loved ones.

CLINICAL TRIALS

Bret Friday, MD Hematologist/Oncologist

Essentia Health cancer patients benefit from a generous partnership with the University of Minnesota.

Nearly half of all Minnesotans will be diagnosed with a potentially life-threatening cancer during their lifetime. Essentia Health patients will soon have better access to new cancer treatments and enhanced care thanks to a new state-funded partnership between University of Minnesota and the state’s major

health systems, including Essentia Health.

As part of the Minnesota Discovery Research and InnoVation (MnDRIVE) partnership with the State of Minnesota, the University is launching the Minnesota Cancer Clinical Trials Network (MNCCTN) with multiple locations across the state. Led by the Masonic Cancer Center, University of Minnesota, the goal of the MNCCTN is to improve cancer outcomes for all Minnesotans through greater access to cancer clinical trials in prevention, treatment, and survivorship. The partnership will provide Essentia $500,000 to support expanding access to clinical trials.

Cancer patients in northern Minnesota have already benefited from access to clinical trials at Essentia Health’s Cancer Centers in Duluth, Brainerd and Fargo. “The State’s cancer research network will augment the work we are currently doing at Essentia’s cancer

clinical trial program to provide our patients greater access to the ground-breaking research from institutions in Minnesota,” says Dr. Bret Friday, a hematologist/oncologist at Essentia Health’s Cancer Center in Duluth.

56 percent of Minnesotans have fewer options for treatment because they live more than 30 miles from a hospital or clinic that offers access to clinical trials. By bringing cancer clinical trials to those living in Greater Minnesota, the MNCCTN will increase access to potentially lifesaving and life-changing therapies and treatments, strengthen healthcare systems, create more equitable access to care, and could improve cancer outcomes throughout the state.

“Our long-term goal is that every cancer patient in northern Minnesota has access to clinical trials close to home” says Dr. Friday. With the inception of the State’s cancer research network, Essentia has expanded access to cancer trials at multiple clinics, including Virginia, Hibbing, Deer River, Detroit Lakes, Park Rapids, and Fosston. Additional centers will be added in the future. The cancer network is currently funded for two years.

The Essentia Health Community Cancer Research Program has been a national leader in clinical trials research for more than 35 years. Communities within the Essentia Health catchment area have access to state-of-the-art cancer care through participation in National Cancer Institute (NCI) supported clinical trials as part their program. For more information about EHCCRP clinical trials visit: http://www.cancerhelpessentiahealth.org

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CANCER SCREENING GUIDELINESKnowing your family history is key and can help determine at what age some screenings should start

Colon and Rectal ScreeningMost people should start at age 50. Ask your doctor when you should start and what test is best for you. You may need to start sooner if you have risk factors such as:

■ You are African American■ Someone in your immediate family has had colon cancer

Lung CancerYou should consider being screened with a low-dose CT scan if you have all three of these risk factors:

■ You are 55-77 years old■ You are a current smoker or a former smoker who quit less

than 15 years ago■ You have a smoking history of at least 30 pack-years

(This means 1 pack a day for 30 years or 2 packs a day for 15years)

Skin CancerKnow the melanoma ABCDE’s:

■ Asymmetry: One half is unlike the other■ Border: Irregular, scalloped or poorly defined border■ Color: Varied from one area to another, shades of tan &

brown, black: sometimes white, red or blue ■ Diameter: Melanoma’s are usually greater than 6mm (pencil

eraser), but can be smaller ■ Evolving: A mole or skin lesion that looks different from the

rest or is changing shape or color

Breast Cancer Screening■ 40 and older: annual mammogram and clinical breast exam■ Some individuals have a higher risk of developing breast

cancer. The ideal screening routine for these women is bestdetermined individually with a physician

Cervical Cancer Screening■ Women age 21 to 29 years with Pap test every 3 years■ Women between 30-65 years, screen with a combination of

HPV and Pap test every 5 years■ Women in menopause should report any unexpected

bleeding to their doctor

Prostate Cancer ■ Starting at age 45, men should talk to a health care provider

about the pros and cons of testing so they can decide if testing is the right choice for them

■ If you are African American or have a father or brother whohad prostate cancer before age 65, you should have this talkwith your health care provider starting at age 45

Tips for Reducing Your Cancer Risk

What is known about cancer prevention is still evolving. However, it’s well-accepted that your chances of developing cancer are affected by the lifestyle choices you make. So if you’re concerned about cancer prevention, take comfort in the fact that some simple lifestyle changes can make a big difference.

Consider these cancer prevention tips: ■ Avoid tobacco■ Eat a healthy diet■ Maintain a healthy weight and by physically active■ Protect yourself from the sun■ Get immunized■ Get regular medical care

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New Team Members

Matthias Albin, MDInterventional Radiology32nd Avenue Clinic

Eunkyung Michelle Bahn, MDNeurosurgery32nd Avenue Clinic

Adam DeFoe, MDInterventional Radiology32nd Avenue Clinic

Zachary Ernst, MDGeneral Surgery32nd Avenue Clinic

Corbett Haas, DDS, MDOral & Maxillofacial Surgery32nd Avenue Clinic

Paul Williams, MDEar, Nose & ThroatSouth University Clinic

County at DiagnosisWest Market

Minnesota

BeckerBeltramiBig StoneCassClayClearwaterGrantHennepinHubbardMahnomenNorman

Otter TailPenningtonPolkRed LakeRoseauStearnsStevensTraverseWadenaWilkin

North Dakota

AdamsBarnesCassCavalierDivideEddyGrand ForksGriggsMercerPembina

RamseyRansomRichlandSargentStarkSteeleStutsmanTraillWalsh

South Dakota

MarshallRoberts

CaliforniaLos Angeles

CANCER CARE AT ESSENTIA HEALTH

Essentia Health-Central

Essentia Health-East

Essentia Health-West

* Northwest Wisconsin Cancer Center of Memorial Medical Center in Collaboration with Essentia Health

The Essentia Health Cancer Center offers a comprehensive cancer care program throughout Northwestern Wisconsin, Northern Minnesota and Eastern North Dakota. From diagnosis to treatment and after-care, our teams listen to you and offer you personalized, state-of-the art care.

Our cancer care teams work together across all of Essentia Health on ways to offer additional treatments, services and resources to our patients and their caregivers, such as Psychosocial Distress Screening, Nurse Navigators and the expansion of our clinical trials.

NORTH DAKOTA

MINNESOTAWISCONSIN

Jamestown

Fargo

Fosston

Detroit LakesPark Rapids

Virginia

Brainerd

Spooner

Hayward

Ashland*

Hibbing

Duluth

Patient residence at time of diagnosis (2017)

County names are hidden under each layer.States are only colored white.

ESSENTIA HEALTH CANCER CENTER | 2018 ANNUAL REPORT ESSENTIA HEALTH CANCER CENTER | 2018 ANNUAL REPORT20 21

Essentia Health Cancer Center - Fargo, North Dakota1702 South University Drive | Fargo | 701-364-8910 | EssentiaHealth.org