Brain Cancers

>> i hope you've had an opportunity to watch the pbs special, cancer: the emperor of all maladies on net. both the book and the film show that we have made remarkable progress in understanding the complexities of cancer. next, we'll introduce you to

some remarkable nebraskans, living with cancer. * >> i took that to mean my cancer was terminal. that it had spread throughout my body. it was too late. >> i was totally devastated. and

it was very hard to think about anything except cancer and death and dying and missing out on everything. >> as bad of a journey as its been there's been phenomenal people walking with me. >> the greatest out of all this would be to see a world cancer

free in the next generation. >> welcome, i'm dennis kellogg. joining us in the discussion is dr. ken cowan, director, of the eppley institute and the director of the fred & pamela buffett cancer center, and dr. sarah thayer, cancer specialist and

physician-in-chief of the buffet cancer center at unmc in omaha. later we will be joined by andy hoffman and unmc dr. renaisa s. anthony. we will also introduce you to a few amazing nebraskans living with cancer. welcome.

thank you for joining us tonight. >so you're both on the ground level at cancer research in nebraska and it seems we've made progress in fighting cancer over the last hundred years or so. but cancer claimed more than 3400 nebraska lives in 2011,

which is the last year available for stats. so we begin with a very simple question and yet also probably a very difficult question. are we winning the war on cancer? >> there's been a series as was outlined in the book and series.

there's been a number of developments over the last 50 years in specifically developing new therapies. even in the last 20 years there's been continued to improve in both early detection, identifying patients earlier, improvements in detection

treatments, prevention, they've made things better for cancer patients today. >> what are the most common types of cancer we see in nebraska and what are the most deadliest types of cancer we see in nebraska? >> well, some of the most common

cancers we see are lung cancer, prostate cancer, breast cancer and colon cancer. certainly there are significant number of those, but the deadly ones are really if you think about it, it's going to be lung cancer first, colon cancer second and believe it or not

pancreas in nebraska is third. breast and prostate take the fourth position, which is slightly different than the nation in nebraska it's the third >> so there's cancer we search going on right here in nebraska to fight some of those types of

cancers. let's talk about that. give us an overview of what type of research is going on here in our state. >> well, a broad depth of research and a variety of diseases you just spoke about. pancreatic is one of the

strengths at unmc. two after the areas we've been strong at the university, so we've had researchers in these areas going back 20 or 30 years developing teams and continuing to expand their efforts. pancreatic cancer, again, a very major edition to our pancreatic

cancer both care team swell research teams. they're looking at early detection, ways of treating it, et cetera and a transplant program started in 1982 and been one of the largest transplant facilities in the country. it's been a major program for

the university for over 30 years now. >> and doctor thayer what are obstacles we face? >> the two we can't control that much about is time and money. so we need a lot of time with really good researchers exploring different

possibilities. remember research is broken down into multiple different facets. for example we have basic science researchers. they look at some of the cornerstones, initiators of these cancers, what drives the formation of its behavior.

because cancer is not cancer is not cancer. remember, we have very many different types of cancer, but the behavior, the biology is extremely different. what might promote its growth and why have these behaviors, why some can be cured and why

some can't. those discoveries really occur in the laboratory and we need huge number of researchers with good, foundational labs that are well funded in order to address some of these underlying questions. the second phase is translate

some of these early discoveries and see if any of them have any possibility of being used in the clinics. and then ultimately the clinical researchers basically take this idea and say, hey, can we use that as a target? can we use it as a predictive

marker? does it predict, is it a good behaving tumor? does it predict who will respond to certain treatments? can we design a more effective treatment for that person by looking at these. you can see the spectrum of

education is extraordinary. from the science lab to the translational researchers to the clinical researchers and hopefully change the lives for our patients. >> absolutely. and when a patient hears that word or gets that diagnosis,

hears the word cancer, it can be devastating. how one man rose above the original diagnosis is truly inspiring. * >> that night i planned my suicide. i was going to go to a nice

hotel and take my shotgun broken down in a suitcase and end it there. >> that was john's reaction upon hearing that he had cancer. >> and i just decided i wasn't going to die that kind of death. >> just one day after having a tumor in his small intestine

removed, the surgeon told him that although the surgery was successful they found cancer in his lymph nodes. >> i took that my cancer was terminal. the next day john was visited by analogy colings. an oncologist.

>> he said, so tell me about your cancer. >> and i told him i knew it was >> he said, i will make a deal with you, if you promise to maintain a positive attitude, and it's vital you do, i will give you your life back. and instantly i did a 180.

>> john immediately started treatment at methodist cancer center. >> i don't know what to expect. i guess i expected death and dying. last thing in the world i expected was in the form of joyce and ethel, the two

greeters. she had me laughing before i got to the front desk and full of love and hugs. i began to realize i'm not walking into death and dying. i'm coming in to a new family here. >> john had a cat scan at the

end of six months. he was cancer free, but the good news would be short lived. >> six months later he found two tumors. >> john endured hard chemo and several rounds of radiation. in the midst of his treatment he found out ethel was retiring.

>> i told my wife i'm going to apply for that reason. she said, you're 61 years old, you have terminal cancer. i said, yeah, yeah, i'm 61. i got terminal cancer. i'm perfect for it! *q;*w >> john got the job and through

radiation and chemo he stood at the door. >> hi, hi, how we doing today? >> welcoming weary patients. every day. for four hours a day. >> during the worst days, the hardest days i had a button and i wore it on my smock every day

that says, my cancer is terminal, i'm not. >> ladies, how we doing? most people go through their life and never find their calling. they do a job, they raise a family, they have grand kids. >> i push her around.ã§[ dmfr

>> you push her around all the time. okay. >> they never really find what they're going for. >> this is my last visit. i won't see you for a while. >> i found it. i know exactly what i was born

for. i'm doing it. is it okay if i pray for you? >> you bet. lord, we just lift mary up. this isn't a job, this is a ministry. >> thank you very much. >> you bet ya.

>> bye-bye. >> i wouldn't trade my life with anybody. >> what a great attitude. so when a patient gets that initial diagnosis they hear the c word, the word cancer, there's obviously going to be anger and depression.

as a doctor what can you tell the patient in order to make that state of depression that it doesn't extended on forever? >> i think one of the key things is to take away their fear. many of them come in with exactly that same fear, they're terminal, this is a death

sentence. for the majority this is not their outcome. what we need to do is be able to speak to them in terms of where they are in their cancer, what stage they are, what treatments we have to offer, and what success we have in that cancer.

so to quickly get information to that patient so he can decipher what's real. that's the most important initial thing. >> that day when they hear that word is actually the most difficult day in their life. it changes their life forever.

but as doctor pointed out, most people today do survive that disease. there's over 14 million americans alive today as cancer survivors. that's more than four times the number of lives in 1971. so there's been tremendous

progress in diagnosing these diseases earlier and treatments are far more effective. many more people are surviving this disease and going onto lead a life. what i tell patients every day is that you'll get beyond this. we can understand what your

disease is. we can understand how to treat it. we can understand making you understand that you're going to survive this disease, but it will change your life forever, just like in that video. it changes your life forever.

you will forever be different. you'll be a better person. you'll be a better father. you'll be a better husband. you'll be a better everything to everybody. it does change your life forever. you'll look at life differently

than everybody else. and so many people are diagnosed, but everybody in their family is touched by cancer. >> well, having hope of recovery is a powerful motivator. we'll visit a nebraskan who's finding a way to cope with the

deadliest of cancers. >>> jeff schmahl was the vision behind husker vision. jeff originated husker vision and created the goose bump moment known as the husker tunnel walk. he was busy working in athletics and media until this latest

shock. now at age 58 jeff is living with stage four pancreatic >> it did come as a very, very big shock. i mean, i had had a pain in my side for probably about a month. i thought it might be an ulcer, a gallbladder, you really don't

think you've got cancer or anything big like that, and then to find out that not only is it cancer but it's the worst kind of cancer that you can have, which is pancreatic cancer. >> it's a very slow, growing cancer in your pancreas. once it spreads then that's when

it turns deadly very, very6ã‘pkw>ã· quickly. once i started chemotherapy my numbers started to get good, and so i had reason to be optimistic that the chemotherapy was working and that i had a chance to get better, and the type of cancer that i have literally

only 2% of people make it five years. really for pancreatic cancer right now there are no cures. >> the hardest thing for me is how many shots he takes a day. how many pokes of needles he takes throughout the day. how many medicines he takes

every single day. there's a lot of poison going into his system. a lot of poison to kill this, the big c, what he calls it the g9pbig c.8 >> at the suggestion of a friend husker volleyball legend, terry, he writes a personal blog on his

>> the name of the blog is the last train. i've always been into analogies. i don't remember how and when it hit me, but that's kind of what hit me was, i'm on my last train ride. and i don't know exactly when the train is going to come to an

end, but my ticket's been punched and i know the destination and now i'm on that ride, and my philosophy there was just, what can i do to make the most of this train ride? and the thing that i've really tried to do in my blog is just be honest.

i'm not trying to impress people. i'm not trying to be a heroic figure. i'm just trying to honestly share my feelings, my thoughts on life and where i'm at right when i started writing the blog, i thought, if the only two

people who read it are my wife and my son, that's enough. >> first blog was very touching, and he made me cry because i'm thinking, is he trying to tell me that it is it. that i'm done. that this is good-bye. i'm on the last train.

my stop is around the corner and i'm done. and i said, i don't want to hear that. i don't want to hear that you're dying or that you're thinking you're going to die tomorrow. and he says, well, that's reality.

and i said, well, you know, you got to think of us and yourself that you're going to fight for this. >> she doesn't really want to think about death. she doesn't, when i write about the fact that i'm going to die she doesn't like it.

>> he wants to have his life celebrated and i get it. i think that's awesome, celebrating your achievements and successes, rather than just remember those last, final moments because that's not what's important. it's important the times you've

shared. not the mourning you've shared in the very end. it's the thing that we have to force ourselves constantly to do is not look at, like, watch dad get sick. it's no, let's cherish the moments we have.

let's cherish his good days and go out and do fun things with our families so we have memories. i don't want to remember the times that he's sick. >> chocolate. >> how about red velvet? >> before jeff's diagnosis, jeff

and maria moved to new york to help with their son's new cookie business. today, they run a thriving cookie bakery in manhattan called schmackary's. >> it actually has pieces of bacon in it. and this is my favorite cookie.

maple bacon. >> he's a junk food junky. >> and it's awesome. >> the store is literally blocks from times square. i mean, you're in the middle of it all. maria and i are very adaptable and we had no doubt that this

was where we should be and wanted to be, and it was fun. it was exciting being part of a cookie store and it doing well. and it's been fun just to watch zach grow as a businessperson, and watch the business grow as well. >> when he was original

diagnosed they said, your dad has a year if he's lucky. six months is more likely. and that hit me like a ton of bricks. my parents, we're like partners. and i don't mean business partners. we're a team.

>> zach will come over maybe once a week and spend the night and maria will cook one of our favorite meals and we'll just sit around and talk and have a great time and maria sometimes will go to bed early and zach and i will stay up for a couple hours and just talk.

>> i guess i'd like to know his true feelings about death, which terrifies me, but to -- if it ever got down to the point to say, like, dad, are you scared? what are you feeling right now? those are the things that i would want to know, but the answer's really hard.

>> i hope the message that people get is that it's going to be okay. this ride that we're on called life is pretty special. if i had to come down to what is it that's the best medicine. it's to make sure you're feeding your soul.

make sure you're doing things that you really, really enjoy to the depths of your person and that you spend time doing those things. >> pancreatic is projected to be the second deadliest cancer by 2030. the survival rate is not great.

doctor, you're an internationally recognized doctor at unmc. your specialty is pancreatic cancer i'll start with you. we seem to be making progress against some other types of why can't we make progress

against pancreatic cancer? >> well, the cancers we're doing the best with have screening modalities and we have a pretty good understanding about what might be caused of them. for example, cigarette smoking and lung cancer. pancreatic cancer is very

difficult because we really don't have a great understanding or big drivers that may be causing the formation of this that's the first thing. the second thing is we really have no screening mechanism for this type of cancer because it's a fairly rare cancer, and so

screening the entire population is cost prohibited, and if we did we don't even have good screening modalities. if we could identify them early enough to have a meaningful outcome. the other thing is that symptoms can't really drive its

presentation. it's a very quiet cancer until the cancer is at an advanced stage where there's very little hope for cure. and when we talk about some of the symptoms that it can have such as what jeff talked about, a little bit of side pain, a

little bit of back pain. maybe he had a little bit of pain after he ate. all these are so non-specific and really direct themselves to more common diagnoses. the results presenting at an the beginning of all these results presenting at an

advanced stage. >> so when the comes to the research being done, what are the positives you can pull out right now? >> first of all we are making progress in pancreatic cancer, and i think the nation as a whole understands the importance

of research and how research and the information that we're getting is the hope in this so the nih has increased funding for pancreatic cancer and there are big groups of people looking at the genetics and tumor environment and all the important things that might be

contributing to this. the key things would be early markets. is there anything we can identify to let us know the cancer is there. ultimately a lot of people are focused on identifying pancreatic cancer early by

perhaps a marker. the other thing that i think is really going on and really important is that for a long time pancreatic cancer was very difficult to study because we didn't have access to tissue. so it became very difficult to basically identify the mutations

that went on that drove the formation of this cancer and important in the biology of this over the course of the last decade there's been an increasing emphasis to try to get tissues so we can identify the genes that might be mutatedd(ã§ih'ã‘ or creating this bad biology,

and the goal is to identify those genes that are driving the behavior of this tumor so we can basically attack that tumor at those points, at those particular mutations and hope to give our patients in the future a directed treatment that affects the tumor without

affecting them. >> it's sad that we have some of the strongest programs in pancreatic research in nebraska. so they have led a team here not last 20 years. they have four of the largest grants from the national cancer institute looking at early

detection of pancreatic cancer and national cancer institute. we've also had a special program research excellence funded for 15 years now directly developing new therapies for pancreatic so it's a program that started back in the '70s with the development of the first --

[ indistinguishable ] which there was no models for it's really a real strength in nebraska to have this research. >> that's great to hear about that hope. and that is good news. >> our next story features another legend.

jack hoffman. today cancer trials and therapies are presenting new hope for team jack. >> seven-year-old jack hoffman, a pediatric cancer patient. >> it was a touchdown run during the 2013 husker spring game. most us ever of us learned the

polite of jack hoffman. >> so the end zone! >> diagnosed with pediatric brain cancer the year before he made his run undergoing chemotherapy. for a short time his cancer was stabilized but last fall the tumor began to grow and jack

enrolled in a downed breaking -- ground breaking clinical trial. >> it was back in 2009 of new it occurs in his kind of tumor. we've treated about 30 kids. >> when you have an opportunity to engage in a clinical trial and participate taking a drug that is new and fresh, it can be

the difference between life and death for kids. jack has a genetic mutation in his tumor. genetic mutations serves as the gas pedal for a brain tumor. i always tell people if you have a bad tree in the forest and you want to get rid of the tree

chemotherapy starts the forest fire. jack is on a -- we have a bad tree in the forest and we're going to go after it with a chain saw. >> jack receives monthly treatments in boston and the results of the ground-breaking

drug he's taking are promising. as it's shown to stabilize or shrink brain tumors. >> the problem is that we're not sure if the one that is stop growing are now stopped for good and are dead, but the scar or whatever is still there, or whether there's still some live

cells there. the only way to answer that is to do a big operation. the other thing we're going to look at that will take more time is once you've completed the drug, does the tumor stay stopped forever or will it grow again?

woe don't have all the answers yet. in terms of the ability to shrink or stop growing the vast majority of the tumor, somewhere in the 90% range is great for anything that's been done. for something that was only discovered six years ago.

>> that's the thing about a clinical trial. they're trials. we don't have a proven set of data. it's kind of like rolling the dice, but when you're a child with a brain tumor you have to role the dice.

>> so jack's dad, and i guess his official spokesman, andy hoffman joins us. thanks, andy. tell us how he's doing. >> clinically jack is doing super. he's on a targeted drug therapy and so that's really the

blessing of all this is that you wouldn't know he's even undergoing chemotherapy. he takes the drug twice a day. he's got to do a lot of travel going back to boston. but clinically he's doing great. and the thing that to me -- the story that jack tells is really

the importance for funding pediatric brain cancer research. this trial is available to him because someone six, seven years ago said, hey, let's invest in pediatric brain cancer. today they're able to match that abnormality up with a drug that was approved for adult cancer

therapy. that doesn't happen without research funding. >> when it comes to the clinical trials we heard you say it. you have to roll the dice in this situation. what went into the decision for your family about deciding to

participate in the clinical trial? >> well, it's a big decision. the thing about cancer therapy with kids, pediatrics, there's 13,000 children that are diagnosed with any form of pediatric cancer. 4,000 kids diagnosed with

with such a lack of funding for the disease, with less than 4% of the federal dollars being invested in pediatric cancer research you really don't have a lot of options. that's all that's available. one new drug approved by the fda in the last 25 years for kids

that's our only access to new therapies. that's kids' only access is through clinical trial. a lot of times kids go through these trials and they don't make it all the way through the phase one, the phase two to phase three to where they're finally

approved.ã³1y y]qjy kids are at an disadvantage. when it comes to fighting cancer because of the gross lack of funding in this country. >> the clinical trial jack is in is on the east coast. talk about the stress on the family going through that.

the travel, the missing school, the separation. >> that piece of it is there. jack's not special. so many kids diagnosed with brain cancer or any childhood cancer, they have to travel. kind of the joke is have brain tumor, we'll travel.

there is no travel site between the mississippi river and the rocky mountains, so you're going to have to get on a plane if you want your son to be able to participate in this targeted drug therapy. there's no choice, and so you put your boots on and you kind

of take that nebraska attitude and you just go to work. and you do what needs to be done to beat this thing because that's -- there's no other option. >> dr. thayer and cowan. we talked earlier. nebraskans aren't always eager

to participate in clinical trials. why is that? >> i'll go back to how important clinical trials are to move the field along. it turns out funding for research in pediatric cancer is very underfunded.

over the years since so few children got cancers, researchers tended to put as many pediatric patients on clinical trials as possible. there's been more improvement in particularly in lieu keep ya. 90% of pediatric cancer patients were enrolled in trials over the

year. less than 5% of adult patients get enrolled in clinical trials. you can't improve the therapy if you can't prove it's more effective. we need more difficult patients going on clinical trial and we -- we need more adult patients

need more research in both adult and pediatric. but pediatric cancers are different than adult cancers. you can't take the research being done in adult cancers and apply it to pediatric cancers. we need more funding for research and we need to have

more patients be enrolled in clinical trials. >> what do you want the public to know about raising a child with cancer? >> never lose help. fight like mad. we are so incredibly inspired as a family to know so many other

pediatric cancer families throughout the state of nebraska and really throughout the country. if that day ever comes don't ever give up and go as a hard and fast as you can. i think the real message here is that we as a society should be

embarrassed by the lack of funding that our private drug companies are investing in pediatric cancer research, that our federal government is not spending on pediatric cancer. that's an embarrassment to our country, and that needs to change.

z and this disease needs to be put on the national agenda. >>> one of the exciting things we've been able to do is team up >> you and your family had a ming fif and decided to turn it into a positive so you started a team jack foundation.

now, about three years later you've raised more than $2 million for pediatric brain cancer research. are you already making an impact with that money? >> one of the exciting things that we've been a i believe to do with that money is team up

with two private non-profit foundations and help fund a it's a trial that's just getting ready to enroll patients and right here in the united states and it's exciting because this is a new therapy that kids with brain tumors are going to have available to them that wouldn't

otherwise be available to them without the team jack foundation and without the support of nebraskans. that's direct impact. we've got some amazing other things we're able to do with the money that we're excited about. we've got some other things in

the works as well. so there's a lot of things that can be done and what we're trying to do is make as much impact with the dollars we raise. >> you are very proud of nebraska for the role it's taken.

>> nebraska's amazing. i think nebraska's a leader in supporting pediatric cancer research, not just at the state legislative level but at the community level and husk fan level. team jack isn't the only foundation out there trying to

raise money for research and do things and this state is wrap your arms around this entire disease state and we couldn't be more thankful for that. >> it's not only about raising money, which they've been very good at trying to do. raising awareness is so

important. they've been instrumental about the importance of funding research. >> thank you so much for coming in. >> thank you for having us. >>> more many cancer patients and survivors, keeping a healthy

attitude can be the best medicine. >> i was diagnosed with breast cancer on march 27, nine years ago. >> i was totally devastated. my mom said, sheryl, this is going to be bigger than you. and she's right.

>> sheryl's friends rallied in an effort to raise her spirits. >> it was my third treatment so i lost my hair. my friends threw me a hat shower. that's when the creativity started. i had a viking cap.

we had to open the roof of her car, the sunroof, so we could put the horns out. oh my god, this is fun. and then walking into the cancer center the stares that you got. oh my god, she's crazy. >> for sheryl the funny hats turned into costumes and

bringing baked goods for other patients.n1/gszã± she used this as a distraction from the treatments. >> going through the treatments you always felt ill and tired and sick and tired of being sick and tired. it was easier to focus on what

outfit to wear. what cookies to bake. it gave me the energy to get to the next appointment. >> patients who take a proactive part in fighting their cancer, take a can-do attitude. if you start at the bottom of a mountain and you say there's no

way i'm going to get to the top of that then you're probably not going to. if you start at the bottom and say, i'm going to get to the top of that mountain. you got a better chance than the other person. [ laughter ]

>> after beating her cancer, sheryl decided to continue bringing smiles and positive energy to other patients. ã§ã¡>> you need some more? >> friends, family and fellow survivors joined sheryl's flock which was named after one of the first hats that she wore.

>> how are you? >> i'm good, how are you? >> i'm good. >> we are flamingo s for friends laughing, achieving miracles, inspiring and nurturing gifts offered in smiles.

i have seen big changes when we come through the cancer center. it's usually a quiet, calm place, and then we arrive and people are starting to talk to each other. >> smile! and i just see a totally different atmosphere once we've

come through. it's just really, really cool how it's grown. >> and did you get kisses today? >> yes, i did. >> all right, because it's a special day. >> it's kind of magical. >> well, we want to welcome

dr. anthony. from the unmc department of behavioral health. thank you so much, dr. anthony, for joining us. >> thank you for the invitation. >> i want to talk about health disparities. when we talk about african

american women in nebraska have about the same rate of incident, but more african american women are dying at a higher rate than caucasian women of breast >> i commend you for having health disparities as part of this discussion. if you do the numbers and the

math, breast cancer diagnosis for african american women can actually be a death sentence. and we think that's for a couple reasons. some are social determinants. some are public health perspective. is that african american women

may be less likely to have insurance and therefore less likely to have prevention in terms of the screening that's really important for mammograms. are there cultural differences? for some women that is the case. what we also know is there are some genetic differences as

when african american women and women of color, hispanic women as well, are finding that they are, what we call triple negative. meaning their receptors for estrogen are negative and those are important for some of the medications that we have that we

treat cancer with. we were talking about clinical trials and we found that out through some of the trials in which we had more caucasian women who were enrolled and found some life-saving medication that when we gave them the caucasian women they

did quite well and when we gave it to the african american women, they were dying. they don't have the receptors that this medication is working on. so they have to start over with african american women and looking at some different types

of modalities that would be helpful. i want to emphasize that breast cancer, even though men can be impacted by breast cancer as well, it's gender specific for the most part and women of all races are diagnosed with breast cancer and as you age that is

your greatest risk factor. >> look towards mammograms and some of the studies show that racial and ethnic minority groups have fewer mammograms, more time between the mammograms and don't act as quickly when something suspicious comes up. how often should women be

getting mammograms and when should they start? >> that's a great question. we are at a debate in this country of when they should start. at my clinic we start screening at age 40. most breast surgeons, people who

do this work and understand that work recommend that at age 40 you should get your first mammogram. i tell my patients in community-based education, for your 40th birthday you should be going to get your mammogram. there are other thoughts where

in some of the literature they're recommending at age 50. i tell women that they should be partnering with their physician, talking to their physician, and based on that relationship making that decision, but where i work we start at age 40. in the state of nebraska we have

a program called, everyone that matters. they will cover everyone who think they can't afford to get mammograms and they start at age 40. >> and access to care isn't just an issue for minority, but we live in a large state, if you

live in the rural area you may have an issue with care in general. >> where someone lives, where someone works, where someone plays and prays impacts their survival. i'm lucky to be in omaha. if i get in an accident on dodge

street, my ability to get into a surgeon will more likely save my life. it likelihood of me getting to a nur -- neurosurgeon:women, we're always taking care of other our own needs a lot of times are last on the list. it takes time to schedule the

appointment, to find a place that has mammography services, to go in and get the test, and go back to find out what the results are, and a lot of times i think what happens is women put it on the back burner. if you live in a place and you have to drive 90 minutes or 60

minutes, you may be less likely to take that initiative to get screened and that screening is so important. >> absolutely it is. thank you. in nebraska rural patients need to go to great lengths for cancer treatment.

tracy traveled thousands of miles from her home to get treatment for breast cancer. she's taken the extra step in registering in a registry. >> when you get to the radiation you're driving every single day to have radiation treatment that may only last for five minutes.

we were driving an hour one way. the fatigue plays a part toward the end. >> it must have been exhausting. >> it was, very much. naps are a good thing. >> tracy already led a busy life before she was diagnosed with stage 1 breast cancer in 2014.

besides working three nursing jobs and looking after seven children and stepchildren, her husband raised cattle in nebraska. >> work full hours and come home about 6:00 at night. usually got some livestock to take care of.

sometimes we're out here chasing cows in the dark. >> fighting cancer in rural nebraska means spending a lot of time in the car. she's covered 10,000 miles in the last year, including trips to lincoln, 140 miles away for surgery and countless trips to

grand island for chemotherapy and radiation. that much time on the road lets the mind wander. >> will you get to witness all those milestones in a family's but we're very positive that whatever's meant to be will be. doctor is an amazing man, but i

feel really encouraged to have him as my decision. >> her doctor is based over grand island and goes to clinics out of hasting. >> majorityvf2v6$c㧠of what cancer patients live in rural setting, and with that having some -- two more registry and.

is crucial. >> patients from 23 hospitals across the region are donating blood and tumor samples to create a registry. researchers can compare dna to reveal genetic patterns. >> we'd like to be able to say that a given genetic signature

or profile will give us more information than the standard microscopic exam. but that takes lots and lots and lots of information. >> that's where patients like tracy come in. >> being a nurse i'm up for anything that involves more

research or data gathering. i was really open to being a part of that. >> there are now more than 2,000 patients in the breast cancer registry. researchers are already sorting through the data. it will be easier to see genetic

patterns that could advance >> that's really encouraging that if something bad is going to happen something good can come out of. >> the good news for tracy is that her prognosis was good, her cancer was caught early. she's finished treatment and it

looks like it's working. >> love to see a happy baby on the ground. >> but she says it's also empower to knowa after her cancer is gone her genetic information could help cure patients in the future. >> the greatest hope would be to

see a cancer-free world for our next generation. you hear of all the kids in st. jude and we all have the people in our community that are adults that have cancer and it would be wonderful to ir rad indicate. >> why is it important for a

registry like this to bring in more data pr rural areas? what does that add to the research? >> i think it adds a broader patient sample. if you stay in a tiny area, the exposures that a patientbfdx<ã³? may have are common to a city that

may not be applicable to a rural environment. having a good pool of patients with their different tumor types can contribute to the data. i think having too much of one may not be applicable to the other. in order to have the widest

possible net you need to have the widest possible patient population. >> is genome therapy a game changer? >> i'll go back to the registry. it's more than just a genetics study. it's a data base of all the

patients we can enroll with breast cancer across nebraska and actually there's patients in the great plains and north and south dakota and across the country who have taken on their registry as part of their projects. their family history, past

history, medicines tuiut;8ã±?ã± been it tells us about their exposures to different things, their lifestyle, diet, exercise, their smoking habits, their weight over different time periods and again what sort of activities are exposed. do they live in rural nebraska,

are they farmers or ranchers? we have a broad cohort of patients in this. they give us their tissues, blood samples and tissues. we use the blood to look at who's really at risk for breast there are two gene that is we know of that were discovered in

the late '90s and early 2000s, some of which are done right here in nebraska with dr. henry lynch creating a lot of the samples to mary king who did the but there are other genes at some mutation lead to an increased risk and we're looking at some of the factors.

we could actually look at the changes in the cancer cells and tells us something about drives the cancer and what targets the mutations we might use to treat those patients with. again, we're trying to use chemotherapy standard but the future of these target

therapies, so if we can have the data base of the changes and make sure patients are eligible for clinical trials using these it also tells us something about does the exposure lead to the patient getting to different change that is tell us something about their risk.

be able to screen patients and treat patients much more effectively. >> i have to say that breast cancer and the research that's grown behind breast cancer, we have thousands of women and thousands of studies. breast cancer is actually a

model cancer. it was taking what was yesterday's research is today's so we use molecular subtyping to identify those women with very difficult cancers verses those cancers that are easily controllable. dr. anthony mentioned erpr.

well, we know that if the tumor cells expressed them we can regulate them through blocking those receptors. we have chemotherapies directed specifically at that onco gene. you can see that the tailor treatmented and careful subtyping and putting patients

into effective treatments is a we're expanding how much more we can understand about this tumor. but breast is a wonderful model of what will come for other cancers in the future. >> are we seeing more nebraskans take advantage of screenings? >> i think that nebraska --

excuse me, that when it comes to women-specific screening, and we're talking about breast cancer right now, but in other cancers cervical cancers, i believe they're models. we have great screenings for them and great treatments for them.

what i think is one of the barriers is education. if our center and at unmc we're into community education. they spent tons of years in school and we practice and learn these things and we're constantly up to date on what's going on, but the average human

being may not know. so what we're doing is we're getting out and not just in omaha but across the state and spreading the message of what can you do to prevent these diseases once you have cancer, what you do to screen for them. what the best treatments are for

when it comes to breast and cervical cancer. i think getting people out and screened is really important. and our state had the program and covers not just mammograms for 40 plus but pap tests as >> this is a disease we know a lot about now in terms of

vaccines that can prevent the infection of cervical cancer in our lifetime. if we have active public policies about screening and vaccination we can prevent this >> what excites you the most about the research that's going on right now?

>> i think basically the key thing is the more we understand about a cancer, the higher the likelihood we'll have an effective treatment and we'll be able to cure that cancer. that is the thing that holds all of us in research. especially those of us who deal

with deadly cancers. i don't think any of us could do it if we were going to offer the same treatment today as we will tomorrow. the exciting part is changing the future for our patients, and it's really going to to become a >> we talked about the

importance of research in the laboratory and research in the clinic and care of patients in the clib -- clinic. it's really getting a team together to approach the cancer patient from the bench to the bedside. understanding how you move the

discoveries into the clinic as quickly as possible for the benefit of patients. in the past we had -- some of us would treat breast cancer, some of us cervical cancer, we understand that every single cancer is different, and some breast cancers is more like

one cancer at the genetic level. we should form these teams bigger and have an approach looking at what drives the cancer and try to use the models that we look at in some diseases to try that in other diseases using the genomic approach to understanding, and that's the

future in terms of the excitement where research is leading to new therapy. >> knowing what's going on with research and prevention, screenings, are you optimistic about the future of battling cancer in nebraska? in addition to what we've been

talking about we've left out technology. with paps, tele medicine, in the 21st century, diagnosis and treatment, i'm just excited to see where we are and to be at unmc in nebraska and the outstanding research that's being done from the bench to the

bedside, and then also taking that message from the bedside to the outside and the community. i'm just very optimistic. >> i would say nebraska can actually lead the world. we actually have such a close knit community across the state. the cancer center through the

registry has been building these relationships to work with cancer patients in their local hospitals and understand what we can do to help raise the standard of care across the entire state. as we've highlighted the cattle industry, we've had a

relationship with the cattle to raise awareness about the importance of cancer research. so we have an opportunity with the state of this size population to actually understand the entire mechanism of cancer across the state and work together to make sure that

every single patient has the best care possible. >> well, thank you all for