Research connection could help answer questions about rural breast cancer


April 3rd, 2015


Cancer is more likely to be fatal for rural residents than most city residents. It is hard to know why. Rural patients often live hours from their doctors, and farther from researchers. A cancer registry is trying to bring research closer to home.

Lincoln, NE – Just over a year ago, Tracy Dethlefs learned she has stage 1 breast cancer. Since then, she estimates she’s charted some 10,000 miles travelling from her farm near Loup City in central Nebraska to area hospitals for treatment. Every surgery, round of chemotherapy and radiation treatment was a road trip.


“Radiation treatments usually (take) only about 5 minutes (on) a day that they have to see you,” Dethlefs said. “But for a week, for seven weeks in a row, you’re driving every single day to the cancer treatment center. We’re about an hour away from cancer centers.”

Life was already busy. Dethlefs holds down three nursing jobs in Lincoln, Kearney, and at the Loup City high school. She has seven children and step-children. And back on the farm Tracy and her husband keep a small herd of black, Angus cattle.

Walking through a dusty corral during calving season, she spotted a newborn lying in the sun.

“Love to see a healthy baby on the ground,” Dethlefs said. “Shawn and I both grew up with cattle so this is probably our first love. If we won the Powerball this is what we’d be doing.”

But Dethlefs says at times during her treatment, the cows had to take a back seat.

“We work our full hours and then come home about six o’clock at night or so,” she said. “So sometimes we’re out here chasing cows in the dark.”

Dethlefs experience is not unusual. Distance is one of the main barriers to treatment for rural cancer patients. It’s also a barrier for research. At the cancer clinic in Hastings, Neb. Dr. Sitki Copur, who treated Tracy Dethlefs, is seeing another patient who came all the way from Kansas.

“And our service area extends from South Dakota to Kansas and west into Nebraska Pahnhandle,” Copur said.

Copur is based at St. Francis Medical Center in Grand Island, Neb. but travels to satellite clinics in the area.

He says rural patients are underrepresented in research. The big research centers are at urban hospitals in places like Omaha, Denver, Kansas City, or Iowa City. So urban patients have good access to the leading research.

“The rural people don’t and it’s a loss for both science and the patients,” Copur said.

Researchers may be missing environmental and genetic factors that could be unique to rural cancer patients. The University of Nebraska Medical Center in Omaha started to bridge the gap a few years ago by creating the Breast Cancer Collaborative Registry.

Cancer patients provide blood and tumor samples, and fill out questions about their family history and lifestyle. Researchers comb the database for patterns.

“It collects a lot of cultural information,” said Dr. Edibaldo Silva, a cancer surgeon at UNMC. “It collects a lot of racial information, collects a lot of age, a lot of genealogy information.”

With that kind of data on rural cancer patients, the registry allows researchers to ask questions they haven’t asked before. Perhaps in the future, a patient’s treatment can be tailored to their cancer’s genetic ID.

“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 that we’ve used in the last 200 years,” Silva said. “But that takes lots and lots and lots and lots of information.”

More than 20 hospitals are collecting data from states like Colorado, Nebraska, Iowa, South Dakota and North Dakota. Around 2,600 patients are enrolled in the breast cancer registry so far, including Tracy Dethlefs from Loup City.

As more people sign on, Dethlefs hopes researchers will learn what, if anything may raise the cancer risk for rural patients.

“I think you’re finding if there are any common environmental factors, if it could be anything related to our area we live in, water we drink, if it’s our diets that are different,” Dethlefs said. “Anything like that is going to help find different ways to prevent it in the future generations.”

The good news for Dethlefs is that her prognosis is good. The radiation and chemotherapy appear to have worked. Now her case is stored with thousands more in the breast cancer registry. She says, after an exhausting year living with cancer, it’s encouraging to know something good could come from it.

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