HJBR Jul/Aug 2021

HEALTHCARE JOURNAL OF BATON ROUGE I  JUL / AUG 2021 9 Cancer is such a broad term. It is like using the word human to describe our species. We are one, but we are not the same. It is a word that makes us stop in our tracks – there are no words, that I know of, comparable. And just for the sheer sake of space we will be using the word broadly in this interview. For 50 years this year, Mary Bird Perkins Cancer Center has been a hub of cancer care in Louisiana. We took a moment to sit down with Jonas Fontenot, PhD, MS, chief operating officer and chief of physics at Mary Bird Perkins Cancer Center, to discuss where we are 25 years after President Richard Nixon signed the National Cancer Act, marking the United States’ official declaration of war on cancer. Dianne Hartley, Editor As one of the gener- als on the war on cancer, how is this long- running war going? Jonas Fontenot, PhD, MS We’re making prog- ress. And, because of how you just framed the discussion, that is, cancer is not one thing to one person, it means many differ- ent things to many different people. There is no one solution. There’s no one cure for everything. What we have with cancer is a huge array of different types of the disease and how that disease interacts with people. And so, consequently, what we need is an army of solutions — an entire collection of ways to fight cancer in the different ways that it presents itself and affects people. It can be difficult to measure progress, because some diagnoses, at cure rates for patients with breast cancer and prostate cancer, particularly at early stages, our rates of control for those types of diagno- ses are extremely good and have improved tremendously over the last several decades. But, there are other areas where we haven’t made quite as much progress — lung can- cer and pancreatic cancer are two examples where survival rates haven’t come along at the same rate that they have with say, breast and prostate. That’s not to say we’re not making progress in all areas of cancer man- agement, but there are some certain disease types where progress has been compara- tively slower. Editor Louisiana has some of the highest mortality rates for cancer in the country. Why do you think that is? Fontenot I think there’re many reasons for that. One of the reasons is we have a cul- ture in Louisiana that really enjoys food and really enjoys other types of activities that can present factors that make cancer more common and that can make cancer more advanced when it’s detected: our rates of obesity, for example, are much higher in Louisiana, and that has a relationship with cancer incidents; our rates of smoking and our rates of alcohol consumption are com- paratively higher, and those also correlate with higher rates of cancer incidents; our adherence with cancer screening — early detection is key, and Louisiana is one of those states that has not done a great job historically as a population — making sure that we go to our yearly mammograms, we see our urologist on an annual basis within our screening guidelines. You cou- ple the risk factors with the lower compli- ance with screening and diminished access to care in some parts of the state, and all of that adds up to, I think, comparatively poor performance when it comes to outcomes for patients in many different parts of the state. Editor National stats show a decrease in the last 10 years in cancer morbidity. Is Louisiana seeing the same trend? Fontenot Yeah, we’ve seen the same trend as the other states, and that really has to do with advances in screening and care for patients who were diagnosed. The difference with Louisiana is that we’ve started with a higher baseline, so even though we’ve been able to make progress over the last decade or so, we’ve remained one of the states with the highest cancer mortality because of the many risk factors that I mentioned earlier, which haven’t changed materially over the last 10 or so years. Editor There’s been much talk about Louisi- ana’s “Cancer Alley” nationally and interna- tionally. Mary Bird Perkins straddles the pet- rochemical corridor facilities. Do you think that the term “Cancer Alley” is a fair assess- ment of what’s going on in that area? Fontenot Well, I think it’s a fair assessment in as much as we have attributes and char- acteristics of our culture that lend itself to higher risk factors for cancer incidents and higher risk factors for cancer mortality. Can- cer is a complex disease, and you usually cannot trace an incident, a case of cancer, to a single event. There are some exceptions to that, but by and large, the risk factors for cancer often conspire together in aggregate to materially raise cancer incidents and cre- ate a notion or perception of “Cancer Alley.” I wouldn’t necessarily ascribe that only to being specific to the Baton Rouge petro- chemical corridor, but I would extend that to most of Louisiana, in general, as having risk factors that are much more highly cor- related and associated with cancer incidents and death from cancer. Editor Do you think there ultimately will be conclusive evidence of increased cancer rates in the petrochemical industry, in that area? Fontenot I do. I think there will be a defini- tive answer eventually. I think the answer is