Randy Hillard: 100 Percent Preventable
Nov. 25, 2014
James Randolph (Randy) Hillard is a professor of psychiatry in both the College of Osteopathic Medicine and the College of Human Medicine. In addition to emergency psychiatry and student mental health, he is interested in hospice medicine, health disparities and Helicobacter pylori.
Stage 4 Metastatic Adenocarcinoma of the Gastric Antrum—my wife says that I cried when I heard the pathology report after my gastrectomy. I do not remember that but, I am a physician, so I knew what the diagnosis meant. I do remember, though, what I was thinking later when my gallows humor kicked in, “Great. Now I have a fatal cancer. It is not even one of the more popular cancers. And it was 100 percent preventable.”
My biopsy was positive for infection with Helicobacter Pylori, which has been proven to cause virtually all cancers of my type. I had had intermittent dyspepsia over the years and been prescribed protein pump inhibitors, but I was never tested for H. Pylori.
I had an aunt who died of stomach cancer, but that was in the 1980’s before helicobacter had even been discovered. My brother was tested and treated for helicobacter 15 or 20 years ago due to dyspepsia. He has not had stomach cancer. Of course, now I wish that we were identical twins to make this a better “case report.”
I have had generally excellent primary care physicians through the years, but since stomach cancer and helicobacter infection are relatively rare in the United States, they just never thought of it. I do not think that my family history of stomach cancer was ever even recorded in my medical record.
My oncologist, who I idolize, treats only about one case of stomach cancer a year. He practices at an NCI designated cancer center, but he did not know that I should be tested and treated for H. Pylori after my partial gastrectomy, or that my children should also be tested and treated.
When I insisted that my three children be tested, one of them had his doctor tell him it was unnecessary. Another had trouble with insurance reimbursement. Needless to say, I kept harassing them until they got tested.
Even excellent physicians in the U.S. do not test and treat nearly as often as they should, according to the most recent and authoritative international guidelines. Nowhere in the U.S. has there been a systematic strategy for detection of helicobacter in high-risk groups, such has been done elsewhere in the world. This is in spite of the fact that many populations in the U.S. have been shown to be at very high risk of stomach cancer.
My tumor was positive for the HER-2 antigen, which is good news because Trastuzumab (Herceptin) infusions have kept me alive for almost four years, although my original prognosis was less than one year. The bad news is that just the cost of my infusions has been well half a million dollars so far. My total cost of treatment is now well over a million dollars. We could have detected and eradicated a lot of H. Pylori for that amount of money and saved an incalculable amount of human suffering.
Helicobacter tried to kill me; now I am trying to kill Helicobacter. It only seems fair. My weapon is education. Please be my partner.
Photo by Kurt Stepnitz