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Episode 2, Part 2: The Long Road to Treatment

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Episode 2, Part 2: The Long Road to Treatment

Dec 20, 2023

A chance meeting with a community nurse saved Huntsman Cancer Institute investigator Jakob Jensen, PhD, and shaped his career as a groundbreaking cancer researcher.


Heather Simonsen, MA
Public Affairs Manager


Jakob Jensen, PhD
Researcher at Huntsman Cancer Institute
Associate professor of health and kinesiology
Professor in the Department of Communication at the University of Utah

Episode Transcript

Topics by Timestamp

Welcome and Introductions (00:51)

Heather Simonsen: Hello, and welcome to Cancer-Free Frontier podcast where we ask the question, how can we deliver a cancer-free frontier? I'm your host, Heather Simonsen.

Today on the podcast we'll be talking to one of our investigators, who has a fascinating story. He grew up in a very small town, and a chance meeting and a life-threatening diagnosis inspired his career. Jakob Jensen, PhD, is an expert in health communication and a member of the Cancer Control and Population Sciences core at Huntsman Cancer Institute at the University of Utah (the U). He is the associate dean for research in the college of humanities and a professor in the department of communication at the U. Dr. Jensen, welcome.

Introduction to Circle, Montana (1:36)

Jakob Jensen: It's my pleasure to be here.

Heather Simonsen: You grew up in Circle, Montana. Tell us a little bit about your hometown.

Jakob Jensen: Well, Circle, Montana is a little bit of a media darling within Montana. It's a town of around 500 or 600 people and it's in a very, very large county, so low population density. We're called round towners within Montana. I think that started off as a nickname that was meant to make fun of us, but we actually liked it. So, it's home to the Round Town Tavern, for example now, and we call ourselves round towners. Circle is a really kind of traditional rural community in that we have things like Town and Country days, and county fairs, and the primary economy is farming and ranching. It is home to Mid-Rivers, which is a large communication cooperative. Many, many decades ago, a couple of Circle people decided to start a communication cooperative in Round Town and who would have guessed that was a great idea, but it turns out it was. That's a little bit of its story.

Jakob (left) and his brother, Judd, look out over the family farm.
Jakob (left) and his brother, Judd, look out over the family farm.

But also, I say it's a bit of a media darling because it shows up in the news from time to time and I think partly because people love the fact that it's named after a shape. Circle, Montana is already an unusual name. Starbucks, for example, did a whole bunch of things on us because we're the farthest place from a Starbucks in the continental United States. We've been on NBC News many, many times. We were the first community featured in Main Street in America, that was a segment that they did. We've been on Unsolved Mysteries in 2020. So, when Montanans hear about Circle, Montana, one of the first things they tend to think is, “Oh, well, they're probably in the news again, they always get picked up for one reason.” So here we are, again!

Heather Simonsen: Here you are again! That’s so funny. I feel like I need to visit Circle, Montana.

Jakob Jensen: You know, it's also featured in the book if, you've ever read the book, Zen and the Art of Motorcycle Maintenance.

Heather Simonsen: Yeah.

Jakob Jensen: He drives through a Montana town named after a shape, and that would be Circle.

Heather Simonsen: Wow! That's so fascinating. Goodness, well, for sure. That's going to be on my list of places to go. Especially, I'm sure it's beautiful.

Jakob Jensen: It's Badlands, right? So, it's a great place to look for dinosaur bones. In fact, a lot of dinosaurs are found there every year. It's right by Fort Peck Lake, so it's a beautiful lake country, but it's very much the kind of rugged, Badlands country of the East, eastern part of the state.

Heather Simonsen: Wow, and you had a really a pivotal moment of your life when you were how old? 18? 19?

Jakob Jensen: I’d have been 19.

Heather Simonsen: 19, and you went to a public swimming pool in your hometown. What happened?

The impact of one community nurse (4:24)

Jakob Jensen: Yeah, I was a lifeguard, actually at that swimming pool. I also taught swim lessons for both four to six-year olds, and older kids. After I was done teaching the four to six-year olds one morning, I think it was in July of 1998, not to date myself, but I had stayed after a little bit to kind of do some follow-up lessons with one of the four-year olds at that time and her mom also happened to be the public health nurse for the county, so she was sitting there watching us. After I finished up, she walked up to me and she thanked me for staying after, then she said, “Oh, I should tell you that I was watching you during that swim lesson and you have a very strange mole in the middle of your back. Has anyone ever noted it to you?” And I said, “No.” I said, “Thanks for telling me.” Then I walked back into the lifeguard station.

There were three other lifeguards in there and I said, “Oh, you know, Sue,” her name is Sue Good. I said, “Sue Good just told me that I have this really strange mole in the middle of my back. Have any of you ever noticed it?” And all the other lifeguards go, “Oh, yeah, you have a weird mole.” And I go, “Oh, thanks for the heads up on that.” 

Jakob Jensen working as a lifeguard at the community pool in Circle, MT.
Jakob Jensen working as a lifeguard at the community pool in Circle, MT.

Then you know, to cut to the chase if you will, I eventually went in and got that mole removed. I had to go about an hour-and-a-half away from Circle. The closest surgeon to Circle is about an hour-and-a-half away in Sydney, Montana, and really, that's one of the stories of eastern Montana is very limited infrastructure.

If you need, really, any sort of specialty care or anything beyond kind of rural health clinic functionality, you're going to have to drive, and an hour-and-a-half is an easy drive, I mean, normally, we're driving four to five hours. So, I went there and a surgeon who's, you know, he's one of these amazing guys, he's passed away now, but he was one of these amazing surgeons that basically did everything in eastern Montana. He removed the mole and he was suspicious of it right when he removed it. In hindsight, now that what I know about skin cancer, I know that he immediately was pretty sure it was melanoma. You know, turns out that it was and then I started my cancer journey at 19. A strange cancer journey it was.

Heather Simonsen: I’m sure, and do you ever let yourself think about how, what if she hadn't said that?

Jakob Jensen: Right. You know, I do think about that, because no one else had said anything and you're sort of reminded about how social norms sometimes drive health, right? Because in the same way that, for example, when somebody's having, in cardiac arrest, there's sort of a bystander passivity that kicks in where people are standing there and they freeze up. I think sometimes that happens in a lot of health situations. You know, here's a case where people had seen this mole but nobody was saying anything, even people who worked with me every day.

We had already done training on skin cancer. It was part of the American Red Cross lifeguard training at that time, so you would have thought that people would have mentioned it. I'm not trying to, I'm teasing them a little bit. I mean, they were all 18 and 19-year old kids just like me and we did a half-an-hour training so it's not like they were experts. But yeah, I think about that, you know, how much longer would it have went? And then what might that have meant, right? And I say that, especially now I think of that, but at the time, I was 19, so to be honest, when I first found out I had melanoma, I didn't even really know what melanoma was. It's just another thing. I was like, “Oh, that's a type of skin cancer.” Right? My aunt, one of my aunts gasped when I told her because she knew but I was, you know, that's just another name for me.

How a cancer diagnosis inspired Jakob’s career (8:22)

Heather Simonsen: Yeah, and how would you say this experience inspired your career?

Jakob Jensen: In a lot of ways. My primary research program is in skin cancer communication, and in trying to innovate new ways of identifying skin cancer, finding it faster, teaching people, notably rural individuals, how to identify cancerous lesions on their skin. Melanoma being the focus of that, although that's just true of skin cancer research in general, most of it focuses on melanomas. You could look at my research career and say, “Well, it looks like that diagnosis led to a whole career.”

I will say there was a gap though, in between that. It wasn't an immediate thing that I sought to do. You know, when I originally went to college, I was really training to become a U.S. Marshal. I wanted to go into law enforcement, not health. My dad was a sheriff for over 30 years, so I had always anticipated going into law enforcement. I ended up meeting a girl and she wanted to go to grad school, so I ended up going to grad school, and then through that graduate journey, I eventually found my way back around to this path. I was originally a little bit standoffish about studying skin cancer. I think a lot of people that have had a cancer story, you're conflicted about it because you think, “Well, do I want?” It's very personal and there's a lot of emotion involved in it. You're concerned that that might start to influence potentially what you do in ways that could be unhealthy.

There's also sort of a sense that there's both having had cancer and they're studying cancer and they're two very different things. I try not to confound the two, right? There's a lot of people that are amazing skin cancer researchers that I've never had skin cancer and I don't think that that hinders their ability to understand it. In fact, sometimes I have to sort of check that at the door. I didn't originally start. I didn't set out to study skin cancer after it but then human nature being what it is, I found my way back to it.

Fatalistic views of cancer (10:33)

Heather Simonsen: Yeah, and your research really focused on how people think about cancer in these rural and frontier counties compared to urban areas. From what I understand you found they have a more fatalistic view of cancer. You know, it's inevitable, there's nothing that can be done to prevent it. Tell me about that. I mean, that sounds to me like a very dangerous assumption.

Jakob Jensen: Yeah, it's a finding that I think the cancer research community and the cancer clinical community are still trying to wrap their heads around in terms of what to do with it. Rural individuals are far more fatalistic than their urban counterparts and notably about cancer is what my data has shown, although, I think that we suspect this is true in many health issues. They're more likely to think that it's inevitable that they'll get it, that it's inevitable that if they get it, that they'll die of it, that there's very little they can do to prevent it, to treat it, to engage it, that's fatalism, kind of stated simply.

From my standpoint, I'm interested that they feel that way and I'm also trying to understand why they feel that way. That's one place where my experience probably is helpful. Growing up in a rural place, I would say the lived reality of it is very limited access to resources. Then what do people do when they struggle to get access? They have to cope with that and no one wants to live being like, “Well, I don't have access to this, and that is bad. That will increase my likelihood of death.”

So instead, if we can't change that situation, we change the way we think about it. I like to tease one of my uncle's he wouldn't mind me teasing him, he likes to be teased. One time he and I are talking and we had had a relative die of brain cancer. Mark Jensen, he was a great guy, and my Uncle Jack goes, “Well, you know, makes you think, he found out he had brain cancer and he didn't live much longer after that. You know, what if?” And I said, “Well, what's the ‘what if’ in that statement?” he's like, “What if he hadn't found out?” And that's kind of back to your question, right? I thought, “Are you suggesting that if he didn't know that he had brain cancer, that he would have survived it?” And Jack goes, “Yeah, he found out about it and then he died.” I think, well, that's an interesting way to cope because notice the implication of that statement. The implication is, “You don't really need access to anything because all it will do is cause you to worry to death. So, what if he hadn't used that resource?”

And I totally understand, I tease him about it, because I totally understand the logic behind it. That is what it felt like to go through it. We found out about it and then it was so fast. here was sort of, “He had seemed healthy, and then all sudden, he knew he had cancer, and then he seemed very sick. He stressed himself to death.” Then you say, “Well, okay, since we couldn't have prevented that,” says the rural person, “I'm going to then dismiss all the resources I don't have access to, because they would only hurt me anyways.” It's surprising how often you run into that logic in rural America.

And I say it as somebody who loves small towns. I'm the rare small-town person who left a small town but I could have just as easily stayed. In fact, I anticipated staying, I was the third of three sons and I always imagined my brothers leaving town and going off to do great things, which they're both attorneys, so they did. I sort of imagined myself staying. 

Jakob Jensen on the family farm.
Jakob Jensen on the family farm.
Jakob Jensen riding a horse.
Jakob Jensen riding a horse.

I almost didn't go to college, to be totally honest. I was thinking I would just stay and either become the sheriff or become a law enforcement officer and I'd love living in small towns. I'm a country mouse by nature. So, I say that with all the love in my heart about rural people. We cope with all of these access issues by saying that the resources don't matter, so then for those of us who are trying to help rural populations, that's the first barrier we face. They're going to reject resources and they're going to reject them because they've had to learn to live without them.

The first step in accepting that resource is accepting you haven't had it and that that's likely caused a lot of real heartache within your community. It's much easier to just say cancer is inevitable and it's part of life. Rural people are more prone to say things like, “Well, everybody dies of something. Well, you gotta go some way. Right?” And we often say this to justify very, very poor behavior, by the way, and to justify why, well, okay, here's an example of just sort of the extreme nature of rural life within the Intermountain West. I, at two different points in my life, have had cancer removed from my body and neither instance, did I ever interact with a dermatologist or with an oncologist. I now work with dermatologists and oncologists on a daily basis but at no point in either of my cancer journeys, both of which were melanoma, did I ever even talk to a dermatologist or talk to an oncologist.

Heather Simonsen: Wow, I mean, that is sobering, and especially since we know there is so much you can do, as far as like wearing sunscreen, eating a healthy diet, regular exercise, getting regular cancer screenings, catching it early, when it's most treatable. But there is this disconnect, as you say, between these proactive steps. Does some of this have to do with trust? A lack of trust?

Jakob Jensen: I think so. Again, that can be a coping mechanism but it can also be so much of our discourse is focused on the city mice, is focused on the cities because there's so many more people there. That's where a lot of our communication comes from. Here we are sitting in Salt Lake City and I think it's very easy for rural populations to feel distrustful because they feel like they're outsiders. I think today they sometimes feel like there may be villains, that they're portrayed, maybe negatively, and problematically, and that leads to trust issues, that leads to disconnect. It’s something that we're really focused on at Huntsman Cancer Institute, is thinking about, as we try to serve all the populations in this very large Intermountain Region, how can we start building trust from the onset? I think that's about them seeing us, and hearing us, and knowing that there's a large number of us that come from this region, or come from similar areas and walks of life. They’re not unknown to us. We are thinking of them. We are part of their community.

Solutions to mistrust in rural and frontier communities (18:07)

Heather Simonsen: And that goes beyond just, taking our screenings to them. It's more about connecting on a friend level, you know, them seeing us at the county fair, right? Talk to me a little bit about the importance of kind of thinking outside the box in in coming up with solutions.

Jakob Jensen: Yeah, I'm so glad you mentioned being at the county fair because that's been a deep part of our conversation up at Huntsman Cancer Institute. How do small towns perceive outsiders and how can we engage that? What I have said from the start is, you have to think about rural communities. I think within the Intermountain Region, we should also be thinking about tribal communities in the same way, by the way, most of which are rural as well, as communities that often have a lot of predators that come after them.

They get preyed on a lot. They have outsiders come in who do not have their best interest at heart. They learn to be defensive. They learn that even, and when I say don't have their best interests at heart, sometimes that's even good people that arrive to rural communities in the wrong way. We're there because there's something we want and then when we get it, we're gone and they never see us again. This is sometimes the first thing they say to us in conversation. “Well, is this going to be one of those situations where there's something you want and the moment you have it, you're gone? Like, is that this interaction? Or is this something else?” Unfortunately, there's just a long history of us doing that.

When I say us, I mean Huntsman Cancer Institute, but I mean, all researchers, pretty much anybody from outside of rural communities. This is unfortunately, the track record we've left behind, so they understandably feel that way. Circle is also right by several tribal communities, for example, Wolf Point, Montana and Poplar, Montana, you have Assiniboine and Sioux there, and several other tribes. I also have that sort of lived experience. I would say that's the same kind of feeling you get there, they'll say, “Okay, is this a situation where there's a meaningful relationship? You want to develop it? Or is it just you need something?” That’s almost the biggest criticism is, you know, I once said the most damning statement that a rural person can make about you, is that they think you're there because you need something. It's a statement that says, “They don't think you're genuine.”

Then how do we start to come in a different way? Well, we should be present when we don't need something. Rural people really put a lot of stock into who shows up to the county fair, who shows up to the district basketball tournament, who's here for Town and Country days.

We did an American Cancer Society event where we did like a walk to raise money for breast cancer, who sponsored that, who showed up to it? It really means a lot in rural communities. I said to Huntsman Cancer Institute, I said, “Look, if you want to meaningfully engage these populations, you have to be more visually present.” As a sort of silly, but true example of that, I go back to the county fair and Circle every so many years, because I love it, I have a lot of stories about it, but I go back there, every couple of years. One year, I came back and I decided I wanted to study some things in in my hometown. I set up a booth and we were collecting some data, then I left the University of Utah Huntsman Cancer Institute sort of pop-up tent behind, I just donated it to the fairgrounds.

They continued to use it in the years that followed and I didn't even really think of it when I did it. Then, of course, you know, a bunch of kids grew up in Circle where they were seeing the University of Utah and Huntsman Cancer Institute all the time, so then the next time we came calling, there was increased awareness and openness to it. Of course, they knew I was there, but they were also, “Oh, yeah, like at the fairgrounds, I see the Huntsman tent all the time!” I thought, right, even though it hasn't even been us, they’ve seen it. I thought, “Okay, well, there you go.”

There's sort of brand awareness, and that's presence and that's a company they know, that's a brand that is in the county. It’s a silly example but it's the kind of thing that I think rural people put a lot of stake into and I'm hopeful that under this next leg of our journey, we're going to invest in that. I think there's some really creative ways that we're kind of planning to come at that and really engage those communities. It's a challenge, though, right? With the largest area of service in the United States, and it is largely rural. It's largely frontier, actually, it's even one degree, more rural than rural.

Heather Simonsen: Yeah, and the things you're talking about with trust, it strikes me as they really don't want somebody who's just going to drive through Circle and leave, but take the time to understand the community and appreciate it and get to know the people, right?

Jakob Jensen: That's exactly right. There’s a legacy left behind in a lot of these communities, and I could tell dozens of stories about this, where they’re sort of failed efforts that were, I won’t say halfhearted, but they maybe didn't have the community's best interest in mind. In the late 1980s, a lot of Montana, Idaho, and Wyoming communities, for example, had telecommunication systems built into the community, so in Circle, they built this telecommunication hub in our shop building, this room that we always had shop classes in where they did the teaching part, they turned it into like a telecommunications hub.

There was a ton of excitement about this, all the things that would come from this, “Oh, we'll be able to do, you know, college classes through this, and we'll be able to do all this training, and we'll be able to do telemedicine through this.”

It really never bore fruit and it felt like there was a grant that built it, there was a few little pilot things they did for about a year to two years, and then it just faded away. Interestingly enough, we never really saw that, again, until COVID hit and then suddenly telemedicine was a necessity, and that's produced a much bigger impact in terms of tele infrastructure on rural communities than anything that came before. I don't know if rural communities have totally come to grasp with that, but it did. Of course, even when COVID hit and they said they were going to solve a lot of things with telemedicine and tele infrastructure, rural people were very skeptical. When you said telemedicine, or you said telecommunication, many of them thought “Oh, okay, we heard this song and dance before and I never did anything.”

That's the sort of baggage that is there, that we have to acknowledge and work around. What does it do? It produces fatalism and produces trust issues. That's why I'm very mindful to never describe fatalism or trust issues, as you know, “Oh, well, they think this incorrectly.” No, they think that because that's their lived experience. They think that because that's what survival is in a small town.

Skin cancer in rural America (25:17)

Heather Simonsen:

It makes so much sense. Your cancer journey with skin cancer. Skin cancer happens to be one of the most common cancers in rural America, and preventable.

Jakob Jensen: Yeah.

Heather Simonsen: So, this strikes me as truly lifesaving research that you're doing.

Jakob Jensen: Well, that’s kind of you to say. One thing I would stress, you noted that there's lots of things people can do from a prevention standpoint, one of the easiest things that you can do, and I would say the best thing you can do, is invest in good sun shirts. I strongly recommend rural populations. Think about sun shirts, what they have in that space, how they use them. I like sun shirts, in some ways better than sunscreen, if I'm totally honest, especially for individuals who are going to be working during peak hours.

They should be investing in real sun shirts, a long sleeve shirt is better than nothing, but I would recommend an actual breathable sun shirt. That's the kind of thing that I think adherence is much higher on. Its actual effectiveness is much better over the course of a day because even when we get people to put sunscreen on in the morning, reapplication remains a real issue. That's not to dismiss sunscreen, it's simply to say, I do think a good sun shirt, and a good sun hat, for example, has a lot of mileage for rural people and does a lot to prevent skin cancer. It's something that I would encourage rural communities to think about and invest in.

I know we're going to be investing in it from a Huntsman standpoint. That's one of our standard, sort of, giveaways at the moment, is sun shirts that are branded, then you could also be there in the community, they see you.

I mentioned that because as somebody who worked in agriculture, I grew up on a farm, t-shirts were very common from brandings, to seating to baling, to anything between. I wore a t-shirt all the time, maybe a baseball cap. That’s not the greatest move for someone who works in the in the heat of the sun. I also say that because sometimes our sun safe advice doesn't resonate with rural populations. And a good example of that is, the American Academy of Dermatology really endorses avoiding peak hours of sun as a way to prevent skin cancer.

Heather Simonsen: But you can't do that if you're working on a farm.

Jakob Jensen: It falls flat as advice, right? Agricultural communities go, “Well, do you know how agriculture works?” Peak hours are peak hours. That's when you're harvesting and that's when you're grinding away. That's problematic to me as a communication scholar because the moment that they unravel one piece of advice as falling flat, is far more likely they will just reject and insulate.

It feels like you're not speaking their language, you don't comprehend their situation. I never actually communicate that piece of advice to rural populations, right? Because I just know that they're going to say, “Well, okay, in theory I could just stay out of the sun, sure, but I can't so there it is.” I don't want to cultivate fatalism in them because there's a trigger for fatalism. The moment I got start down that slope, when I start down that road, the end of that road is fatalistic thinking. “Okay, I could do those things, well I can't do those things, so in practical terms, I can't do this. It's inevitable I will get skin cancer.”

Heather Simonsen: It’s almost like everything after you say that is kind of white noise.

Jakob Jensen: Yeah.

Heather Simonsen: It's not applicable to me.

Jakob Jensen: Right, and then they just say, “People get skin cancer in rural communities because we have to, that's just part of working outside.”

Heather Simonsen: Also, from what I understand there's still that myth that you get that first burn and then after that it's going to get tan. But the reality is, tans are sun damage. The tanner you get, the more damage you have.

Jakob Jensen: When I was a kid in the 80s, not a great time for skin cancer, by the way, the golden period of poor skin cancer prevention. I remember that people would tell me all the time in the beginning of the summer, burn till you peel and that will protect you the rest of the summer.

Jakob Jensen leaning up against his car in Circle, MT.
Jakob Jensen leaning up against his car in Circle, MT.
Jakob Jensen fishing as a child.
Jakob Jensen fishing as a child.

So, from about 1983 to about 1992, every summer I just burned till I peeled and I remember just literally peeling the skin off and thinking, “Now I'm safe for the summer.” Now I think “Oh,” and the listeners are going and then later he got skin cancer and then later I got skin cancer. That is the end of that journey, everybody.

Heather Simonsen: Yeah, well, I remember even putting on baby oil. Like, no talk of sunscreen. It was you go to the beach, you put on baby oil. I can't believe that when I when I look back now. It seems just crazy. But of course, we know better now.

Jakob Jensen: Holding reflective metal to try to magnify the sun on you. You know, these are the images that, and you have baby oil on you at that time, these are the images that really linger in the mind.

Helping people in rural and frontier counties identify cancerous lesions (30:54)

Heather Simonsen: Absolutely. What's next with your research?

Jakob Jensen: A lot of my research lately has been on two fronts. The first is trying to develop visual materials that help lay individuals identify cancerous lesions quickly. It remains a challenge and it's an important thing that we address. A lot of the materials that we use to teach people how to identify something like melanoma could use some innovation. They don't accurately represent state of the knowledge.

Doug Grossman, Yelena Wu, and I have been, and many others, have been working to develop new materials that we think quickly and meaningfully teach people, “What does melanoma look like? How do you identify it?” Some of this is moving away from what the ABCD’s of skin cancer. There's this sort of classic skin cancer education that says you can identify a cancerous lesion by looking for the ABCDs, asymmetry, and these sorts of things, each letter stands for a feature that allegedly reveals skin cancer. Not terrible, I will tell you, and still probably usable, but it doesn't map as well to actual identification of melanomas as you would hope.

Other ways of getting at it would be things like ugly duckling sign. Ugly duckling signs simply says, your body is covered with lesions, your lesions have an identifiable fingerprint, just like your actual fingerprints, so don't think of moles as being atypical in and of themselves. Think of them as being atypical for you. When you should be concerned is that you have a lesion on your body that does not look like lesions on your body, you have a mole that does not look like your moles normally look. That's the ugly duckling. That's typically not a good sign. Right? So that will more reliably find the needle in the haystack. It's also easier to teach.

Other things that we're experimenting with right now or things like rapid exposure, we call it “rap ex”. Rapid exposure basically works on this principle, one of the reasons it's hard to identify melanoma for most people, as you just haven't seen very many, and if you had, then when you saw a new one, you would say that's a melanoma. That's how your brain actually identifies almost anything. I have I have two sons, a 12-year-old and a seven-year-old and so I also get a constant sort of case study in how young brains learn about the world. It's amazing how quickly the brain starts to latch from an example to an exemplar. They see a picture of a dragon, and they go, “Oh, that's what dragons are.” Then they encounter another dragon and they go, “This is a dragon, right? Got it.”

The brain is pretty good at it but it's ever better the more examples it sees. The more and more examples you feed it, the more and more it develops a template that allows it to really pick up on subtlety. Notice that in something like identifying a dragon, that's kind of easy to do, relative to identify not just a mole but a specific, concerning mole. Humans pick up what moles are really, really quickly but features that tell me a mole is problematic, that's a lot more subtle.

In rapid exposure, we will show people you know, 100 images of melanomas in about a minute. The brain likes images fast, doesn't like to just sit and linger. It likes to just see them quick, quick, quick, boom, boom, boom, boom, boom, rapidly. Then we say okay, now, can you find new melanomas? Early research is showing that the answer to that question is yes, the brain likes examples.

We came up with this idea, Kevin, John, and Doug Grossman and Yelena Wu, and several others came up with the idea because as I was studying how dermatology fellows were trained, the dermatologists who are training them repeatedly say the same thing. I shadowed several dermatologists and I just kept hearing them say this, “I know this is the first one of these you've ever seen, you'll eventually see enough of these that you'll, start to go, ‘oh, that's one of those again.’” They say, “Once you've seen enough of them, then you'll be able to identify them.”

I thought, the way they teach dermatology fellows to identify moles isn't, they say, “Here are the ABCDs,” they say, “Once you've seen enough of these, you'll just know them.” I thought that's actually how you learn to find them. You have to see examples. Well, anyone can actually have that, so our goal with that is once we feel really good about rapid exposure. We're going to disseminate that to schools, it'll become a part of just standard health, notably in rural schools, and that will be a way that you just learn to identify melanomas and skin cancer early on.

Heather Simonsen: That sounds wonderful. When you were talking about the ugly duckling, I had that same experience in my own life, in my hairline, I thought it was just a zit, just that I was breaking out, but it didn't go away. I went to my dermatologist and found out that could be the beginnings of skin cancer. We were able to treat it with a cream that I put on my face and get rid of all of it. But I had always thought of melanoma like you think of this big, crazy mole, right? This was tiny. No one else would have probably even noticed it but me. It was just very, very small. What I learned from that is, it didn't go away. If you break out it's going to clear up, that's going to change, but the fact that it stayed there was the telltale sign that it was something more.

Jakob Jensen: Yeah, that's a great story. It's really telling right? Melanomas sometimes look a lot different than our sort of abstract template in our head. They can be smaller. They almost cannot look like moles in the traditional sense, but they don't come looking like they're big, bad, ugly moles. Therefore, they sit there and linger longer than they probably should. And along the hairline, all the more reason that you'd go, what is this? It could be a lot of things, right?

Community nurses: the lifeblood of rural and frontier counties (37:24)

Heather Simonsen: Right. Exactly. Well, how are you today, Dr. Jensen? You look healthy life is good. All as well, with your cancer journey.

Jakob Jensen: All is well. The story ended well for me, and I actually haven't even had a mole removed from my body in quite some time. Which those of you that have been through a skin cancer journey, you will know that getting moles removed is a part of that process. My skin cancer journey was very strange in that way.

A lot when I was much younger, but then as I've aged so far, knock on wood, I haven't had that part normally. Of course, skin cancer risk increases with age, the older we get, the more likely that we have cancerous lesions. I'm sort of living the journey in reverse at the moment, I hope that continues by the way, but things are absolutely wonderful and I'm so glad for that. That's another reminder that actual cancer stories sometimes are upside down a little bit. They can be a little different than the trendline.

Heather Simonsen: Thank goodness for that nurse who alerted you when you were 19.

Jakob Jensen: Yeah, she still is the public health nurse, by the way, in McCone County. So, Sue Good, shout out to Sue Good. There you go.

Heather Simonsen: Thank you, Sue. And all the Sues of the world, right?  

Jakob Jensen: That's a lot of rural communities that have public health nurses. The community nurses are the lifeblood of those communities from a health standpoint. When you think about the Intermountain West, the number of counties that don't have an MD, that may not have a hospital is shockingly high. That's why I said before, it's not even so much that they're rural, they’re frontier, which frontier counties are the least population dense, they have very limited infrastructure, the classic example is they don't have a hospital.

For example, they might have a clinic, and even then, sometimes it's a partially staffed clinic. The clinic has the person in it on Tuesdays, so try to get injured or ill Tuesday because that's when they're going to be there. In those counties, it's the community, it’s the public health nurses that are that are carrying a lot of the weight, that are delivering a lot of the education and knowledge. I think that's also what Huntsman Cancer Institute is trying to think about. On the ground, those can be some of the most important individuals, at actually helping the community. They often have an almost impossible job, you know? McCone County's two-and-a-half times the size of Rhode Island. It’s one public health nurse. This is a, it's a large area of service.

Delivering a cancer-free frontier through technology (40:15)

Heather Simonsen: Wow, that really puts it in perspective. And is a great lead into my final question, which is the question I ask all of our guests. And that is, what does it mean to you to deliver a cancer-free frontier?

Jakob Jensen: It's a really good question. Start off by saying, I think the next 100 years are the most important years in research, perhaps in the history of our species. I anticipate that we will, in a practical way, essentially defeat cancer over the next 100 years. I am in this school of thought that says the defeat of cancer will be the transition from it being a disease that we fight acutely to something that we just manage. To me, that's actually what defeat means. That it has become something that largely is a survivable illness that you just mitigate when you get it, sometimes with medicine, sometimes with brief treatment, but then you move on. It's essentially like outpatient surgery and over-the-counter drugs.

I find it hard to believe that we would go another 100 years and that wouldn't be the case. I would not take that bet to say that cancer makes it to the next century. So, what does what does that look like from a rural standpoint? Well, I know certain things are not going to be true. I know that rural communities are not going to suddenly have a cancer center. I know that most rural communities are not suddenly going to have an oncologist. I know, for example, in skin cancer, that we do not have enough dermatologists right now to even staff, city populations, let alone rural populations, I know that we're not likely going to have things like specialists who are doing any kind of rural rounds on any kind of widespread scale.

I know the infrastructure is probably not going to change in terms of the brick and mortar in the people all that much. That's a little bit of a sober place to start my statement. But on the other hand, I know that a lot of technology holds promise if we can implement it correctly. Artificial intelligence to me, is a key part of the rural cancer journey. Technology integration and connection, with the caveat that rural communities are becoming more rural with each passing year. Never forget that when we say rural communities right now, they're more rural right now than they were last year and they're more rural right now than they were last decade. Because cities continue to grow and consume suburbs and consume outlier communities. Every year there's the rural communities that are left are the ones that are truly remote from the cities. Our rural population gets more and more rural.

Jakob Jensen (right) and Heather Simonsen recording the podcast.
Jakob Jensen (right) and Heather Simonsen (left) recording the podcast.

Fortunately, our technology gets stronger and stronger, and our connections get better. I really do think that tech future is the way to go. I think sort of a cancer-free frontier, or a cancer-engaged frontier is communities that are more fully engaged. From a tech standpoint, from an infrastructure standpoint, it's why I put a lot of stock in partners like Rocky Mountain Power. You know, to me, these are the sort of partners that can consistently deliver some sort of infrastructure that is in those counties, that is in those communities, and that can actually bridge them to the cancer community in a meaningful way. That we have increased prevention and faster detection and maintenance simply because cancer research has advanced and they're able to benefit from it.

And I’ll kind of bring it full circle by just saying, notice that all of that is me saying, “We have to get the communities connected, and feeling like they're a part of cancer prevention and detection,” which I think they do not feel that way right now. And, and to me, if they did feel like they were connected, then that significant benefit that we will realize over the next century will also be realized by them. If I could flip it to the dark side of this.

The concern that anyone should have listening to this, is that this wonderful advance we’ll have in cancer will be true for people who live in the city but it will not be true for people that don't. There's a real possibility of that. Right? In fact, the history of medicine is that story lived out again and again and again. And if we don't actively engage it, then we could have a situation where if you live in a city, cancer is manageable, and really cancer has been defeated. But if you live in a rural community, cancer is still a leading cause of death. And did you not benefit from the cancer revolution and, and by the way, that, unfortunately is a lot of the story right now. Right?

That's the painful story right now, the painful story right now is if you get melanoma and you live in Salt Lake City, you're far less likely to die from it, than if you get melanoma and you live in any rural community in the Intermountain West, they're far more likely to die, they're going to be diagnosed later, they're going to be far less likely to receive the same treatment, and optimal treatment, and they're much more likely to die of it, regardless of the cancer.

So right now, that is that disparity, but with greater connection, with engaging that fatalism, I think that those communities will benefit from that revolution in a way that they currently are not. And I don't just hope it, I think that it will come to pass, but we're going to have to make it so it's going to require some investment, some good partners, some smart moves. It's going to require those communities themselves feeling like they're a part of this. It's why maybe one of the kind of subtle things that has happened, that is incredibly important to cancer, I think, in the Intermountain West, but also maybe more globally, because I feel like what we're doing here is also going to shape a lot of what's happening around the world.

But one of the most important things is when Huntsman Cancer Institute was able to successfully make the case to the National Cancer Institute, that our area of service was not Utah, that it was Montana, that it was Idaho, that it was Wyoming, that it was Nevada, and Utah, that all of those states were actually full of people that Huntsman served. That is what is true. And before we were able to make that case, and make it in a way that was compelling. By the way, they wouldn't even listen to it initially. They just rejected it. They would say things to us like, well, Montana is going to have its own Comprehensive Cancer Center.

Montana is not going to have its own Comprehensive Cancer Center any time in the next 100 years. That's a painful fact. Okay, so that response really fell flat. And unfortunately, what the implication was people in Montana, were left out, right, they were not going to get served.

So when we were able to successfully make that case and reshape our area of service, it then meant that conversations like this happen, and all of a sudden, you know, places like HCI realized, oh, we have a bunch of Montanans, you have a bunch of Idahoans, and Wyomingites and people, we have a bunch of people who live or work at Huntsman Cancer Institute that are from these areas who are desperate to try to serve those communities, too and now we have are positioned to do so. And I really think that's going to prove to be a powerful part of this. And we're going to look back and say that was a moment when things got a lot better for those communities. A subtle thing, but an important one.

Heather Simonsen: Dr. Jakob Jensen, it's been such a pleasure. Thank you so much for being here with us today.

Jakob Jensen: It's my pleasure.

Expressing gratitude (48:01)

Heather Simonsen: We extend our gratitude to Dr. Jakob Jensen for sharing their expertise and experiences with us today. To our dedicated listeners, we appreciate your support. For additional resources, be sure to check out the show notes. And if you want to stay connected with us and be the first to know about upcoming episodes. Don't forget to hit that subscribe button on your favorite podcast platform.

We truly appreciate it if you could take a moment and leave us a rating or review. Your feedback is so meaningful. We truly are so very grateful. And please tell your friends and family about the podcast and share episodes on social media. We're always eager to hear from you whether you have questions, comments, suggestions for future topics or a personal story you'd like to share, please visit our website, I'm your host and executive producer of a cancer free frontier, Heather Simonsen. We are thankful to the entire Communications and Public Affairs team at Huntsman Cancer Institute. A special thanks to The Pod Mill and Mix at Six Studios for their help with this episode.