Tripp Fay/For the Summit Daily News
Joel Wexler has made quite a few friends during his five years as a full-time Keystone resident, but it's his black Labrador retriever, Gussie, of whom he's most fond.
She's been by his side for a majority of his 13-year journey of frequent cancer screenings. In 2009, doctors were concerned about elevated levels of prostate-specific antigens, so they watched his health closely until he was ultimately diagnosed with cancer in 2021.
From the moment Wexler met Gussie, about a decade ago, the pair has been inseparable. Wexler can be spotted riding his fat-tire bike or trekking through snow-covered landscapes, Gussie following close behind.
Wexler used to be an avid skier — usually racking up 130 days on the mountain each season — but while zig-zagging down the slopes, his mind would often linger on the pup he left at home.
On days like the one when Wexler updated his will, when the threat of cancer can make life feel overwhelming, it is Gussie who lifts his spirits the most.
At this point, he said he's not overly concerned about having prostate cancer, but, even still, the news came as a blow.
Cancer in the High Country
Similar to Wexler's experience with cancer, roughly 1.9 million people in the US are expected to be diagnosed with some form of cancer in 2022, according to estimates from the National Cancer Institute.
But when looking at how Summit County compares to the other counties in Colorado, data from the Colorado Department of Public Health and Environment's Colorado Central Cancer Registry shows Summit County had the lowest age-adjusted incidence rate for new cancer diagnoses per 100,000 people (272.9) when looking at the most recent 10-year period of data (2009 to 2019). Dolores County in southwest Colorado had the next lowest age-adjusted incidence rate during that period, with 274.3 cases per 100,000 people.
John Arend, program manager of the Colorado Central Cancer Registry, wrote in an email that these age-adjusted incidence rates "help to mitigate differences in the age-distribution of the populations that are being compared." He went on to explain that "age-adjusted incidence rates are the most-commonly used statistic to describe a community's cancer burden and to compare it to other communities' rates."
All rural mountain communities near Summit County had age-adjusted incidence rates over 300 diagnoses per 100,000 people in the same time period: Grand County's rate was 308.3, Lake County's was 316.8, Park County's was 338, Eagle County's was 346.7, and Clear Creek County's rate was 368.2.
Age-adjusted incidence rates, for the same time period, increase when moving further east toward Front Range communities: Boulder County's rate was 392.4, Broomfield County's rate was 401, Douglas County's rate was 408.7, Denver County's rate was 416.3, and Jefferson County's rate was 416.9.
The Colorado Department of Health isn't the only entity to publish promising Summit County data, either. According to a 2017 study published by the Institute for Health Metrics and Evaluation, Summit County was one of five counties in the nation that had the lowest death rates in 2014 for lung cancer, breast cancer and prostate cancer. These cancers are reported to be the most common types of canceraccording to the National Cancer Institute.
So why does cancer seem to be less prevalent, statistically, in Summit County? Ann Wilcox, director of the oncology service line for Vail Health, believes it has to do with the community's lifestyle.
"We lower our risk factors — one of the ways — with a healthy lifestyle," Wilcox said. "We are lucky enough to be in an environment where healthy eating and activity is part of our day-to-day. You don't say to somebody, 'What did you do on the weekend.' You say, 'Did you do the peak or did you do the river or did you get on your bike?'"
This healthy lifestyle cannot be understated when discussing cancer. According to the World Health Organization, cancer causes 1 in 6 deaths, meaning it is a leading cause of death worldwide. Some common risk factors for developing cancer include tobacco use, alcohol consumption, unhealthy diet, physical inactivity and air pollution.
That's not to say that those living in Summit County are insulated from the risk of developing cancer. Wilcox pointed out that family history and access to health care also play a role.
Jenna deJong/Summit Daily News
When Wexler, who is 68 years old, was diagnosed, it wasn't his first experience with cancer. His mother was diagnosed with lung cancer, and his brother was diagnosed with prostate cancer.
Despite Wexler's healthy lifestyle, other risk factors — some of which are outside his control — could have contributed to his diagnosis.
According to the National Cancer Institute, prostate cancer is the most common cancer and the second-leading cause of cancer deaths among men in the US The five-year relative survival rate is about 97%. The institute's website indicates the rate of new cases of prostate cancer is nearly 113 cases per 100,000 men per year.
When looking at how Summit County compares to its neighbors, the rates vary. According to the Colorado Department of Health's dashboard for cancer cases, Summit County's age-adjusted incidence rate for prostate cancer from 2009 to 2019 was 50.51 new diagnoses per 100,000 people. For reference, Lake, Park and Grand counties all had lower rates than Summit. Eagle and Clear Creek counties have higher rates.
Jenna deJong/Summit Daily News
The proximity of the sun
Although Wilcox said the lifestyle of people who choose to live at higher elevations could reduce cancer rates, there are some drawbacks. Part of the healthy living Wilcox referenced has to do with being outside and exploring the community's abundant recreation opportunities, which means higher exposure to the sun.
"We're a mile closer to the sun, and we're outside all the time," Wilcox said, adding that even driving your car from Summit County to Denver involves higher risk than driving closer to sea level since the sun is hitting your hands at a higher intensity. "Our passions of living outside, which is why we live here, just expose us."
Dr. David Biggs, who practices oncology and hematology at the CHPG Medical Oncology Summit in the Medical Office Building in Frisco, agreed that people living at higher elevations have to be more cautious of skin cancers.
"Skin cancers would be the thing that people are more susceptible to up here just because of the thinner atmosphere and more ultraviolet exposure," Biggs said.
A study published in 2018 by Frontiers for Young Minds took a deeper look at this. The study investigated Leadville because it is the highest US city, sitting at an elevation of 10,152 feet, and because it “has high rates of skin cancer.” The study determined that in high-elevation locations, "there is decreased atmospheric shielding from UV radiation, which leads to 50% more ultraviolet exposure than at sea level."
Although the data does show a slightly higher incidence rate for melanoma cancers or basal skin cancers for Summit County, it is still not to the level of other counties in the state, including Denver, Jefferson, Douglas or Broomfield counties or even some rural mountain communities. Clear Creek, Eagle and Park counties all have higher age-adjusted incidence rates than Summit's rate of 23.91 new cancer diagnoses per 100,000 people. Lake and Grand counties both had lower age-adjusted incidence rates for skin cancers between 2009 and 2019.
Living with cancer
During the course of his treatment, Wexler said he never considered moving from Summit County. It's a place that he loves too much to leave and a place where he and his dog call home.
Him and Gussie still plan to take journeys through town as he rides his fat-tire bike with her closely in tow. Although his cancer isn't quite in remission yet, he's remaining optimistic and staying active with his lifestyle, like he always has.
Through the doctors visits, tests and check ups, the pair remain inseparable.
For now, he plans to continue spending time with Gussie, making as many memories as possible while his body continues to fight off whatever cancer is left in his body.