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Playing This One for Keeps Cincinnati Post writer Mark Neikirk interviewed Check Your Genes Board Member in November, 2007. She is rail thin. Her hair is short, soft wisps of new growth - the third time she's had to regrow it after chemo.

But don't mistake Nancy Romer for frail. She is kinetic. Her hands are in motion with every word, her face least comfortable when not smiling, and her voice, though a touch raspy, is the voice of a fighter.

I'd like to write that ovarian cancer is no match for Nancy but I cannot. As much as she deserves that inspiring sentence, she is battling a killer. It isn't known yet who is going to win. But bet on her.

Six years ago, Nancy, who lives in Edgewood, was 32 and a working mom with serious earning power in a sales job. When abdominal and back pains lingered seven months after the birth of a second child, her doctors ordered an ultrasound, which suggested cysts. The surgeon found cancer instead, advanced enough to threaten Nancy's life imminently.

High-dose chemo, radiation and bone marrow transplants followed. It's the kind of intense treatment that can save your life if you can only survive it. There were times she seemed to be on her last breath. Through all of it, she and her family wondered "what if?" - what if her cancer had been discovered earlier and treated earlier?

"Ovarian is a silent killer. There's not a lot of early symptoms. That's the thing. There's not," Nancy told me over coffee a few days back.

But the tools for early detection are improving. Genetic research especially has brought advances as scientists see more clearly what throws the switch to let a cancer start and what shuts it off.

Nancy's mother, Kentucky Appeals Court Judge Judy West, died of breast cancer at a young age. That put Nancy on high alert for breast cancer. Ovarian cancer wasn't on her radar. It should have been. The two can be linked.

After her diagnosis, Nancy was recommended for genetic screening because it can find mutations in the genes known as BRCA-1 and BRCA-2, which, if present, kick the odds of both breast and ovarian cancer way up. Nancy's screen uncovered precisely that genetic warning.

Her misfortune was to find out after her cancer had its head start. Nine of ten women diagnosed early live five years or longer. If the cancer is found in its later stages, the numbers are reversed. Nine of ten die. Nancy's screening was too late to benefit her direclty, but it meant her siblings and her children should be screened for the mutation. They might be spared what Nancy has not.

Much of Nancy's life since her diagnosis has been devoted to treatment. Right now, that means weekly chemo. But she also is devoted to spreading the word about genetic testing. She and her family have launched Check Your Genes, or if you prefer i-age labels, checkyourgenes.org. Yes, she has a website. Have a look. Write a check if you like what you see.

Her message is that some people - she is one - are genetically predisposed to certain cancers, and tests can tell who is and who is not. As simple as it sounds, it is not. Life rarely gets more complex.

First of all, the health care system cannot afford to screen everyone. But for people with certain family histories screening makes sense, including economic sense. Nancy's medical bills have totaled nearly a million dollars. Besides being more effective and less invasive, earlier treatment would have cost a fraction as much.

The second complexity is what to do if screening detects a higher risk for cancer.

Preventative chemo or a double mastectomy are options, but either is a difficult step for a healthy person. A less radical response would be more frequent blood tests for the first sign of cancer. Nancy says she probably would have gone that route.

In our nation right now we are having a great debate over health care. Mostly, it centers around whether we should change how we pay for it. It is an important debate, but it is not the whole debate. Catastrophic cancers raise questions beyond bookkeeping. Deploying a better system of early detection is near the top of the list. Genetic screening, which is advancing rapidly, will make the question more pressing.

You many remember Nancy as Nancy West, a guard on the Thomas More College women's basketball team. She set a record for assists back in the 1989-90 season. "I could see the court well," she told me.

She still does. But the court is much larger, the stakes higher and the assists from Nancy all the more valuable.

Mark Neikirk is director of the Scripps Howard Center for Civic Engagement at Northern Kentucky University. His e-mail address is neikirkm1@nku.edu.

Special thanks to Mark for writing this piece. You can find the original article on the Cincinnati Post website.