Archive for the ‘Cancer’ Category

Lung Cancer Screening: what we know and what we can do in Maryland

August 15, 2016

Lung cancer is the second most common cancer and the leading cause of cancer death in both men and women in Maryland. The incidence and mortality of lung cancer keep in as high as national level based on the 2014 cancer report of Maryland. Smoking is the most common high risk in lung cancer responsible for 90% of lung cancer in male and 78% of lung cancer in female in Maryland. There is 14.9% of the adult population (aged 18+ years)—over 640,000 individuals— who are current cigarette smokers. Across all states, the prevalence of cigarette smoking among adults ranges from 9.3% to 26.5%. According to the largest National Lung Screening Trial (NLST) in America, LDCT (Low-dose CT) screening for lung cancer had a 15 to 20 percent lower risk of dying from lung cancer than participants who received standard chest X-rays.

lung-cancer-facts

Source: National Cancer Institute; National Lung Screening Trial (NLST)

USPSTF defined the people who are under the high risk of lung cancer as having the history of heavy smoking (smoking at least one pack a day for 30 years, either the current smokers or former smokers who quit within the past 15 years) between the ages of 55 to 80, and also recommended annual screening(level B) for lung cancer with LDCT in this selected population.

Screening histroy of USPSTF.jpg

Source: Lung Cancer Alliance (LCA)

Center for Cancer Prevention and Control in Maryland Department of Health and Mental Hygiene plans to implement LDCT lung cancer screening among the heavy smoking population over the state. We Marylanders will get continuous smoking cessation education and qualified screening process guideline, and the screening centers will be monitored in instruments, physicians and technicians following the quality and safety standard of ACR. In addition, the follow-up schedules and treatment strategies will be built up simultaneously.

The percentage of smokers is parallel with the education and income level nation widely. The LDCT screening among heavy smokers can be better intervened based on the policy and financial support from government, it’s really critical to make efforts for the better future of heavy smokers in Maryland.

 

A Patient Navigator’s Support for the New York State Breast Cancer Initiative’s 4-Hour Leave for Breast Cancer Screening

March 8, 2016

Breast cancer is the most common cancer among women in New York State,[1] and mammography has been shown to be effective at detecting tumors at earlier stages of development than clinical breast exam.[2]

breastcancer_stat_paperworkSource: https://www.ny.gov/programs/new-york-state-breast-cancer-programs

 

All eligible New York State public employees are currently entitled to one annual 4-hour leave from work in order to undergo mammography for early detection of breast cancer. Governor Cuomo wants to expand this policy to cover the private sector, so that all New Yorkers will have the right to life-saving screening without putting their employment status in jeopardy.

As a patient navigator in a cancer center in East Harlem, I believe that this policy will be instrumental in saving lives. Many of the patients we see would be classified as “working poor” – despite often holding two jobs and working constantly, they still live in a state of poverty. Even one day’s lost wages could upset the extremely delicate balance they live and cast them into a state of catastrophe. As a result, many people will often choose the work they need to put food on the table over getting a screening that has little apparent immediate benefit. Unfortunately, this often results in the women who do develop breast cancer only finding out they have the disease at a later stage, making it much more difficult to treat.

Numerous private sector businesses, including M&T Bank and Amneal Pharmaceuticals, have indicated their support for the policy. This is not to say that everyone is on board – there are those organizations[3] who believe that even the state employees’ guaranteed leave for screening is s superfluous use of New York State citizens’ tax dollars. I, however, would disagree – increased screening coverage would not only save lives, but it would also save the state money in the long run. Treating late stage breast cancer is extremely expensive compared to early stage cancer. Since screening should ensure that most breast cancers are caught and treated early, this will reduce the burden on the economy,[4] and especially on the state’s budget by reducing costs for Medicaid and Medicare Services, which insure a great deal of the people who would benefit from the new policy.

References

[1] https://www.ny.gov/new-york-state-breast-cancer-programs/new-york-state-breast-cancer-services

[2] http://www.cancer.org/healthy/toolsandcalculators/remind-me?_ga=1.268218890.549704867.1457131056

[3] http://www.stopthetaxshift.org/employee-relations/29-paid-leave-for-cancer-screenings-

[4] Mandelblatt, Jeanne, Harold Freeman, Deidre Winczewski, Kate Cagney, Sterling Williams, Reynold Trowers, Jian Tang, and Jon Kerner. “Implementation of a Breast and Cervical Cancer Screening Program in a Public Hospital Emergency Department.” Annals of Emergency Medicine 28, no. 5 (November 1996): 493–98. doi:10.1016/S0196-0644(96)70111-7.

 

Development of a National Breast Cancer Screening Policy in Jamaica

August 14, 2015

Too many Jamaican women are dying from breast cancer. Although the rate of breast cancer was expected to rise with the introduction of mammography, as it did in other countries, it has remained relatively stable. This discordance is due to Jamaica’s under-utilization of mammography services and lack of a national breast cancer screening policy. In the absence of a screening policy, many cancers go undetected at early stages when cancer is most treatable.

Currently, mammography is not available in the public sector, effectively excluding those who cannot afford it at a private clinic or pay for the lower cost mammography through the Jamaica Cancer Society (JCS). Furthermore, those women who can pay are unlikely to seek screening without a physician referral. A national screening policy would standardize age at screening, encourage mammogram referrals, and allocate funding for public mammography services. This policy may also encourage partnerships amongst the stakeholders to provide additional sources and mobilize all available resources.

Though many stakeholders support the development of a screening policy, governmental action has been stagnant due to funding limitations. The JCS has been active in raising breast cancer awareness and providing screening services to low-income individuals, but it is severely handicapped by lack of funding. Furthermore, with the threat of increasing breast cancer incidence due to wider adoption of western diets and lower exercise levels, more women are at risk for developing disease that may go undetected.

We are calling for the development of a national breast cancer screening policy in Jamaica and we urge the Ministry of Health to act now in making this a national priority. The cost of implementing such a policy should be viewed in the broader context of cost savings from the early detection of breast cancer and thus decreased utilization of expensive late stage cancer care.

Renewing the debate for an HPV school-entry vaccination mandate in Maryland

August 14, 2015

HPV vaccine being administered (JOE RAEDLE / GETTY IMAGES)

In 2007, a human papillomavirus (HPV) school-entry vaccination mandate was introduced and then withdrawn in the Maryland legislature.  The major concerns at the time was that the vaccine was too new, it was too costly, and that it was intended to prevent a sexually transmitted disease.

Since then, no substantial action has been taken and there has been no formal deliberation about re-introducing an HPV vaccine mandate in Maryland.  In the years since the mandate was introduced, cervical cancer has continued to rise in Maryland with nearly 200 new cases per year according to the most recent data from the Maryland Department of Health.

It is unanimous among the scientific community that nearly all cervical cancer cases are caused by HPV.  It is understandable that the public was apprehensive of the HPV vaccine in the past, but now we know that:

  • The vaccine has been administered for nearly 10 years and is proven to be safe
  • The vaccine is very effective and can prevent thousands of deaths from cervical cancer
  • There is no evidence that the HPV vaccine increases the chances of risky sexual behavior
  • Insurance plans are required to cover the cost of the vaccine under the ACA and it is also available at no cost through Medicaid’s Vaccines for Children Program

Virginia, the District of Columbia, and recently Rhode Island have enacted school-entry mandates for HPV vaccination.  DC passed the law in 2007 and as a result, they are now a national leader in HPV vaccination coverage.

It has been eight years since the HPV vaccine mandate was first debated in Maryland and it is time to renew that debate.  If Maryland is serious about preventing a deadly form of cancer, they should follow their neighbors’ lead and enact a school-entry HPV vaccination mandate.

Addressing a root cause of the most pervasive killers in Mongolia: an unhealthy diet

March 6, 2015

MyPlateIn land of blue sky, non-communicable diseases (NCDs) are on the rise. The most prominent sources of mortality and morbidity among Mongolians are cardiovascular disease, cancer, and adult-onset diabetes. According to the World Health Organization (WHO), NCDs “are estimated to account for 79% of total deaths” within the population. Hence, there is a desperate need to address one of the leading causes of the most pervasive killers in Mongolia – an unhealthy diet.

As populations all over the world are experiencing epidemic rates of overweight and obesity, online resources and tools can help to empower people to make healthier food choices for themselves, their families, and their children. ChooseMyPlate.gov is a website that has a plethora of tools and resources that could assist Mongolians in healthier meal planning. The photo above demonstrates the appropriate balance for a healthy meal using the five different food groups within a typical place setting. The site also has a Healthy Eating on a Budget section, which has tips for grocery shopping, preparing healthy meals, sample menus, and resources for professionals. For eating outside of the home, vegetarian restaurants are becoming more popular in Mongolia and a list of them can be found here. Finally, the SuperTracker helps people log food consumption and physical activity throughout the day to analyze what they can improve on to make their lifestyle choices healthier. A screenshot of this terrific resource can be found below.

supertracker

 

A call for action: Additional behavior change advocacy is needed on the national level and within the capital of Ulaanbaatar (where a majority of the country’s population resides) to incite healthier eating practices in Mongolia. There is a need for more behavior change advocacy programs by the Ministry of Health (MoH) targeted at the workplace level as well as within the school systems. The MoH could utilize the Network of Health Related Organizations in Mongolia to ensure a cohesive, nationwide approach.  Another critical resource for spreading the message of healthy eating will be the Business Council of Mongolia.  Furthermore, the WHO is well positioned to assist the MoH with the implementation of additional efforts and could also help reinvigorate the Association of the National Mongolia Network for Workplace Health Promotion.  A coordinated effort on behalf of the Mongolian population to help assist with addressing unhealthy eating behaviors and incentivizing people to integrate more fruits and vegetables into their dietary routine is necessary in order to quell the rise of NCDs among the population.

 

Should Maryland consider an HPV Vaccine Mandate for School Entry?

August 15, 2014

 

HPVpicture

The 2014-2015 Maryland Vaccine Requirements do not require the HPV Vaccine for school entry. A short drive away, in Virginia 7th graders are required to have the HPV vaccine.  Should Maryland mandate the HPV vaccine for school entry?

HPV is the MOST common Sexually transmitted infection in the US (CDC). Of the 40 HPV types, two (16,18) are known to cause 75% of cervical cancers and  90% of genital warts (6,11). Daily, 33 women are diagnosed with Cervical Cancer, the 2nd most common female cancer in the US.  There are 14.1 million new cases of HPV infections in the US per year. The two HPV Vaccines GARDASIL and CERVARIX are offered but not required by most states. Only a handful of states legislatures have passed laws to require the HPV vaccine for school entry.

0914-web-HPV

A 2013 Pediatrics survey reported an increase in parental vaccine safety concerns (4.5% 2008 to 16.4%  2010). The survey also reported common reasons for not vaccinating children against HPV:”not sexually active (11%); Safety concerns (16.4%); “Not necessary” ( 17.4%). Per the CDC, the HPV Vaccine side effects  are similar to most other vaccines and there is no known cause for increased concern. Virginia Del. Kathy J. Byron (R-Lynchburg), tried to lift the requirement. Byron said, “We just want to make sure parents are evaluating the risks of what they’re giving their daughters, and not a legislative body”. In the Post, Byron also highlighted “The medical community is still undecided”. Although, the major healthcare stakeholders (CDC and American Academy of Pediatrics) support HPV vaccination, their policies fall short of suggesting mandates for school entry. In addition, a few physicians have brought the science into question. Dr. Diane Harper, says the “vaccine is being way oversold”. Harper goes onto state that “Ninety-five percent of women who are infected with HPV never, get cervical cancer.” The vaccine manufacturers acknowledge it does not provide 100% protection against HPV or cervical cancer. The true efficacy of the vaccine will not be known for another 20 years, when the first cohort reaches adulthood and cervical cancer rates can be measured.  It is no wonder parents and legislators are confused about whether the vaccine should be mandated. However, both sides acknowledge cervical cancer is a deadly, serious disease.To that end, the possibility to protect and prevent cancer is a CRUCIAL medical advancement that should not be understated. Unfortunately, if the HPV vaccine is not mandated, many parents may choose to opt out unless other  educational interventions are offered. A community activist approach utilizing women’s groups, and community organizations could provide improved education, and de-mystify the vaccine. A Maryland mandate should be passed to improve vaccination rates. However, legislators  may need a more vocal medical community consensus. Therefore we need to increase physician-patient dialogue and community education to encourage vaccination.

*Map NY Times 2011

Second-hand tobacco smoke: Smoking in restaurants and bars in the rural Rockcastle County in Eastern Kentucky.

August 14, 2014

GetInvolved_SecondhandSmoke_finalSecond-Hand-3

(image source left, right)

Data pooled from 192 countries reveals that globally secondhand smoke exposure causes over 600,000 deaths annually of which nearly 53,800 deaths occur in the U.S. annually. Second hand smoke is more than three times as toxic as mainstream smoke. The most likely victims of secondhand smoke are people who do not smoke as their personal habit. Among these victims, restaurant and bar workers have the greatest risk of developing lung cancer compared to other occupations. In order to eliminate secondhand smoke from restaurants and bars, adopting a Rockcastle county-wide ordinance banning smoking in restaurants and bars is the best imaginable policy.

2smokechartstateinfo_secondhand_730px

(image source left, right)

Ever wondered why secondhand smoking persists in the bars and restaurants of Rockcastle County, Kentucky? Perhaps it is because this county is located in Kentucky which is famous for tobacco products. “NO”. In Kentucky, twenty three communities have already established smoke-free policies covering all workplaces and enclosed public places. About 34.2% of people are covered by strong local smoke-free ordinances or regulations. Why not the same in Rockcastle County? It is primarily because of the strong resistance from local business owners who have the unfounded fear of loss of business and income. They do not know that this resistance is harmful rather than meaningless for their business.
Their business could be more successful by simply making it “smoke free.”

 

 

The message is clear. Smoke free ordinance has never harmed business and it even makes bar and restaurant business successful. I know business owners got fed up for listening to how bad the smoke is for their customer’s and employee’s health. This time it is different. They are willing to listen to this money making information.

What are other barriers to prohibit this county from becoming a smoke-free environment? Can you come up with any ideas? I can’t.

Then it’s time to establish a smoke-free ordinance in our County.           

Latina Health: Higher Cervical Cancer Rates Need More Focus & Funding in California

August 14, 2014

Imagine your doctor tells you it’s cancer—not only that, it could’ve been prevented with a screening test and now, a vaccine. This terrible scenario faces women diagnosed with cervical cancer daily. In 2010, the Centers for Disease Control and Prevention reported 11, 818 cases and 3, 939 deaths from cervical cancer in the United States.

Latinas are particularly affected, with the highest HPV-associated cervical cancer rates. This is partly because Latinas have lower rates of screening using the Pap test, which looks for cervical changes linked to precancer and cancer. In 2010, less Latinas had a Pap test than in 2000.

Latinas are 45% more likely to be diagnosed with cervical cancer, 40% more likely to die according to the 2010 National Vital Statistics Reports (image source).

Why aren’t Latinas getting screened? Many issues exist in the Latino community such as fear of stigma, language barriers and poor communication.

Cervical cancer represents a major health disparity for Latinos, among others (image source).

Cervical cancer is also prevented by vaccination against human papillomavirus, or HPV. HPV is a sexually-transmitted infection linked to a variety of cancers besides cervical. Licensed by the FDA in 2006, vaccines like Gardasil are available, but underutilized. Only slightly more than half of teenage girls received this cancer preventing vaccine in 2013—a far cry from the goal of 80% vaccination.

The best way to reverse this trend among Latinas is to focus on promoting Pap tests and vaccinations against HPV. States with a high percentage of Latinas, such as California, must expand funding to women’s healthcare services to specifically target this vulnerable population.

For more information about cervical cancer, visit the National Cervical Cancer Coalition at www.nccc-online.org (image source).

 

Genes are Out! cDNA is in?

August 17, 2013

June 13, 2013 was a victory in the fight against breast cancer. The Supreme Court ruled in the case of Association for Molecular Pathology et al. v. Myriad Genetics, Inc. et al. that naturally occurring genes are no longer patent protected, thus voiding several patents that were placed on discovered genes, such as Breast Cancer 1 (BRCA1) and 2 (BRCA2) genes. BRCA1 and BRCA2 are commonly used in early detection screening for breast and ovarian cancers; and this ruling to nullify gene patents will promote less expensive diagnostic testing that can reach a wider patient base and more opportunities for collaboration among researchers.

Image taken from Huffington Post article "Defending Genomic Liberty." http://www.huffingtonpost.com/christopher-e-mason/gene-patent-myriad_b_3273744.html

Image taken from Huffington Post article “Defending Genomic Liberty.” http://www.huffingtonpost.com/christopher-e-mason/gene-patent-myriad_b_3273744.html

But the fight is not over. In the decision, the Supreme Court ruled complementary DNA (cDNA) as “…not a ‘product of nature,’ so it is patent eligible under (35 USC) §101” because “cDNA does not present the same obstacles to patent-ability as naturally occurring, isolated DNA segments.” cDNA is essentially a copy of DNA, and while it many times is produced in a laboratory for testing, it is also found naturally in the body. In fact, 8,000 naturally occurring cDNAs have been identified.

Therefore cDNA should be ineligible for patent protection under the “laws of nature, natural phenomena, and abstract ideas” stipulation. Doing so will produce additional diagnostic testing and collaborative research opportunities.

That’s why we need your help. Make your voice heard by:

  1. Asking your congressman to revise legislation 35 USC 101 to include cDNA as part of the laws of nature ineligibility clause.

  1. Commenting on the Federal Register under the USPTO’s proposed guidelines about why cDNA should be considered ineligible for patent protection.

  1. Contacting the American Civil Liberties Union regarding your concerns on this decision, and encouraging them to comment.

  2. Expressing your concerns to the Biotechnology Industry Organization and asking them to take action.

How Can We Help Women Survive the Financial Tsunami that Comes with a Breast Cancer Diagnosis?

October 29, 2012

According to the American Cancer Society, 1 in 8 women in the US will be diagnosed with breast cancer in her lifetime http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics.  In the 6-12 months it takes to complete treatment, women undergo multiple diagnostic tests, biopsies, surgeries, chemotherapy, physiotherapy and radiation.  Treatment is time consuming and often times debilitating, making it difficult for women to work.  The combination of increased medical expenses, routine living expenses and cessation of income, often generates enough debt to financially destroy families http://www.dailyfinance.com/2011/10/06/breast-cancers-financial-toll-part-2-where-to-go-for-help/.  

Current and retirement savings are the first to be wiped out.  The next line of defense in the battle for financial survival is credit card debt.  Once credit cards have been maxed out, foreclosure and homelessness are not far behind.  Hardest hit by the financial tsunami are those in female-headed households.  At a time when they are fighting for their lives, these women are also being crushed by a mountain of debt and harassed by debt collectors.

Given the power of breast cancer lobby groups and the amount of fundraising taking place in the name of breast cancer, one cannot help but wonder why there aren’t more resources allocated to providing meaningful financial support for women in treatment.  Although foundations exist which offer small grants, their support is a drop in the bucket given the magnitude of the problem http://www.patientadvocate.org/index.php?p=18.  Social Security disability benefits are not an option for most of these women.  Unless their cancer is advanced and there is significant metastases, most women do not qualify for SSI until they have been unable to work for a minimum of 12 months.

In an effort to address this problem, the breast cancer lobby should focus more attention on obtaining financial support for women currently in treatment.  This financial support should come both from fundraising, and by urging members of Congress to support legislation that allows women in treatment to be eligible for Social Security disability benefits.