Study Corrects Cancer Data and Finds Cervical Cancer Rates, Disparities Higher than Thought

1024px-squamous_cell_carcinoma_in_the_cervix_pap_stainA new study corrects cervical cancer incidence and mortality rates to account for hysterectomy, and finds both incidence and mortality of cervical cancer has been grossly underestimated, especially in the black population, in which hysterectomy rates are higher. The study, led by Anna L. Beavis, M.D., MPH of Johns Hopkins Medicine finds the prevalence of hysterectomy was greatest in white and black women aged 65 to 69 years, but the peak was significantly higher in black women (58% vs 43% for white women). After correction, the black mortality rate was 10.1 per 100,000 (5.7 per 100,000 without correction), whereas the corrected rate for white women was 4.7 per 100,000 (3.2 per 100,000 without correction). Without correction, the disparity in mortality between the races was underestimated by 44%. The oldest black women had the highest corrected mortality rate at 37.2 deaths per 100,000, a rate that rivals the rates of undeveloped countries.

We asked Otis W. Brawley, M.D. MACP , the American Cancer Society chief medical officer, to respond to the study. 

“This is an important and very well-done study that has real implications in cancer medicine. The United States has very high rates of hysterectomy, so recalculating incidence and mortality after removing those who have had a hysterectomy, and who therefore cannot get cervical cancer, makes sense. After all, statistics are usually provided only for those at risk. For example, testicular cancer rates include only men and not men and women. Even with breast cancer, for which men have very low incidence, we commonly report incidence and mortality in women only.

otis-brawley-potraits-5x7-2016“The message to healthcare providers, insurers, policy makers, and patients is the same: Disparities not only exist in cervical cancer, but at even higher rates than we knew. This study should clearly focus public health efforts about the magnitude of this problem, and help strengthen efforts to overcome it.

“Why do these disparities exist? The reasons are complex, and deeply ingrained in our society. There is good evidence in a number of diseases, even beyond cancer, that even when screening rates are similar, the quality of screening is not. This concept of disparity has been shown true not only in screening, but also in diagnostics and treatment of breast cancer and colon cancer as well as in the treatment of hypertension, diabetes, and cardiovascular disease. It seems quite plausible this is also the case in cervix cancer. We frequently focus on whether screening, diagnostics, and treatment occurred, but we often forget to take into account the quality of these interventions. Even in the case of radiation therapy there is a significant literature on the disparities in completion of treatment.

“Common reasons for the disparities include things like overcrowding and overtaxed doctors and clinics in socioeconomically deprived communities. Patients also have challenges in getting care; simple things such as transportation, especially for radiotherapy where one needs to receive it on a regular basis can be an obstacle. In addition, disparities are often tied up in issues that lead to patients leaving treatment before their therapy is complete.”

 

Posted in Access to Care, Cervical, Disparities, Prevention, Screening | Leave a comment

A Healthful Way to Give to Cancer Patients

As the holidays approach and the year ends, a lot of people are looking for ways to give back, whether it’s gifts to loved ones or donations to their favorite charity (and of course we hope you’ll support the American Cancer Society).

But there’s another way to give; a way to help people with cancer and others stay healthy as winter approaches: By getting your flu shot.

16731-a-nurse-giving-a-middle-aged-man-a-vaccination-shot-pvLast year, most of the people who got flu shots (and only about half of us did) likely did it for a personal reason: to avoid getting flu. But there’s another, altruistic aspect to vaccination that is equally, or perhaps even more important.

Because the vaccine is not perfect, increasing the population of people who get vaccinated is a key part of protection, thanks to something called herd immunity.

People undergoing treatment for cancer as well as others whose immune systems may be compromised may not get as good a response to the vaccine, so it is especially important that those around them –including but not limited to families, loved ones, friends, co-workers, and health professionals– be  vaccinated to reduce the risk of spreading the flu to cancer patients and other vulnerable populations. Also vulnerable are pregnant women, older people, young children, and others with chronic conditions like asthma or diabetes.

You can protect not only yourself but others by getting vaccinated, reducing the chances of flu spreading to these vulnerable populations. It’s a potentially lifesaving gift at a time when many of us are looking for ways to give back.

Visit http://www.cdc.gov/vaccines/adults/find-pay-vaccines.html to find and learn how to pay for a vaccine.

Posted in Prevention, Survivorship, Treatment, Uncategorized | Tagged , , | Leave a comment

Melanoma and Alcohol: Another Explanation

A study getting some attention today links alcohol intake with an increased risk of melanoma, an association that had been suggested in previous smaller studies as well as in a combined analysis of 16 studies. party-1173651_960_720How could alcohol raise the risk of melanoma, a cancer strongly linked to ultraviolet (UV) radiation? Well in fact, UV radiation probably shouldn’t be counted out as the possible cause just yet.

Those who’ve studied science are familiar with the saying: “correlation does not imply causation.” That means that just because two factors are associated with each other doesn’t necessarily mean that one causes the other.

tanning-bedSometimes associations between two factors are due to chance (or coincidence); sometimes other factors can be the culprit behind the association between two factors; and sometimes there are other reasons that could lead to a biased association.

That may be the situation with the new study linking melanoma and alcohol. While the investigators of this study did attempt to control for difference in sun exposure, another factor, the use of tanning beds which emit UV radiation and are a known cause of melanoma, may be the culprit. Susan Gapstur, PhD, vice president of epidemiology comments:

“In fact, a recent review (Preventive Medicine Reports 3 (2016) 139–144) pointed out that indoor tanning may explain a recent trend in melanoma. Over the past 15 years, there has been a significant increase in melanomas that appear on the trunk in females, especially in areas where indoor tanning is prevalent.

“Indeed, this new study showed the association between alcohol and melanoma was strongest for the trunk. While those who consumed 20 grams or more of alcohol per day were 2 percent more likely to be diagnosed with melanomas of the head, neck, or extremities, they were 73 percent more likely to be diagnosed with melanomas of the trunk.

“I do wonder if the finding of this study is confounded by tanning bed use. There is evidence, that tanning bed users –particularly young users–are more likely to smoke, drink, and/or use drugs.”

Posted in Behavior, Environment, Lifestyle, Prevention, Research, Skin cancer | Tagged , , , , | Leave a comment

CDC: Two shots enough for most young patients getting HPV vaccine

gardasil_vaccine_and_boxThe Advisory Committee on Immunization Practices (ACIP) has revised its vaccination schedule for HPV vaccination among younger populations. ACIP says those starting vaccination between ages 9 and 14 can now get just two doses of HPV vaccine rather than three, with the second dose administered 6 to 12 months after the first dose. Three doses remains the recommendation for those 15 and over and for immunocompromised persons. Previously, ACIP recommended all age groups get three doses of the vaccine, with the second dose administered 1 to 2 months after the first, and the third dose administered 6 months after the first dose.

We asked Debbie Saslow, PhD, Senior Director, HPV Related and Women’s Cancers about the change.

The ACIP’s action to revise its recommendation sets in motion the ACS process to review and update its own guideline, which currently closely mirrors the previous ACIP recommendation and emphasizes the need for on-time vaccination, i.e. at age 11-12, when vaccination is most effective.

Read more about HPV vaccines here.

Posted in Uncategorized | 1 Comment

Report: One in Four Americans over 50 is Inactive

Researchers from the Centers for Disease Control and Prevention (CDC) released new data on the prevalence of physical inactivity among adults age 50 years and older. Inactivity is 63745_151_previewdefined as no activity beyond what one has to do just to get through the day (activities of daily living). When asked “During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?”, 27.5% of the adults surveyed responded ‘no’ – indicating that more than one in four adults 50 and over are inactive.

The prevalence of inactivity varied by region. It was highest in the South (30.1%), followed by the Midwest (28.4%), Northeast (26.6%), and West (23.1%).  The survey also found that inactivity was significantly higher for women, Hispanics and non-Hispanic blacks, and adults with one or more chronic diseases. Inactivity for cancer survivors was reported at just 31.6%.

We asked Colleen Doyle, MS, RD, managing director of nutrition and physical activity at the American Cancer Society for her take on the new data.

“This report is a wake-up call and quite literally a ‘call to action.’ Being physically active reduces the risk of premature death and can help reduce the risk of many chronic diseases, including cancer. Physical activity also helps support improvements in quality of life and healthy aging. While we’ve known that the level of physical inactivity among adults is far too high, this report underscores the fact that inactivity is highest among those who could benefit the most from it.

“Adults with at least one chronic condition were more likely to be sedentary than those without a chronic condition. In the case of cancer, more than 31% of cancer survivors reported getting no physical activity outside of daily life. Studies have shown that exercise can improve cancer survivors’ physical functioning, fatigue, anxiety, depression, self-esteem, and happiness. In addition, studies among survivors of certain cancer types have shown that physically active survivors have a lower risk of recurrence and improved survival compared with those who are inactive.

“For those who do not have a history of cancer, the evidence is clear that being active and reducing sedentary behavior can help reduce the risk of a variety of types of cancer.

The American Cancer Society recommends that everyone, including cancer survivors, strive to be active at for least 150 minutes per week and to avoid inactivity. To encourage and support all individuals in increasing their physical activity level is critically important to our mission to reduce cancer incidence and mortality, as well as to improve the quality of life of cancer survivors.

“It’s important to consider why many Americans are not meeting physical activity guidelines. And there are likely multiple reasons. What is evident, though, is that in many communities, living a physically active lifestyle can be a challenge. The ways in which communities are designed and built can present challenges. When everyday destinations are far from home, walking, bicycling or other forms of active transportation may not be an available or convenient option. Safety concerns, such as lack of access to sidewalks, bike lanes, and traffic control measures, can also be barriers to being active. Lack of access to parks, public pools and green space, which tends to be higher in poor and under-served communities, also contributes to lower rates of physical activity.

“There is much being done but much more that needs to be done to reduce physical inactivity and help people of all ages and health conditions live more physically active lives. All sectors can work together to:

  • Support safe, efficient, and pedestrian-friendly public transit systems and transit-oriented development, and to create and improve walking trails and parks.
  • Open and promote places in communities for individuals to be active such as schools, parks, and malls.
  • Provide evidence-based community programs that help adults, including those with chronic conditions like cancer, start and continue to be active.
  • Work with health professionals to link their patients to community programs and resources for physical activity.

“And as individuals, there is much we can do, too. Commit to be more active yourself, on a daily basis. Encourage and support your family members, friends and co-workers to do the same. Speak up; participate in local planning efforts that support safe and convenient places to be active. Working collectively, we can help create healthier environments to support all of us in living a more physically active life.”

Posted in Access to Care, Disparities, Environment, Lifestyle, Physical Activity, Survivorship | 1 Comment

The Numbers behind the ProtecT Trial

This week’s release of the first study comparing outcomes between surgery, radiation, and active surveillance got a lot of buzz. But even then, some pretty important details did not get as much coverage as they probably could, and maybe even should have.

Here’s a quick look at the numbers behind two major statistics you may have heard in the coverage of this important study.

1: Men assigned to active surveillance had twice the risk of cancer progression and spread compared to men who got immediate treatment.

This is why it’s important to know the difference between relative risk and absolute risk. Relative risk is in relation to some other thing (e.g.: “twice as likely”). Absolute risk is what the chances actually are (e.g.: 1 in 6).

progressionSo “twice the risk” tells us something important, but not everything important. Absolute risk tells a more complete story.

Among those men who got immediate treatment, three out of 100 saw their cancers progress in ten years.

Among men under active surveillance, the rate was six out of 100.

So immediate treatment (surgery or radiation) did indeed result in half the risk. But the increase in “absolute risk” was 3%, which helps put “twice the risk” into perspective. Also, it’s a reminder that current treatment is not foolproof, and that some cancers progress despite our best efforts.  

2: More than half of men undergoing active surveillance ended up receiving treatment anyway.

Based on this stat, it would be easy to say all of the men diagnosed with early-stage prostate cancer using PSA might as well have gotten treatment. But take a closer look at the numbers.

As it turns out, protectabout third of the men assigned to active surveillance decided with their doctors to undergo treatment anyway. And understandably. Imagine the anxiety of knowing there’s a cancer inside you, for years. 

Meanwhile, 20% of the men doing active surveillance saw their cancer progress enough to warrant more radical treatment. And just as important: 44% of men made it through the ten years with no progression.

No one’s saying these details change the outcome or conclusion of the study. Seemingly everyone agrees, as my  favorite chief medical officer said yesterday, that the study “will help inform [the] discussion for men making what is a highly personal, and often difficult choice.” Let’s be sure, then, that men hear the numbers behind the stats.

Posted in Communications, Prostate, Research, Treatment | 1 Comment

New study compares surgery, radiation, and active surveillance in prostate cancer

36718_66_previewA long-awaited study from researchers in the United Kingdom compares three major approaches: surgery (radical prostatectomy), radiation, and active surveillance (also known as ‘watchful waiting’) for men with localized prostate cancer diagnosed with prostate specific antigen (PSA) blood test, and has some eye-opening results.

The report, appearing in the New England Journal of Medicine, finds that after ten years, men undergoing either of the three approaches had similar, low rates of death from prostate cancer. Surgery and radiotherapy reduce the risk of cancer progression over time compared with active monitoring, but cause more side-effects. We asked Otis W. Brawley, M.D., chief medical officer, for his response to the study.

“This study tells us that prostate cancer detected by PSA grows very slowly. Only about 1 in 100 men diagnosed with prostate cancer using PSA died of prostate cancer over ten years, a mortality rate that was lower than what the authors expected to see.

Otis Brawley

Otis W. Brawley, MD, Chief Medical Officer, American Cancer Society

“The men in the study had the same mortality rate regardless of the treatment they received, even when that treatment was no treatment. This study has just ten years of data, and it may take 20 or 25 years to see survival improvements from treatment, so we cannot say yet with certainty whether and how much of an advantage treatment has over no treatment. We can only say that at ten years, there is no difference.

“Men who received treatment did have half the risk of cancer spread, known as metastatic disease, of men who were monitored carefully (~2.5%-3% of men receiving surgery or radiation versus 6% of men in active surveillance). But a significant proportion of the men whose cancer had spread had no symptoms.

“On the other hand, the men receiving treatment were more likely to have side effects, some of them serious, over the ten years; things like bowel, bladder, and sexual dysfunction. Men who were monitored carefully without treatment, of course, avoided those side effects. And if they showed signs of their cancer spreading, those men could and did get treated.

“We may eventually find out that treatment using radiation and surgery will reduce the risk of death from prostate cancer decades later. We will also need to carefully measure if it reduces death from other causes, as well, to get a full picture of the risks and benefits of treatment.

“This paper shows clearly that treatment, whether with radiation or surgery, can reduce the chances of metastatic cancer. But it also shows that observation, or active surveillance, is a reasonable option for men diagnosed with localized prostate cancer through PSA screening and especially for men diagnosed with low or moderate grade localized disease.

“As the authors point out, active surveillance and/or delayed treatment avoids the side effects from treatment in those who do not need treatment, but there is an increased risk of cancer progression and spread, and some symptoms may increase gradually over time.

“The American Cancer Society recommends men be informed of the potential risks and potential benefits of prostate cancer screening and treatment before making a decision about whether to be screened. This study will help inform that discussion for men making what is a highly personal, and often difficult choice.”

Posted in Prostate, Research, Screening | 2 Comments