Wednesday, April 25, 2012

Spring Toward Cancer Prevention: CNiC in the News

It's been an active spring for Cancer News in Context staff, particularly so for its executive editor, Graham Colditz, who has had a number of events and published pieces which have grabbed positive media attention.

Most recent was a journal article - co-authored with Sarah Gehlert and CNiC contributor Kate Wolin - in Science Translational Medicine, which detailed the pathways toward more effective cancer prevention research and policy.   In addition to mass media coverage of the article, Scientific American wrote a broad companion piece for their Observations blog, and The Atlantic online published Colditz's distilled thoughts on 5 Ways to Jumpstart Cancer Prevention.

Colditz has also given a number of key lectures this spring on cancer prevention and risk assessment.  In March - along with Erika Waters - he presented at an NIH webinar on the framework responsible for the 17 year success of his Your Disease Risk website. To complement his recent Award for Excellence in Cancer Epidemiology and Prevention from the American Association for Cancer Research (AACR), he presented a lecture at the AACR annual meeting titled: Integrating Risk Across the Lifespan: The Case for Breast Cancer Prevention.

Also published this spring by CNiC staff was a paper detailing the science behind its popular brochure:  8 Ways to Stay Healthy and Prevent Cancer.  

Tuesday, April 24, 2012

Population Health Sciences. Washington University School of Medicine.

Schroeder has argued that much of our health and wellness is within our reach, and that behavior may account for 30 to 40% of our disease burden. He notes that we can improve our international ranking on many measures of health through simply implementing things we already knowLikewise we recently made the case for vastly reducing the cancer burden by acting on what we know (see article). For a quick summary see Scientific American or The Atlantic.

An expanding range of research activity by faculty members at Washington University School of Medicine addresses everyday problems in population health and the translation of research discoveries to the delivery of effective health services for the population living in St. Louis and across the State of Missouri.

Examples of effective services include the research and delivery of prevention by Dr. Jeffrey Peipert, Vice-Chair for clinical research in the department of obstetrics and gynecology. The CHOICE project, offers and a revolutionary example of increasing access to contraception to reduce unintended pregnancies in the region.

Dr. Platz, pediatrics, offers an innovative resources for adolescents to access medical care in the community, at no cost. Drop in and see the Spot

Within the Siteman Cancer Center and the Department of Surgery, the Program for the Elimination of Cancer Disparities (PECaD) engages a range of community partners in activities that promote wellness, increase access to cancer prevention services, and aim to reduce disparities in the burden of cancer in our community (see articles). For example, we recently partnered with People's Health Centers to increase access to mammography in North County. Within the medical center, as a resource for the region, the Institute for Clinical Translational Science offers resources for community members to engage in research projects. Our ongoing studies of obesity and cancer bring many different disciplines together to address this growing problem.

Faculty members are pursing a broad range of research and delivery projects that build on the resources of the medical center and WUSM to bring state of the art discoveries to everyday care and applications in the community. Many of these are summarized on our web site. Briefly, Dr. Kathleen Wolin leads a trial of weight loss after breast cancer to address ways we may improve outcomes for women with breast cancer. Dr. Kim Kaphingst studies communication of genetics testing for women with breast cancer and their family members. Dr. Mary Politi collaborates with clinicians to study how to better engage doctors and patients in shared decision making. Dr. Erika Waters studies how we can improve the way we present risk. Dr. Aimee James is studying the different ways we may work to improve access to colorectal cancer screening in our community, and Dr. Siobhan Sutcliffe is studying how exposure in adolescent and young adult years may increase risk of prostate cancer. Dr. Bettina Drake is engaged with community members to understand how African American men relate to research projects and how we can better meet the needs of men who, because of their race, are at increase risk prostate cancer. Dr. Sarah Gehlert has created a resource for women in North St Louis to increase access to information about breast cancer and wellness. Dr. Melody Goodman is working to understand how we might improve the reporting of disparities and how the measures we chose when reporting can influence how we move forward to reduce these inequalities. At the broader level of how our society is structured and influences our health, Dr. Christie Hoehner is evaluating how the design of our towns and cites is related to physical activity and obesity. Dr. Katie Stamatakis is studying how our public health departments respond to obesity and work to reduce obesity in our communities.

Colleagues in internal medicine are studying how overweigh and obesity at the time of diagnosis of lymphoma may change response to therapy for this malignancy, and how we can improve the quality of colon cancer screening. In anesthesiology, colleagues are working to improve the experience of surgery and outcomes after anesthesia (see article).

The range of research projects led by a faculty members in the School of Medicine is clearly broad and encompassing many approaches to improve health in our society. Key crosscutting issues include access to prevention services, behavior strategies that will reduce the incidence of cancer and many other chronic diseases, and policy approaches to reduce exposure to carcinogens in our homes, workplaces, and society.

In addition to these ongoing research projects, faculty at Washington University School of Medicine undertake research projects to bring services to the underserved, to improve the routine care of pregnant women, those undergoing an aesthetic procedures, and those using other preventive services.

This exciting range of research and delivery projects offers unique opportunities for participation in state-of-the-art research by trainees and by community members. 

Thursday, April 12, 2012

Further evidence that alcohol causes breast cancer

The development of breast cancer spans decades. Wellings set forth a model of cellular changes in his seminal papers describing cell changes in normal breast tissue and the progression to advanced benign lesions, ductal carcinoma in situ, and invasive breast cancer 1. Our previous work on adolescent and early adult alcohol intake and breast cancer risk had focused largely on self-reported biopsy confirming benign disease 2 or actual diagnosis of breast cancer 3.
In our new paper 4 we draw on the rich resource of benign breast lesions that have been reviewed by world leaders in breast pathology. This review assures us of consistent classification of these premalignant lesions. With these confirmed premalignant lesions conclusions on the action of alcohol on breast cancer risk can be more directly related to documented changes at the cellular level.

We prospectively assessed alcohol intake at ages 18 to 22 and followed participants in the nurses Health Study II to identify those women who developed benign breast disease and those who remained free from disease. After pathology review we had over 650 cases of premalignant breast lesions.  The diagnosis of these lesions carries a twofold increase in development of breast cancer 5,6. Alcohol intake showed a strong positive relation between intake and increased risk of benign lesions. Compared to women who did not drink alcohol during adolescent- those who consumed more than one drink per day, on average, had a relative risk of 1.35 - a 35% increase over the risk of never drinkers.

Since these lesions carry a substantial increase in risk of subsequent breast cancer – this study points directly to the withholding of alcohol leading to lower risk of progression down the pathway to invasive breast cancer.

Related posts

Literature cited

Wednesday, April 11, 2012

Risk, Benefits, and Low Use of Chemoprevention for Breast Cancer

Medications proven to prevent breast cancers in women at high risk of the disease have been approved for use in the United States since 1998, but only a surprisingly small percentage of women actually choose to use these drugs.   A new Susan G. Komen Perscpectives article - co-written by CNiC staff - explores this issue in detail - discussing risks and benefits of chemoprevention, who is likely to benefit the most from such medications, and possible reasons why usage is so low.

Susan G. Komen for the Cure
Medications to Prevent Breast Cancer: Missed Opportunities?

Tuesday, April 10, 2012

The Titanic and The Health Divide

While tragic events can bring the issue of inequality to the headlines every once in a while, it’s more often a problem that lives under the radar of most people.  Yet, as the gaps between rich and poor continue to grow wider and wider and health care coverage remains an important issue, there’s no better time to take a deeper look at the important links that exist between race, class and health.

That health can be impacted by factors like race and class isn’t breaking news. Health disparities have likely been around since the dawn of civilization, and one of the starkest and most well known examples of health disparities is now a hundred years old: The sinking of the Titanic.  On that fateful night in April, 1912, over 1500 souls perished.  But the tragedy wasn’t felt equally across all groups on the ship.  A close look at the passenger list, revealed that third class passengers died at a significantly greater rate than those of the second and first class passengers who paid the more expensive fares. 

Such disparities continue to track race and class today when you look at a number of important health outcomes.  African-Americans die from heart disease and stroke at a greater rate than any other group.  They’re also more likely to have hypertension, and along with American Indians, share the highest rates of diabetes. 

For cancer, the picture is much the same. African Americans experience cancer rates that are more than twice as high as American Indians, about 50 percent higher than Hispanics and Asian/Pacific Islanders, and 10 percent higher than whites. Racial and ethnic differences in cancer mortality are even more pronounced, with African Americans again having the highest rates.

Looking outside of race, factors like income and education level--so called socioeconomic factors--also have a large influence on health:  so much so that many in the health field call poverty itself a carcinogen.  Rates of heart disease, stroke, and diabetes are also higher in those with lower income and less education.

Why do these disparities exist?  The simple answer is that there are a lot of different reasons.  Unequal access to quality health care and screening services is one very important one.  But there are other important issues around education, language, and living/work environments—to name just three.  Tied together with such things, race and income are also often linked to important health risk factors like smoking, being less active and being overweight.

Clearly, the issue of health disparities is very complex and won’t be solved overnight. But, the situation is far from hopeless.  Awareness of the issue is on the rise, and state and local communities are starting to take concrete steps to fix the problem—whether its offering universal health insurance or helping bring better food choices to poor neighborhoods. 

It’ll be a mix of such small and large steps that eventually help fill the health divide in the United States.