May 22, 2014
By Gery P. Guy Jr., PhD, MPH
If you read no further, know this: there is no such thing as a safe tan. Indoor tanning is just as dangerous, if not more, than tanning outside in the sun. In fact, indoor tanning injures thousands of people each year badly enough to go to the emergency department. Indoor tanning can cause sunburn and damage to your eyes that could lead to vision loss. Indoor tanning can also cause premature skin aging, including loss of elasticity, wrinkling, age spots, and changes in skin texture.
Most dangerous of all, indoor tanning is a recognized cause of skin cancer, including deadly melanoma. Skin cancer is the most common form of cancer in the United States. Approximately 3.5 million cases of non-melanoma skin cancers are treated each year, and more than 70,000 melanomas are diagnosed yearly. While many cancers have been on the decline in recent years, rates of melanoma, which causes the most skin cancer-related deaths, have been on the rise. Increased exposure to ultraviolet radiation (UV) through indoor tanning may be partially responsible for the continued increase in melanoma, especially among young women. Indoor tanning is particularly dangerous for younger and more frequent users.
There are a lot of misconceptions about indoor tanning, so it's important to know the following:
- Tanned skin is not healthy skin. That "healthy glow" from the tanning bed indicates damage to your skin. Whether tanning or burning, you are exposing yourself to harmful UV rays. In fact, every time you engage in indoor tanning, you increase your risk of melanoma. The truly healthy glow is your natural skin color. More...
May 13, 2014
By Ted Gansler, MD, MPH
Like other contributors to the Expert Voices blogs, I am occasionally asked to reply to questions from journalists about various cancer-related topics. The most recent question I received is whether it is true that women who carry a cell phone in their bras are at increased risk for developing breast cancer.
This kind of question is surprisingly difficult to answer. It's relatively easy to write about things that are known to cause cancer. It's more difficult to be confident that something does not cause cancer, but one can still provide some guidance if there have been at least a few carefully-conducted epidemiologic studies with negative results. The most challenging requests we receive are often about questions that researchers have not addressed by scientific studies of humans populations. This is one such question.
Cause or Coincidence?
There are a few known instances of breast cancer in young women who have kept cell phones in their bras. (Even when cell phones are not being used for conversation or texting, if they are on then they still periodically emit low energy electromagnetic signals to stay in touch with nearby cell towers.) Because breast cancer is an uncommon and tragic occurrence among young women, these cases have received significant attention on television and on the Internet. But it is the nature of these media to emphasize unusual events, so of course we don't hear much about the millions of women and men who carry phones close to various organs and still remain healthy. More...
April 15, 2014
By Kassandra I. Alcaraz, PhD, MPH
During National Minority Cancer Awareness Week and National Minority Health Month, the American Cancer Society, health agencies, and other organizations seek to raise awareness of health disparities, or health inequities, among racial and ethnic minority groups. Most of us have probably seen or heard the phrase "health disparities." But what, exactly, does this phrase mean? And why is it important?
The U.S. Department of Health and Human Services defines a health disparity as "a particular type of health difference that is closely linked with social or economic disadvantage."
These disadvantages include things like racial discrimination, racially-segregated neighborhoods, and social stratification (the inequitable distribution of privilege, power, wealth, and resources in our society), and they have resulted in unequal access to quality health care, health information, and health programs for racial and ethnic minority groups. These "root causes" not only make the nation unhealthier as a whole but also present real challenges to eliminating disparities.
Although health disparities are not limited to racial and ethnic minority populations, this particular month gives us a dedicated time to better understand disparities among these groups. In the United States, racial and ethnic minority populations bear a disproportionately high burden of disease such as cancer. Generally these groups have worse outcomes than non-Hispanic whites when diagnosed with the same disease. More...
March 31, 2014
By Alvaro Carrascal, MD, MPH
You may have seen some of these headlines recently in national newspapers and online:
More coffee linked to higher mortality rate: study
Four cups of coffee a day may raise early death risk in younger adults
4 Cups of Coffee a Day Can Be Deadly
New Study: Coffee Can Kill You
Under 55? Think twice before you reach for that extra cup of coffee, researchers say
After seeing these reports on the web and morning news, I had a thought as I reached for my morning cup of joe: Should I consider tea instead?
As a person who grew up drinking 2-3 cups of coffee a day, should I change my habits based on these news reports? What would happen if I don't? Should these reports stop my life-long friendship with Juan Valdez? More...
March 12, 2014
By Richard C. Wender, MD
About a year ago, U.S. Assistant Secretary for Health Howard Koh, MD, invited a small group of people to his office to discuss the opportunity for the nation to start a full court press to end colorectal (colon) cancer as a major public health problem in the United States. The meeting idea came from a conversation on his back porch with his college friend Ron Vender, MD, who had just been elected President of the American College of Gastroenterology (ACG). Howard asked Ron how he could most effectively work with the ACG and, together, they decided that it was the right time to tackle colon cancer in a big way.
Dr. Koh invited leaders of the organizations that were at the center of public health efforts to increase colon cancer screening rates to attend the meeting. Screening is looking for cancer in people who have no symptoms of the disease. In the case of colon cancer, screening can find the disease at an early, more treatable stage, and it can also prevent it altogether. This is because colon cancer screening tests often find polyps, which can then be removed before they have a chance to become cancerous.
Leaders from the American Cancer Society and Centers for Disease Control and Prevention (CDC) were joined by leaders of several other vital governmental agencies, gastroenterologist organizations, and the National Colorectal Cancer Roundtable (NCCRT). The NCCRT is an organization co-founded 17 years ago by the American Cancer Society and CDC. Today, the NCCRT brings together close to 80 organizations with a single common goal: to increase colon cancer screening rates, our most effective way to fight the disease. The key to the NCCRT's success has been its commitment to joining diverse organizations as equal stakeholders, to do the kind of work that no one organization can accomplish alone. It's a great example of public health in action. More...
March 06, 2014
By Ambassador Sally G. Cowal
We celebrate International Women's Day March 8. Originally, it was an event to promote equal political rights, including the right to vote, for women. As a Chicagoan I'm proud to say that one of the earliest Women's Day observances was held in that city in 1908!
Today, although women have the right to vote almost everywhere, health inequalities and disparities between women in the developed and developing worlds -- and between men and women in many countries and regions of the world -- continue to exist.
Women's health is important, not only for women, but for men and for families. Women are the caregivers in most places in the world, and when a woman is ill or dies prematurely, her family -particularly her children - carry the burden. That is one of the reasons why it is so important to prevent premature illness and death in women from cancer. Although we think of cancer as a disease that affects people in high income countries, the reality is that 57% of cancer cases and 65% of cancer deaths are in low and middle income countries - that is 5.3 million deaths a year. And the trends point to a continuing shift of the burden to lower income countries.
In addition, the cancer experience in lower income countries is very different from the experience of cancer patients in the US. For example, in the US, 60% of breast cancer cases are diagnosed in the earliest stages of disease, whereas in Brazil only 20%, and in Mexico, only 10% are diagnosed at an early stage. When cancer is caught later, treatment is less likely to be successful. As a result, advances in cancer survival that we have experienced over the last few decades in the US are not reflected in the experiences of people with cancer in lower income countries. More...
February 25, 2014
By Katherine Sharpe, MTS
Recently, in a meeting, a representative from another patient advocacy organization made a comment that caught my attention. He said, "People vet their plumbing company more than they do their hospital." I reflected on this comment and for many people that is probably true. The Better Business Bureau has long offered "grades" on businesses, based on certain criteria. But with about 5,000 hospitals nationwide, how do you know which are the most trustworthy and are best to give treatment?
What is accreditation?
One way is through accreditation. Accreditation, simply put, is a formal process to show that a hospital meets certain standards. The standards are designed to improve the safety and quality of care provided to patients and encourage continuous improvement efforts within a hospital.
The standards focus on how patients receive care, what kinds of rights patients have, and hospital functions that are essential to providing safe, high-quality care. These might include things like clinical ethics (the making of "right" decisions in the delivery of health care), infection control and prevention, how the building is managed and maintained, and how patient information is managed. Accreditation standards are usually seen as cutting-edge yet achievable for hospitals.
These quality measures have been developed for several disease types. In cancer, for example, a facility might be required to have wide-ranging diagnostic and treatment services on-site and participate in cancer-related clinical research.
Also, there can be varying categories of accreditation, so that the best fit can be established for a particular type of center. Standards for pediatric cancer facility might be different from those for an adult cancer center, for instance. More...
February 12, 2014
By Ted Gansler, MD, MPH
In the course of my routine medical journal reading last year, I came across a short article in The Lancet Oncology about chocolate and cancer prevention. I saved that file on my computer (without reading it), thinking that it might serve as the point of departure for a lighthearted and slightly romantic Valentine's Day essay on this blog.
With that deadline only a few days away, I opened the file and read the article, as well as a few others. The good news is that chocolate does not cause cancer and that moderate consumption of dark chocolate may have a positive impact on heart disease risk. The rest is more complicated.
If you try an Internet search for words like "chocolate prevents cancer," you will find several thoughtful summaries of the available evidence. You will also find some cute but misleading articles implying that eating a lot of chocolate candy prevents cancer. And, you will find a lot of articles with cute headlines and introductions that save their unsweetened facts for the conclusion.
My favorite scientific reviews of cancer and chocolate evaluate information from pre-clinical studies, observational epidemiological studies, and clinical trials separately, and I will follow this approach to get the most thorough view of the topic.
What lab studies can tell us
Most pre-clinical studies are experiments that use lab animals (in this case, mice and rats) or cells growing in lab dishes. The theme of the cell experiments involves adding specific chemicals from chocolate (such as polyphenols, catechins, and proanthocyanidins) and observing what they do to various cell processes that are known to have an effect on cancer formation, growth, spread, etc. Some of the rat and mouse experiments added specific chemicals from chocolate to the animals' food, whereas others used liquid chocolate extracts or unsweetened cocoa powder. More...
January 23, 2014
EDITOR'S NOTE: The President's Cancer Panel has released a report that says increasing HPV vaccination is one of the most important opportunities in cancer prevention. The report calls for re-energized efforts to promote vaccination and reach the HPV vaccines' potential to save lives by preventing avoidable cancers in men and women. It explores underuse of HPV vaccines, identifies key barriers to increasing vaccine uptake, and provides actionable recommendations for overcoming these obstacles. To coincide with the release, here is our recent blog on the subject.
By Debbie Saslow, PhD
The HPV vaccines (Gardasil and Cervarix) have been recommended for girls in the US for nearly 10 years. They protect against human papillomavirus (HPV), the virus that causes most cases of cervical cancer, and Gardasil also protects against nearly all cases of genital warts. Uptake of HPV vaccination has been slow in this country, though; less than 35% of girls have gotten all 3 recommended doses.
Despite low vaccination rates, we have already seen HPV infections (related to the types of HPV targeted by the vaccines) drop by 56% in the United States. In countries that have higher vaccine rates, there are even larger drops. Indeed, data published last year suggest that higher vaccination rates could reap great benefits.
The potential to eliminate genital warts
A study from Australia, where more than 70% of adolescent girls are vaccinated, suggests that in countries where vaccine coverage is high, genital warts may be eliminated in the coming decades.
The government-funded Australian HPV vaccine program has provided free vaccine in schools to 12- and 13-year-old girls since 2007. From 2007-2010, free vaccine was also offered to girls and women ages 14-26.
The number of cases of genital warts among young people has dropped dramatically since the program began. More...
January 15, 2014
By Richard C. Wender, MD
Fifty years ago, on January 11, 1964, Luther Terry held a press conference to announce the results of the first Surgeon General's report on smoking and health, the most impactful public health document in history. The report laid to rest over a decade of debate about the health risks of smoking by definitively stating that smoking causes lung and laryngeal cancer in men, chronic bronchitis, and other diseases.
Research conducted by the American Cancer Society and other groups had already demonstrated the adverse health effects of smoking, but, until the Surgeon General's report, the tobacco industry had been successful in hiding the truth. The extraordinary methods used by the Surgeon General to ensure that the report was completely unbiased -- including allowing the tobacco industry to veto nominees to serve on the panel -- the thoroughness of the research, and the clarity of the conclusions, all led to one outcome: the end of the debate about the health risks of smoking and the launch of the true fight to end the use of tobacco products. The progress in the tobacco fight over the past 50 years represents one of the most successful, life-saving public health campaigns in our nation's history.
The public health victories, and the challenges
Forty-three percent of Americans smoked prior to the Surgeon General's report; 18% smoke today. Smoking in airplanes, restaurants, and places of employment has largely disappeared. We're now fully aware of the addictive nature of the nicotine in tobacco products, and the importance of preventing and treating that addiction. Tobacco executives were eventually forced to admit, before Congress and the country, that they were long aware of the addictive nature of their products as well as the harmful health effects.
We've learned that raising the cost of a pack of cigarettes is the single most effective way to reduce the number of people who start using tobacco products and the most effective way to promote quitting. Tobacco tax increases have been implemented in many states. As of 2009, the FDA was granted the authority to regulate tobacco products, although the tobacco industry has placed substantial roadblocks in the path of effective FDA action. The United States is not alone. Smoking rates in most high-resource ("Western") nations like England, Canada, and Australia have substantially declined, comparable to the progress that we've seen. We've witnessed 50 years of amazing progress; we truly do have much to celebrate.
And much to lament. More...