EXPERT VOICES

Timely insight on cancer topics from the experts of the American Cancer Society

American Cancer Society Expert Voices

The American Cancer Society

Does it matter if a cancer center is accredited?

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...

Filed Under:

General

Can eating chocolate prevent cancer?

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...

Filed Under:

Diet/Exercise | Ted Gansler

The HPV vaccine could do even 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...

The Landmark Surgeon General Report on Smoking and Health, 50 Years Later

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.

Learn more about the 50th anniversary of the Surgeon General's Report on Smoking and Health:

The Hammond/Horn study

The effects of tobacco control

Rates Drop for New Lung Cancer Cases in the US

Tobacco and Cancer

Guide to Quitting Smoking

 

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...

Filed Under:

Tobacco/Smoking

How I talk to patients about clinical trials

December 02, 2013

By Fadlo R. Khuri, MD, FACP

 

As a physician focused on the treatment of patients with cancer, many of whom face a potentially incurable disease, I make 3 promises to my patients:

1) We will always tell them the truth.

2) We will always do our very best for them, placing their interests and those of their families above all others.

3) We will never abandon them. 

These are important words to relay to a patient, particularly those who are considering participating in clinical trials.  The question, then, is, "Why should cancer patients participate in clinical trials?"

Cancer clinical trials are one of the most important methods we have to move the field forward. After all, it was through clinical trials that we have developed cures for childhood acute leukemia, Hodgkin disease, and testicular cancer, how we developed long-term highly effective therapies for chronic myeloid leukemia and breast cancer, and how we created personalized genetic therapies for lung cancer, melanoma, and other diseases. Cancer clinical trials also let us know how patients are feeling about their care, and can improve approaches for the treatment, prevention, and cancer screening tests for cancer patients. 

One of the first things I do as the treating physician is to complete a history and physical exam of the patient. The information I gather helps me form an opinion, and it helps me gain the trust of the patient and his or her family. 

After obtaining the history and physical information that I need, I discuss standards of care and explain why this care, like radiation or chemotherapy, might work (or not work). It is important to acknowledge our limits while reassuring patients of our considerable experience in treating others with a similar disease. I have occasionally seen physicians who rush to discuss the clinical trial before going through the full range of standard treatment options available. Identifying the standards of care and presenting them as a viable option for patients is far more likely to reassure patients that all options have been carefully considered. More...

Filed Under:

General

What really works to help you quit and avoid tobacco?

November 17, 2013

By Thomas J. Glynn, PhD


The American Cancer Society's first Great American Smokeout was celebrated November 18, 1976. Gerald R. Ford was President of the United States, the "War on Cancer" had begun just a few years before, Barack Obama was 15 years old and, according to a Gallup Poll taken that year, 37% of American adults smoked cigarettes.

This year, the 37th anniversary of that first Great American Smokeout, the percentage of Americans who smoke has nearly been cut in half, to 19%. And, those who do smoke use far fewer cigarettes than in 1976, from about 4,000 cigarettes per year for every U.S. adult then, to about 1,200 now.

Certainly, we know that any cigarette smoking is dangerous to the smoker and non-smokers who inhale cigarette smoke. We also know that far too many Americans continue to smoke - 44 million, at last count. Still, astounding progress has been made in combatting what is the nation's largest cause of preventable death and disability.

How do we know what works?

How was such progress made? What actions were taken to achieve such significant changes in the face of the tobacco industry's relentless, illegal, and well-funded efforts to addict men, women, and children to their deadly products? There is no easy answer to that question. But we do know that, over the past 37 years, a wide range of interventions - in communications, education, policy change, and medicine - have been undertaken. Interventions in all of these areas have been effective, but some have been more effective than others. More...

Stigma presents an extra burden for many lung cancer patients

October 28, 2013

By J. Lee Westmaas, PhD

 

Some of us, at some point in time, have felt judged negatively by others or discriminated against because of some personal characteristic or behavior. Researchers refer to this as feeling stigmatized, and lung cancer patients report feeling this way more than patients with other types of cancers.

Many individuals with lung cancer fear that others will react to their diagnosis with blame, exclusion, rejection and/or discrimination. Many actually experience this as well.  A primary reason is that smoking is so strongly linked to lung cancer.

Blaming the victim


Lung cancer was one of the first diseases to be identified as caused by smoking. Smoking rates have decreased dramatically since the 1960s due to laws to restrict smoking, greater publicity on the many harms of smoking, and a change in public attitudes toward smoking. More...

Filed Under:

J. Lee Westmaas | Lung Cancer

Should women at high risk for breast cancer take drugs to prevent it?

October 14, 2013

By James C. Salwitz, MD


Breast cancer will kill more than 450,000 women worldwide this year, and in the United States alone, 232,000 will be newly diagnosed. Two important recent events shift the conversation from disease treatment to prevention. The most public was the stunning statement of actress Angelina Jolie that she had both her breasts removed because she carried a breast cancer gene (BRCA1). This announcement served to greatly increase awareness and discussion of choice in preventing the disease. 

Second, was the decision by the U.S. Preventative Services Task Force (USPSTF) to recommend the use of medications for prevention of breast cancer in women who are at increased risk.

Many factors influence breast cancer risk


In order to prevent breast cancer, we must first understand its causes. While we do not know all, we do understand that certain factors increase the chance of getting breast cancer. Some of these risk factors can be reduced through improved lifestyle, but not all.

Most breast cancer occurs not because of known genetic mutations, but because of a combination of risk factors. One important risk factor is increasing age, with most breast cancers occurring in women 55 years of age and older.

Some risk factors include an early age for a first period (start of menses), a late first pregnancy, and no pregnancy at all. Breast-feeding decreases cancer rates. Prescription estrogen replacement, especially after menopause, increases breast cancer risk. The more alcohol a woman drinks, starting even with small amounts, the higher her chance of getting the disease. Obesity and low amounts of exercise increase the chance of developing breast cancer, too.

If a woman has increased breast density on mammogram, this increases the chance of being diagnosed with breast cancer. If a woman has any breast biopsies, particularly if the biopsies showed benign growth of the lining of milk ducts ("proliferation"), this increases risk. Certain benign duct changes, such as hyperplasia or atypia, greatly increase risk. Also, ductal or lobular carcinoma-in-situ (DCIS and LCIS) greatly increase the chance of developing invasive breast cancer.

Finally, family history, even without a defined cancer gene like BRCA1 or BRCA2, increases the likelihood a woman will get breast cancer. Each first-degree relative (mother, sister, daughter) who has breast cancer increases further the chance of breast cancer. The younger the breast cancer occurred, the greater the risk to the patient. More...

Why are black men negatively affected by prostate cancer more than white men?

September 24, 2013

By Durado Brooks, MD, MPH


When the US Preventive Services Taskforce (USPSTF) made their startling recommendation against screening for prostate cancer last year there was a widespread outcry from prostate cancer doctors and patients. Resistance was especially strong among black prostate cancer survivors and the doctors who care for them, arguing that the scientific studies that led to the USPSTF recommendation did not include many black men. Is this simply another case of "political correctness?" Isn't prostate cancer colorblind? Doesn't cancer behave the same in all men, regardless of race?  

In reality there are a number of differences in how prostate cancer impacts black men compared to men of other racial and ethnic backgrounds. Black men are 60% more likely than white men to be diagnosed with prostate cancer during their lifetime, and are more than twice as likely to die from the disease. Black men are also diagnosed at a younger age (about 3 years younger on average) and are more likely to have "high grade" tumors - the kind of tumors that grow rapidly, spread to other parts of the body, and often cause death. Research has given us some insights on why these differences exist and what they mean for black men who face decisions about prostate cancer screening and treatment. More...

What is Blue Button?

September 16, 2013

[Ed. note: This guest post by Lygeia Ricciardi of the Office of Consumer eHealth, Office of the National Coordinator for Health Information Technology, US Department of Health and Human Services, explains how the Blue Button can help you access and use your healthcare records.]

 

Wouldn't you like to have key information about your health or the health of a loved one safely and easily accessible via mobile phone or computer?

Think of Blue Button as an easy way for you to get your health records securely and electronically. It won't magically fix everything, but it's paving the way for a more personalized, convenient, and higher quality healthcare experience for patients and their families by putting vital information at their fingertips.

The Blue Button symbol is now appearing on health-related websites nationwide. Click it to get key information from your personal health records securely and electronically from your doctor, insurance company, pharmacy, or lab. You can check your information, share it, and use it to manage your health... and make your life easier. More...

Filed Under:

General

About the Blog

Expert Voices will give you more than the statistics: it will give you insight. More