Cancer Complexity

Lately I've been reading a lot of articles complicating the idea that finding cancer early is always a good thing. For example, I just read this NPR article about a Norwegian study that found that mammography can lead to the "over-diagnosis" of breast cancer by finding a tumor "that would never have gone on to cause symptoms or death." This is somewhat similar to some of the criticisms of the P.S.A. test for prostate cancer, which caused a lot of men to get treated for prostate cancer when they likely would have died of something else before the prostate cancer caused any problems.

It seems like the critiques of these screening tests go beyond whether or not the screening tests have high enough specificity and sensitivity (both concepts I first learned about in an epidemiology class here!), and have more to do with the nature of the cancers themselves. It's an interesting idea to me that may be some types of cancers aren't as well-suited for a screening test, since finding them early doesn't lower mortality. Apparently that's the cause with testicular cancer, which, according to the Mayo Clinic, is "highly treatable at all stages, so finding testicular cancer early doesn't make a cure more likely." Judging from this new Norwegian study and from other recent studies, it sounds like with breast cancer, there may some types of breast cancer that are good to find early while there are a few types of breast cancer that might not have the same benefits to being found early.

All of this adds a lot of complexity to an already complicated health problem. The fact that even within a kind of cancer there may be some types that benefit to screening while other types don't is really complicated to communicate to patients. I think generally speaking it's still very much agreed that the mammography, the Pap test, and the various kinds of colorectal cancer screening tests are still good and important to do. One harm of these findings is that it may lead people to not get screening tests done, since they figure "What's the point?", when in reality these screening tests still save lives.

Anyway, that's just been on my brain lately!

I should also note that April is Sexual Assault Awareness Month and there are a lot of great events coming up if you're in the Iowa City area. I know I'll definitely be going to the Take Back the Night rally and the Clothesline Project.

And this is an article my friend showed me that I read recently that was interesting: White Until Proven Black: Imagining Race in the Hunger Games - Anna Holmes, The New Yorker
This doesn't have to do with health; it's about race in books (specifically the Hunger Games but it branches out from there). I'm a fan of the Hunger Games and was really disturbed by some of the racist responses to the casting in the movie and I thought this article explored what those responses mean.

Trip to the State Capitol!

Yesterday I traveled with a social worker and a group of nurses from the Oncology Nursing Society to Des Moines to talk to state senators about cancer issues. On the way up, I gave an overview of the Iowa Cancer Consortium and the ICC’s legislative priorities for the year. It was really interesting to hear about what the nurses wanted to talk to legislators about.

A lot of them expressed frustration over the current medical home system, which was created to help people under the IowaCare plan. IowaCare covers low-income people who don’t qualify for Medicaid but aren’t insured, but unfortunately if they have cancer, they have to go to the UIHC in Iowa City to get their treatment, even if they live on the other side of the state. Many of these patients have difficulty paying for transportation to get to Iowa City and don’t have a place to stay once they get here. A medical home model had been created to allow IowaCare patients to get their primary care needs met closer to home at certain clinics, but this has caused many of its own problems, as there is no standardization for what the clinics can provide for these patients. Fortunately, a lot of this will change once the Affordable Care Act is implemented, since the majority of people in IowaCare will qualify for Medicaid once it’s been expanded (and then won't be required to go to Iowa City for specialty care), but until that happens, these patients still need help.

We were able to meet with four senators, including the senator from my hometown (Sen. Hogg of Cedar Rapids, who high-fived me when he found out I went to high school where his kids go) and my own senator Joe Bolkcom. Both Hogg and Bolkcom and another senator we met with, Sen. Dvorsky, are already really involved in cancer prevention and control efforts, which is wonderful. We were only able to talk with each of them for about ten minutes, but we left them each a folder filled with information about our legislative priorities and a copy of the Iowa Cancer Plan. It was a good trip!

Pandemic! (the board game)

Last night I played the board game Pandemic with some friends. I've been wanting to play this board game for a while (I'm a big fan of board games) and this one was really fun, and definitely the most public health-related board game I've ever played.

One of the neatest characteristics of this game is that it's cooperative. Although everyone is a unique professional with different skills, they all work together to try to contain four different diseases that are quickly spreading across the globe. You win if you find the cures for the four diseases before too many outbreaks occur or you run out of cards to draw. Unfortunately last night we were not able to beat the spread of the diseases and ended up losing, but I'm looking forward to playing it again soon! Hopefully our loss doesn't reflect my real-life public health skills!

Anyway, I could talk about board games forever, but here are some articles I read recently that you may also find interesting:

Cancer is just as deadly as it was 50 years ago. Here's why that's about to change. - Charlie Jane Anders, io9


Child abuse experts call for U.S. campaign - Frederik Joelving, Rueters

Researchers say malaria deaths are twice the official count - Richard Knox, NPR

Food deserts

I recently did a group presentation on Food Deserts for my Environmental Health class. According to the CDC, food deserts are "areas that lack access to affordable fruits, vegetables, whole grains, low-fat milk, and other foods that make up the full range of a healthy diet." One thing we learned while researching food deserts is that there's even one in Iowa City. There's a great online tool available that was developed by the USDA that allows you to search by address and see if there's a food desert in your area. The food desert in Iowa City included the very place where we were giving our presentation (which was in the University of Iowa medical school building, part of the health sciences campus).

Even though I had known some about food deserts before this presentation, this USDA report to Congress about food deserts was very interesting and had a lot I didn't know before. One of their major findings was that access to food actually isn't an issue for the majority of people - the bigger issues may be easy access to unhealthy foods and the cost of food. They also outline a lot of neat potential solutions to food access issues, including community food projects, and some of the major gaps in the research.

Anyway, next week is the last week of classes and I have two big papers due on the same day and then two big tests on the same day (it seems like it always works out like that, doesn't it?), so I should probably get back to work!

Here are some articles I thought were interesting:

Emergency Room Closures Hit Minorities, Poor Hardest - Kristopher Husted, NPR
Depressing.

Xeni Jardin Live-Tweets Her First Mammogram, Is Diagnosed With Breast Cancer - Dodai Stewart, Jezebel
I've been reading BoingBoing for years - a blog that Xeni Jardin helped found - so when I read this, it almost felt like it had happened to someone I know. I thought this article had some good points about the fact that she live-tweeted her experience getting her first mammogram and her results is a "sign of How We Live Now." Stewart also notes that "Jardin's decision to update her followers as she went for her breast exam highlights a positive aspect of public sharing: The ability to reach out of a community, and have that community embrace you, in turn."

Scooby-Doo and Secular Humanism - Chris Sims, Comics Alliance
This has nothing to do with public health, I just thought it was a really good read. My partner Tim, who is a major Scooby-Doo fan, showed it to me, because I am not a big fan of the show (I've just always found out pretty boring and formulaic.) This article does make a compelling case for why Scooby-Doo is awesome. As a person who values rationalism, I was somewhat moved (although I still don't have an urge to watch Scooby-Doo).

Back from DC!

I got back from the American Public Health Association conference yesterday, which was held in DC this year. The trip was really fun! I still can't get over how great it is that the MPH program and CBH department basically paid for the whole trip (airfare/travel, registration, and hotel); it's definitely pretty wonderful to get the opportunity to DC for free and be around public health leaders.

Like last year's conference (and most conferences in general, I think), some of the sessions were excellent while others were more so-so. I've found that it seems like most of the sessions are very focused on researching health problems, which, while obviously very important, can be a little frustrating if you're working in an implementation/practitioner capacity. It's always great to learn new things though, and it was fun hanging out with other MPH students and one of my coworkers. It was also nice to see DC again (I hadn't been there since I was in elementary school). One of the highlights of the trip was going to Sprinkles, a cupcake shop that has ridiculously good cupcakes! It was also kind of cool to see Occupy DC (which was set up very close to my hotel).

One of the most amusing things at the conference - an exhibit had ties for sale with disease patterns.

Here are some articles I've read recently that I've thought were interesting:

Native Foster Care: Lost Children, Shatter Families - Laura Sullivan and Amy Walters (NPR)
Absolutely heartbreaking story about how Native American children are disproportionately taken from their homes and put into foster care.

Her Name is Jahessye Shockley. - Francie Latour (The Hyphenated Life) 
A sad and well-written article about how missing white children get way more media attention (and donations) than missing children of color.

The Birth Control Solution - Nicholas D. Kristof (NYT Op-ed)
A simple case for increased birth control. It's hard to argue with this logic, even if you are pro-life.

What's Luck Got To Do With It? - Jim Collins and Morten T. Hansen (NYT essay)
An interesting article on luck and "return on luck."

Informed Patient: A New Push to Prevent Infections in Cancer Patients - WSJ Health Blog 
About the CDC's new campaign and website.

Mammogram's Role of Savior is Tested - Tara Parker-Pope (NYT Well)
Interesting article about mammograms. It seems that recently there's been more discussion on the potential downsides of various cancer screening tests. Even though this article was interesting, I have to say I'm still a big supporter of mammography - it still has been proven to save lives.

Early Detection

My friends joke that all I do is talk about cancer, and here I am - talking about cancer again. But big things have just happened in the cancer world! The United States Preventive Services Task Force (USPSTF) recently decided to not recommend using the P.S.A. test on healthy men to screen for prostate cancer. This decision came after the USPSTF reviewed five clinical trials that showed that the P.S.A. test often results in tests that cause needless complications and that it does not lower mortality. This is a controversial decision for some, especially since there are many men who believe the P.S.A. test saved their life and there are a number of groups who advocate for increased use of the P.S.A. test.

I think this article, the Shortfalls of Early Cancer Detection, brings up some very interesting points, in light of this new decision. Harris states that "scientists had found cancer cells in the blood of patients with seemingly tiny, localized cancers, suggesting that cancer cells could spread silently early in the course of disease. In that case, so-called early detection might not really be early, or of much value. Researchers coined the term 'biological predeterminism' to underscore how the cellular makeup of a given cancer — rather than when it was found — was most important in determining survival." (emphasis mine).

Early detection is a central part of cancer control, and I think it should continue be, especially for the cancers we have effective and proven-beneficial screening tests for (breast, cervical, and colorectal). With these three caners, early detection does make an impact on mortality, and increasing the use of the evidence-based screening tests is an important way to control cancer. But I think Harris makes a good point that maybe for some cancers, finding it early doesn't lead to decreased mortality, and that needs to be taken into account when considering which best course of action to take in terms of research. Although I think for some cancers, like lung especially, the development of an effective screening test would be very beneficial and could lower mortality, maybe there are other cancers where finding it early wouldn't necessarily lower mortality. Maybe for those cancers, a different route needs to be taken, like developing alternative treatments that are more effective.

Anyway, enough about cancer. I'm looking forward to this weekend. I'll be going to see the Old Capitol City Roller Girls play their last bout of the season, the Monster's Brawl. The Roller Girls and some people attending will be wearing costumes, so that should be fun!

Here are some other articles I've read recently that you might be interested in:

Domestic Violence Law Repealed by Lawmakers in Topeka, Kansas - John Hanna, Huffington Post
Pretty upsetting.

Sexy Breast Cancer Ads: Provocative or Patronizing? - Kate Dailey, Daily Beast
I am not a big fan of sexy breast cancer ads and I think Dailey does a nice job of summing up some reasons why - the main one being that it can detract people from the fact that breast cancer affects real people, and the reason we should care isn't to "save second base," but rather to save people.

First Lady Targets World Record for Jumping Jacks - AP
Gotta love Michelle Obama. I think this is pretty fun.

The Mammotives Project Begins!

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The Iowa Cancer Summit just launched their social media campaign project, which is funded by the American Cancer Society, to help understand why women decide to get - or not get - screened for breast cancer. The project is call Mammotives. In addition to Mammotives.org, Mammotives is on Facebook and Twitter. All Iowa women, ages 40+, are welcome to join the conversation. Please spread the word too! We want to reach as many Iowa women age 40 and older as possible. For more information about the project in general, click here.   


I'm really excited for this project, which has been planned by my coworker Kelly Sittig, fellow MPH student Megan Lessard, and people at the American Cancer Society, along with other partners at the Iowa Department of Public Health and the Care For Yourself Program. Although I haven't been very involved in this project, my one claim to fame is that I helped come up with the name! Full disclosure: this awesome website, Wordriod, helped. Wordriod creates a bunch of natural-sounding new words based on what you type in and checks to see if they already exist on the internet. It's really fun!

Iowa Cancer Summit

The Iowa Cancer Summit was Monday and yesterday, and fortunately I was able to go yesterday. The Summit is an annual statewide event that brings together over 100 people involved in cancer control practices. A major theme at this year's Summit was the unveiling of the newly revised Iowa Cancer Plan, which is available to download online here. The plan is meant to guide cancer control practices across the state for the next 6 years and is separated into four major sections: Prevention, Screening, Treatment, and Quality of Life.

The keynote speaker this year was Dr. Laura Seeff, the Comprehensive Cancer Control Branch Chief for the CDC. Her talk was great; one of the take home messages was about the importance of policy and systems-level change, and that we should be sure to include efforts to change those instead of focusing only (or even primarily) on individuals. She also talked about the importance of working together with other chronic disease control efforts and groups dedicated to improving health in other ways to make sure we aren't all duplicating efforts and not being as effective as we could otherwise be.

One of my favorite parts of the Summit, however, was the Cancer Survivors Panel breakout session. Three cancer survivors spoke on the panel about their experiences. The speakers were Gail Orcutt, a radon-induced lung cancer survivor who is a tireless radon advocate and simply a wonderful person; Greg Cantwell, a stage 4 brain cancer survivor; and Gabbi DeWitt, whose mom passed away from cancer this spring. (The ICC, like the National Coalition for Cancer Survivorship, defines cancer survivors as those who have been diagnosed with cancer, those who are affected by a loved one's cancer, and caregivers). One major theme of their stories was the importance of having care coordinated. As a cancer patient, you see many different specialists, and sometimes they do not communicate with each other, meaning that major problems/complications can be overlooked and it can be very confusing. I was especially thankful for Gabbi's insights into the benefits of hospice. I think many times the focus in cancer treatment is how survivors are going to win their battle with cancer, but sometimes that is not possible, and that can be very difficult for people to accept or even want to talk about. Gabbi, who works in hospice herself, said that her mom was able to be on hospice care for 11 weeks before she passed, and that those 11 weeks were wonderful and "like a breathe of fresh air." Her mom was able to stay at home and spend time with her friends and family. For more information about hospice, here's a fact sheet from the National Cancer Institute.

This was the second Cancer Summit I've been able to go to, and it's always great to see so many great people dedicated to fighting cancer.
 
Anyway, before I got, here are some articles I've read this past week that you might find interesting:

Study Cites Increase in Throat Cancers from HPV - Denise Grady, NYT
Further support for the importance of the HPV vaccine and for the importance of vaccinating boys.


Hormonal Contraceptives May Raise HIV Risk for Men and Women - Scott Hensley, NPR Health Blog


Top 5 Unnecessary Health-care Costs - Jonathan D. Rockoff, WSJ Health Blog
"Doctors’ prescribing a brand-name statin, without first  checking to see if a lower-priced generic drug would cut a patient’s cholesterol sufficiently, results in $5.8 billion in excess health-care spending, according to the research letter published Oct. 1."


Should a Candidate's Weight be Part of the Conversation? - Katherine Hobson, WSJ Health Blog
My opinion to this question is a definite no.

Iowa's Colorectal Cancer Dialogue

Last Friday, I went to Iowa's first Colorectal Cancer Dialogue, which was organized by the Iowa Cancer Consortium, the American Cancer Society, and the Iowa Get Screened Program. The day-long conference was all about colorectal cancer (CRC) - a type of cancer I didn't realize was as common as it is until I started working for the ICC. This may sound ridiculous, but I didn't even know until recently that one of my grandparents was a CRC survivor. (I found out when I was asking one of my parents about our family medical history; my grandparent had been diagnosed and treated for CRC long before I was born and died when I was in elementary school.)

Colorectal cancer is the second leading cause of cancer-related mortality (lung cancer is the leading cause). The fact that it causes so much mortality is especially upsetting considering that its one of the few cancers for which there are screening tests available and if its found early, the chance of 5-year survival after diagnosis is 90%.

Much of the discussions at the Dialogue focused on how to increase CRC screening rates, either by targeting physicians and other health care providers to recommend screening or by educating adults about the various screening options/providing the tests themselves. When people think of CRC screening, they usually only think of colonoscopy, but there are actually three different kinds of screening tests that have been shown to be effective for average-risk adults aged 50 to 75, including getting an annual fecal immunochemical test (FIT). The speakers included Dr. Durado Brooks (national director of the CRC and prostate cancer division of the American Cancer Society), the University's own Dr. Charles Lynch and Dr. Barcey Levy, and ACS's Lorrie Graaf. Many materials from the Dialogue, including presentations, are available to everyone on the ICC website.

Here are some random public health articles you might be interested in:

Conservatives Step Up Attacks On Public Funding For Birth Control - Julie Rovner
Rep. Steve King from Iowa apparently doesn't realize that women can be on birth control and still have children some other time in their lives.

Time to Revive Home Ec -Helen Zoe Viet
"Too many Americans simply don’t know how to cook. Our diets, consisting of highly processed foods made cheaply outside the home thanks to subsidized corn and soy, have contributed to an enormous health crisis."

Med Schools Fall Short on LGBT Education - Eliza Barclay

And here's a picture of my cat, Alley, sitting on my lap while I tried to work on a literature review paper yesterday: