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.

Fat Talk Free Week!

This week is Fat Talk Free Week. This article in the Huffington Post really captures what the week is all about. Dr. Rosenberg describes "fat talk" as "comments like 'I feel so fat in these clothes,' or 'do I look fat?' It can also be saying to someone else, 'You look great, did you lose weight?' This implies that lost weight is the metric of looking good."

I know I used to make self-depreciating comments in high school and early in college - it's just such a part of our culture and I think in many circles it's an expected way for women to talk. Starting in college, I began to stop saying things like that, because I started to realize that making those comments isn't just dissing yourself - it sends a message to others as well. I can't count the number of times friends of mine (many of whom are much smaller than me) have commented negatively on some aspect of their body ("My arms are so gross," "I feel like a cow"), and I've thought - what does that say about my body and how it looks? Obviously, their intention is just to remark on their own body/express their opinions about themselves - not to insult anyone else, but I think people often forget that their negative comments send a message to others about what's acceptable and what's not acceptable in terms of body size.

Here are some articles I've read this week that you might find interesting:

Interview: James Hansen on the Tar Sands Pipeline protest, the Obama administration, and intergenerational justice - Jerry Cope, Huffington Post
I've become really interested in the Tar Sands pipeline - which, if you don't know about it, is basically a proposed project to have a large oil pipeline go through the United States to link crude oil from Canada to refineries in Illinois, Oklahoma and the Gulf Coast. Leading climate scientists like James Hansen (a UI grad and Iowa native who heads the NASA Goddard Institute) and environmentalists (such as Bill McKibben) have said this pipeline would be "game over" for the environment and have gotten arrested for protesting it. I really hope Obama rejects the proposal.


Pedestrians on streets designed for cars - Lisa Wade, Sociological Images
Features some great examples of problems in the built environment

Men with disabilities face increased risk of sexual violence - Whitney Blair Wyckoff, NPR

Can the 14th amendment defend itself? - Linda Kerber, CNN Opinion
I just saw Linda Kerber speak this morning at the law school and it was very interesting (my friend who attends law school told me about the lecture and invited me to come with her). Ms. Kerber talks a lot about the importance of historical context in understanding the constitution. The 14th amendment is not something I had thought a lot about, but I think her take on why it is important in terms of immigration is fascinating.

Film Underscores Koreans' Growing Anger Over Sex Crimes - Choe Sang-Hun, NYT
A recent South Korean film about the sexual assaults of a number of deaf students in a school and the lax punishments the perpetrators got has "tapped into the widespread anger of official reluctance to take sex crimes seriously, and over how justice is served." Nearly a 10th of the country's population has seen the film.

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.

Working for a Non-profit

I love working for a non-profit. I've worked at Iowa Cancer Consortium (ICC), a state-wide cancer control non-profit, since June 2010 and it's been a really wonderful experience. While I know there's a lot of variation within the non-profit sector, generally speaking I think many non-profits can provide unique opportunities for students interested in public health. Since non-profits are often (unfortunately) working on a very tight budget and have activity-packed staff, students can often take on more responsibility than they may otherwise be able to in jobs in other areas.

Through working at the ICC, I've been able to work on a range of projects and expand my skills and knowledge considerably. My boss and coworkers have taught me a lot and continually provide me with guidance. I've been able to help plan conferences (like the upcoming Iowa Cancer Summit, which is open to anyone interested in cancer control efforts!), design materials, write grants, edit web pages, conduct literature reviews, contribute to revising the state cancer plan, facilitate membership meetings, learn a lot more about cancer control methods and cancer itself, and meet some cancer control leaders from across the state.

Granted, there are some downsides to working in the non-profit world: the disappointment when a proposed project doesn't get funded, the uncertainty when the fiscal year ends. But all in all, it's been an invaluable experience and I'm looking forward to working with them for the rest of the school year.

The Rape Victim Advocacy Program in Iowa City is another great non-profit I love being a part of. I don't work there, I'm just a volunteer advocate, but the women that work there are incredible and they do many very important things, like provide free counseling for survivors and conduct sexual assault prevention education.

Anyway, enough about non-profits! Here are some articles you might find interesting:

Women could be given the right to choose Caesarean Birth - James Gallagher
I've been interested in birth and its medicalization for a few years now. I feel a little conflicted about the right to choose to have a C-section. On the one hand, I could see how it may be empowering to have women be able to control their childbirth to this degree, but on the other hand, a C-section is a pretty major operation. Plus, childbirth is a natural process that sometimes becomes a medical emergency, but certainly isn't always. I lean towards the view that it's best to avoid getting a C-section unless it's absolutely necessary, but I can understand why some women may feel differently.

Obama Administration Abandons Stricter Air-Quality Rules - John M. Broder
Depressing, but on the bright side - at least Obama isn't actively trying to dismantle the EPA.

Fewer Americans Are Smoking, And Those Who Do Puff Less - Timothy W. Martin
Some good news and bad news in this article. Especially relevant to Iowans since we just lost millions in state anti-tobacco funding.

Texas wildfires destroy more than 700 homes in two days - CNN Wire Staff
Really terrifying stuff. I have some friends in Austin; hopefully the fires stop soon. I'm a little surprised about how long its taken for these fires to get national attention (although the Southern drought in general didn't get very much national attention this summer either, I thought).

And to end this post: I thought this youtube video was pretty funny.