Last year during a routine check-up, my new doctor found a lump in my right breast and referred me to the mammography department of her clinic for follow-up diagnostic testing. It took me weeks of persistent calls to book my appointment, and when I showed up I was sent home without a mammogram because the referral wasn’t logged in their electronic records. I played phone tag with my doctor for another few weeks before the referral was recorded, and I had to begin the process of booking a mammogram all over again. The results were benign, but I was instructed to come back in six months to check on the lump.
Cancer screening saves lives. And people are more likely to get screened if their doctor recommends it. That’s why Blue Cross Blue Shield of Louisiana and The Louisiana Colorectal Cancer Roundtable (LCCRT) recently recognized 22 Quality Blue Primary Care primary care doctors who screened 80% or more of their eligible patients for colorectal cancer between September 1, 2016 and September 1, 2017.
I recently had a bad dream where I was being chased by some obviously bad dudes and woke up in a cold sweat right before they were going to shoot me.
And though I know I’m much more likely to be shot in the United States than just about everywhere else in the world (a discussion for another time and place), less than 4% of U.S. deaths are caused by firearms. Overwhelmingly what kills us – and what we really need to be afraid of – is ourselves.
Public safety is the number one function of government. Almost everyone would agree with that statement. Whether it’s enforcing building codes so the ceiling doesn’t come falling down on us or food safety laws that mean we don’t eat rotten meat, most people agree these are important protections. There is, however, a glaring public safety gap in Louisiana and it’s centered on clean indoor air - specifically smoking indoors. In the state law that made office buildings and restaurants smoke-free, there is a loophole that allows bars and casinos to still let toxic, cancer-causing chemicals be released in the air that people breathe.
The State Cancer Plan is published by The Louisiana Comprehensive Cancer Control Program, which is part of the Louisiana Cancer Prevention and Control Programs, and which are housed at the LSU School of Public Health.
New Orleans, LA – LSU Health New Orleans School of Public Health’s Louisiana Comprehensive Cancer Control Plan 2017-2021 provides a roadmap to reduce cancer deaths in Louisiana over the next five years. The plan, created by LSU Health New Orleans’ Louisiana Comprehensive Cancer Control Program and its partner organizations, is available at http://louisianacancer.org/publications/.
Normally when I leave the house, I do a quick check to make sure I have everything I need. “Wallet, keys, phone” is my routine mantra as I head for the door. But now that we are in the thick of festival season, I’m adding a few things to that list: hat, sunglasses and sunscreen!
Throughout my professional life, I’ve been passionate about everyone getting the cancer screenings they need. And I’ve done a good job of getting myself screened how and when American Cancer Society says that I should. But when I got to 50, the age when you should get screened for colorectal cancer if you are at average risk, I talked the talk, but didn’t walk the walk. I knew I was a hypocrite, but I put it off for a couple of years.
World Cancer Day, February 4th, happens to fall between two big cancer awareness months: cervical & colorectal cancer. Director of the Louisiana Cancer Prevention & Control Programs (LCP), Donna Williams, told the Louisiana Radio network during her interview that, “The goal of World Cancer Day is to raise awareness about cancer prevention methods… Everywhere all across the world there are things that can be done to decrease the deaths from cancer.”
In Louisiana, February means Mardi Gras, and Mardi Gras means decadence. Unfortunately, we here at the Louisiana Cancer Prevention and Control Programs are all too aware that decadence can mean cancer. Obesity and excessive alcohol consumption have both been linked to a long list of cancers, and the sugar on top of your king cake can literally feed tumor growth. So are health-conscious revelers doomed to miss out on all the fun? Of course not! In fact, by thinking outside of the box, you can find ways to make “Fat Tuesday” one of the healthy-er days of the year.
Cervical cancer does not discriminate. Any woman regardless of race/ethnicity, socioeconomic status, age, or geographic area is at risk for cervical cancer, with Louisiana cervical cancer rates and deaths higher than the national average (5th in cervical cancer deaths.) According to the Centers for Disease Control and Prevention (CDC), more than 90% of cervical cancers are caused by the human papillomavirus (HPV). HPV is a very common virus shown to not only cause cervical cancer, but certain other cancers and genital warts. The CDC estimates 79 million people in the United States are infected with HPV, with approximately 14 million becoming infected each year and nearly 27,000 U.S. cancers resulting from it. Overall, the National Cancer Institute says HPV causes approximately five percent of all cancers worldwide.
When people are young and asked what they want to be when they grow up, the answers are almost always ambitious. Kids want to be things like astronauts, superheroes, firefighters or movie stars. At that age, kids believe they can make a huge impact because their hearts are full of hope and the possibilities are endless.
Our mission at the Louisiana Prevention and Control Programs (LCP) is to “eliminate suffering and death in Louisiana by focusing on cancers that can be prevented or detected early and cured.“
If you’re someone going through cancer treatment, and ever need to evacuate your home (a strong possibility on the Gulf Coast), please remember these key things as you prepare to leave:
In one of the more recent Tips From Former Smokers television ads, a man named Roosevelt says, “Always thought that cigarette smoking just messed up your lungs. I never thought, at only 45, it would give me a heart attack.”
No one has suddenly discovered a cure for cancer, though you might not know that given how much the topic has been in the news this year. Between changing screening recommendations and talk of a “moonshot” approach to a cure, what’s your average person to think about cancer these days?
Easy Ways You Can Beat Cancer
Let’s start with some good news and advice. Some of the most deadly and common cancers in the United States – and the world – are cancers we can actually do something about easily.
For example, the deadliest and second most common cancer everywhere is lung/bronchus cancer. Tobacco kills and there’s no two ways about it. Don’t use tobacco and the chances that you will end up with these cancers are almost none.
But those cancers are not the only ones tobacco causes. It’s been proven more recently that tobacco also contributes to colon, liver, kidney, bladder, stomach, pancreatic, cervical and rectal cancers, as well as acute myeloid leukemia. Throw in the fact that tobacco is the leading cause of cardiovascular disease, which is the leading cause of death worldwide, and know that it’s a death wish to ever start the habit or not try to quit.
That’s also why so many individuals, companies and communities are working on limiting access and exposure to the stuff through tobacco taxes, smoke-free policies, higher insurance rates, etc. And while many tobacco users (a minority of the population) like to claim its use is a matter of freedom, most people don’t usually think of ingesting poisons and other carcinogenics as “being free.” That’s why there are laws and regulations protecting people from other known toxins and why people don’t play in traffic. Sure, one is free to do so, but it’s not generally considered a good idea.
The freedom argument is weakened further by the fact that non-smokers can get cancer from secondhand smoke, which takes away their choice or right to breathe non-poisonous air. And as tobacco users cost everyone more money in terms of higher monthly health insurance premiums and taxes (for example, direct smoking expenditures cost Louisiana families $1,207 each year), a smoker’s “freedom” is often very expensive for everyone else.
Fortunately, a slew of other cancers don’t have addictive components with which to contend or big corporate backers. These are cancers that can be prevented or caught early. For example, the most common cancer of all is skin and there’s a really easy way to prevent that: protect yourself (and children!) from the sun. It’s that simple.
And then there are cancers that can be prevented and/or caught early through regular screenings. These include breast, prostate, colon and cervical, which, again, are some of the most common and deadly cancers people get. That’s why it’s vitally important that people know what those regular screening intervals are.
When Should I Get Screened?
Ah, there’s the rub, you’re thinking. Haven’t health experts been changing up a bunch of those recommendations? They have and, as bothersome as that is to both the public and the health experts who have to convey that information, the fact is that when it comes to diseases and other scientific advancements, knowledge often comes in incremental bites and sometimes advice changes.
Prostate Cancer: What Men Need To Consider
Take for example, prostate cancer. Other than skin cancer, it’s the most common cancer in men. One in seven men will be diagnosed with prostate cancer at some point during their lifetime, while one in 38 will die from it. So when prostate-specific antigen, or PSA, screening tests came along in 1987, men were understandably counseled to get one.
The problem, however, is that prostate cancer screening has had almost no effect in lowering prostate cancer death rates. And that’s because most prostate cancers consist of extremely slow-growing, nonlethal tumors, which never cause harm. Add to that the fact that prostate cancer treatment can often leave men impotent and incontinent, and you’ve got a case where “the cure is worse than the disease.” So the United States Preventative Services Task Force (USPSTF), which is charged with providing evidence-based recommendations on clinical preventive services, gave the PSA test a “D” rating and advised health providers not to recommend it.
However, that is not to say men need not do anything. The Centers for Disease Control and Prevention (CDC), the American Cancer Society and other health organizations recommend that men learn about prostate cancer and then speak to their doctor to make an informed decision as to what they should do when it comes to screening. Factors such as age (the older a man, the greater the risk), family history (a father, brother or son with the disease means a two-to-three times higher risk) and race (African American men have higher incidence rates) should be considered before undergoing testing. And if a localized cancer is detected, “active surveillance” or “watchful waiting” is emerging as a way of dealing with it. In that process, the cancer is monitored via PSA and digital rectal exams on an ongoing basis and if it worsens, only then treatment is undertaken.
Breast Cancer: When Women Should Mammogram
Then we come to women’s cancer screenings. When the USPSTF changed its breast screening recommendations recently, there was a lot of uproar. In dealing with average-risk women (no family history), the USPSTF recommended that women ages 50 to 74 get mammograms every two years, which was a change from the former annual recommendation. More controversially, the USPSTF recommended that average-risk women, ages 40 to 49, make the mammogram decision on an individual basis, stating that potential harms, such as false-positives and treatment for non-threatening cancers, increases in this age group, but does not substantially lower the death rate.
That’s a bit in contrast with the American Cancer Society, which says that average-risk women ages 40 to 44, should decide on an individual basis; recommends that women ages 45 to 54 get a mammogram every year; and women age 55 and older should get one every two years.
Either way, the takeaway message here is that women need to get screened on a regular basis, either annually or biannually, perhaps starting at age 45 and definitely by age 50, as the risk of breast cancer increases in one’s later 40s and through the 50s. Fortunately, under the Affordable Care Act or “Obamacare,” breast cancer screening is covered (some grandfathered plans may not), so a woman can often choose with her doctor as to what age and how often she can get a mammogram.
Cervical Cancer: Pap Tests How Often for Women?
Cervical cancer screening recommendations have changed too. The days of the annual Pap test are gone, except for high-risk women, and though there are some slight variations in screenings recommendations from various expert health organizations, here is what everyone basically agrees on: Average-risk women ages 21-65 should get a Pap test every three years. Women ages 30-65 should get a Pap test every three years or co-testing with HPV every five years.
And, of course, since the HPV vaccine prevents almost all cervical cancer, all girls age 11-26 should get the vaccine. Boys, age 11-21, need to get the vaccine too as it prevents a number of cancers that also affect them.
Colon Cancer: It Affects Everyone
This one is simple. Average-risk people, age 50 and over, need be screened regularly for colorectal cancer. The good news is that there are a variety of ways to do that, including simple, at-home options and that health insurance now covers those preventive screenings. So talk to your doctor and get screened!
In the end, people should remember there are three easy ways to beat some of our worst cancers: 1) Don’t use tobacco; 2) Get regular screenings; and 3) Cover you and your children up in the sun.
If you remember The Monkees and the Jackson 5, or ever used the term “groovy” in a non-ironic way while sporting an Afro or mop-top, you are probably due for a colorectal cancer screening.
Sure, that may seem like a strange segue to you, but being familiar with these pop culture milestones marks you as someone who is likely to be 50 or older. And that means your colorectal cancer risk is going way up.
Ah, yes, the joys of getting older. The good news, however, is that colorectal cancer screenings can easily detect the disease in a pre-cancerous or early stage, which translates to an over 90 percent survival rate. And now thanks to the Affordable Care Act (ACA), also known as Obamacare, colorectal cancer screening tests are now covered by health insurance with no out-of-pocket expenses for people 50 and older.
If you live in Louisiana, you really need to pay attention to this information. That’s because this highly preventable cancer is killing a lot of people in the Bayou State. Aside from lung cancer, colorectal is the most deadly cancer in the state, which is not surprising when people understand that Louisiana has both the third highest incidence and death rates of colorectal cancer in the country.
Why? Let’s Talk Demographics
Louisiana has a large number of African Americans and, unfortunately, African Americans are the ethnic group with the most colorectal cancer and the most deaths from colorectal cancer in the country. In addition, it seems that health providers are not recommending colorectal cancer screenings as much as they should, with African Americans stating the number one reason they haven’t gotten a screening is because their doctor didn’t tell them to.
A recent study has also shown that Cajuns have some of the highest incidence rates of the disease in the country, due to possible genetic factors. More study is needed on the subject, but Cajuns should understand that they may be more at risk - and that they really need to get screened. Plus anyone who has a history of polyps, colorectal cancer, inflammatory bowel disease and other related inherited syndromes, should also know to talk to their doctors about when they should start screening and how often.
Finally, people in Louisiana are just unhealthier than a lot of people in the rest of the country. Smoking is one cause of colorectal cancer and Louisianians smoke more than the average U.S. resident. Louisianians also are more likely to be obese, and there is a strong link between obesity and colorectal cancer, especially in men. Diets high in red and processed meats have now been shown to cause colorectal cancer, and there’s no question Louisianians love their sausages and boudin. Throw in heavy alcohol use and a lack of physical activity and you have a deadly mix of ingredients that helps explain Louisiana’s colorectal cancer problem.
So What Can People Do? 80% by 2018
The National Colorectal Cancer Roundtable, along with newly formed Louisiana Colorectal Cancer Roundtable (LCCRT), are promoting the “80% by 2018” screening goal for everyone 50 and older, so people can spread the word-- or maybe even nudge - family and friends to participate.
As for health providers, they can do the following:
· Be sure your office has adopted or is following evidence-based guidelines from national experts, such as the American Cancer Society or the United States Preventive Services Task Force.
· Be sure to provide screening recommendations for African Americans, Hispanics and the “Newly Insured,” who may not yet understand that these screenings are covered.
· Stress to all patients“the best test is the one you’re going to get,” so that people who can’t, say, afford or take time off from work for a colonoscopy or are just uncomfortable with the idea, understand that they have inexpensive, at-home screening FIT and FOBT options.
· Educate the people who don’t think screening is important, putting it off or rationalizing the need away (“I don’t have a history of it or know anyone with colon cancer…”).
Remember, in the words of the Colon Cancer Alliance, colorectal cancer is “Preventable. Treatable. Beatable.”
To learn more about the LCCRT, please go to: www.louisianacancer.org/lccrt-home.
The LCCRT was established by a partnership of the CDC-funded Louisiana Cancer Prevention and Control Programs (LCP) housed at the LSUHSC School of Public Health, LSUHSC Shreveport Feist Weiller Cancer Center and the American Cancer Society.
It’s rare that in the face of an extremely difficult problem, that a simple, win-win solution presents itself, but that is happening right now in Louisiana, which is facing both an astronomical health and fiscal crisis.
And it all centers on tobacco. The deadliest, not to mention one of the most common cancers in the state (as well as the country and the world), is lung cancer. That fact should not be news to anyone. But maybe people haven’t totally understood that tobacco has now also been proven to cause a whole host of other cancers, including: colon, liver, kidney, bladder, stomach, pancreatic, cervical and rectal cancers, as well as acute myeloid leukemia.
That’s quite a list. Throw in the fact that tobacco is the leading cause of cardiovascular disease, which is the top cause of death and disease everywhere, and even somebody who doesn’t have a good grip on health statistics or fiscal matters, can understand that tobacco kills and costs us a lot of money in the process.
Show Us The Money
Tobacco-related disease in Louisiana costs the state $1.89 billion a year in health care costs, which is approximately $2,400 in taxes for every Louisiana family. And that doesn’t even count costs such as the higher health insurance premiums everyone pays because of tobacco. One of the reasons why is Louisiana has one of the lowest cigarette taxes in the country. Not surprisingly, it turns out when it’s cheap to smoke, more people do it. This is especially true of kids, ensuring a never-ending supply of customers for Big Tobacco, as well as a never-ending and expensive health crisis for the state.
Health experts say that raising the price $1.25 on cigarettes and equalizing the tax rate on other tobacco products will stop 23,000 kids under 18 from starting to smoke (kids are particularly price-sensitive), as well as save 16,000 Louisiana adults from a premature death. And the health savings in the future would amount to millions.
That makes so much sense on the face of it, it would seem it would be a “done deal.” And now the state is catapulting down a $1.6 billion budget hole, which, thanks to the way the state constitution is written, means dire consequences for the health and education of Louisiana citizens, (including possible loss of TOPS college tuition funds and even the loss of the LSU football program). It is clear that something must be done and done fast.
That’s why everyone from health experts to fiscal conservatives are touting a tobacco tax increase. It’s a common sense, fiscally responsible and life-saving solution. It also holds people accountable for their behavior, which is probably why it appeals to people on both sides of the political aisle and why a vast majority of Louisiana voters favor such a tax.
The fact that Louisiana is further recognizing the evils of tobacco is evidenced in the whopping success of the smoke-free ordinance in New Orleans, which is soon celebrating its year anniversary. Only six months after its enactment, the ordinance has an 80 percent approval rating – up from the 66 percent who favored it before it took place. The dire predictions of lost business and revenue in bars and casinos proved to be unfounded.
East Baton Rouge is now considering going smoke-free too, and initial reaction has been more than enthusiastic, with initial polling showing that 70 percent of its voters favor smoke-free policies in all places, including bars and casinos.
It would seem people aren’t buying the “freedom” argument that tobacco users (a minority of the population) and some business owners like to make, as most people don’t usually think of ingesting poisons and other carcinogenics as “being free.” As one public health spokesperson put it, “It’s like playing in traffic. Sure, you’re free to do it, but I wouldn’t recommend it.”
The freedom argument is further weakened by the fact that non-smokers can get cancer from secondhand smoke, which takes away their choice or right to breathe non-poisonous air. Just as there are laws and regulations protecting people from other known toxins, people are now recognizing that they need protection from tobacco - history and Big Tobacco money notwithstanding.
In the end, a smoker’s freedom is very expensive in death, disease and costs for everyone else. Louisiana is now recognizing that fact and doing something about it.
For more information about smoking and how to quit, go to the Louisiana Cancer Prevention and Control Programs website at http://louisianacancer.org/smoking/.
The CDC-funded Louisiana Cancer Prevention and Control Programs (LCP) are housed at the LSU Health Sciences Center School of Public Health.
If there was an easy way to stop your children from getting cancer, wouldn’t you do it? And wouldn’t you at least expect your doctor to tell you about it? It’s a no-brainer, right?
Wrong. As it turns out, doctors aren’t always doing a good job of making sure kids are being vaccinated against HPV, which can cause cancer later in life. Over and over again, studies, including reports from physicians themselves, show that doctors simply don’t discuss the subject with parents.
This failure has even become a topic of concern nationally. “Doctors, Not Parents, Are The Biggest Obstacle to The HPV Vaccine,” read a recent National Public Radio (NPR) headline, which was accompanied by a story entitled “U.S. Teens Still Lag In Getting Vaccinated Against HPV.” The Boston Globe’s recent story on the subject was entitled “Study Says Doctors Passively Discourage HPV Vaccines,” while The Daily Beast asked “Why Do Doctors Hate This Vaccine?”
The upshot is that parents shouldn’t wait for doctors to recommend the HPV vaccine - parents should tell doctors that their kids (boys and girls) need the HPV vaccine, starting at age 11 and 12.
Doctors, Don’t Treat It As An Option
So why are doctors falling down on the job of getting kids immunized against HPV? At the recent American Public Health Association conference in Chicago, research revealed several interesting points.
For one thing, unlike every other vaccine, more than 60 percent of doctors think of the HPV vaccine as “optional,” especially when it comes to boys. And because doctors don’t rank the HPV as important, it often doesn’t get discussed at all, even during “sick” visits where other vaccines are commonly brought up. Doctors also perceive that a discussion of the HPV vaccine takes longer, so they often leave it to last, which also leads to it getting less attention. And, according to the NPR report, many doctors will discuss the vaccine without actually recommending it, while many others simply forget to mention it at all.
That is why health experts recommend that doctors get in the habit of treating the HPV vaccine as they do all other vaccines. At age 11 or 12, all boys and girls should start the three-dose HPV vaccine. As that is the same age that the Tdap (tetanus, diphtheria, pertussis) and meningococcal vaccines are administered, the HPV vaccine should be listed right along with those as a routine immunization. Researchers also says it helps when schools require the vaccination on medical forms as they do other vaccines.
Perception v. Reality
So how did this vaccine somehow end up on the D-List in doctors’ minds? The vaccine was given an unfortunate gender/sexual connotation that obscured what the vaccine really accomplished: preventing cancer in women and men. It is interesting, as well as a puzzlement to health experts, that the Hepatitis B vaccine, the only other vaccine that prevents cancer and is administered to infants, has no such connotation, even though Hepatitis B can be spread sexually, just like HPV. And while the vaccine was first approved for girls, it is now recommended for both boys and girls. Still many doctors became wary of discussing the HPV vaccine with parents at all, while others discussed it in terms of perceived sexual risk, another mistake.
That reluctance and mischaracterization can cost lives. Nearly all adults will get HPV at some point in their lives, with one in every four U.S. adults currently infected. And though most of those infections will go away on their own without people even realizing they are infected, a certain number will lead to cancer. The HPV vaccine can prevent many of those cancers, including cervical (the most common HPV cancer, with almost all cases being caused by HPV), as well as many vulvar, vaginal, penile, anal and head and neck cancers. The vaccine also prevents genital warts.
As for why the vaccine is administered to preteens, it is done at that time to help ensure the best immunological response (as with other childhood vaccines) and to make sure that the protection is in place well before those teens become sexually active. Concerns that the vaccine would promote sexual behavior have been shown to be completely unfounded, but, sadly only 38 percent of teen girls and only 14 percent of teen boys are getting all three doses of the vaccine, a rate that is far below the 80- and 90-percent rates for other vaccines.
Good News for Doctors
The latest research shows that doctors really can make a difference in increasing HPV vaccination rates. According to Melissa Gilkey, the lead author of the study featured in the NPR story, the single biggest barrier to HPV vaccination is not receiving a recommendation from a health provider. That factor far outweighs parental reluctance, with research showing that parents aren’t as hesitant as doctors about HPV vaccination and just require more information.
All doctors need to do is treat the HPV vaccine as any other and be prepared to answer questions about effectiveness, safety and misconceptions just as they would any other vaccine. In the words of Dr. John Hallberg, an MD and associate professor at the University of Minnesota Medical School, who produced a movie called “Just Another Shot: Reframing the HPV Vaccine” in conjunction with the Centers for Disease Control and Prevention (CDC), “No drama needed.”
For more information on the HPV vaccine, go to http://louisianacancer.org/hpv-vaccine/.
The CDC-funded Louisiana Cancer Prevention and Control Programs (LCP) are housed at the LSU Health Sciences Center School of Public Health. For more information on cervical cancer screenings, visit LCP’s Louisiana Breast and Cervical Health Program (LBCHP) at www.lbchp.org.