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Cancer, Dermatology, Public Health, Research, Stanford News

Melanoma rates exceed rates of lung cancer in some areas

Melanoma rates exceed rates of lung cancer in some areas

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Californians, step away from the beach and grab a hat and sunscreen. Our team of researchers from the Cancer Prevention Institute of California/Stanford Cancer Institute released a new report (.pdf) this week documenting the rapidly growing burden of melanoma in Marin County, California. This small, homogenous (and wealthy) county just over the Golden Gate Bridge from San Francisco has been the focus of cancer studies before, as high rates of breast cancer were first reported there in the late 1990’s (rates declined there as in the rest of the country in 2003 when women stopped taking hormone therapy).

Our most recent cancer registry data show that rates of malignant melanomas in Marin County are 43 percent higher than the rest of the San Francisco Bay Area and 60 percent higher than other parts of California among non-Hispanic whites, who because of their fairer skin tones are diagnosed with melanoma at 20-30 times the rate of other ethnic groups. Also of concern is that the death rate due to melanoma is 18 percent higher in Marin whites than whites in other regions, a significant difference not seen before. Most of the elevated rates are limited to persons over age 65, especially men.

The Bay Area news media reported our findings as front-page news. Most coverage centered on the question of why the rates are so much higher in Marin County. Our best guess is that the higher average socioeconomic status of its residents corresponds to a higher proportion of people with the known risk factors for melanoma: fair complexion (pale skin, blonde or red hair, blue or green eyes) and a history of “intense intermittent” sun exposure over their lifetimes (exposure in big doses like you might get on a beach vacation in the winter).

However, it is also likely that better access to health care and skin screening has resulted in earlier diagnosis, a notion confirmed by the higher proportion of melanomas in Marin County caught when thin and more curable. Local dermatologists reacted to the statistics with some surprise, but didn’t change their standing advice regarding skin cancer prevention: talk to your doctor about skin screening and stay sun safe by wearing hats, long-sleeves and broad-spectrum sunscreen during outdoor activities.

One statistic mostly overlooked by the media was our finding that melanoma is now the second most common cancer diagnosed in men living in Marin County, as rates have surpassed those for lung cancer. This pattern is very different than that observed for whites in the US and world, for whom prostate or lung are first, and melanoma is ranked much lower. With one of the most successful public tobacco control efforts in the world, most populations in California have seen rapid declines in the incidence of smoking-related cancers of the lung and respiratory system.

Unfortunately, it seems for older white persons in Marin County (as well as parts of Utah and Hawaii, where smoking rates have also declined), melanoma and skin cancers represent a major—and relentlessly growing—cancer threat. Perhaps putting down the cigarettes was accompanied by more time at the pool or beach without adequate sun protection. Although California was the first state to ban tanning bed use by minors, we should look to Australia and other countries also battling rising skin cancer rates for innovative new policies and strategies for encouraging safe sun exposure in our at-risk communities.

Christina A. Clarke, PhD, is a Research Scientist and Scientific Communications Advisor for the Cancer Prevention Institute of California, and a member of the Stanford Cancer Institute.

Previously: Beat the heat – and protect your skin from the sun, Working to protect athletes from sun dangers, As summer heats up take steps to protect your skin, Stanford study: Young men more likely to succumb to melanoma and How ultraviolet radiation changes the protective functions of human skin
Photo by stefan klocek

Health Disparities, Men's Health, Public Health, Research, Stanford News, Women's Health

Why it’s critical to study the impact of gender differences on diseases and treatments

man_womanWhen it comes to diagnosing disease and choosing a course of treatment, gender is a significant factor. In a Stanford BeWell Q&A, Marcia Stefanick, PhD, a professor of medicine at the Stanford Prevention Research Center and co-director of the Stanford Women & Sex Differences in Medicine Center, discusses why gender medicine research benefits both sexes and why physicians need to do a better job of taking sex difference into consideration when make medical decisions.

Below Stefanick explains why a lack of understanding about the different clinical manifestations of prevalent diseases in women and men can lead to health disparities:

…Because we may have primarily studied a particular disease in only one of the sexes, usually males (and most basic research is done in male rodents), the resulting treatments are most often based on that one sex’s physiology. Such treatments in the other sex might not be appropriate. One example is sleep medication. Ambien is the prescription medicine recently featured on the TV show, 60 Minutes. Reporters found out that women were getting twice the dose they should because they had been given the men’s doses; consequently, the women were falling asleep at the wheel and having accidents. Physicians had not taken into account that women are smaller and their livers’ metabolize drugs differently than do men’s. Some women have responded by reducing their own medication dosages, and yet that practice of self-adjusting is not the safest way to proceed, either.

Previously: A call to advance research on women’s health issues, Exploring sex differences in the brain and Women underrepresented in heart studies
Photo by Mary Anne Enriquez

Aging, Chronic Disease, Public Health, Research

How multiple chronic conditions are affecting older Americans’ life expectancy

old_coupleOne in four adults in the United States has two or more chronic conditions, according to the latest data from the Centers for Disease Control and Prevention. And, findings published in the August issue of Medical Care show that the burden of multiple chronic diseases could explain why life expectancy increases among elderly Americans are slowing.

In the study (subscription required), researchers at Johns Hopkins Bloomberg School of Public Health analyzed a nationally representative sample of 1.4 million Medicare beneficiaries. According to a release:

The analysis found that, on average, a 75-year-old American woman with no chronic conditions will live 17.3 additional years (that’s to more than 92 years old). But a 75-year-old woman with five chronic conditions will only live, on average, to the age of 87, and a 75-year-old woman with 10 or more chronic conditions will only live to the age of 80. Women continue to live longer than men, while white people live longer than black people.

It’s not just how many diseases you have, but also what disease that matters. At 67, an individual with heart disease is estimated to live an additional 21.2 years on average, while someone diagnosed with Alzheimer’s disease is only expected to live 12 additional years.

On average, life expectancy is reduced by 1.8 years with each additional chronic condition, the researchers found. But while the first disease shaves off just a fraction of a year off life expectancy for older people, the impact grows as the diseases add up.

Previously: Americans are living longer, but are we healthier in our golden years?, Longevity gene tied to nerve stem cell regeneration, say Stanford researchers, Study shows regular physical activity, even modest amounts, can add years to your life and TED Talk with Laura Carstensen shows older adults have an edge on happiness
Photo by Marcel Oosterwijk

Public Health, Research, Sleep

Why sleeping in on the weekends may not be beneficial to your health

Why sleeping in on the weekends may not be beneficial to your health

tired_072214Many of us, myself included, use the weekends to pay off the sleep debt we accrued during the work week. However, excessive sleeping can often leave us feeling more fatigued. A piece published today on Wired Science examines this phenomenon and discusses why clocking extra hours of shut-eye doesn’t necessarily benefit our health. Nick Stockton writes:

Oversleeping feels so much like a hangover that scientists call it sleep drunkenness. But, unlike the brute force neurological damage caused by alcohol, your misguided attempt to stock up on rest makes you feel sluggish by confusing the part of your brain that controls your body’s daily cycle.

Your internal rhythms are set by your circadian pacemaker, a group of cells clustered in the hypothalamus, a primitive little part of the brain that also controls hunger, thirst, and sweat. Primarily triggered by light signals from your eye, the pacemaker figures out when it’s morning and sends out chemical messages keeping the rest of the cells in your body on the same clock.

Scientists believe that the pacemaker evolved to tell the cells in our bodies how to regulate their energy on a daily basis. When you sleep too much, you’re throwing off that biological clock, and it starts telling the cells a different story than what they’re actually experiencing, inducing a sense of fatigue. You might be crawling out of bed at 11am, but your cells started using their energy cycle at seven. This is similar to how jet lag works.

The article goes on to explain that past research has shown that, “If you’re oversleeping on the regular, you could be putting yourself at risk for diabetes, heart disease, and obesity.”

Previously: The high price of interrupted sleep on your health, Examining how sleep quality and duration affect cognitive function as we age, What are the consequences of sleep deprivation? and BBC study: Oh, what a difference an hour of sleep makes
Photo by Stephen Poff

Medicine and Society, Podcasts, Public Health

The vanishing U.S. surgeon general: A conversation with AP reporter Mike Stobbe

The vanishing U.S. surgeon general: A conversation with AP reporter Mike Stobbe

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There is currently no U.S. Surgeon General. Like everything else in Washington today, a confirmation vote by the U.S. Senate on President Obama’s choice, Harvard physician Vivek Murthy, MD, has been squashed by politics. Last spring, White House press secretary Jay Carney said that the administration was “recalibrating and assessing our strategy on moving forward with the nominee.” In March, The Hill newspaper reported that up to 10 Senate Democrats signaled they would oppose Murthy’s confirmation after the National Rifle Association made it clear Murthy’s support for bans of certain types of firearms and ammunition purchases made him an unthinkable choice.

Now if you’ve forgotten there even is a position called the U.S. Surgeon General post, think C. Everett Koop, MD, or Joycelyn Elders, MD. Koop and Elders were two recent appointees who used their bully pulpit to raise a national discussion about AIDS and teen pregnancy. (Both were  lightening rods within their respective administrations – Koop in Reagan’s and Elders in Clinton’s. Elders was eventually dismissed by the White House after wading into too many contentious issues.)

Does the position even matter anymore? Associated Press medical reporter Mike Stobbe thinks it does. He’s written a fascinating book (Surgeon General’s Warning, University of California Press) about the history of the position and those who served. The book explains how the surgeon general became the most powerful and influential public health officer in the country and how those powers were later stripped away. An excerpt from Stobbe’s book appears in the current issue of Stanford Medicine magazine, where he catalogs the ups and downs of the individuals who held the position. The strong ones and the weak ones. Those who made a difference and those who faded away in controversy or without making a mark on the nation’s public health dialogue.

He writes, “Surgeon generals have played that crusader role better and more often than any other national public health figure. Absent such a crusader, the public’s health is prey to the misinformation and self-interest of tobacco companies, snake-oil salesmen and other malefactors.” Listen to my 1:2:1 podcast with Stobbe to hear more of his thoughts.

Illustration, which originally appeared in Stanford Medicine, by Tina Berning

HIV/AIDS, In the News, Public Health

Free, one-minute HIV testing…while you shop for clothes?

Free, one-minute HIV testing...while you shop for clothes?

outoftheclosetPerhaps you’re familiar with cafe-laundromats or sushi restaurants with tap dancing. But did you ever visit a second-hand clothing and furniture store to take care of your health-care needs? An audio segment and post on the KERA News (Dallas) blog features a local Out of the Closet shop with a free HIV testing site, and soon a community pharmacy, inside their thrift store – making it the 22nd branch of the U.S. chain to have both.

Bret Camp, the Texas regional director of the AIDS Healthcare Foundation, which operates the thrift stores, said in the post, “Our pharmacy will have everything from blood pressure meds to diabetes supplies…How many places can you go and look at jeans while you’re waiting for your medication?”

More from the post:

It’s an innovative idea, says [Douglas Owens, MD,] a professor of medicine at Stanford University who also serves on the U.S. Preventive Services Task Force.

A number of organizations, including the CDC and U.S. Preventive Services Task Force recommended universal HIV testing. Of course testing is only the first step, Owens says.

“When people get an adequate treatment for HIV, the drugs reduce their infectivity and so treatment for HIV not only benefits the person who has HIV; it also provides a very important public health benefit that reduces transmission,” Owens explains in the audio segment.

Previously: Task force recommends HIV screening for all people aged 15 to 65, Using Facebook to prevent HIV among at-risk groupsTask force issues draft recommendation for universal HIV screening and National HIV screening and testing could be very cost-effective
Photo by Marilyn Roxie

Addiction, Emergency Medicine, Public Health, Research, Technology

Text messages after ER visit could reduce young adults’ binge drinking by more than 50 percent

Text messages after ER visit could reduce young adults' binge drinking by more than 50 percent

Bar_texting_0701414Researchers have demonstrated that text message programs can, among other things, help diabetes patients better manage their condition, assist smokers in kicking their nicotine habit, and encourage expecting mothers to get flu shots.

Now new findings published in the Annals of Emergency Medicine show that text messages can also be an effective tool for reducing binge drinking among young adults whose hazardous alcohol use has resulted in an emergency room visit. During a 12-week study, 765 patients who were treated in the emergency room and screened positive for a history of hazardous drinking were divided into three groups. The first group received text messages prompting them to respond to drinking-related queries and received text messages in return offering feedback aimed at either strengthening their low-risk drinking plan or promoting reflection on their drinking plan or decision not to set a low-risk goal. Another group received only text queries about their drinking, and the remaining individuals received no text messages.

A story published today on PsychCentral reports on the researchers’ results:

The group receiving both text message queries and feedback decreased their self-reported binge drinking days by 51 percent and decreased the number of self-reported drinks per day by 31 percent.

The groups that received only text messages or no text messages increased the number of binge drinking days.

“Illicit drugs and opiates grab all the headlines, but alcohol remains the fourth leading cause of preventable death in the U.S.,” said [Brian Suffoletto, MD, assistant professor in the Department of Emergency Medicine at the University of Pittsburgh School of Medicine].

“If we can intervene in a meaningful way in the health and habits of people when they are young, we could make a real dent in that tragic statistic. Alcohol may bring them to the ER, but we can do our part to keep them from becoming repeat visitors,” [he added].

Previously: CDC explores potential of using smartphones to collect public health data, Could better alcohol screening during doctor visits reduce underage drinking?, Personality-based approach can reduce teen drinking and The costs of college binge drinking
Photo by Anders Adermark

Parenting, Public Health, Research, Sleep

The high price of interrupted sleep on your health

The high price of interrupted sleep on your health

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As the mother of a 10-month-old, I’m constantly answering the question: Is your son sleeping through the night? And, much to my dismay, I have to repeatedly answer, “No.” So I was interested, and considerably alarmed, to read about new findings showing that interrupted sleep could be as harmful to your physical health as a lack of sleep.

A Time article published today describes the study and the Tel Aviv University researchers’ results:

Students slept a full eight-hours one night followed by a night of interrupted sleep in which they received four phone calls directing them to complete a brief computer exercise before returning to bed. The morning after both nights, the volunteers completed tasks to measure their attention span and emotional state — results proved that just one night of interrupted sleep had negative effects on mood, attention span and cognitive ability.

[Lead researcher Avi Sadeh, PhD,] believes that several nights of fragmented sleep could have long-term negative consequences equivalent to missing out on slumber altogether. “We know that these effects accumulate and therefore the functional price new parents — who awaken three to ten times a night for months on end — pay for common infant sleep disturbance is enormous,” he said in a statement.

In addition to parents with young children, the findings are applicable to people in certain age groups that experience fragmented sleep, as well those with jobs where frequent night wakings are common.

Previously: Stanford expert: Students shouldn’t sacrifice sleep, What are the consequences of sleep deprivation? and Study: Parents may not be as sleep-deprived as they think
Photo by Christina Spicuzza

Cancer, Clinical Trials, Pediatrics, Public Health, Research

Researchers call for broader age limits for cancer trials to increase participation of teenage patients

Researchers call for broader age limits for cancer trials to increase participation of teenage patients

Findings published today in the Lancet Oncology highlight the need to increase the flexibility of age limits for cancer trials so that more teenage patients have access to experimental treatments. “Right now too many of our young patients are needlessly falling through the gap between paediatric and adult cancer trials,” said Lorna Fern, PhD, who led the study and co-ordinates research for the Teenage and Young Adult Clinical Studies Group of the UK-based National Cancer Research Institute.

In the study (subscription required), researchers examined strategies to boost participation of teens and young adults diagnosed with cancer in clinical trials. The study involved 68,275 patients, aged 0-59 years, who were diagnosed with cancer within a five-year window. According to a release:

The study showed [trials designed with broader age limits] led to a 13 per cent rise in 15-19 year old cancer patients taking part in clinical trials between 2005 and 2010 (from 24 to 37 per cent), and a five per cent rise in 20-24 year olds (from 13 to 18 per cent). Children under 14 taking part in trials rose by six per cent (from 52 to 58 per cent).

This rise was due to the increase in availability and access to trials for young people, increased awareness from healthcare professionals, patients and the public about research and importantly the opening of trials with broader age limits which allow older teenagers and young adults to enter trials.

Fern added, “By encouraging doctors to take into account the full age range of patients affected by individual types of cancer, we’ve shown that it’s possible to design trials that include teenage cancer patients and, importantly, that better match the underlying biology of the disease and the people affected.”

Previously: High rates of incarceration among black men could be skewing study results, Stanford researchers examine disparities in use of quality cancer centers and NPR explores the need for improving diversity in clinical trials

Public Health

Another reason to skirt traffic: health risks associated with noise pollution

trafficMapping out a 4th of July weekend adventure, I’m scheduling my drive down the I-5 by counting backward from arrival in time for a 10:30 a.m. yoga class. And, like many Californians, while planning my life around yoga I’m also thinking about alternate driving routes and factoring in time for road congestion. With tomorrow’s commute front-of-mind, I was interested to read about a recent report on the unhealthy effects of noise pollution from traffic – something I hadn’t considered. (But yoga seems like a good return to center following a sympathetic nervous system-stimulating drive.)

Scientists at Chalmers University of Technology in Sweden have recommended strategies to improve urban environments in ways that reduce traffic noise and stress-related health effects such as stroke and heart disease that may be linked with it, according to a release.

More from the release:

Last fall, [Tor Kihlman, PhD,] and [Wolfgang Kropp, PhD,] initiated a meeting between international experts from the automotive industry, universities and government agencies in Innsbruck to discuss technical possibilities to achieve better urban environments.

“Many of the needed measures are ideal for implementation in dense cities. They are often in line with what is required to tackle climate change. Here are double benefits to point to,” says Tor Kihlman, mentioning three examples: the procurement of quiet public transport, reduced speed, and the usage of buildings as as effective noise barriers, through good urban planning.

The new report describes the first steps needed, politically, for society to move towards substantially reduced health effects caused by traffic noise.

Previously: Study shows link between traffic noise, heart attackCan commuting by car or public transit negatively impact your health? and The hazards of sitting in traffic
Photo by Samantha Bilodeau

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