Published by
Stanford Medicine

Category

Stanford News

Cancer, Dermatology, Public Health, Stanford News

Melanoma rates exceed lung cancer in some areas

Melanoma rates exceed lung cancer in some areas

stinson_beach
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, Cali. 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

Patient Care, Stanford News, Videos

More on the Navy pilot with mysterious symptoms – and the Stanford doctors who diagnosed him

More on the Navy pilot with mysterious symptoms - and the Stanford doctors who diagnosed him

Last week, we blogged about a Navy pilot whose mysterious symptoms were diagnosed by clinicians here. A just-published Stanford Hospital video shares more of Robert Buchanan’s compelling story.

Previously: Medical mystery solved: Stanford clinicians identify source of Navy pilot’s puzzling symptoms

In the News, Pain, Patient Care, Research, Stanford News

More attention, funding needed for headache care

More attention, funding needed for headache care

In case you missed it, the San Francisco Chronicle ran a story over the weekend on migraines – and researchers’ ongoing search for a cause and universal treatment. Robert Cowan, MD, director of the Stanford Headache Clinic, was one of the people featured and told writer Stephanie M. Lee:

Headache care is 50 years behind things like diabetes and cancer… It just hasn’t had the attention, hasn’t had the funding, in order to get to the answers we need.

Previously: Director of Stanford Headache Clinic answers your questions on migraines and headache disorders and New Stanford headache clinic taking an interdisciplinary approach to brain pain

In the News, Stanford News

A curated selection of news from Dean Lloyd Minor

A curated selection of news from Dean Lloyd Minor

What should you be reading today? Over on OZY’s Presidential Daily Brief, Lloyd Minor, MD, dean of the medical school, points readers to some of the most interesting stories in medicine, bioscience and beyond. Among his picks as guest curator are a recent Atlantic article on creativity and a Guardian piece on hill climbing. Of the latter he writes:

Climbing and walking in the hills provides beneficial exercise, relaxation and renewal. Hope Whitmore, a writer living outside Edinburgh, Scotland, describes her journeys as well as her struggles with rheumatoid arthritis. As someone who loves to walk two dogs in the foothills of the Santa Cruz Mountains, I can certainly relate to Whitmore’s description of her evening walks as “a healing, a cleansing of the soul, drawing a line between the workaday world and the night time.”

Previously: A closer look at Stanford medical school’s new dean

Ethics, Events, Health Policy, Stanford News, Transplants

How can we end the donor organ shortage?

How can we end the donor organ shortage?

organ donorOur country’s organ shortage is an issue of critical importance – especially to the more than 100,000 Americans currently waiting for an organ transplant. In the words of Stanford’s Keith Humphreys, PhD, “Everyone agrees that 18 people dying each day on transplant waiting lists is unacceptable, but there is fierce disagreement about what to do about it.”

Next week, Humphreys will moderate a panel discussion that delves into the issue. He’ll be joined by three experts – including Stanford bioethicist David Magnus, PhD – who will discuss the effect of the organ donation on our country’s overall health and debate the ethical and practical aspects of proposals to solve the problem. Among the most controversial proposed approach and something that will be vigorously debated: paying people to donate their organs.

The event, part of Stanford’s Health Policy Forum series, will be held on July 28 at 11 AM at the Li Ka Shing Center for Learning and Knowledge, in room LK130. For those local readers: It’s free and open to the public, but space is limited. More information can be found on the forum website.

Previously: Students launch Stanford Life Savers initiative to boost organ donation, Full-length video available for Stanford’s Health Policy Forum on serious mental illness, Stanford forum on the future of health care in America posted online and Stanford Health Policy Forum focuses on America’s methamphetamine epidemic
Photo by Mika Marttila

Global Health, Nutrition, Research, Stanford News

Stanford researchers address hunger in new book on food security

Stanford researchers address hunger in new book on food security

riceA piece from Stanford’s Freeman Spogli Institute for International Studies notes how experts across campus are working together to address the complex global problem of hunger. A new book, The Evolving Sphere of Food Security (Oxford University Press, August), discusses the problem from numerous perspectives, including medicine, in its 14 chapters. The book’s editor, Rosamond Naylor, PhD, is director of the Center on Food Security and the Environment, which is housed jointly within the FSI and the Woods Institute for the Environment.

From the piece:

“This book grew out of a recognition by Stanford scholars that food security is tied to security of many other kinds,” said Naylor, who is also William Wrigley Senior Fellow at the Freeman Spogli Institute for International Studies and the Stanford Woods Institute for the Environment. “Food security has clear connections with energy, water, health, the environment and national security, and you can’t tackle just one of those pieces.”

Stanford has a long history of fostering cross-disciplinary work on global issues. It is in this spirit that the idea for the book was born, Naylor said. The book weaves together the expertise of authors from the fields of medicine, political science, engineering, law, economics and climate science.

A recurring theme throughout the book – also reflected in its title – is the evolving nature of the food security challenges countries face as they move through stages of economic growth. At low levels of development, countries struggle to meet people’s basic needs. For example, Naylor’s chapter on health, co-authored with Eran Bendavid [MD] (medicine), Jenna Davis [PhD] and Amy Pickering [PhD] (civil and environmental engineering), describes a recent study showing that poor nutrition and rampant disease in rural Kenya is closely tied to contaminated, untreated drinking water. Addressing these essential health and sanitation issues is a key first step toward food security for the poorest countries.

Previously: Seeking solutions to childhood anemia in ChinaWho’s hungry? You can’t tell by lookingCould a palm oil tax lower the death rate from cardiovascular disease in India? and Foreign health care aid delivers the good
Photo by Thomas Wanhoff

Events, Medicine and Society, Stanford News

On death and dying: A discussion of “giving news that no family members want to hear”

On death and dying: A discussion of "giving news that no family members want to hear"

The standing room only crowd at the Stanford Humanities Center had come to hear physicians read their own writing about the most difficult of topics: “I Am Afraid I Have Bad News: Death and Dying in Medicine.” The enthusiastic response to the topic demonstrated the interest in and need for such a forum. “This is a topic we just don’t talk about enough, in medicine and in society,” said Ward Trueblood, MD, a member of Stanford’s Pegasus Physician Writer’s group who curated the event.

Trueblood’s own experiences as a trauma surgeon, particularly during the Vietnam War, affected him deeply. “When I went to medical school, they didn’t teach you about death and dying,” he explains. Trueblood has found writing to be a powerful way to process his experiences. His memoir, Blood of the Common Sky: A Young Surgeon in Vietnam, will be published this year, and his book of poetry To Bind Up Their Wounds is available on Amazon. Trueblood appreciated being able to give fellow physicians an opportunity to share their experiences with death and dying through personal poetry and essays.

Gregg Chesney, MD, a critical care fellow, read two poems, including “Lost in Translation”:

In trying to explain how “she hit the floor with a thud”

now means “she never woke up

and never will,” something was lost.

Yes, that is her heart tracing its beat across the monitor, but that swollen tangle

of blood, wrapped and knotted at the base of her brain

has pressed the leafless stalk of her medulla and left her

brain dead.  There is no one-more-test, no

chance-for-recovery, but at 2am, rendered in secondhand Mandarin,

that point might be missed, or left to dangle precariously,

soured and unplucked,

as he works out how to raise a 3 year-old on his own.

As Chesney finished the poem, his six-month old son cooed in his mother’s arms. The irony of the moment was not lost on the audience, as they contemplated the fate of the young father in Chesney’s poem.

Bruce Feldstein, MD, Stanford’s hospital chaplain, read “At My Father’s Bedside,” in which he shared what he had learned from his patients with his dying father:

The moment itself is peaceful, I’m told. No fear. Simply letting go. Smooth, like a hair being pulled from milk… You know, we human beings have been dying for a long time. Your body has a natural wisdom built right in for shutting itself down. The body knows just what to do. And there are medicines along the way to keep you comfortable.

During the Q&A session, an audience member asked Feldstein if there was anything he wished patients knew about their physicians. “Yes, how much doctors care,” Feldstein responded. “And that this effects them too. How difficult it can be to be the medical professional in that instance, giving news that no family members want to hear about their loved one.”

Continue Reading »

CDC, Nutrition, Pediatrics, Public Safety, Research, Stanford News

“Happy Meal ban”: Where are we now?

"Happy Meal ban": Where are we now?

MuppetBabiesA newly released Centers for Disease Control report of a study conducted at Stanford has examined the effects of San Francisco’s 2010 “Happy Meal ban.” The ban prohibited the free distribution of toys with unhealthy meals; the fast-food restaurants McDonald’s and Burger King instead sold the toys for 10 cents. Though neither restaurant complied with the ordinance’s specific calls for changes in nutritional content, improvements have been made.

As reported by SFGate.com:

…over the study’s two-year period, McDonald’s in particular made big changes to its Happy Meals, said [Jennifer Otten, MD,] of the University of Washington School of Public Health — first in California, then nationally.

The fast food giant cut the amount of French fries it serves in Happy Meals in half, replacing them with apples; stopped serving caramel sauce with apples; and began offering nonfat chocolate milk to customers. Otten said those substitutions were “pretty dramatic,” — they reduced the calories in a Happy Meal by 110, and cut the sodium and fat content of the meal as well.

Otten and her colleagues, including senior author Abby King, PhD, concluded in the study, “Although the changes…  did not appear to be directly in response to the ordinance, the transition to a more healthful beverage and default side dish was consistent with the intent of the ordinance. Study results… suggest that public policies may contribute to positive restaurant changes.”

Previously: How fast-food restaurants respond to limits on free toys with kids’ meals, Toying with Happy Meals, How food advertising and parents’ influence affect children’s nutritional choices and Living near fast food restaurants influences California teens’ eating habits
Photo by Ursala Urdbeer

Health Disparities, LGBT, Mental Health, Patient Care, Stanford News

Stanford med student discusses his documentary on LGBT vets’ health

Stanford med student discusses his documentary on LGBT vets' health

doublelifeWhen Stanford anesthesiologist Audrey Shafer, MD, welcomed attendees to a screening of “The Camouflage Closet“ on campus recently, she noted the artistic accomplishments and service work of the film’s director, Michael Nedelman. (And also mentioned he was “a Stanford medical student in his spare time.”) Nedelman, who will be entering his third year here, conducted a project with nine LGBT veterans, all patients at the Veterans Affairs Palo Alto Health Care System, exploring their experiences of trauma and recovery.

Nedelman and his collaborators engaged in a community-based participatory method of film-making, allowing participants to tell their stories through art as a path toward empowerment. The participants were provided with cameras to document their stories; they also had a say in the editing process. And while the project was neither officially sanctioned research nor therapy, many of the participants found the process therapeutic. Christine Stout-Holmes said this in the film about sharing her story:

It’s healing. It makes me feel like, “Hey, I don’t have to be agoraphobic.” “Hey, I don’t have to isolate.”

Of course, I feel fists beating me on my back, but I know that that’s not now. And I know that what I’m doing now is going to benefit clinicians, and vets, and hopefully artists, and young girls to know that every story is important.

Since the film’s premiere last June, it has screened at the National Queer Arts Festival, the 31st annual Gay and Lesbian Medical Association conference, and at universities, film festivals and VA hospitals across the U.S. and in Mexico.

Below, Nedelman answers questions about his work.

You have a BA in film studies from Yale. How did you decide to attend med school, and have your interests in art and medicine always intersected?

It took me a while to understand exactly how my interests in art and medicine intersected, but it turned out they had a common ancestor in my love of story.

A few years out of college, I was working at Mount Sinai in New York City on both clinical research and documentary film studies. Whether or not there was a camera in the room, I loved hearing people’s stories, and turning those stories into something meaningful. But in a medical context, I also saw the opportunity to get involved in these stories – to reach past the lens and make a tangible difference.

Combining the two wasn’t really a new concept, though. My first major work in college was a photography project addressing preventable blindness in South India. As with “The Camouflage Closet,” I loaned out cameras to rural vision clinic patients who were able to document their restored sight through images that were important to them. But I had no idea that hyphenating doctor-filmmaker was even an option until I discovered, and later met with, filmmakers like Maren Grainger-Monsen, MD, and Gretchen Berland, MD. Something clicked when I figured out that patient care and digital media could go hand-in-hand.

What are some of the issues faced by this population that you’re most interested in exploring through storytelling?

Some of the issues I found most compelling are not just the unique challenges faced by some individuals (e.g. witch hunts of the pre-DADT – “Don’t Ask, Don’t Tell” – era, increased rates of military sexual trauma, barriers to accessing care), but also the creativity and strength that come from their recovery narratives. Alongside some of the heavier moments in the film, there’s some humor, too. I think I personally learned a lot from the veterans’ resilience, and how their pride – for being LGBT, and for being veterans – factors into their personal growth.

What do you hope viewers will take away from your film?

I hope viewers will come out of the film with a desire to learn more about the unique challenges, types of trauma, and sources of resilience among a previously silenced community. I think there’s a lot to identify with in the film, whether or not you identify as LGBT or a veteran, and there’s a lot to be said for turning empathy into action. This is partly why we also created an accompanying educational resource that summarizes previous research, evidence-based suggestions for culturally relevant care, and resources for clinicians and veterans.

The veterans were excited that clinicians and providers would see and learn from their work. But at the end of the day, I wonder if some of them might have answered this question a little differently. Something we often heard among the vets was, “Even if just one other veteran out there sees this and knows they aren’t alone, we’ve accomplished what we came here to do.”

Previously: Documentary on LGBT veterans’ PTSD, trauma and recovery premieres tomorrow and Photography and storytelling may help poor women with HIV cope with their illness
Film still from “The Camoflauge Closet” courtesy of Michael Nedelman

Stanford Medicine Resources: