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Cancer, Dermatology, Parenting, Pediatrics, Research

Want teens to apply sunscreen regularly? Appeal to their vanity

tanning_021314When it comes to encouraging teenagers to take measures to reduce their risk of skin cancer, new research suggests parents and health educators should emphasize how ultraviolet light causes wrinkles and other signs of premature aging.

In the study, researchers recruited high-school students and randomly assigned them to two groups. One set of participants watched a health-based video that highlighted skin-cancer risks, while the other group viewed a video focusing on the cosmetic changes due to ultraviolet light. Students completed questionnaires demonstrating their knowledge about ultraviolet light and use of sun-protective behaviors before and after watching the videos. According to a University of Colorado Cancer Center release:

… despite knowing the skin cancer risk from ultraviolet exposure, the group that had watched the health-based video showed no statistically significant increase in their sun-protective behaviors. On the other hand, the group that had been shown the appearance-based video reported a dramatic increase in the use of sunscreen.

“For teenagers, telling them [ultraviolet] exposure will lead to skin cancer is not as effective as we would hope. If our endgame is to modify their behavior, we need to tailor our message in the right way and in this case the right way is by highlighting consequences to appearance rather than health. It’s important to address now – if we can help them start this behavior when younger, it can affect skin cancer risk when older,” [says study co-author April Armstrong, MD.]

Previously: Beat the heat – and protect your skin from the sun, As summer heats up take steps to protect your skin, How ultraviolet radiation changes the protective functions of human skin, Medical experts question the safety of spray-on tanning products and The importance of sunscreen in preventing skin cancer
Photo by David van der Mark


A rare cancer survivor’s journey to thriving and advocating

We’ve partnered with Inspire, a company that builds and manages online support communities for patients and caregivers, to launch a patient-focused series here on Scope. Once a month, patients affected by serious and often chronic diseases share their unique stories. In honor of the upcoming Rare Disease Day (Feb. 28), our latest comes from Tammy Andries of Madison, Wisconsin, a survivor of rare cancer.

When I was first diagnosed with a neuroendocrine pancreatic tumor I didn’t dwell on the fact that I had cancer. With three kids at home, I knew we needed to do all we could to beat the disease. I was 39 years old when I was diagnosed, I had always been healthy, and I knew that God was giving me signs that things were going to be OK. What I didn’t know was that He was giving me an opportunity to meet so many wonderful and caring people over the next eight years of my journey.

Like many others who are diagnosed, I had no signs or symptoms. My cancer was found completely by chance. I went into the emergency room, in a city we didn’t live in, with excruciating pain, and was told I had kidney stones. I was given pain medicine and told that the stones would pass. They never did. Instead, I ended up in another ER (in the city we had just moved to) with doctors doing a CT scan of my abdomen. They found an 8-cm mass on the head of the pancreas and told me to contact my primary care physician to schedule some more tests.

Shortly thereafter I heard those dreaded words, and through all of the tests, procedures and second opinions, I kept seeing signs that things were going to be all right. And so many gifted people were now in my life to help me through the diagnosis, surgery and recovery. The surgeon I had, confident and strong, yet so caring and compassionate. The young intern who sat with me at night and quizzed me on things so that he could present my case during rounds. Having a rare form of pancreatic cancer makes you something of a celebrity.

A few months after my Whipple procedure, I went to a symposium of the Pancreatic Cancer Action Network. It was at that forum that I knew what my next purpose was. I had lived through the frequent trips to the bathroom after meals, the not knowing if the twinges and aches I was now feeling were normal parts of the recovery or not, and the feelings of extreme fullness after having only eaten three bites of a meal, but I couldn’t live with the fact that no one knew much about this insidious disease and that research dedicated to pancreatic cancer lagged so far behind other major cancers. I got involved, and now I’m an advocate for others.

As time passes and the medical appointments get farther apart, I worry a little less. Knowing more about this disease has helped me become more confident in myself, my faith, and my ability to help others faced with the same word I once faced: “You have cancer.”

Tammy Andries is a volunteer and advocate for the Pancreatic Cancer Action Network.

Cancer, NIH, Public Health, Women's Health

Study shows daily aspirin could lower women’s risk of ovarian cancer

Study shows daily aspirin could lower women's risk of ovarian cancer

aspirinA team of researchers at the National Cancer Institute have conducted the largest study to date assessing the relationship between non-steroidal anti-inflammatory drugs and ovarian cancer risk. Their findings show that taking aspirin daily may lower women’s risk of ovarian cancer; however researchers caution that more studies are needed before clinical recommendations can be made.

In the study, researchers examined a dozen previous epidemiological studies that included roughly 8,000 women diagnosed with ovarian cancer and nearly 12,000 women who did not have the disease. According to an NCI release:

The researchers determined that participants who reported daily aspirin use had a 20 percent lower risk of ovarian cancer than those who used aspirin less than once per week. For non-aspirin NSAIDs (non-steroidal anti-inflammatory drugs), which include a wide variety of drugs, the picture was less clear: the scientists observed a 10 percent lower ovarian cancer risk among women who used NSAIDs at least once per week compared with those who used NSAIDs less frequently. However, this finding did not fall in a range that was significant statistically. In contrast to the findings for aspirin and NSAIDs, use of acetaminophen, which is not an anti-inflammatory agent, was not associated with reduced ovarian cancer risk.

This study comes on the heels of Stanford research showing that aspirin use appears to cut the risk of another type of cancer (melanoma) in women.

Previously: Can repackaging aspirin get more people to take it daily for prevention? and New research shows aspirin may cut melanoma risk
Photo by Chaval Brasil

Cancer, Infectious Disease, Pediatrics, Public Health, Research, Sexual Health

Girls don’t have riskier sex after the HPV vaccine

Girls don't have riskier sex after the HPV vaccine

HPV vaccineWhen the first vaccines were introduced against the human papillomavirus, some people worried that this anti-cancer vaccine would give young women the wrong idea. The vaccines, which protect against common cancer-causing strains of HPV, don’t guard against other sexually transmitted infections or unwanted pregnancies. But some parents and physicians thought that vaccine recipients might forgo condoms more often, have more sexual partners or otherwise engage in riskier sexual behaviors than women who were not vaccinated.

However, a study published today in Pediatrics says that’s not the case. According to the new research, young women don’t change their sexual behaviors after receiving the HPV vaccine. The researchers asked more than 300 girls and women, aged 13 to 21, about their risk perception and their sexual behaviors when they received their first dose of the HPV vaccine. They followed the group over time, repeating the questions 2 and 6 months later, when the vaccine’s booster shots were delivered.

“Most participants in this study did not perceive that they had a lower risk for STIs other than HPV, and most believed that safer sexual behaviors were still important,” the study’s authors wrote. Later, they add, “These findings contribute to the growing literature suggesting that HPV vaccination is unlikely to alter sexual risk behaviors in young women.”

I asked Stanford’s Sophia Yen, MD, for her take on the results. Yen provides HPV vaccinations in her role as an adolescent medicine specialist at the Teen and Young Adult Clinic at Lucile Packard Children’s Hospital Stanford. “The findings are not surprising and re-emphasize what other studies have shown,” she told me, adding that she hopes the study will be repeated in males, since boys have now begun receiving the HPV vaccine, too.

In the meantime, Yen plans to continue using this and other scientific evidence to reassure parents about the value of the vaccine. “I hope that the findings of this study and its many other predecessors will become widely known to parents and other non-adolescent medicine specialists who see adolescents, and to policymakers,” she said. “Let’s prevent STDs and cervical cancer together.”

Previously: Study shows racial disparities in HPV vaccination, Packard Children’s adolescent and young-adult specialist offers tips for college-bound students, HPV-associated cancers are rising, HPV vaccination rates still too low, new national report says and Only one-third of teenage girls get HPV vaccine to prevent cervical cancer
Photo by wintersoul1

Cancer, Dermatology, Research, Stanford News

Humble anti-fungal pill appears to have a noble side-effect: treating skin cancer

Humble anti-fungal pill appears to have a noble side-effect: treating skin cancer

anti-fungal pill

Curing cancer isn’t cheap; developing new drugs comes with a multimillion-dollar price tag. Plus, there’s the rigmarole of animal testing, IRB reviews, FDA approval, and so on. What if you could just skip all of that, and get the drug to patients directly and at a lower price than an existing treatment option? You could, if you can successfully recycle a drug that’s already on the shelves at the pharmacy.

A few years ago, Stanford researchers led by Philip Beachy, PhD, got an inkling that a pink-and-blue capsule that removes unsightly toenail fungi also has a secret superpower: It might be able to treat skin cancer. The first set of clinical trials testing the effect of the oral pill, itraconazole, on skin cancer is the focus of a new study published online today.

Led by Stanford dermatologist and senior author Jean Tang, MD, PhD, the study shows proof of itraconazole’s ability to reduce tumor size and spread in patients with basal cell carcinoma, the most common type of skin cancer.

“We are shortcutting the [drug development] process,” says Tang, “by using a drug that’s already been around for 25 years and given to tens of thousands of people.”

From our press release on the study:

Itraconazole, which is prescribed for common fungal infections, kills fungal cells by blocking the production of a vital membrane component. In cancer cells, the drug appears to disable the Hedgehog signaling pathway — a cascade of cellular events triggered by the Hedgehog protein signal that is vital to cell growth and development.

Oral drugs for basal cell carcinoma are rare. These tumors are usually treated through radiation or cut out surgically. But surgery on advanced stage tumors may not always be effective and can greatly scar and disfigure patients.

Tang tested the drug itraconazole on 29 patients with a total of 101 tumors and found that it both blocked the Hedgehog pathway and reduced tumor size at the normally-prescribed anti-fungal dosage. As I describe in the release:

Patients were given itraconazole pills twice a day for a month. Another small group was given a lower dosage of itraconazole for a longer duration (an average of 10 weeks). In the first group, the drug reduced Hedgehog pathway activity by an average of 65 percent and tumor size by 24 percent. Patients in the second group, with lower itraconazole doses, showed similar reductions in tumor size.

And the best part? This medication is several times cheaper than vismodegib, the current and only go-to oral drug for basal cell carcinoma ($20 versus vismodegib’s $250 per day). It can also potentially treat tumors that are immune to vismodegib and other Hedgehog-pathway-blocking cancer drugs, says Beachy.

Ranjini Raghunath is a writing intern in the medical school’s Office of Communication & Public Affairs.

Previously: New skin cancer target identified by Stanford researchers, Funding basic science leads to clinical discoveries, eventually, Studies show new drug may treat and prevent basal cell carcinoma and Common drug might help prevent skin cancers
Photo by Worak

Cancer, Research, Stanford News, Surgery

Chemistry technique improves cancer surgery

Chemistry technique improves cancer surgery

mass spectrometer

For many cancers of the stomach and intestinal tract, removing the tumor is the best way of treating a patient. The problem is that the cancerous cells don’t necessarily look any different from the normal cells. I wrote recently about a new technique to pick out those cancerous cells and help surgeons completely remove the tumor.

What’s fun about this story is that the idea started with a chemist, Livia Eberlin, PhD, who’s a post-doc in lab of chemistry professor Richard Zare, PhD. Zare is a member of Stanford’s Bio-X and from that has experience working with colleagues across campus. He suggested to Eberlin that she find a surgeon who would be willing to collaborate with her and test her approach to identifying the cancerous cells.

Eberlin knew that surgeons rely on pathologists during a surgery to help them figure out if they’ve removed the entire tumor, but the initial results aren’t always accurate. In some cases, pathologists find out days later, when results of a slower, more accurate test are complete, that the patient might need to come back for another surgery to remove more tissue.

Eberlin called up surgeon George Poultsides, MD, to see if he’d like to collaborate on her idea. As I wrote in my piece:

Eberlin’s expertise is in mass spectrometry, a tool not commonly used in a hospital setting. It takes a sample in one end, turns the molecules into charged particles, then detects how long it takes each charged molecule in that sample to migrate down a vacuum tube. The result is a jagged mountain range of tens of thousands of peaks, each representing a single chemical in the sample. The height of the peak indicates how much of that chemical the sample contained.

The idea was that maybe some of those peaks would be different in tissue samples that had cancerous cells versus those that didn’t. If it worked, this mass spectrometry approach might end up being more accurate than the approach being used now.

It took a team of statisticians, pathologists, surgeons and chemists to develop and test Eberlin’s idea. In the end, their approach seemed to be more accurate than what’s being used now. They are going to try their approach on a larger group of stomach cancers and in other cancers to see if it can help improve the odds of completely removing all cancerous cells during surgery.

Previously: Good-bye cancer, good-bye stomach: A survivor shares her tale
Photo – of Livia Eberlin, PhD, at a mass spectrometer used to identify cancerous cells in tissue samples – by L.A. Cicero

Cancer, Neuroscience, Patient Care, Stanford News

A Stanford physician’s take on cancer prognoses – including his own

In a New York Times SundayReview piece, Paul Kalanithi, MD, a chief resident in neurological surgery at Stanford, describes cancer prognoses from two perspectives, both his own. The 36-year-old doctor writes about reading scans to help colleagues decide if surgery is the right course of treatment for certain brain-cancer cases. He details the important and difficult job of facing patients who ask questions about their chance of survival. Kalanithi also reveals what he learned about the question and answer processes since he was diagnosed with cancer eight months ago, and how he’s learned to live with conviction despite a prognosis of uncertainty.

From the piece:

For a few months, I’d suspected I had cancer. I had seen a lot of young patients with cancer. So I wasn’t taken aback. In fact, there was a certain relief. The next steps were clear: Prepare to die. Cry. Tell my wife that she should remarry, and refinance the mortgage. Write overdue letters to dear friends. Yes, there were lots of things I had meant to do in life, but sometimes this happens: Nothing could be more obvious when your day’s work includes treating head trauma and brain cancer.

But on my first visit with my oncologist, she mentioned my going back to work someday. Wasn’t I a ghost? No. But then how long did I have? Silence.

The path forward would seem obvious, if only I knew how many months or years I had left. Tell me three months, I’d just spend time with family. Tell me just one year, I’d have a plan (write that book). Give me 10 years, I’d get back to treating diseases. The pedestrian truth that you live one day at a time didn’t help: What was I supposed to do with that day? My oncologist would say only: “I can’t tell you a time. You’ve got to find what matters most to you.”

Previously: Both a doctor and a patient: Stanford physician talks about his hemophilia, A patient’s journey with lung cancerBig data = big finds: Clinical trial for deadly lung cancer launched by Stanford study, Red Sunshine: One doctor’s journey surviving stage 3 breast cancer, Cancer survivor: The disease isn’t a “one-off, one-shot deal” and When the journalist becomes the patient

Cancer, Stanford News

Saying thank you with art: Stanford undergrad pens one-woman play on cancer

Saying thank you with art: Stanford undergrad pens one-woman play on cancer

Camille face painting

These days, most people say “thank you” with a quick e-mail or text. If they’re really grateful they may (gasp!) hand write a note. Stanford senior Camille Brown wrote a one-woman play.

Brown is a science, technology and society major and has penned and performed “Seeing the Spectrum,” a series of intimate monologues telling the story of Camp Kesem at Stanford – a summer camp for the children of cancer patients – from the campers’ perspective. Brown has volunteered with the student-run camp for her entire college career, and during that time she has counseled, hugged, face-painted and sat quietly with countless children facing the reality of a parent with cancer.

It’s a reality Brown knows all too well. The day she graduated high school her family learned of her mother’s diagnosis with Stage 3 colon cancer. Brown’s entire Stanford experience has been colored by cancer and, remarkably, she’s focused on her gratitude. Not for the cancer, of course, but for her Camp Kesem community, from which she says she’s received far more than she’s given.

So, as she approaches her final year of camp (only undergrads can be counselors) she created “Seeing the Spectrum,” with support from a Spark! grant from the Stanford Arts Institute, as her unique and lasting expression of appreciation.

I sat down with Camille Brown on the morning before her first performance – a very special private show for Camp Kesem counselors, campers and families. Here is part of our conversation.

Tell me about your play.

“Seeing the Spectrum” is a collection of eight monologues based on interviews I conducted with 15 Camp Kesem campers about their experiences with their parent’s cancer and with camp. Each monologue is fictionalized to preserve anonymity, and some are composites of two or more interviews.

The idea is to help people outside the program understand the enormous impact that Camp Kesem has on the lives of the campers and their families. For these children it is very important that they have a week that is more than bereavement counseling, but rather is a week of friends, water fights and silliness, because they are going through situations that essentially don’t let them be kids anymore. And Kesem is more than just the week of camp; these kids gain a year-round community.

What inspired you to create it?

I work at the Stanford Humanities Center and they assigned me to write an article about Anna Deavere Smith’s 2012 guest lecture on grace. She explained her process of basing her monologues on interviews. She picks a topic and then talks to a number of people to get multiple perspectives. While working on the article it occurred to me that Camp Kesem would make a great subject.

What has working with Camp Kesem meant to you?

I was initially terrified to do it, because I worried that if I became involved as a counselor I would be projecting my feelings about cancer onto the campers, and it would be a horrible experience for everyone. But in fact, the more work I have done with camp, the more I have just been able to fall in love with the kids and feel that I am combating this frustrating force of cancer in my life by helping to give them a chance to handle it. I actually feel a little bit selfish because the kids are like my therapy. They are so resilient – some going through situations worse than my own – and I feel that I have been able to learn more about myself by trying to be selfless for them.

Continue Reading »

Cancer, Pediatrics, Public Health, Research

Questioning whether physicians are equipped to care for childhood cancer survivors

Questioning whether physicians are equipped to care for childhood cancer survivors

You’ve likely seen the headlines today that Americans’ risk of dying of cancer has declined 20 percent over the past two decades. The encouraging drop in deaths from cancer has translated into a growing population of survivors of the disease, particularly among children. But recent findings question whether the physician community is prepared to provide care for young cancer survivors when they reach adulthood.

In the study (subscription required), researchers surveyed more than 1,100 general internists and inquired about their knowledge of the special medical needs, such as  increased screening, of these patients. HealthDay reports:

Between 25 percent and 37 percent said they would be at least “somewhat comfortable” caring for a childhood cancer survivor. Their responses varied based on the type of cancer the patient had, the researchers reported.

When asked about screening guidelines for childhood cancer survivors, most physicians did not know the guidelines well enough to make an appropriate recommendation for their patients.

Only 9 percent understood that women exposed to chest radiation as children need annual mammography and breast MRI scans. More than 40 percent said they weren’t sure of the guidelines.

Just 15 percent knew that childhood chemotherapy patients need an echocardiogram every other year to check for heart problems. More than half said they would not proceed with further echocardiograms, and another 19 percent said they weren’t sure of the guidelines.

To increase internists’ knowledge about this patient population, researchers encouraged doctors to spend time working at a cancer survivor’s program, and advised pediatric oncologists to educate patients on the necessary medical information needed by their future physicians and to partner with patients’ adult health-care providers to improve transition of care.

Beyond cancer, the United States has become a nation of survivors – many of whom have unique health needs. As reported in a past issue of Stanford Medicine, in addition to those who have beaten cancer, one in 45 adults has survived a stroke and hundreds of thousands survive a heart attack each year.

Previously: Cancer survivor: The disease isn’t a “one-off, one-shot deal”, Report forecasts U.S. cancer survivors to increase to 18 million in a decade, Helping kids love life after cancer and Surviving pediatric brain cancer

Cancer, Stanford News, Stem Cells

Stanford among the beneficiaries of major gift from Ludwig Cancer Research

Stanford among the beneficiaries of major gift from Ludwig Cancer Research

Daniel K. Ludwig was a reclusive, self-made billionaire and a friend of President Richard Nixon who took the president’s “War on Cancer” to heart. In his will, Ludwig left his entire fortune to cancer research. Now, the New York-based Ludwig Cancer Research is announcing one of the largest gifts ever made to cancer by an individual donor: $540 million to be shared by six leading cancer centers nationwide.

The beneficiaries include the Ludwig Center for Cancer Stem Cell Research and Medicine at Stanford, which will receive $90 million to spur its innovative work on cancer stem cells, which are believed to drive the growth of many cancers. The center, founded in 2006, has received $150 million from Ludwig Cancer Research to date.

Irving Weissman, MD, the center’s director, said Ludwig was willing to invest in cancer stem cells at a time when there was great controversy in the medical community about the role of these cells – and whether they existed at all.

“The Ludwig was absolutely critical to taking this very high-risk research into a real and rapid understanding of cancer cells,” said Weissman, the Virginia and D.K. Ludwig Professor for Clinical Investigation in Cancer Research at Stanford. As a result of the Ludwig support, he said, “We have taken many of our understandings of cancer stem cells into potential therapeutics.”

Weissman and his colleagues at the Ludwig center have discovered that virtually all human cancers express a protein known as CD47, which functions as a “don’t-eat-me-signal” to fend off potential attacks from the immune system. They have developed an antibody against CD47 which has been shown to attack a wide range of solid tumors. The scientists plan to begin a clinical trial in early 2014. They also plan to test it in combination with other antibodies to see if there is a synergy that will make it even more effective, Weissman said.

With Ludwig support, Weissman is also moving forward with clinical trials with a therapy that could dramatically improve survival rates for women with metastatic breast cancer. The innovative approach was tested more than 15 years ago in a small group of women, 33 percent of whom are still alive and well. With the standard treatment, the survival rate after 15 years is just 7 percent, Weissman said. The trial was discontinued by the sponsoring company but with Ludwig support, Weissman and his colleague, Judith Shizuru, MD, an associate professor of medicine, have obtained the rights to the process and plan a larger trial in 2014. “We need urgently to take this forward,” he said.

Previously: Single antibody shrinks or eliminates human tumors in mice at Stanford and Cancer stem cell researchers are feeling the need for speed
Photo of Irving Weissman in featured entry box by Flynn Larsen

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