11 ANSWERS TO TOUGH QUESTIONS ABOUT LIVER CANCER

Liver cancer, one of the more preventable diseases, rises for non-Asians living in Los Angeles County.The Los Angeles Cancer Surveillance Program (CSP), a state-mandated database managed by the Keck School and the USC Norris Comprehensive Cancer Center, provides scientists everywhere with essential statistics on cancer

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Newswise, August 22, 2016In the past four decades, liver cancer rates have more than doubled among non-Asians living in Los Angeles County, according to a recently released report card administered by USC.

The increase is also reflected among the county’s Asian-Americans.

For some perspective, in the seven years between 2005 and 2012, liver cancer rates increased by 33 percent among white men and by 21 percent among Latino men. The increase was more modest with women in these groups — partially because liver cancer is more common in men.

While Vietnamese are the most likely ethnic group to be diagnosed with the disease, between 2005 and 2012, liver cancer rates actually dropped. The decrease was 1.3 percent among Vietnamese men and 8.7 percent for Vietnamese women.

The data comes from “Cancer in Los Angeles County: Trends by Race/Ethnicity 1976-2012.” Released on Aug. 15, the book is based on all cancers diagnosed among Los Angeles County residents over the past 37 years — more than 1.3 million cases.

Each year about 16,000 men and 8,000 women die from liver cancer in the United States, according to the Centers for Disease Control and Prevention.

V. Wendy Setiawan, assistant professor of preventive medicine at the Keck School of Medicine of USC, is an expert in cancer epidemiology. She shares her thoughts on the deadly but often preventable malady.

Q: Why is liver cancer on the rise among whites in L.A. County?

VWS: We know that chronic hepatitis C is a major risk factor for liver cancer in whites. We are seeing the rise because of the elevated prevalence of hepatitis C infection among white baby boomers who used illicit drugs in the ’60s and ’70s. The increasing number of people who are overweight/obese and/or diabetics have also contributed to this trend.

Q: Why is liver cancer becoming more prevalent among Latinos?

VWS: Liver cancer is becoming more common in Latinos because obesity and metabolic syndrome [diabetes] — important risk factors for liver cancer — have become a big problem in this population. Public health efforts to prevent and control diabetes and obesity in this population may reduce the liver cancer burden. Lifestyle changes are advisable.

Q: Why are immigrants from East Asia and Southeast Asia at higher risk of liver cancer?

VWS: In most Asian countries and for immigrants from these countries, liver cancer is mainly due to chronic hepatitis B infection. Vietnamese, for example, have the highest liver cancer rates in L.A. County. Studies have shown that the prevalence of hepatitis B virus carriers is quite high among Vietnamese.

Fortunately, hepatitis B infection can be prevented; the hepatitis B vaccine is safe and highly effective. With the implementation of this vaccination program in newborns, the rate of liver cancer has been declining in high-risk Asian countries. We expect the rate of hepatitis B-related liver cancer will continue to decline.

Q: How is coffee a protective agent against liver cancer? How much coffee should someone drink for this protective effect?

VWS: There are thousands of compounds in coffee. The most studied compounds in relation to liver function and disease are caffeine, diterpenes and chlorogenic acids, but the exact constituents that protect against liver cancer are still unknown. A recent World Health Organization report showed that coffee drinkers’ risk of liver cancer decreases 15 percent for each cup they drink per day.

In my study, we compared coffee drinkers to non-coffee drinkers. People who reported drinking two to three cups of coffee per day had a 38 percent drop in liver cancer risk. For those who drank four or more cups daily, their risk of developing liver cancer dropped by 41 percent. We mainly observed the beneficial association with caffeinated coffee, not with decaf tea, tea [green/black] or soda.

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Anthony El-Khoueiry, chair of the Clinical Investigations Support Office at the USC Norris Comprehensive Cancer Center and an associate professor of clinical medicine at the Keck School, is known nationwide for his clinical research on liver cancer. He answers some important questions about the disease.

Q: Why do men tend to have higher liver cancer rates than women?

AEK: There is no clear answer. Scientists are looking at the role of hormones. One hypothesis is that estrogen has a protective effect on women, especially in the premenopausal years, but that alone cannot explain everything. Some studies in laboratory animals also suggest that androgen male hormones may contribute to the risk of liver cancer.

Q: Long-term alcohol abuse increases the risk of liver cancer. At what consumption level does alcohol become a serious risk factor?

AEK: Hepatologists usually say an average of three alcoholic drinks a day or higher puts people at high risk for cirrhosis, where healthy liver tissue is replaced with scar tissue. Cirrhosis could lead to liver cancer.

Q: Should people who have liver cancer abstain from alcoholic beverages?

AEK: This is a poorly studied area. Continuing alcohol consumption may not impact the behavior of the cancer itself; however, it could negatively impact underlying liver function, which could in turn prevent oncologists from being able to treat tumors properly. It would be best to discontinue alcohol consumption if one has liver cancer in order to minimize the ongoing insult to the liver and prevent added pressure on the already compromised liver function.

Q: What is causing the drastic increase of liver cancer cases?

AEK: Scientists believe hepatitis C and obesity, along with diabetes, are the main causes for the increasing rates of liver cancer. Obesity and metabolic syndrome — characterized by abdominal obesity, diabetes, high blood pressure or high cholesterol — are established risk factors of liver cancer. Metabolic syndrome could lead to non-alcoholic steatohepatitis (inflammation in the liver along with fat deposition), which can lead to cirrhosis and liver cancer.

These are relatively recent observations, so therapeutic interventions to lower liver cancer risk have not been fully established. One could, of course, follow common sense: lower weight, have a healthy diet, exercise regularly to prevent metabolic syndrome.

Q: What preventive measures can be taken?

AEK: The risk factors for liver cancer are alcohol, hepatitis B and C, autoimmune hepatitis or any continuous inflammation of the liver that leads to cirrhosis.

• Avoid excessive intake of alcohol.
• Get the hepatitis B vaccination.
• Avoid dangerous behavior that increases the risk of hepatitis C: sharing needles or syringes, multiple sex partners, unsafe sex with infected individuals.
• Get FDA-approved treatments for hepatitis C.
• If you know that you have any form of chronic liver disease, it is important to see a liver specialist [hepatologist] and have routine surveillance to catch cancer early. Surveillance includes liver ultrasound and a blood test for a tumor marker known as alpha fetoprotein.

Q: How important is early diagnosis?

AEK: If the disease is caught early, then you can cure it. Surveillance for people who have chronic liver disease is helpful to catch small tumors early. The chances of cure are much higher when the cancer is early (no more than 3 tumors and less than 3 centimeters in maximum size). The two main treatments that provide a cure include liver transplant and surgery to remove the tumor.

Q: Have there been any breakthroughs in treatment?

AEK: The challenge in the treatment of liver cancer is that doctors have to balance the cancer and the underlying liver disease and cirrhosis. Patients do better with liver cancer when they are treated by a multidisciplinary team of doctors that includes different specialties. At USC, any patient with liver cancer is reviewed at a multidisciplinary tumor board to make a joint and comprehensive plan that maximizes the patient’s chances.

Historically, we have had limited treatment options for patients with advanced liver cancer who are not candidates for surgery or liver transplant. Things are changing rapidly in this area thanks to new research and clinical trials. One of the exciting areas that is showing promise is using drugs that stimulate the patient’s own immune system to recognize and fight the cancer. USC has played a leading role in the early studies to evaluate this approach, which is now showing good promise and is being studied in large, international clinical trials.

Eight Years Old and Growing Fast: DIAN Is Becoming an Alzheimer’s Movement

Newswise, August 22, 2016 — When the Dominantly Inherited Alzheimer’s Network started in 2008, there were questions about whether it could succeed. It did.

At eight years old, DIAN has fully enrolled its first therapeutic trial and more trials are in planning stages, and its observational cohort study is producing longitudinal data for a quantitative prediction model of Alzheimer’s disease progression.

Underpinning the science is a growing international community of families who support each other with warmth and considerable spunk as they navigate both the disease and their intensive research participation to beat it. In a five-part series, Gabrielle Strobel takes the movement’s measure.

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EXPERT ANSWERS 7 QUESTIONS ABOUT MELANOMA

While the deadly skin cancer has risen nationally for more than 30 years, its growth in Los Angeles County has slowed.

The Los Angeles Cancer Surveillance Program (CSP), a state-mandated database managed by the Keck School and the USC Norris Comprehensive Cancer Center, provides scientists everywhere with essential statistics on cancer.

Newswise, August 22, 2016 — The melanoma rate among white women living in Los Angeles is declining for the first time in 37 years, according to a new cancer report card administered by USC.

Between 2005 and 2012, white women experienced a 4 percent decrease in the rates of melanoma diagnoses. Latina, Filipina and Chinese women also experienced a slight decrease.

In comparison, the proportion of white male Angelenos developing the malignant form of skin cancer has slowed but is still on the rise, as has been the case since 1976. Between 2000 and 2005, their melanoma rate rose by 15 percent. Seven years later, the rate of increase was only 4 percent.

This data comes from “Cancer in Los Angeles County: Trends by Race/Ethnicity 1976-2012.” Released on Aug. 15, the book is based on all cancers diagnosed among Los Angeles County residents over the past 37 years — more than 1.3 million cases.

Melanoma accounts for only 1 percent of skin cancers, yet it is the reason for the majority of skin cancer deaths. Most people affected by the disease are white. Those who are fair-skinned and burn easily or individuals with a large number of moles are at higher risk.

One in 50 whites, 1 in 200 Hispanics and 1 in 1,000 blacks develops melanoma. Thus, whites are at higher risk of developing melanoma.

In 2016, California is expected to have the most cases of melanoma (8,560), according to the American Cancer Society. Florida comes in a distant second (6,200), followed by New York (4,250).

Ashley Wysong, assistant professor of clinical dermatology and director of Mohs (a relatively new surgical technique) and dermatologic surgery at the Keck School of Medicine of USC, shares her expertise and provides skin care advice.

Q: Why have melanoma rates doubled between 1982 and 2011?

AW: In fact, there has been a 619 percent increase since 1950. The majority of melanoma cases can be explained by a combination of genetics and ultraviolet exposure from the sun as well as artificial UV through tanning beds.

We also are seeing a worrisome increase in melanoma rates among adolescents and young adults.

Q: Why have skin cancer rates among Hispanics risen by almost 20 percent?

AW: Skin cancer is not just a problem for people with fair skin. Because skin cancer often is not of concern in patients with skin color, we often see delays in diagnosis and treatment, with associated higher rates of morbidity and death.

The cumulative effects of UV over a lifetime are associated with increased rates of most skin cancers. Efforts are being made to educate Latino, Asian, black, Native American and other ethnic communities about the importance of skin self-examination and skin cancer screening.

Q: If people are more likely to use SPF and have a better skin care regimen now compared to the 1970s, why are melanoma rates rising?

AW: The most common mistakes people make when applying sunscreen is:

• not picking the appropriate sunscreen
• not applying enough sunscreen
• not reapplying often enough

When choosing a sunscreen:

• Individuals should look for sunscreens labeled as “broad spectrum,” which means that they have both UVA and UVB protection.
• The sunscreens should be at least SPF 30.

When applying sunscreen lotion, you typically need to apply generously (a golf ball-sized amount) to the entire body. Sunscreen should be reapplied every two hours and after swimming or significant sweating.

To be honest, most people find it difficult to follow these recommendations for various reasons, myself included! Because of this, I often recommend to my patients to avoid sun exposure during peak UV hours of 10 a.m. to 4 p.m. and to invest in wide-brimmed hats, UV sunglasses and photoprotective clothing. Many clothing brands have started carrying UPF clothing (UPF is similar to SPF) that is comfortable, breathable and easy to wear.

Q: Melanoma is the deadliest type of skin cancer. What happens when it is caught early?

AW: When caught in the early stages, melanoma very rarely goes outside of the skin and is highly curable. Your dermatologist or dermatologic surgeon could surgically remove the cancer using local anesthesia.

Q: If I’m a redhead or if I freckle easily, should I be on high alert about skin cancer?

AW: Redheads, blondes and people that freckle easily often have less natural protection from the sun. Melanin, the natural UV protection found in the top layer of the skin, is present in lower amounts in light-skinned and light-haired individuals. Because of this, redheads, blondes and individuals that freckle easily have to be even more careful in the sun.

Q: How safe is tanning and the ointments used to tan?

AW: There is no such thing as a “safe” tan. Both baby oil and tanning oil are dangerous. In general, being outdoors without proper photoprotective clothing, hats, sunglasses or sunscreen increases one’s risk of developing melanoma and non-melanoma skin cancers. Tanning in and of itself, as well as freckles and “sun spots,” are signs of damage to the skin.

Baby oil provides no protection from the sun and may actually intensify the sun’s rays. The typical “tanning oil” has an SPF of 2 to 4, which provides very minimal protection from damaging UV radiation.

Q: What are the misconceptions and tips you would like to highlight?

AW: Unfortunately, there is a lot of misinformation out there about the use of sunscreen, leading individuals to avoid its use or to flock to “natural” or “herbal” sunscreens that have not been tested by the FDA. 

This is very risky and it’s important for individuals to be well-informed and to discuss these decisions with their dermatologist. Seeking shade, wearing protective clothing or hats and avoiding peak UV hours are always recommended.

Outdoor athletes are at increased risk for skin cancer due to long hours of exposure, often during peak hours of UV exposure. In addition, sweating may increase photodamage by intensifying the skin’s sensitivity to ultraviolet radiation and the risk of sunburn.

While melanoma is the deadliest skin cancer, non-melanoma skin cancer is exceedingly more common. One in four Americans will develop some form of non-melanoma skin cancer in their lifetime. 

Every year in the United States, there are three to four times as many non-melanoma skin cancer cases compared to all other cancers combined. Anything new, growing, changing, bleeding or not healing on the skin should be evaluated by a board-certified dermatologist.

8 THINGS WOMEN SHOULD KNOW ABOUT BREAST CANCER

White and black women in Los Angeles County are the most likely to be diagnosed with breast cancer, but Asians are slowly catching up

 

August 22, 2016--The Los Angeles Cancer Surveillance Program (CSP), a state-mandated database managed by the Keck School and the USC Norris Comprehensive Cancer Center, provides scientists everywhere with essential statistics on cancer.

Newswise — Asian women living in Los Angeles County are experiencing more breast cancer now than they faced nearly four decades ago, according to a recently released cancer report card administered by USC.

When compared to other Asian groups, Filipino women face the most breast cancer diagnoses in the county, but their risk is on the decline. The diagnoses went down 6 percent in the seven years between 2005 and 2012.

In contrast, Korean women are on the bottom of the list but are experiencing a steep and continuous increase in breast cancer rates, nearly quadrupling in the 32 years between 1980 and 2012.

The data comes from “Cancer in Los Angeles County: Trends by Race/Ethnicity 1976-2012.” Released on Aug. 15, the book is based on all cancers diagnosed among Los Angeles County residents over the past 37 years — more than 1.3 million cases.

Breast cancer is the most common cancer in women regardless of race or ethnicity and the most common cause of cancer death among Hispanic women, according to the Centers for Disease Control and Prevention. It is the No. 2 cause of cancer death among white, black, Asian and Pacific Islander women.

An estimated 246,660 women will be diagnosed with invasive breast cancer in 2016, and about 40,450 women will die from the disease this year, according to the American Cancer Society.

Christy Russell, director of the Harold E. and Henrietta C. Lee Breast Center at USC Norris Cancer Hospital and an associate professor of clinical medicine at the Keck School of Medicine of USC, has treated breast cancer patients for 30 years. Russell shares what has she gleaned from all that oncology experience.

Q: Although fewer Korean women develop breast cancer than any other ethnicity, their breast cancer risk has soared in the past 37 years. Why are more Korean women developing breast cancer?

CR: Presumably, they have taken on more “American lifestyle” choices, which would mean earlier puberty, later menopause, fewer pregnancies, less breastfeeding, perhaps less physical activity, higher body weight and possibly alcohol. Extensive epidemiologic studies need to be done to figure out which, if any, of these factors attributes to the rising rate of breast cancer risk in Korean women.

Q: Why do Filipino women have the highest breast cancer risk among Asians? What might be causing a decline in this group’s breast cancer occurrence?

CR: I can’t answer this question. Epidemiologic studies would need to be done to assess the timing of their adoption to the “American lifestyle.”

Q: If adopting a more American lifestyle could be the culprit, why has the rate of breast cancer among white and black women begun leveling off in the past decade?

CR: The risk of breast cancer in white and black women is likely leveling off because of their steady use of screening mammography. Additionally, during the time frame when their risk of breast cancer is developing, they probably continue to have similar lifestyle habits as those in years past, such as age at first full-term pregnancy, length of breastfeeding, use of hormone replacement therapy, exposure to alcohol and total body weight.

Q: What causes breast cancer?

CR: Breast cancer is related to lifetime exposure of the breast tissue to uninterrupted estrogen and progesterone. The ovaries produce these hormones. Anything that prolongs the exposure to these hormones will increase a woman’s lifetime risk of breast cancer.

Once a woman begins her ovarian function during puberty, there are limited things she can do to reduce her risk of developing breast cancer. Interruptions in the menstrual cycle will reduce risk. The earlier and the more frequently she interrupts her menstrual cycle, the greater reduction in risk of breast cancer. This includes full-term pregnancy, prolonged breast feeding, steady and continuous physical activity, and maintaining a low and healthy body weight.

Q: What role does alcohol play?

CR: More than 100 epidemiologic studies have consistently found that alcohol use is related to the risk of developing breast cancer, and there is no “safe” amount. The more alcohol consumed, the higher the risk.

After menopause, alcohol, higher body weight and hormone replacement therapy all increase the risk of breast cancer. These are all related to continued exposure of the breast to either estrogen alone or estrogen plus progesterone in the case of hormone replacement therapy.

Q: Girls are reaching puberty earlier nowadays — sometimes starting at age 8. What does early puberty mean for breast cancer risk?

CR: Initiation of puberty is related to a young woman attaining a specific height and weight. Presumably, the body knows when it is capable of childbearing and thus puberty begins. Populations in the world with greater health and nutrition during childhood will decrease the age at which their girls start puberty.

Reaching puberty earlier increases the amount of estrogen and progesterone a young woman receives in her lifetime, so earlier puberty increases her risk of developing breast cancer.

Q: Should menopausal women abstain from hormone replacement therapy to limit their breast cancer risk?

CR: The use of hormone replacement therapy is a very personal decision and should be based on the extent of menopausal symptoms such as hot flashes, sweats and sleep disturbance. The use should be limited in terms of number of years and should be discontinued as early as possible to reduce the subsequent increased risk of breast cancer. The longer a woman is exposed to hormone replacement therapy, the greater her risk of developing breast cancer.

However, that being said, the majority of breast cancer risk is related to one’s lifetime exposure to estrogen and progesterone and is not just related to what happens after menopause.

Q: When are most women diagnosed with breast cancer?

CR: Even though the majority of female breast cancer risk is established during the years between puberty and menopause, breast cancer generally occurs in older women. The median age for the appearance of breast cancer in women is mid-sixties.

REPLACING JUST ONE SUGARY DRINK WITH WATER COULD SIGNIFICANTLY IMPROVE HEALTH, VIRGINIA TECH RESEARCHER FINDS

Choosing drinks with fewer calories can help reduce excess weight and improve dietary choices.

Newswise, August 17, 2016 — Think one little sugary soda won’t make a difference on your waistline? Think again.

If people replace just one calorie-laden drink with water, they can reduce body weight and improve overall health, according to a Virginia Tech researcher.

“Regardless of how many servings of sugar-sweetened beverages you consume, replacing even just one serving can be of benefit,” said Kiyah J. Duffey, an adjunct faculty member of human nutrition, foods, and exercise in the College of Agriculture and Life Sciences and independent nutrition consultant.

 Consuming additional calories from sugary beverages like soda, energy drinks, and sweetened coffee can increase risk of weight gain and obesity, as well as Type 2 diabetes and cardiovascular disease.

Duffey’s findings, which were recently published in Nutrients, modeled the effect of replacing one 8-ounce sugar-sweetened beverage with an 8-ounce serving of water, based on the daily dietary intake of U.S. adults aged 19 and older, retrieved from the 2007-2012 National Health and Nutrition Examination Surveys.

Duffey, along with co-author Jennifer Poti, an assistant professor of nutrition at the University of North Carolina at Chapel Hill, showed that this one-for-one drink swap could reduce daily calories and the prevalence of obesity in populations that consume sugary beverages.

The 2015 Dietary Guidelines for Americans recommend that no more than 10 percent of daily calories come from added sugar and that calorie-free drinks, particularly water, should be favored.

“We found that among U.S. adults who consume one serving of sugar-sweetened beverages per day, replacing that drink with water lowered the percent of calories coming from drinks from 17 to 11 percent,” Duffey said.

 “Even those who consumed more sugary drinks per day could still benefit from water replacement, dropping the amount of calories coming from beverages to less than 25 percent of their daily caloric intake.”

As Duffey found, a reduction in the amount of daily calories coming from sugary drinks also improves individual scores on the Healthy Beverage Index – a scoring system designed to evaluate individual beverage patterns and their relation to diet and health based on standards set forth by the Beverage Guidance Panel and the Dietary Guidelines for Americans.

Duffey developed this index in 2015 with Virginia Tech nutrition researcher Brenda Davy, a professor of human nutrition, foods, and exercise in the College of Agriculture and Life Sciences and a Fralin Life Science Institute affiliate.

Their preliminary data showed that higher scores correlate to better cholesterol levels, lowered risk of hypertension, and in men, lowered blood pressure.

The broader goal of the index is to help people identify what and how much they drink each day, as drinking habits can impact eating habits.

Higher calorie drinks, such as sweetened soda and high-fat milk, have been associated with diets rich in red and processed meats, refined grains, sweets, and starch, according to a 2015 review study by Duffey, Davy, and Valisa Hedrick, an assistant professor of human nutrition, foods, and exercise in the same college at Virginia Tech.

Lower-calorie drinks, such as water and unsweetened coffee and tea, were associated with alternative diets rich in fruits, vegetables, whole grains, fish, and poultry.

Diet drinks are also healthier alternatives to sugary drinks, explained Duffey, but other research has shown that people who drink water over low-calorie alternatives still tend to eat more fruits and vegetables, have lowered blood sugar, and are better hydrated.

The initial study was funded by the Drinking Water Research Foundation, an independent not-for-profit organization that supports research in areas related to consumer- and drinking-water-industry interest.

U.S. RANKS FIRST IN HEALTH CARE SPENDING, BUT CANCER OUTCOMES DO NOT REFLECT THE INVESTMENT, STUDY FINDS

As published in JNCCN, researchers at The University of Texas MD Anderson Cancer Center found that, at the state level, wealth—not health expenditure—is a determinant for better outcomes in most cancers.

Newswise, August 17, 2016 — FORT WASHINGTON, PA — The U.S. health care system is characterized—on a global level—by its unsustainable health care spending, which does not necessarily correlate to better outcomes in patients with cancer. With $2.9 trillion spent on U.S. health care in 2013, the United States ranks first in health care spending among the world’s leading economies.[1]

To investigate the implications of socioeconomic status (SES) and health expenditures on cancer outcomes and mortality, researchers at The University of Texas MD Anderson Cancer Center, led by Jad Chahoud, MD, conducted an ecological study at the state level for three distinct patient populations: breast cancer, colorectal cancer, and all-cancer populations.

Dr. Chahoud and his associates found that high health care spending did not correlate with better outcomes and lower mortality in colorectal cancer and all cancers, but that state-level SES and wealth does have a positive impact on cancer outcomes and mortality.

The study, “Wealth, Health Expenditure, and Cancer: A National Perspective,” was published this week in the August issue of JNCCN – Journal of the National Comprehensive Cancer Network and is available free-of-charge at JNCCN.org through October 31, 2016.

“Our work provides a new perspective on cancer outcomes disparities in the United States, laying the groundwork for future research to assess the effect of the Affordable Care Act on cancer outcomes across states,” said Dr. Chahoud.

Dr. Chahoud and colleagues extracted gross domestic product (GDP) and health expenditure per capita from the 2009 Bureau of Economic Analysis and the Centers for Medicare & Medicaid Services (CMS), respectively. Using data from the National Cancer Institute (NCI), the investigators retrieved breast, colorectal, and all-cancer age-adjusted rates and computed mortality/incidence (M/I) ratios for each population.

In addition to the association between GDP and lower M/I, the data showed a rift between northern and southern states in all three patient populations, with patients in southern states faring worse.

“Our study highlights regional disparities in terms of financial and cancer outcomes, indicating a potential inefficient allocation of resources in the efforts against cancer,” said Dr. Chahoud.

According to the study, the only cancer type in which high health care spending led to lower M/I was breast cancer. The authors suggest that this finding potentially indicates the effectiveness of screening mechanisms, navigator programs, and advocacy organizations, among other initiatives at the state level.

However, in one of a pair of complementary point/counterpoint editorials in the same issue, Melissa A. Simon, MD, MPH, and colleagues from Robert H. Lurie Comprehensive Cancer Center of Northwestern University and Rush University, warn against allowing the data to guide—or misguide—policy makers in states that have high health expenditures to cap or decrease spending for certain health issues.

“Increased spending does not necessarily improve quality of care, but capping or cutting spending on health care does not necessarily solve problems either,” Dr. Simon noted.

Dr. Simon and colleagues’ editorial further notes that the data in this study predate the Affordable Care Act and describes the need for further study and analysis to inform the “the complicated interplay of wealth, health expenditures, and their relationship to cancer screening.”

In the counterpoint, Dr. Chahoud and colleagues agree on that need. “The goal of our study is not to misguide policy makers; instead it is to highlight a problem of disparity and to fuel the discussion at the national level,” responded Dr. Chahoud. “We are not recommending the ‘capping’ of health care spending. Instead, we are advocating for smart spending because complementing financial resources with other community-based and low-cost preventive measures is critical, especially in prevalent cancers, such as breast and colorectal.”

To access the August issue of JNCCN, visit JNCCN.org.

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About JNCCN – Journal of the National Comprehensive Cancer Network
More than 23,000 oncologists and other cancer care professionals across the United States read JNCCN–Journal of the National Comprehensive Cancer Network. This peer-reviewed, indexed medical journal provides the latest information about best clinical practices, health services research, and translational medicine. JNCCN features updates on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), review articles elaborating on guidelines recommendations, health services research, and case reports highlighting molecular insights in patient care. JNCCN is published by Harborside Press. Visit JNCCN.org. To inquire if you are eligible for a FREEsubscription to JNCCN, visit http://www.nccn.org/jnccn/subscribe.asp

About the National Comprehensive Cancer Network
The National Comprehensive Cancer Network® (NCCN®), a not-for-profit alliance of 27 of the world’s leading cancer centers devoted to patient care, research, and education, is dedicated to improving the quality, effectiveness, and efficiency of cancer care so that patients can live better lives. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers.

The NCCN Member Institutions are: Fred & Pamela Buffett Cancer Center, Omaha, NE; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; City of Hope Comprehensive Cancer Center, Los Angeles, CA; Dana-Farber/Brigham and Women’s Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA; Duke Cancer Institute, Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Mayo Clinic Cancer Center, Phoenix/Scottsdale, AZ, Jacksonville, FL, and Rochester, MN; Memorial Sloan Kettering Cancer Center, New York, NY; Moffitt Cancer Center, Tampa, FL; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH; Roswell Park Cancer Institute, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center, Memphis, TN; Stanford Cancer Institute, Stanford, CA; University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; UC San Diego Moores Cancer Center, La Jolla, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Colorado Cancer Center, Aurora, CO; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; The University of Texas MD Anderson Cancer Center, Houston, TX; University of Wisconsin Carbone Cancer Center, Madison, WI; Vanderbilt-Ingram Cancer Center, Nashville, TN; and Yale Cancer Center/Smilow Cancer Hospital, New Haven, CT.

Clinicians, visit NCCN.org. Patients and caregivers, visit NCCN.org/patients. Media, visit NCCN.org/news.

EXERCISE CAN TACKLE SYMPTOMS OF SCHIZOPHRENIA

Newswise, August 17, 2016 — Aerobic exercise can significantly help people coping with the long-term mental health condition schizophrenia, according to a new study from University of Manchester researchers.

Through combining data from 10 independent clinical trials with a total of 385 patients with schizophrenia, Joseph Firth found that around 12 weeks of aerobic exercise training can significant improve patients' brain functioning.

The study by Firth, Dr Brendon Stubbs and Professor Alison Yung is published in Schizophrenia Bulletin, the world's leading journal on Schizophrenia and one of leading periodicals in Psychiatry.

Schizophrenia's acute phase is typified by hallucinations and delusions, which are usually treatable with medication.

However, most patients are still troubled with pervasive 'cognitive deficits'; including poor memory, impaired information processing and loss of concentration.

The research showed that patients who are treated with aerobic exercise programs, such as treadmills and exercise bikes, in combination with their medication, will improve their overall brain functioning more than those treated with medications alone.

The areas which were most improved by exercising were patients' ability to understand social situations, their attention spans, and their 'working memory' - or how much information they can hold in mind at one time.

There was also evidence among the studies that programs which used greater amounts of exercise, and those which were most successful for improving fitness, had the greatest effects on cognitive functioning.

Joe Firth said: "Cognitive deficits are one aspect of schizophrenia which is particularly problematic.

"They hinder recovery and impact negatively upon people's ability to function in work and social situations. Furthermore, current medications for schizophrenia do not treat the cognitive deficits of the disorder.

"We are searching for new ways to treat these aspects of the illness, and now research is increasingly suggesting that physical exercise can provide a solution."

He added: "These findings present the first large-scale evidence supporting the use of physical exercise to treat the neurocognitive deficits associated with schizophrenia.

"Using exercise from the earliest stages of the illness could reduce the likelihood of long-term disability, and facilitate full, functional recovery for patients."

INTERMEDIATE HDL CHOLESTEROL LEVELS MAY BE BEST FOR LONGEVITY

Highlights

• In a large study of male veterans, both low and high HDL cholesterol levels were associated with higher risks of dying prematurely compared with intermediate levels, forming a U-shaped curve.
• The beneficial properties of HDL cholesterol were attenuated, but remained significant, in the presence of kidney disease.

Newswise, August 17, 2016 — A new study indicates that maintaining an intermediate level of high density lipoprotein cholesterol (HDL-C) may help people live longer.

The study, which appears in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN), found that both low and high HDL-C levels were linked with a higher risk of premature death. Also, intermediate HDL-C levels were associated with a lower risk of death across all levels of kidney function.

Patients with kidney disease often have reduced levels of HDL-C, which may partly explain their higher risk of dying prematurely; however, the relationship between HDL-C and premature death in patients with kidney disease is unclear. To investigate, a team led by Benjamin Bowe, MPH and Ziyad Al-Aly, MD, FASN (Washington University School of Medicine and VA Saint Louis Health Care System) retrospectively studied 1,764,986 US male veterans with at least one measurement of kidney function and one measure of HDL-C between October 2003 and September 2004. Participants were followed until September 2013.

The researchers found that both low and high HDL-C levels were associated with higher risks of dying during follow-up compared with intermediate HDL-C levels, forming a U-shaped relationship between HDL-C and mortality risk.

The beneficial properties of intermediate levels of HDL-C were attenuated, but remained significant, in the presence of kidney disease.

“The finding that high HDL-C was also associated with higher risk of death was not expected and has not been reported previously in large epidemiologic studies such as the Framingham Heart Study and others,” said Dr. Al-Aly.

“Prior epidemiologic studies significantly advanced our understanding of the relationship between cholesterol parameters and clinical outcomes; however, these studies are limited in that the number of patients in these cohorts is relatively small compared with the current Big Data approach.”

He noted that a Big Data approach allows a more nuanced examination of the relationship between HDL-C and risk of death across the full spectrum of HDL-C levels.

“Our findings may explain why clinical trials aimed at increasing HDL-C levels have failed to show improvement of clinical outcomes,” noted Bowe.

Study co-authors include Yan Xie, MPH, Hong Xian, PhD, Sumitra Balasubramanian, MS, and Mohamed Zayed MD, PhD.

Disclosures: The authors reported no financial disclosures.

The article, entitled “High Density Lipoprotein Cholesterol and the Risk of All-cause Mortality among U.S. Veterans,” is online at http://www.cjasn.asnjournals.org/ 

UAB Optometrist Improves Treatment and Care for Patients with Dry Eye

Newswise, August 10, 2016-– The Food and Drug Administration recently approved lifitegrast, a new eye drop for treating signs and symptoms of dry eye in adult patients. 

Kelly Nichols, O.D., Ph.D., a dry eye expert and dean of the University of Alabama at Birmingham School of Optometry, conducted research studies for the parent drug company to explore the efficacy and safety of lifitegrast in treating this eye condition that affects more than 16 million adults in the United States.

Inflammation associated with dry eye may eventually lead to damage to the surface of the eye.

“Dry eye is a common complaint to eye care professionals, with millions of U.S. adults experiencing the symptoms of this often chronic disease,” Nichols said.

“It is critical for eye care professionals to have a dialogue with patients who report symptoms because dry eye can be a progressive ocular surface disease.”

The twice-daily eye drop solution of 5 percent lifitegrast ophthalmic solution is the only prescription eye drop indicated for the treatment of both signs and symptoms of dry eye, and it is the first new dry eye prescription drop approved in the last 13 years.

Nichols and a team of researchers studied 1,181 patients, of whom 1,067 received lifitegrast in four placebo-controlled 12-week trials. Signs and symptoms were assessed at baseline and at weeks two, six and 12.

In all four studies, eye dryness was significantly reduced, with two of the studies showing improvements at week two.

Results from inferior corneal staining tests — used by physicians to detect abrasions on the cornea — showed improvement in three of the four studies.

Nichols continues to push for funding and advancement for dry eye research and treatment.

Prior to FDA approval of the lifitegrast eye drop, Nichols presented a congressional briefing in Washington, D.C., addressing research into dry eye for the National Alliance for Eye and Vision Research. She focused on the cause and potential therapies for dry eye that are being funded through the National Eye Institute and in private industry.

Focusing her research on all aspects of the eye, Nichols discussed the mechanics of the three layers of the tear film and the importance of each from the cornea outward:
• Mucin layer: helps tears adhere to the eye
• Aqueous layer or water layer: nourishes and protects the cornea
• Lipid or oil layer: lubricates and prevents evaporation and provides smooth refractive surface needed for optimal vision.

“We are unsure which of the 200-plus different lipids and 500-plus unique proteins are most important for protecting and lubricating the eye, and the absence or insufficiency of which results in dry eye,” Nichols said.

There are more than 30-plus new dry eye basic, translational and clinical studies being funded by the NEI/National Institutes of Health to further explore these lipids and proteins, with more than 50 papers being published monthly.

“Funding from NIH is helping the optometry world make significant strides in understanding the cause and treatment of dry eye,” Nichols said. “We still have a long way to go, but prevention and early detection are major goals. There is hope for dry eye patients worldwide.”

Diagnosis of dry eye is identified by an eye care professional based on careful evaluation of signs and symptoms, including dryness, discomfort, vision changes and damage to the surface of the eye. Specialty testing for dry eye is performed at the Dry Eye Relief Clinic at UAB Eye Care, in the School of Optometry.

Obesity on the Rise in Adults with a History of Cancer

 Colorectal and breast cancer survivors and non-Hispanic blacks at highest risk for obesity

Newswise, August 10, 2016-- A study at Columbia University's Mailman School of Public Health showed that obesity was more prevalent in patients with a history of cancer than in the general population, and survivors of colorectal and breast cancers were particularly affected. 

The study is among the first to compare rates of obesity among U.S. cancer survivors and adults without a history of cancer. Findings are published online in the Journal of Clinical Oncology.

Results were based on data from a nationally representative sample of 538,969 non-institutionalized adults aged 18 to 85 years with or without a history of cancer who participated in the annual National Health Interview Survey from 1997 to 2014. Obesity was defined as body mass index ? 30 kg/m2 for non-Asians and ? 27.5 kg/m2 for Asians.

Among 32,447 cancer survivors, the most common diagnoses were cancers of the breast followed by prostate, and colorectal cancers. Populations with the highest rates of increasing obesity were colorectal cancer survivors followed by breast cancer survivors. African-American survivors of all three cancers were particularly affected.

"Our study identified characteristics of cancer survivors at the highest risk of obesity, which are important patient populations in which oncology care providers should focus their efforts," said Heather Greenlee, ND, PhD, assistant professor of Epidemiology at the Mailman School, and principal investigator.

From 1997 to 2014, prevalence of obesity increased from 22 percent to 32 percent in cancer survivors and from 21 percent to 29 percent of adults without a history of cancer. During this time, rates of obesity grew more rapidly in women cancer compared to both male cancer survivors and compared to women with no history of cancer.

In female colorectal cancer survivors, those who are young and non-Hispanic black and had been diagnosed within 2 to 9 years had the highest increasing rates of obesity.

Similarly, among female breast cancer survivors, those who are young, were diagnosed within the past year, and are non-Hispanic white had the highest increasing obesity rate.

Among male colorectal cancer survivors, the highest increases in obesity were among older men, non-Hispanic blacks, and those at or greater than 10 years from diagnosis.

In contrast, prostate-cancer survivors with the highest increases in obesity were younger, non-Hispanic whites, and 2 to 9 years from diagnosis.

"While our findings can be partially explained by the growing population of patients with breast and colorectal cancer - the two cancers most closely linked to obesity -- we identified additional populations of cancer survivors at risk of obesity not as well understood and which require further study," observed Dr. Greenlee.

"These results suggest that obesity is a growing public health burden for cancer survivors, which requires targeted interventions including weight management efforts to stave off the increasing obesity trends we are seeing in cancer survivors," noted Dr. Greenlee.

Secrets of Age-Related Diseases May Lie in Cellular Targets Identified

Newswise, August 3, 2016— New insights on age-related diseases may hold the key to both delaying aging and, in the process, reducing the occurrence of diseases including cancer.

These findings have been reported by a team from Roswell Park Cancer Institute and Everon Biosciences in the journal Aging.

“The majority of aging theories agree that chronic inflammation associated with secretions by senescent, or aging, cells are the underlying cause of frailty and of multiple age-related diseases, including cancer,” says senior author Andrei Gudkov, PhD, DSci, Senior Vice President for Basic Science at Roswell Park.

“Our study has redefined a subset of these cells as belonging to the category of macrophages. This finding requires a re-interpretation of the mechanisms underlying these cellular targets and a reconsideration of their potential for anti-aging treatments.”

Scientists have named the subtype “senescence-associated macrophages,” or SAMS.

“Our research allowed us to redefine the nature of cells that are sources of poisonous inflammation associated with aging. These cells appear to be not senescent cells, but are actually part of our natural immune system. This finding allows us to identify targets as well as agents that can eradicate senescence-associated macrophages, with the ultimate goal of finding new ways to treat cancer and other age-related diseases,” adds Dr. Gudkov.

Exercise Results in Larger Brain Size and Lowered Dementia Risk

 Newswise, August 3, 2016--

 RESEARCH ALERT

Exercise results in larger brain size and lowered dementia risk

FINDINGS
 — Using the landmark Framingham Heart Study to assess how physical activity affects the size of the brain and one’s risk for developing dementia, UCLA researchers found an association between low physical activity and a higher risk for dementia in older individuals. This suggests that regular physical activity for older adults could lead to higher brain volumes and a reduced risk for developing dementia.

The researchers found that physical activity particularly affected the size of the hippocampus, which is the part of the brain controlling short-term memory. Also, the protective effect of regular physical activity against dementia was strongest in people age 75 and older.

BACKGROUND
Though some previous studies have found an inverse relationship between levels of physical activity and cognitive decline, dementia and Alzheimer’s disease, others have failed to find such an association. The Framingham study was begun in 1948 primarily as a way to trace factors and characteristics leading to cardiovascular disease, but also examining dementia and other physiological conditions.

For this study, the UCLA researchers followed an older, community-based cohort from the Framingham study for more than a decade to examine the association between physical activity and the risk for incident dementia and subclinical brain MRI markers of dementia.

METHOD
The researchers assessed the physical activity indices for both the original Framingham cohort and their offspring who were age 60 and older. They examined the association between physical activity and risk of any form of dementia (regardless of the cause) and Alzheimer’s disease for 3,700 participants from both cohorts who were cognitively intact. They also examined the association between physical activity and brain MRI in about 2,000 participants from the offspring cohort.

IMPACT
What this all means: one is never too old to exercise for brain health and to stave off the risk for developing dementia.