family practice issues and general life events

Posts tagged ‘cdc’

Lung Cancer Awareness Month

November brings a whole new series of things to be aware.  We can now put away our pink, and pick out a different color to wear.   Many of these are not as sexy as breast cancer, but just as important, and lung cancer is the biggest cancer killer of them all.  We as a society view lung cancer as a cancer due to the consequences of ones actions.  Since 80-90% of lung cancers are the result of smoking or second hand smoke, they are just asking for it, right?  Wait a minute, we don’t treat any other cancer this way.  We don’t treat heart disease this way, when our diet and lack of exercise accounts for almost the same percentages for heart disease and diabetes.

Lung cancer has become the punishment cancer that we don’t discuss even though it kills more people than any other cancer. According to the CDC  “Each year, about 200,000 people in the United States are told they have lung cancer and more than 150,000 people die from this disease. Deaths from lung cancer represent about one out of every six deaths from cancer in the U.S.”

One in six deaths from cancer, and yet it doesn’t have a flashy ad campaign.  Its survivors, well there aren’t that many, and let’s be honest it is hard to be sexy with a tracheostomy tube.  And even still smoking isn’t the only risk factor for lung cancer.  Other risk factors include:

  • Smoking.
  • Secondhand smoke from other people’s cigarettes.
  • Radon gas in the home.
  • Things around home or work, including asbestos, ionizing radiation, and other cancer-causing substances.
  • Medical exposure to radiation to the chest.
  • Chronic lung disease such as emphysema or chronic bronchitis.
  • Increased age.

Local, city and state governments have helped decrease smoking with public ordinances, but even still there are areas where smoking is still the norm.  And with medical advances, there are even greater chances that we will irradiate someone into a cancer.  Emergency Rooms now have lists of people that are no longer allowed to have CT scans due to risk of radiation.

While smoking is the single greatest risk factor for lung cancer, it is not fair to write off an entire class of cancer patients due to it.  Smoking increases the risk of almost every cancer.  And lung cancer kills more people than breast, colon and prostate cancers combined.  And to look at its incidence is staggering.  Using the data from 2008, which is the most complete data we have

Lung and Bronchus Cancer Incidence Rates by State

Lung and Bronchus Cancer Incidence Rates* by State, 2008†

Map of the United States showing lung cancer incidence rates by state.

Color on Map Interval States
Light green 23.5 to 59.5 Arizona, California, Colorado, District of Columbia, Hawaii, Idaho, Minnesota, Montana, New Mexico, North Dakota, South Dakota, Utah, and Wyoming
Medium green 59.6 to 66.8 Connecticut, Kansas, Maryland, Nebraska, New Jersey, New York, Oregon, South Carolina, Texas, Vermont, Virginia, Washington, and Wisconsin
Medium blue 66.9 to 73.7 Alaska, Florida, Georgia, Illinois, Iowa, Massachusetts, Michigan, Nevada, New Hampshire, North Carolina, Ohio, Pennsylvania, and Rhode Island
Dark blue 73.8 to 99.3 Alabama, Arkansas, Delaware, Indiana, Kentucky, Louisiana, Maine, Mississippi, Missouri, Oklahoma, Tennessee, and West Virginia

*Rates are per 100,000 and are age-adjusted to the 2000 U.S. standard population.
†U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999–2008 Incidence and Mortality Web-based Report. Atlanta (GA): Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute; 2012. Available at:http://www.cdc.gov/uscs.

Deaths from Lung and Bronchus Cancer by State

Rates of dying from lung and bronchus cancer also vary from state to state.

Lung and Bronchus Cancer Death Rates* by State, 2008†

Map of the United States showing lung cancer death rates by state.

Color on Map Interval States
Light green 18.2 to 45.6 Arizona, California, Colorado, Connecticut, Hawaii, Idaho, Minnesota, New Jersey, New Mexico, New York, North Dakota, Utah, and Wyoming
Medium green 45.7 to 50.7 District of Columbia, Florida, Iowa, Maryland, Massachusetts, Montana, Nebraska, New Hampshire, Oregon, South Dakota, Texas, Washington, and Wisconsin
Medium blue 50.8 to 56.1 Alaska, Georgia, Illinois, Kansas, Michigan, Nevada, North Carolina, Pennsylvania, Rhode Island, South Carolina, Vermont, and Virginia
Dark blue 56.2 to 74.7 Alabama, Arkansas, Delaware, Indiana, Kentucky, Louisiana, Maine, Mississippi, Missouri, Ohio, Oklahoma, Tennessee, and West Virginia

*Rates are per 100,000 and are age-adjusted to the 2000 U.S. standard population.
†U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999–2008 Incidence and Mortality Web-based Report. Atlanta (GA): Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute; 2012. Available at:http://www.cdc.gov/uscs.

This map shows just how prevalent lung cancer is.  And while many states are decreasing the incidence of smoking, there is still a lot more to be done.  In Oklahoma, for example, while city and state buildings are smoke free much of the state is still tribal land, and Indian smoke shops have drive through windows.  The significance of the Indian smoke shops?  Well, they are not subject to all the federal and state taxes on cigarettes.  So increasing tax rates on those products has not reduced sales from these shops.

The other states with the highest risk- well how many of them have livelihoods dependent on the tobacco industry.  This cancer will remain a significant issue until we educate kids effectively, before they ever pick up a cigarette, which in many cases, is at or around the age of 8.  We need to educate their parents that it is not ok for them to pass this addiction to the next generation.

I spend a lot of time counseling for tobacco use in my office, and there is not one who has ever come in and said, “Smoking it the greatest thing I have ever done in my life.”

What does the new data from the CDC actually mean regarding autism?

With this month being autism awareness month and the CDC’s publishing that autism is now 1 in 54 males, and 1 in 212 females with an overall prevalence of 1 in 88, I am inclined to write about how I feel about this.  And in reality I am not sure.   If you take it at face value, autism has increase 23% since 2006.  This is when there was 1 in 110.  And if compared to 1980, the increase is even more incredible.

The problem with looking at this increase is the change in the inclusion criteria.  Whereas in 1980, only the most severely affected was diagnosed.  Those with Aspergers would not have been included, and neither would others on the spectrum.  And if you look at the spectrum, well the entire one actually includes ADD/ADHD.  And recent reports indicate when DSM-V will actually narrow the inclusion criteria, so will the numbers go down?

I thought about my own practice, am I seeing these numbers or am I missing some.  While I might be able to accept the number of girls, I am uncertain about the amount of boys diagnosed.  Am I missing that many?  Or is my practice just not have that many in particular, and some other practice has a greater proportion?

Another angle to look at is the fact that there is increased awareness of the disorder and an increase in the ability to treat.  This happens with all disease states, and often the increase occurs after treatment has been accepted and become routine.  So there is also that.

The other concerning bit of data, is that those that are diagnosed earlier are still sitting at the same frequency.  The diagnosis of the older child (meaning 6 to 8) is actually increasing.  Why wouldn’t it increase in the earlier ages?  Are we still lacking in the ability to fully diagnose the younger children?  Or are those that are getting diagnosed at an earlier age actually suffering from something else?  Maybe that is why they didn’t show the signs earlier because they aren’t autistic.  This is purely a thought on my part

And I often wonder about those doing the diagnosis.  I don’t have time in my office to do the entire diagnostic test.  I wonder if these children with the diagnosis are from the physician (pediatrician or family practice) or if they went to a developmental psychologist or developmental physician.  Sometimes what appears to be true in a 15 minute office visit might be masking something else.  I am not saying that this is the case for all those with the diagnosis, but without access to the entire set of data, the report raises more questions than it answers.  And to be honest, I don’t have time to pour through the data, but I do have many questions, as I compare it to my practice.

In the end, the new report doesn’t answer much.  There are many dedicated scientists who are working on the answers as to who and why.  And they are determining why it appears in one child in a family and not necessarily others.  They are looking into environmental factors and what triggers the expression and why presents in one why and why another.  And there is seeming to be an increase in incidence in children with older fathers, as opposed to many of the other developmental conditions with increased risk in the mother.  Dr Kevin Pelphrey discusses this in his talk with the Autism Science Foundation.(1)

If anything, the report indicates the need for further research.  The need for diagnostic tools to diagnose earlier to start therapy earlier and other recognized effective treatments.  And the need for making sure that it is the diagnosis.  Unfortunately, there is no blood test for autism.  The tests use diagnostic tools which help to indicate whether or not the child meets the criteria.  There are new studies using functional MRI underway which are showing some differences in brain function in infants that later on have the diagnosis of autism, and while exciting, there are still in the study phase.  And in reality, out of reach for many clinicians across the country.  And how do you justify ordering a functional MRI on a seemingly normal infant?  

So to me, this report raises more questions than it answers.  And I will wait to determine whether I accept the report on face value until more data is released.  What it does do is illustrate the need for further research into early detection, and why some children develop autism and some don’t.  We need to look at the environment, both what is around us and what we are ingesting, and above all look at siblings, why does one sibling show signs and another doesn’t.  And why is the incidence so much higher in boys than girls?  But we do need to have a consistent diagnostic criteria, because right now the  ever changing criteria means that we are comparing granny smith apples to apples in general.    

 

1.  Autism Science Foundation: Chat with a Scientist- Transcript: Chat with Yale Autism Scientist Dr. Kevin Pelphrey, April 6, 2012 found online at http://www.coveritlive.com/index2.php/option=com_altcaster/task=viewaltcast/altcast_code=ce2c575ca5/height=550/width=470

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