Princess Health and Officials hope reduction in Ky. colon cancer deaths via screening can be replicated with lung cancer, in which state is No. 1. Princessiccia

Princess Health and Officials hope reduction in Ky. colon cancer deaths via screening can be replicated with lung cancer, in which state is No. 1. Princessiccia

cancer colorectal cancer health reform lung cancer Medicaid obamacare Patient Protection and Affordable Care Act rural health rural-urban disparities smoking smoking bans

Gusty 09:11 Add Comment

Health officials in Kentucky, especially in the eastern part of the state, hope to increase lung-cancer screenings by following a successful colon-cancer screening initiative, Jackie Judd reports for PBS NewsHour. (Centers for Disease Control and Prevention graphic: Colon-cancer screenings are up)

In rural Eastern Kentucky, smoking and lung cancer rates are double the national average, while the state is second in adult smoking rates and leads the nation in lung cancer and rates of death from it. That is "fueled by a toxic combination of poverty, medical illiteracy, limited access to care, lifestyle choices like smoking, and a fatalism that says knowing you have cancer won�t save you."

Another challenge is that local bans of smoking in public places have left two-thirds of residents living in areas with no such bans, and a statewide ban seems unlikely because it failed to pass the state House this year after narrowly passing last year. New Republican Gov. Matt Bevin opposes a statewide ban.

Fifteen years ago Kentucky led the nation in "both the highest incidence and mortality rates for colorectal cancer," Allison Perry reports for University of Kentucky News. Rural residents didn't seek care, partly because of a lack of facilities and partly because of a refusal to schedule an appointment. If local residents wouldn't seek care, health officials decided to bring care to local residents.

"In the seven years following this new focus on colorectal cancer, the screenings rates nearly doubled, from 34.7 percent of the age-eligible population receiving screenings to 63.7 percent," Perry writes. "This raised Kentucky�s rank from 49th in the country to 23rd compared to other states. No other state has had such a dramatic increase in colorectal screenings in such a short period of time. As a result, the lives of many Kentuckians have been saved: the incidence rate for colorectal cancer is down nearly 25 percent, and the mortality rate has dropped 30 percent. Through colorectal screenings, doctors can find precancerous lesions and remove them before they become cancer. Screenings also allow physicians to find these cancers at an earlier stages, when they are more likely to respond to treatment."

The number of cancer screenings jumped in 2014 and 2015, as the state expanded eligibility for the Medicaid program under federal health reform, making many more people eligible for free screenings. Bevin is seeking change the state's program in ways that could require co-payments, premiums and deductibles.

In Kentucky "the challenge is to not only encourage certain lifelong smokers to get screened, but to get them to quit, and for others to never start," especially because of the addictive nature of smoking, Judd reports. "It will be even more difficult than changing the profile of colon cancer, because smoking involves addiction. The hope of public health officials is that the model used to bring down colon cancer deaths can be used to the same effect, not only for lung cancer, but for other diseases plaguing this depressed swath of America."

Princess Health and Combination of tobacco smoke and high radon levels increase Kentuckians' risk of getting lung cancer by a factor of 10.Princessiccia

Princess Health and Combination of tobacco smoke and high radon levels increase Kentuckians' risk of getting lung cancer by a factor of 10.Princessiccia

cancer lung cancer smoking tobacco

Gusty 10:22 Add Comment

Red counties are expected to have an indoor radon level high
enough to require a radon mitigation system. (USEPA map)

Combined exposure to tobacco smoke and radon, an odorless gas that comes from small amounts of radioactive minerals in limestone bedrock, contribute to increased risk of lung cancer for Kentuckians.

Not only do high smoking rates and lack of smoking bans expose Kentuckians to high levels of tobacco smoke, the state's laws don't require testing and monitoring of radon, Elizabeth Adams notes in a University of Kentucky news release that gives this warning: "The risk of lung cancer increases 10-fold when a person is exposed to both high levels of radon and tobacco smoke." She gives two steps to reduce the risk:

Reduce exposure to second- and third-hand smoke. Do not allow smoking in your home or car, and ask smokers who go outside to smoke need to cover their clothes with a jacket before returning inside, or they will bring third hand smoke in with them. Of course, quitting smoking is the best way to protect your health and the health of your family.

Test your home for radon every two years. One can often obtain a free test kit from the health department or purchase one at a home improvement store. Renters can ask their landlord about radon testing. If the radon level reaches 4.0 or above, a radon mitigation system will become necessary. Opening windows or increasing ventilation won't solve the problem. Instead, call a certified radon mitigation company.

If someone living in your house smokes cigarettes, cigars or pipes, you might be eligible to participate in a UK research study examining the combined effects of smoke and radon. To learn more about the study, send an email to ukfresh@lsv.uky.edu or call 859-323-4587.

Princess Health and Princess Health andBreakthrough drugs for targeted diseases work wonders, but are very expensive; some see a trend to worry about.Princessiccia

Princess Health and Princess Health andBreakthrough drugs for targeted diseases work wonders, but are very expensive; some see a trend to worry about.Princessiccia

cancer lung cancer pharmaceuticals research skin cancer

Gusty 17:03 Add Comment

Drugs focusing on narrow subsets of broader diseases are now being developed for individuals with specific genetic makeups. This trend prompts questions about who covers the cost, who gets the drugs and which diseases get the investment dollars, Brady Dennis reports for The Washington Post.

The newest "breakthrough" pharmaceutical is a new lung cancer drug named Zykadia, Dennis reports. The Food and Drug Administration released it four months ahead of schedule.

This drug is not designed to treat everyone who has lung cancer, which kills an estimated 160,000 Americans each year, including 3,500 Kentuckians. Kentucky's lung cancer death rate is almost 50 percent higher than the U.S. rate, placing Kentucky first in the nation for new cases and deaths from lung cancer.

Zykadia is designed to treat only about 5 percent of patients who fit into a specific subset of the disease: those who have advanced, non-small-cell lung cancer, and a specific gene mutation that causes tumors to resist other treatment, Dennis writes. For them�and only them�the drug has the proven potential to shrink tumors and extend lives.

�It�s a new world,� Wendy Selig, president of the Melanoma Research Alliance, told Dennis. �We�re segmenting what we thought of as large diseases into smaller populations of patients that are defined by genetic distinctions. .?.?. The goal is to match the right therapy to the right patient and to do it with minimal collateral damage.�

Since 2011, the FDA has approved numerous new treatments for melanoma, or skin-cancer patients with certain types of genetic mutations, specific cancers and a small proportion of people with cystic fibrosis, Dennis notes.

The FDA told Dennis that almost 40 of the nearly 50 drugs it has designated as potential �breakthroughs� involve targeted therapies. These targeted therapies often offer recipients earlier and better diagnoses, more effective treatments and even possible cures�or at least more time�for people who previously had little hope.

"But the trend toward targeted medicine also is forcing hard questions on regulators, drug makers, insurers and patients alike: Who should pay for the growing number of specialized drugs, which can cost hundreds of thousands of dollars a year? How does society ensure that everyone who might benefit�rich or poor�can receive treatment? What about patients whose specific conditions or mutations have not attracted investment dollars or the attention of researchers, leaving them to watch and hope from the sidelines?" Dennis writes.

Private insurers and Medicare generally cover the high drug costs, which currently account for only a fraction of overall health-care spending, Dennis reports.

But Barry Werth, an author and journalist who has spent decades writing about the pharmaceutical industry, asks, "What happens when targeted drugs become the rule rather than the exception? Will insurers refuse to cover some of them? Will the government ponder rationing them? Will only the wealthy be able to afford the best and newest treatments?"

This scenario could be happening with Sovaldi, a "groundbreaking new treatment" for the estimated 3 million Americans infected with hepatitis C, Dennis reports. Insurers are publicly rebelling against the drug's price of $1,000 per pill, or $84,000 for a 12-week treatment.

"The worry is that Sovaldi is the poster child for a �tsunami of expensive medicines� that collectively threaten to bankrupt the health-care system," John Rother, president of the National Coalition on Health Care, which represents insurers, employers, consumer and religious groups, health-care providers and some drug manufacturers, told Dennis.

�We�ve been able to absorb it so far because there are very few of them and because they are consumed by very small numbers of people,� Rother said of specialty drugs. �[But] if they�re all priced at the same level Sovaldi is, we really won�t be able to absorb it in the current system. It�s not sustainable.�

Edward Abrahams, president of the Personalized Medicine Coalition, an advocacy organization that includes drug makers, medical providers and patient and research groups, told Dennis that the cost of creating targeted drugs cost billions of dollars and often takes a decade or more to develop. Without the ability to recoup those costs, he said, "research will wither."

�As a society, we�re schizophrenic about this,� Abrahams told Dennis, adding that everyone wants to cure cancer and other diseases. �But at the other end, you have to be willing to pay for these products. .?.?. When you develop a drug for a segmented population, the cost of that drug is likely to be higher than if it worked for everybody.�

Princess Health and Princess Health andSmoking increases risk of getting lung cancer by up to 20%, but add other carcinogens and it can go up as much as 300%.Princessiccia

Princess Health and Princess Health andSmoking increases risk of getting lung cancer by up to 20%, but add other carcinogens and it can go up as much as 300%.Princessiccia

cancer environmental health lung cancer lung disease research smoking tobacco tobacco prevention

Gusty 19:19 Add Comment

If you smoke, your risk of getting lung cancer is as much as 20 times greater than if you don't. But if you smoke and are exposed to other carcinogens such as radon, asbestos, arsenic or chromium, your risk could be 300 times greater, according to "a growing body of research, including two studies under way at the University of Kentucky," reports Laura Ungar of The Courier-Journal.

See below for example of how to use interactive version of map

"The studies help explain why Kentucky�s lung-cancer and death rates are so much higher than for the rest of the nation," Ungar writes, citing experts. The state leads the nation in lung cancer, "and some Appalachian counties� rates are more than double the national average. While Kentucky�s adult smoking rate of 28 percent is the highest in the nation, it�s not enough to account for the state�s sky-high lung-cancer rates."

Here are two possible causes: Appalachian counties are high in arsenic and chromium, and Central Kentucky has high potential for radon gas, which can accumulate under buildings. "The National Cancer Institute says radon by itself is the second-leading cause of lung cancer in the United States, and most radon-related deaths occur among smokers," Ungar notes. "Kentucky has no laws requiring radon testing for single- or multi-family homes, schools or businesses; and no laws mandating radon-resistant construction of new homes," according to Ellen Hahn, a UK professor of nursing and public health.

"While doctors aren�t sure how smoking interacts with such carcinogens in the body," Ungar writes, "some theorize that when smoking damages lung cells� DNA, the lungs become more susceptible to damage from other toxins." (Read more) The map above is interactive on the Kentucky Cancer Registry website. Here's an example of how to display county data, which also shows the beginning of the county list ranked by lung-cancer rate; a map of county lung cancer death rates is also available:

Princess Health and Princess Health andUK researchers work to improve identification of lung cancer patients eligible for participation in clinical trials for new treatments.Princessiccia

Princess Health and Princess Health andUK researchers work to improve identification of lung cancer patients eligible for participation in clinical trials for new treatments.Princessiccia

cancer clinical trials lung cancer research University of Kentucky

Gusty 18:19 Add Comment

At the University of Kentucky, researchers are developing better strategies to identify lung cancer patients who could participate in clinical trials for new treatments. Lung cancer causes more deaths than any other kind of cancer worldwide, and Kentucky's rates of lung cancer and mortality are the highest in the nation.

Unfortunately, fewer than 1 percent of lung cancer patients participate in clinical trials in part because identifying and recruiting eligible participants is difficult and time-consuming, Mallory Powell writes for UK. The disease is often diagnosed so late that there is little time for clinical trials.

"The combination of the burden of lung cancer in Kentucky and the urgency of identifying patients who are eligible for clinical trials motivated Dr. Eric Durben and his team to devise a more efficient method for screening patient eligibility," Powell writes. Durben is director of the Cancer Research Informatics Shared Resource Facility at UK's Markey Cancer Center and an assistant professor in the division of biomedical informatics in the College of Public Health.

Durbin and his team are using unique electronic data sources managed by UK's Center for Clinical and Translational Science, the Institute for Pharmaceutical Outcomes and Policy, the Markey Cancer Center and the Kentucky Cancer Registry to create system system to identify patients who for clinical trials. The two-year project is in its seventh month.

"Clinical trial recruitment is critically important to the Markey Cancer Center if we're going to get lifesaving therapeutics to our patients," said Dr. Susanne Arnold, associate professor in medical oncology and radiation medicine at Markey. "It's also how we make progress in cancer treatment."

While the project is geared toward lung cancer, its results could address other cancers. "What's really exciting about Dr. Durbin's study is that it has the potential to greatly improve clinical research not only in the lung cancer but in other cancers and disease conditions as well," said Dr. Nathan Vanderford, assistant director for research at Markey. (Read more)

Princess Health and Princess Health andSmoking persists or even increases in poor, rural, working-class counties; New York Times cites Clay County as an example.Princessiccia

Princess Health and Princess Health andSmoking persists or even increases in poor, rural, working-class counties; New York Times cites Clay County as an example.Princessiccia

cancer cigarettes county health education health rankings lung cancer poverty rural health rural-urban disparities smoking smoking cessation tobacco tobacco prevention

Gusty 10:55 Add Comment

Clay County has a dubious distinction. It has the highest rate of smoking for any U.S. county with a population under 15,000. Researchers at the University of Washington pointed that out, and The New York Times focused on it in reporting the larger finding: Some poor, rural and working-class counties have increasingly high rates of smoking, while the smoking rates in wealthy counties continue to decline.

Ed Smith Jr.
(NYT photo by Tim Harris)

In Clay County, the smoking rate was 36.7 percent in 2012. �It�s just what we do here,� Ed Smith Jr., 51, told the Times, which reports, "Several of his friends have died of lung cancer, and he has tried to quit, but so far has not succeeded." (Institute for Health and Metrics map shows adult smoking rates by county; Clay and Knox counties are the red area in southeastern Kentucky. The interactive map shows how rates have changed since 1996, overall and among men and women. To view it, click here.)

The smoking rate among adults has decreased 27 percent since 1997, but only 15 percent among poor people, and haven't changed at all for adult smokers living in deep poverty in the South and Midwest, the study found. "The findings are particularly stark for women," Sabrina Tavernise and Robert Gebeloff write. "About half of all high-income counties showed significant declines in the smoking rate for women, but only 4 percent of poor counties did." Education also plays a role. "Americans with a high-school education or less make up 40 percent of the population, but they account for 55 percent of the nation�s 42 million smokers."

Clay County is one of the nation's poorest, and only 7 percent of its people have a college degree. The county seat, Manchester, passed an indoor smoking ban in 2012, and Manchester Memorial Hospital "runs a smoking-cessation program that offers free nicotine patches and gum in an effort to reach low-income smokers," the Times reports. �Smoking cessation is our biggest uphill battle,� Jeremy Hacker, the hospital�s community outreach coordinator, told the newspaper. Smoking is no longer a normal activity in urban places, he said, but in Clay, �It�s not viewed as a problem.� (Read more)