Study finds that one dose of HPV vaccine that targets only cervical cancer is as effective as three doses, now recommended

By Melissa Patrick
Kentucky Health News

A study has found that one dose of the human papillomavirus vaccine Cervarix appears to be as effective in preventing HPV infections that lead to cervical cancer as do three doses, the recommended course of vaccination. Only 25 percent of Kentucky adolescent women initiate the vaccination, and fewer than one in nine of those who do get three does, according to the Kentucky Cancer Consortium.

"Many women around the world and in the U.S. don't get the full three doses that are recommended, so this is promising news," said Elisia Cohen, an associate professor of communication at the University of Kentucky, who does extensive research on community strategies to improve adolescent and adult vaccinations. However, she cautioned that the drug Cervarix is "only 1 percent of the U.S. market" and that the findings from this study do not apply to Gardasil, the drug most commonly used in the U.S.

Dr. Diane Harper of the University of Louisville, one of the researchers, said in a news release, “Kentucky is one of the states that has not had a program in place to make Cervarix available to all of its citizens, and has very low three-dose completion rates of Gardasil.”

Most health departments and physicians choose Gardasil over Cervarix because it protects against four strains of HPV: two strains that cause 70 percent of all cervical cancers and two strains that cause genital warts and oral and anal cancers, concerns for males as well as females. Cervarix only protects against the two strains that cause cervical cancer. "Generally, the thinking is that protection against four strains is better that two," Cohen said.

She said Gardasil 9, which will protect against 90 percent of HPV strains that cause cervical cancer as well as pre-invasive cervical cancer lesions, has just been approved by the U.S. Food and Drug Administration and is going through its labeling process, and will be recommended for both boys and girls.

HPV is the most common sexually transmitted infection in the U.S., affecting an estimated 79 million individuals, according to the federal Centers for Disease Control and Prevention.

The study, published in The Lancet Oncology, analyzed data from two large trials of Cervarix. In the trials, women were randomly chosen to receive three doses of Cervarix or a control vaccine. All of the women were evaluated, regardless of how many doses of the vaccine they received, for the effectiveness of the vaccine for a period of four years. The analysis found that the protection from one dose was similar to that achieved by three doses of the vaccine.

“Knowing that Cervarix offers protection in one dose reassures public health agencies that they are not wasting money when most of their vaccines are given to those who never complete the three-dose series,” the researchers wrote.

The CDC recommends HPV vaccination for girls 11 and 12 years old, and catch-up vaccination for females from 13 to 26. The second dose should be given one to two months after the first injection; the third dose should be administered six months after the first dose.

KentuckyOne Health turns down ethics panel's request to remove or change cancer treatment banner advertisement

A Louisville cancer center features a giant banner that says: "FIGHT CANCER WITH 5 or FEWER TREATMENTS." The treatment, called CyberKnife and performed at the James Graham Brown Cancer Center, is a procedure that directs large doses of radiation accurately to tumors, but it only works for small, isolated tumors, Andrew Wolfson reports for The Courier-Journal.

Dr. Anthony Zietman, associate director of the Harvard Radiation Oncology residence program at Boston's Massachusetts General Hospital, agreed the banner is accurate but said it is misleading, falsely implying CyberKnife can cure cancer. "For the right person, it is a great treatment, but the banner implies it is for everyone," he told Wolfson, adding that fewer than 20 percent of cancer patients at his hospital are eligible for stereostatic radiosurgery treatment.

The University of Louisville Hospital's ethics committee voted unanimously on May 20 to request that KentuckyOne Health remove the banner or change it to give more context. "It is false and misleading advertising," said Dr. Larry Florman, a plastic and reconstructive surgeon who sits on the committee, which includes doctors, nurses and clergy. "It's almost like a scam."

The committee said in an email to KentuckyOne that cancer patients receiving traditional therapy were asking why their treatment included more than five sessions and why they couldn't receive CyberKnife treatments instead. KentuckyOne spokesman David McArthur said after talking with the chairman of the U of L Department of Radiation Oncology and examining clinical results, "We decided that keeping the banner in place is appropriate."

McArthur also noted that CyberKnife can fight cancer after just five or fewer treatments and that in almost three years, "all patients treated with it at the cancer center have received one to five treatments," Wolfson writes. "More than half were treated for metastatic cancer—cancer that had spread." McArthur added, "In the spirit of collaboration, we are looking for additional ways to ensure potential patients have the appropriate information to understand if CyberKnife is the right treatment for them."

Accuray is the Sunnyvale, Calif., company that makes CyberKnife. The company says the therapy is non-invasive and painless. In 2001, the U.S. Food and Drug Administration approved the system for use in any organ, including the prostate, lung, brain, spine, liver, pancreas and kidney.

Free screenings of new Kentucky colon-cancer documentary, plus Q and A, are scheduled in Louisville, Lexington and Hazard

The Colon Cancer Prevention Project is premiering its new documentary, "Catching a Killer: Colon Cancer in the Bluegrass," in three select cities, before it starts airing on KET this summer.

The 30-minute film, which features stories from Kentuckians who have been affected by colon cancer, will be shown June 18 at the Clifton Center in Louisville; June 23 at the Central Library in Lexington; and July 20 at the Perry County Library in Hazard. It includes stories from residents of Appalachia and Louisville, two areas where colon cancer rates are the highest.

All three events will run from 7 to 8 p.m. and include a question-and-answer session with expert panelists after the film is over. Free food, music and photos will be offered before the start of the film, from 5:45 to 6:45 p.m.

The Colon Cancer Prevention Project is Kentucky and Southern Indiana’s only nonprofit focused solely on work to end the second leading cancer killer among men and women. Colon cancer strikes 2,600 Kentuckians each year – making Kentucky one of the worst states in the country for colon cancer incidence – but it is highly preventable with screening.

"Catching a Killer" not only shares the heartfelt stories of our neighbors, but also shares information about screening options and resources in our state.

“Our goal is to make sure people get screened for this disease and avoid ever hearing the words: You have cancer,” Andrea Shepherd, the project's executive director, said in a news release. “We hope that after viewing this documentary, people get on the phone and start talking with their physicians and families about colon cancer screening.”

The events are free and open to the public. More information and an RSVP form is available on the project's website.

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

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.

Markey Cancer Center honors those who have battled cancer by displaying art by or about them: Expressions of Courage

To celebrate National Cancer Survivorship Month, the Markey Cancer Center at the University of Kentucky held an art exhibit June 6 to showcase personal artistic expressions crafted by or in memory of a Markey patient whose battle had ended.

UK patient Phillip Meeks brought
a drawing by his daughter, inspired
by the story of his cancer treatment.

The Expressions of Courage event “honored the experiences of those who have battled cancer with a day of recognition and celebration,” a UK news release said.

"We sent out over 6,000 letters," Cindy Robinson, a Markey nurse practitioner and one of the organizers, said in the release. "And we asked people for any type of creative modality that they wanted to share with us, to share their cancer journey, whether it be positive or negative."

More than 30 artists responded and shared a vast array of talents, from paintings, sculptures and quilting to dancing, singing, and readings of poetry and short stories, just to name a few.

"The artwork is very moving and inspiring, and actually will bring tears to your eyes if you read some of the pieces," Robinson said. "We have some pieces here from patients that are no longer with us, and we personally know those people."

Shawna Cassidy Quan of Richmond was one of the survivors in attendance, having been diagnosed with four different primary cancers over 15 years. Her expression of courage was an essay about her struggles with her multiple diagnoses.

"You figure out the answers to a lot of your problems even while you're sitting down writing," Quan said in the release. "It's just been a wonderful, therapeutic thing for me."

Norton Cancer Center and Markey patient Phillip Meeks traveled nearly two hours from Jeffersonville, Ind., to attend the event. His art piece was a drawing by his daughter, who was inspired by the story of his treatment.

In 2012, Meeks' was diagnosed with acute myeloid leukemia, which required a bone-marrow transplant to survive. The odds of getting one were not in his favor because as an African American, only 7 percent of the bone marrow registry is African-American, and as an adoptee he did not have any biological siblings or parents to be tested.

The day he was admitted to the hospital, Meeks said in the release that they found a token underneath his hospital bed: one side said "Believe in Miracles" while the other side said "Faith."

"To me, that was God's way of saying that I'm there with you, you know, don't be scared," Meeks said.

A donor match was found for him, and he received his life-saving transplant in January 2013.

Meeks, along with many survivors and their families, said that the Expressions of Courage event was not only a day to showcase talent, but a day that survivors could show their appreciation to the staff of Markey.

"I just want to give back," Meeks said. "That's my big thing. How can you thank so many people that are involved in saving your life? There's not a gift that you can give that's big enough. Hopefully this is my one little piece to say thank you for everything that everybody has done for me."

KET to focus attention on cancer with Ken Burns series March 30-April 1, live call-in program on night of April 1

Kentucky Health News

KET will show a three-night series, "Cancer: The Emperor of All Maladies," by Ken Burns, an in-depth look at the history of cancer, patients' stories and the "latest scientific breakthroughs that may have, at last, brought researchers within sight of developing lasting cancer cures," the network says in a news release.

The series, which will air March 30, 31 and April 1 at 9 p.m. ET, is based on the Pulitzer Prize-winning book The Emperor of All Maladies: A Biography of Cancer by Siddhartha Mukherjee.

KET will air companion programs to this series that will focus on Kentuckians.

Bill Goodman will host Dr. Mark Evers, director of the Markey Cancer Center at the University of Kentucky, on "One to One" March 29 at 1 p.m. ET to discuss the latest news in cancer care and research. This show will also air on KET2 March 31 at 7:30 p.m. ET.

On April 1 at 8 p.m., Renee Shaw will host a live call-in program, "Answers for Cancer," as part of KET's "Health Three60" series. This show will offer viewers a chance to ask questions about cancer screening, treatment and recovery resources in Kentucky.

A recording of the program will air on KETKY April 6 at 9 a.m., April 10 at 11 a.m., April 11 at 4 a.m. and April 13 at 2 a.m. (all times ET).

Viewers can submit questions to the original program via Twitter at @HealthKET, by email at healthnews@ket.org, or by phone at 800-753-6237.

Panelists on the program include Donald Miller, director of the James Graham Brown Cancer Center at the University of Louisville; Patrick Williams, medical director at Norton Cancer Institute; Timothy Mullet, lung cancer specialist with UK HealthCare, who is himself a cancer survivor; and Fran Feltner, director of the UK Center for Excellence in Rural Health.

This show will also offer a pre-taped segment that spotlights cancer screening outreach efforts in Kentucky that target high risk populations.

Study suggests there's too much imaging of low-risk prostate- and breast-cancer patients in the Evansville and Louisville areas

Hospitals and doctors in the Evansville and Louisville areas may be doing too much medical imaging on patients with low-risk prostate or breast cancer, according to a study of cases in the middle of the last decade.

Researchers at New York University examined Medicare records from 2004 through 2007 of 9,219 men with low-risk prostate cancer and 30,398 women with low-risk breast cancer, across 84 of the nation's hospital referral regions. They concluded that unnecessary imaging was done in 44 percent of men and 42 percent of women, they report in the journal JAMA Oncology.

The report did not give rates for each hospital region, but ranked them, and Evansville was second, right behind Slidell, La., and Louisville was 24th. Owensboro was 37th. Other regions listed were Paducah, 45th; Nashville, 57th; and Lexington, 78th. For the study appendix, listing the hospital areas and their rankings, click here.

The study found that "hospitals in the Northeast reported higher use of imaging tests for low-risk patients, while other regions, such as the Northwest and Utah, demonstrated more appropriate use of imaging," an NYU press release said. It quoted Dr. Danil V. Makarov, the lead investigator and professor, as saying, “Policy makers and researchers need to target high-utilization regions and promote incentives for appropriate care. Such a focus would enhance efforts to cut excessive health spending and build value-based strategies into health care practice.”

Imaging for prostate cancer generally involves CT scans or bone scans. Imaging for breast cancer generally involves CT, MR and PET scans.

As session nears end, bills on heroin, dating-violence orders, managed-care appeals and lawsuit review panels are hanging fire

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – The General Assembly has sent Gov. Steve Beshear four health-related bills, and several more could reach his desk in the legislative session that ends Wednesday. Legislators will return briefly after 10 days to reconsider any bills Beshear vetoes; they could also pass more bills, but would not be able to override any vetoes.

Here are some of the health-related bills that were pending on Monday; bills with two readings are ready for floor action.

Heroin: tougher penalties and needle exchanges?

Both the Senate and the House have heroin bills and both remain in committee in the other chamber, but hope remains high in both chambers that a compromise can be reached so that a heroin bill will pass this session. Senate Bill 5 is sponsored by Sen. Christian McDaniel, R-Latonia; House Bill 213 is sponsored by Rep. John Tilley. The main differences are how traffickers would be punished and whether to start needle-exchange programs for addicts. The Senate's penalties are tougher and it has opposed needle exchanges, which advocates say prevent disease and death from dirty needles and can lead addicts to treatment.

Now the Senate is moving toward accepting needle exchanges, James Pilcher reports for The Cincinnati Enquirer. Rep. Dennis Keene, D-Wilder, and Sen. Wil Schroder, R-Wilder, said exchanges "are much more likely to be included than when the session started," Pilcher writes. Schroeder told him, "I think there is a real possibility that we could include needle exchanges and then get our tougher penalties." Pilcher reports, "The possible legislative position shift comes as health officials throughout the Tristate have expressed deep concerns about the spread of diseases that can be contracted using dirty needles."

Protective orders for dating violence

House Bill 8, sponsored by Rep. John Tilley, D-Hopkinsville, has received its second reading and is awaiting passage in the Senate. This bill would allow dating partners to petition for interpersonal protective orders if they have been the victim of domestic violence, sexual abuse or stalking. Such orders are now available only to those who are married, live together or have lived together, or an unmarried couple with a child in common.

Kentucky is the only state that offers no protection for such victims. Legislation to do that has stalled in the Senate in earlier sessions, but a Senate committee substitute addresses a key objection, by creating a new chapter in the statutes for the bill, separate from the existing domestic-violence chapter.

Advocates say domestic violence is a health issue not just because of the physical injuries it causes. They say victims are more likely to be depressed, have unplanned and premature pregnancies, go to fewer prenatal visits, and to miss more well-child visits with their children.

Prescription synchronization, managed-care appeals

Senate Bill 44, sponsored by Sen. Julie Raque Adams, R-Louisville, has had its second reading in the House. This bill would allow patients with multiple prescriptions, in consultation with their health-care provider and their pharmacist, to synchronize prescriptions so that they may be picked up at the same time.

House Majority Caucus Chair Johnny Bell, D-Glasgow, has filed a floor amendment on an unrelated issue, to create a state appeals process for health-care providers to appeal decisions of Medicaid managed-care companies. It is the same as or similar to Senate Bill 120, sponsored by Sen. Ralph Alvarado, which has given it a first reading without assigning it to a committee. The Cabinet for Health and Family Services opposes a state appeals process, saying it would have a conflict of interest (successful appeals would cost the state money) and providers have the courts available to them to resolve contractual issues. UPDATE: Bell withdrew his floor amendment to Senate Bill 44 March 9. 

Review panels for suits against health-care providers: Senate Bill 6, filed by Alvarado, remains in the House Judiciary Committee, but a discharge petition was filed March 4 to bring it to the floor, bypassing leaders of the House's Democratic majority. This bill would establish panels of three medical experts, two chosen by each side and the third chosen by the other two, to review suits against health-care providers to determine if the case has merit before the lawsuit can proceed. Panel findings would be admissible in court, but not legally binding. Opponents say that Kentucky already has laws to punish attorneys for filing frivolous cases and that this just adds another barrier for patients seeking justice.

Newborn screenings for fatal disease: Senate Bill 75, sponsored by Sen. Alice Forgy Kerr, R-Lexington, has had two readings. It would require all newborns to be tested for Krabbe disease, a neurological disorder that destroys the protective coating of nerve and brain cells and is fatal once symptoms occur. Treatment with stem cells from an umbilical cord blood transplant is sometimes successful it the infant is treated early enough. The cabinet opposes the bill, saying the screening will cost half a million dollars a year at a time when local health departments are suffering budget cuts.

Spina bifida: Senate Bill 159, sponsored by Sen. Julie Raque Adams, R-Louisville, is in the House and the three-day posting rule has been waived. This bill would require medical providers to supply written, up to date, accurate information to parents when their unborn child is diagnosed with spina bifida so parents can make informed decisions on treatment

Physician assistants: House Bill 258, sponsored by Rep. Denver Butler, D-Louisville, is awaiting Senate passage. This bill allows a physician to supervise up to four physician assistants at the same time, rather than two.

In-home care: House Bill 144, sponsored by Rep. Tom Burch, D-Louisville, is awaiting Senate passage. It would establish a 60-day, hospital-to-home transition program through an approval waiver from the Department for Medicaid Services. The daily cost would have to be less than the average daily nursing home payment allowed by Medicaid. The bill would also provide non-medical support services to the applicant as needed.

BILLS SENT TO THE GOVERNOR

Colorectal cancer screening: Senate Bill 61, sponsored by Sen. Ralph Alvarado, R-Winchester, received final passage in the House March 4. This bill requires that a fecal test to screen for colon cancer, and any follow-up colonoscopy, be considered preventive measures that health insurance is required to cover without imposing additional deductible or co-insurance cost. The bill would apply to health plans issued or renewed on or after Jan. 1, 2016, if it becomes law. A similar measure, House Bill 69, sponsored by Rep. Tom Burch, D-Louisville, is awaiting passage in the Senate with a committee substitute by Sen. Julian Carroll, D-Frankfort, calling for a Medicaid savings study.

Medical order scope of  treatment (MOST) form: Senate Bill 77, sponsored by Sen. Tom Buford, R-Nicholasville, received final passage in the House March 3. This bill creates a medical order scope of treatment (MOST) form that specifically directs the type of treatment a patient would like to have, and how much intervention he or she would like to have, during end-of-life care. It is considered a physician's order, travels with the patient between health care facilities, and must be reviewed annually. The bill clearly defines the order of controlling documents for end-of-life care: the living will first, the MOST form second and the health-care surrogate, which is chosen by the patient and listed on the form, third. The MOST form is already used in 32 states.

Emergency care for strokes: Senate Bill 10, sponsored by Sens. Stan Humphries, R-Cadiz, and David Givens, R-Greensburg, received final passage in the House March 4. The bill requires that a list of all acute stroke-ready hospitals, comprehensive stroke centers and primary stroke centers in Kentucky be posted to the cabinet's website and be made available to all emergency medical services providers, who are required to set their own internal protocols toward assessment, treatment and transport of stroke patients.

Funding for UK cancer research center: House Bill 298, sponsored by Rep. Rick Rand, D-Bedford, received final passage in the Senate March 4. This bill authorizes the state to appropriate $132.5 million, half of the cost, for construction of a new medical research center at the University of Kentucky. The university will raise money to cover the other half. The facility will target prevalent diseases in Kentucky, including cancer, diabetes and cardiovascular disease. The bill required a 60 percent vote in each chamber because it affects the state budget and the legislature is in a non-budget session; it passed the House 83-9 and the Senate 36-1 (Sen. John Schickel, R-Union).

State Senate passes bills to lower a barrier to colon-cancer screening and allow patients to synchronize their prescriptions

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – Two health-related bills, one to remove a financial barrier for colorectal cancer screenings and the other to allow consumers to synchronize prescriptions so they can get all of their medications on the same day, passed the state Senate Feb. 19.

Senate Bill 61, sponsored by Sen. Ralph Alvarado, R-Winchester, would clarify that a fecal test to screen for colon cancer, and any follow-up colonoscopy, are preventive measures that federal health reform require to be covered by insurance. It went to the House on a vote of 31-3.

"The purpose of this bill is to identify and correct ongoing discrepancies in the coding and billing portion of this screening and prevention continuum," said Alvarado, who is a physician.

The two primary ways to screen for colon cancer are colonoscopy or a non-invasive fecal blood test.

This bill was prompted because patients are being charged for a diagnostic procedure instead of a preventive one if they do a non-invasive fecal test that comes back positive, and then get a follow-up colonoscopy. The non-invasive fecal test is coded as a preventive screening, which is covered by insurance, but the colonoscopy is coded as a diagnostic procedure, which comes with a hefty price-tag, sometimes upwards of $1,000, Alvarado said.

Patients are also being charged for a diagnostic procedure if lesions are removed during the screening process, which is standard procedure to do so, since the patient would otherwise have to return for a second colonoscopy to remove them.

This is ironic, Alvarado said in a news release, because if the patient had chosen the more expensive and invasive colonoscopy initially, the insurance company would have paid for it.

This is a "barrier to screening," he said, in a state that leads the nation in colorectal cancer and until recently led the nation in deaths caused by it.

A sister bill, House Bill 69, sponsored by Rep. Tom Burch, D-Louisville, passed the House Feb. 9 and was assigned to the Senate Health and Welfare committee Feb. 12.

By a 34-0 vote, the Senate passed SB 44, sponsored by Sen. Julie Raque Adams, R-Louisville. It would allow patients with multiple prescriptions, in consultation with their health care provider and their pharmacist, to synchronize them so that they may be picked up from the pharmacy at the same time.

"This bill will allow patients to refill and pick up their prescribed medications for chronic conditions on the same day of the month instead of making multiple trips to the pharmacy," Adams said.

"This bill is not just about convenience," Adams said, but also helps make sure patients take their medication, "improving health outcomes and lowering health care cost overall." She cited a study that found patients who participated in a med-synchronization program at their pharmacy were 30 percent more likely to take their medicine as prescribed.

Some are concerned about the front-end cost of this program, "but fail to see the potential cost savings to the health care system overall," Adams said, saying a Medicare Part D cost-benefit analysis found there was an estimated savings of $1.8 billion to the system, and also showed improved medication adherence.

A sister bill, House Bill 140, sponsored by Rep. Addia Wuchner, R-Florence, was assigned to the House Banking and Insurance Committee on Jan. 9.

Medicare to pay for CT scans of people at high risk of lung cancer

Medicare will now pay for low-dose CT scans for people at high risk of getting lung cancer, a change welcomed by officials in Kentucky, which leads the nation in lung cancer and deaths from it.

"This is an important new Medicare preventive benefit since lung cancer is the third most common cancer and the leading cause of cancer deaths in the United States," Dr. Patrick Conway, chief medical officer for the federal Centers for Medicare and Medicaid Services, said in a press release.

Lung cancer is especially deadly because it doesn't cause symptoms until it's too late, killing nearly 160,000 people a year, according to the American Cancer Society.

This new preventive coverage will allow Medicare to pay for a once-a-year, low-dose CT exam for people aged 55-77 who are either current smokers, have quit smoking within the last 15 years or who have smoked at least a pack a day for 30 years, or the equivalent and have a written order from a doctor, reports Maggie Fox of NBC News.

Some doctors question how many people will benefit from the test, which costs $250 to $300, and have voiced concerns that it doesn't always produce clear results, causing patients to endure further testing than might turn out to have been unnecessary. Federal officials disagree, and experts say it will prevent as many 20 percent of U.S. deaths from lung cancer, "making it akin to mammograms and colonoscopies in terms of saving lives," Fox reports.

Heavy use of e-cigarettes may deliver big doses of formaldehyde, which can be a cause of lung cancer, study suggests

Vapor produced by electronic cigarettes can contain a surprisingly high concentration of formaldehyde—a known carcinogen that can cause lung cancer through prolonged exposure—researchers reported Wednesday in a study published in the New England Journal of Medicine, Rob Stein reports for NPR. (Getty Images by Dan Kilwood)

Use of e-cigarettes among rural teens has risen in recent years, prompting the U.S. Food and Drug Administration to propose rules to give it authority over e-cigarettes, an industry that accounts for about $2.5 billion in annual sales.

"E-cigarettes work by heating a liquid that contains nicotine to create a vapor that users inhale," Stein writes. David Peyton, a chemistry professor at Portland State University who helped conduct the research, told Stein, "We simulated vaping by drawing the vapor—the aerosol—into a syringe, sort of simulating the lungs. That enabled the researchers to conduct a detailed chemical analysis of the vapor. They found something unexpected when the devices were dialed up to their highest settings."

The e-cigarette industry dismissed the report, saying they found formaldehyde only when e-cigarettes were cranked up to their highest voltage levels, Stein writes. Gregory Conley of the American Vaping Association told him, "They clearly did not talk to [people who use e-cigarettes] to understand this. They think, 'Oh, well. If we hit the button for so many seconds and that produces formaldehyde, then we have a new public health crisis to report."

"If you hold the button on an e-cigarette for 100 seconds, you could potentially produce 100 times more formaldehyde than you would ever get from a cigarette," Conley said. "But no human vaper would ever vape at that condition because within one second their lungs would be incredibly uncomfortable." (Read more)

Jane Beshear launches campaign for new cancer screening van

First Lady Jane Beshear, along with representatives from the Kentucky Cancer Program, the University of Louisville’s James Graham Brown Cancer Center and KentuckyOne Health, have launched another "Horses and Hope" campaign to raise $1 million for a mobile unit that will provide cancer screenings to under-served populations across Kentucky.

Churchill Downs has committed $90,000 and Kroger $25,000 toward the new cancer screening van, , said a news release from the governor's office.

“For years, the Horses and Hope program has been one of the driving forces behind the portable mammography unit that travels throughout the state offering breast cancer screenings and promoting the message that early detection saves lives,” Beshear said in the release. “We now have the opportunity to expand these services to screen for six additional forms of cancer, and continue our efforts to improve the health and wellness of Kentuckians throughout the commonwealth.”

Kentucky ranks first in the nation for cancer and cancer deaths, with an overall cancer incidence rate that is 14 percent greater than the national average.

The custom-built van will be fully equipped to educate Kentuckians about cancer prevention, and offer screenings for seven cancer types, including breast, cervical, colon, lung, prostate, skin and head/neck at no or little cost to the patient.

For more information and donation opportunities, visit the Horses and Hope site at www.horsesandhope.org/.

Two-thirds of Kentuckians support a statewide ban on smoking in most public places; Stumbo says it's time for a House floor vote

Kentuckians have remained steady in their support for a comprehensive statewide smoking ban with two-thirds supporting it, according to the latest Kentucky Health Issues Poll. Hours after the poll was released, state House Speaker Greg Stumbo said it is time for a House floor vote on the proposal.

The poll, taken Oct. 8 through Nov. 6, found that 66 percent of adults favored a law that would prohibit smoking in most public places, while 29 percent opposed it. These are virtually the same results as last year when 65 percent supported the ban and 29 percent opposed it. The poll's error margin is plus or minus 2.5 percentage points.

The poll was conducted by the Institute for Policy Research at the University of Cincinnati for the Foundation for a Healthy Kentucky and Interact for Health, formerly the Health Foundation of Greater Cincinnati.

Majorities in each political party supported a statewide smoke-free law: 68 percent of Democrats, 67 percent of Republicans and 64 percent of independents. These results were also almost the same as last year. Support for a statewide smoke-free ban decreased among those with a high-school education or less, but increased among those who had been to college. For the detailed results, click here.

Not surprisingly,the poll found that 80 percent of Kentucky adults who have never smoked and 71 percent of former smokers support such a law, while only 40 percent of current smokers do; 53 percent said they oppose it and 7 percent said they didn't know or weren't sure.

Those who said they were in excellent or very good health were most likely to favor a ban, at 75 percent. Generally, the unhealthier the respondent, the less likely he or she was to favor it. Among those who said they were in fair or poor health, 55 percent favored a ban.

Lexington (75 percent) and Louisville (74 percent) showed the highest levels of support for the ban. While most of those in Appalachian area-development districts support it, support in Appalachian Kentucky declined to 54 percent in 2014 from 72 percent in 2013. That was offset by gains in other areas. The error margin for this smaller sample is plus or minus 5.4 percentage points.

Twenty-six states and the District of Columbia have comprehensive smoke-free laws. Kentucky has several reasons to pass one. It leads the nation in smoking as well as lung cancer and deaths from it. Second-hand smoke is estimated to kill 950 Kentuckians a year, and research indicates that it increases the risk of heart and lung disease by 20 to 30 percent.

The Foundation for a Healthy Kentucky noted in its news release that the 2006 U.S. Surgeon General Report recommends "eliminating all exposure to secondhand smoke" and last years report "offered evidence that smoke-free indoor air policies are effective in reducing exposure to secondhand smoke."

A smoking ban came closest to a floor vote in the full House last year, but has never gotten out of committee in the Senate. House Speaker Greg Stumbo said on KET's "Kentucky Tonight" Monday that it is time for a floor vote, the best sign yet that it will get one. But Senate President Robert Stivers maintained that smoking bans should be done locally, not statewide.

After four days this week devoted to organization and ethics training, the legislature will recess until early February. The session of 30 legislative days must end by March 31.

KET program to host authors of "Life Lessons from Cancer" to discuss inspirational messages of book

"One to One" with Bill Goodman will feature the authors of Life Lessons from Cancer, Keen Babbage and his sister-in-law Laura Babbage, on Sunday, Dec. 21 at 1 p.m. ET to discuss the book and its inspirational messages, especially the importance of family when facing life's challenges.

Keen Babbage, a teacher and native Lexingtonian, was diagnosed with cancer in his late 50s, despite a lifetime of healthy habits. He felt moved to share his experience in print.

With the help of his sister-in-law, a registered nurse and chaplain at the Chandler Medical Center at the University of Kentucky, they wrote Life Lessons from Cancer, published in September.

Keen told an audience at the first promotional event in October that he hoped the lessons in the book would be an inspiration and offer guidance for other patients with cancer as well as a resource for health-care providers.

The show will also air on Tuesday, Dec. 23 at 7:30 p.m. ET on KET2.

Lung cancer gets much less research funding than other cancers, but is deadlier, especially in Kentucky

Lung cancer takes more lives annually than breast, prostate, and colon cancers combined, but the disease "generally doesn't get the public attention or research dollars in proportion to its lethality," Arielle Densen, co-founder of Lung Cancer Free World, writes for CNN.

Lung cancer receives $1,442 in federal research funds per death, compared with $26,398 for breast cancer (lung cancer kills nearly twice as many women as breast cancer) and $13,419 for prostate cancer according to a National Institutes of Health study. Funding by private donations increases the gap even further, she writes.

And though lung cancer is usually thought of as a "smokers disease" and often comes with a stigma attached, "the majority of those diagnosed with lung cancer are former smokers or have never smoked at all," Densen writes.

Densen shares the story of her mother, who was diagnosed with lung cancer but had never smoked. Her mom, being a non-smoker and generally "healthy," was told she had pneumonia despite a "lingering, months-long cough." Because she wasn't a smoker it "didn't trigger any red flags." Eventually, a CT scan found a mass in her lung. She was told she had stage 4 lung cancer and had one year to live. But "thanks to advancements in targeted therapies" she lived for 40 months after the diagnosis. She was 59 when she died.

Lung cancer is especially deadly because it usually doesn't cause symptoms until it's already spread to other parts of the body. Kentucky has more cases of lung cancer than any other state, and its lung cancer mortality rate is nearly 50 percent higher than the national average.

The five-year survival rate for lung cancer is around 16 percent and has been for decades and the survival rate for a stage 4 cancer is 4 percent, Densen reports.

Medicare plans to pay for lung-cancer screening, a boon to Ky.

The Centers for Medicare and Medicaid Services plan to start paying for lung cancer screening with low-dose CT scans for people at high risk.

Spiral CT (computed tomography), which is used to look for lung cancer, is a low-dose form of X-ray that delivers about the same radiation as a mammogram, Maggie Fox reports for NBC News.

“I think after a long effort to get to this point, CMS got it right,” Laurie Fenton Ambrose, president and CEO of the Lung Cancer Alliance, told Fox. “This has the potential of being one of the most significant cancer mortality-reducing efforts to date. We are finally focusing on what is a quarter of all cancer, and that’s lung cancer.”

Fox reports, "Experts project that the screening test, which costs $250-$300, may prevent as many as 20 percent of future deaths from lung cancer, making it akin to mammograms and colonoscopies in terms of saving lives."

The proposal covers people aged 55-74 who have smoked at least a pack a day for 30 years, or the equivalent. It is now open for a 30-day comment period.

Lung cancer is especially deadly because it usually doesn’t cause symptoms until it’s already spread to other parts of the body. Kentucky has more cases of lung cancer than any other state, and its lung cancer mortality rate is nearly 50 percent higher than the national average. This year alone, 3,500 Kentuckians will die from lung cancer. Nationally, it kills nearly 160,000 people a year, according to the American Cancer Society.

Concerns about using CT scans to screen for ling cancer are that it isn't cheap, it isn't harmless, and the scans aren't always clear, often causing patients to endure further needless testing, Fox reports: "The national lung screening trial showed that for every five to six lives saved by screening, one person died because of procedures done after screening, including surgery and biopsies that collapsed the lung."

That calls for caution. “We strongly advise older current and former heavy smokers to speak with their doctors about whether CT lung cancer screening is right for them,” Dr. Ella Kazerooni, chair of the American College of Radiology Lung Cancer Screening Committee, told Fox. “If they and their doctor decide that screening is warranted, we encourage patients to seek out an ACR lung cancer screening center.” 

McConnell seeks 'timely and fair review' of plan for Medicare coverage of CT scans for those at high risk for lung cancer

U.S. Sen. Mitch McConnell asked Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner to "give a timely and fair review to determine whether low-dose computerized tomography (CT) scans should be covered by Medicare for patients at high-risk for developing lung cancer," a press release form his office said.

"Lung cancer has the highest mortality rate of all cancers in the United States," Mconnell said. "Additionally, my home state of Kentucky has the highest state mortality rate of lung cancer in the country, and the disease claims the lives of approximately 3,000 Kentuckians every year."

CT scans should be used to detect lung cancer early in individuals who who have a high risk for the disease, the U.S. Preventive Services Task Force recommends. High-risk individuals are those between 55 and 80 who have smoked a pack of cigarettes each day for 30 or more days. The task force noted a significant reduction in deaths from the disease as a result of early detection through CT scans. (Read more)

Kentucky ranks fifth in obesity and its high-schoolers rank first

By Melissa Patrick
Kentucky Health News

Obesity and health problems go hand in hand, and Kentuckians are known for both.

Kentucky now has the fifth highest adult obesity rate in the nation, up from ninth last year, and Kentucky's high-school students are the nation's most obese, according to a report by the Trust for America's Health and the Robert Wood Johnson Foundation.

At least one out of every three adults in Kentucky is considered obese (33.2 percent). This rate keeps going up; significantly higher than the 25.3 percent rate in 2004 or the 12.7 percent rate in 1990.

Baby boomers are the heaviest adults, with 37.1 percent of them considered obese. The report also found that 42 percent of black adults, 24.5 percent of Latino adults and 31 percent of white adults are obese.

Kentucky is joined by 20 other states with obesity rates of at least 30 percent. In 1980, no state was above 15 percent, according to the report, but times have changed. West Virginia and Mississippi tied for the highest rates of adult obesity at 35.1 percent and Colorado has the lowest rate at 21.3 percent, well above that long ago 15 percent.

Not only are the adults in Kentucky obese, so are its children, and kids who are heavy, tend to remain heavy as adults.

Kentucky's high schoolers have the worst obesity rate in the nation at 18 percent. The national average, according to the Youth Risk Behavior Surveillance System, is 13.7 percent. Utah has the fewest obese kids with only 6.4 percent of its high schoolers considered obese.

Obesity rates among 10-to 17-year-olds in Kentucky is also high, ranking 8th with 19.7 percent considered obese. Mississippi ranks highest in this category at 21.7 percent. Obesity rates among Kentucky's 2-to 4-year-olds from low-income families also fall in the top ten of most obese, ranking sixth with a rate of 15.5 percent.

Why does it matter? Obesity takes a huge toll on health, particularly with diabetes, high blood pressure, heart disease, arthritis and certain cancers. Kentucky struggles with each of these diseases.

Kentucky ranks 17th in diabetes. The foundation projects an increase of 51 percent of people with diabetes by 2030, going from 394,029 people with diabetes in 2010 (or 10.6 percent) to 594,058. More than 80 percent of people with diabetes are overweight or obese, says the report.

The projection for high blood pressure in Kentucky is an increase of 33 percent by 2030, going from 881,343 people with high blood pressure in 2010 to 1,175,750 in 2030. Kentucky ranks fifth among states for high blood pressure. High blood pressure is a leading cause of stroke and people who are overweight are more likely to have high blood pressure, says the report.

The foundation projects a whopping 382 percent increase in heart disease in Kentucky by 2030, going from 264,958 people with heart disease in 2010 to 1,278,342 in 2030. Heart disease is the leading cause of death - responsible for one in three deaths - in the U.S., says the report.

Obesity related cancer is expected to increase 158 percent, from 68,075 cases to 176,260 in 2030. Approximately 20 percent of cancer in women and 15 percent of cancer is attributable to obesity, says the report.

Arthritis, however, is projected to decrease by 15 percent from 876,143 cases in 2010 to 748,558 cases in 2030. Almost 70 percent of individuals with arthritis are overweight or obese, says the report.

“Obesity in America is at a critical juncture. Obesity rates are unacceptably high, and the disparities in rates are profoundly troubling,” Jeffrey Levi, executive director of Trust for America’s Health, said in a release. “We need to intensify prevention efforts starting in early childhood, and do a better job of implementing effective policies and programs in all communities – so every American has the greatest opportunity to have a healthy weight and live a healthy life.”

The annual report, titled "The State of Obesity: Better Policies for a Healthier America," was formerly known as "F as in Fat." Adults in the study are considered obese if their BMI is 30 or more.Children are graded on the curve, so to speak; a child is considered obese if his or her BMI is above the 95th percentile for children of the same age and sex.

UK cancer-center director urges lawmakers to raise cigarette tax and pass a statewide smoking ban to reduce cancer deaths

The Markey Cancer Center at the University of Kentucky supports a statewide smoking ban and an increase in the state cigarette tax to significantly reduce cancer deaths in the state, the center's director told a legislative committee Sept. 3.

“We are highly supportive, and we hope that you will be supportive as well, of (these) initiatives that we think will improve the overall health of Kentuckians,” Dr. B. Mark Evers told the state legislative Tobacco Settlement Agreement Fund Oversight Committee.

A news release from the Legislative Research Commission said Evers presented the numbers to back up his advice: Kentucky is first nationally in percentage of people who get cancer, and in overall cancer mortality. Lung cancer alone accounts for about 35 percent of Kentucky cancer deaths; nationally, lung cancer's share is 28 percent.

Twenty-eight percent of adult Kentuckians smoke, with approximately 8,000 deaths each year from smoking-related illnesses. The greatest incidence of tobacco-related cancers is in Eastern Kentucky.

That is the highest percentage in the U.S., Evers notes, adding that there is an indirect relationship between cigarette taxes and smoking rates. Kentucky has the 12th lowest cigarette tax among the states.

"Raising the cost of cigarettes and a statewide smoking ban could help cut Kentucky cancer deaths by 50 percent," Evers said. That is the Markey Cancer Center's goal over the next five years.

The center has a new strategic plan, "Conquering Cancer in the Commonwealth," that focuses on the state's "major cancer killers" -- lung, head and neck, colorectal, breast, and cervical cancer.

In response to a question about how to decrease the number of smokers in Kentucky, Evers pointed to local smoke-free policies and increased efforts in Appalachia toward smoking cessation.

When asked what it will take to lower the percentage of Kentucky smokers to less than 10 percent, Evers recommended three things: increasing the cigarette excise tax, a statewide smoking ban, and instituting lung-cancer screening projects like those in place at UK and the University of Louisville.

“Those three things are really going to help drive down those numbers,” he said.

KET will look Monday night at why lack of sleep is bad for your health, and offer advice on improving sleep quality

We live in a country where a third of adults report that they get less than six hours of sleep a night, which doesn't seem like a big deal until you consider the health risks that are associated with insufficient sleep.

The next edition of KET's "Health Three60" will explore these risks and advise how to improve your sleep quality. The program, "Sleepless in Kentucky," will air Monday at 10 p.m. ET.

Host Renee Shaw and guests will explore links between sleep deprivation and weight gain, diabetes, heart disease, cancer, skin issues, anxiety, concentration skills and impaired motor abilities. They will also look into how screen time (TVs and computers) affects sleep.

The show will discuss sleep apnea, treatments and what to expect in a sleep study. These issues will be examined by Jay McGuire, manager of the University of Louisville Physicians Sleep Center, and Dr. Egambaram Senthilvel, pediatric sleep specialist with University of Louisville Physicians.

The program will also examine how to improve sleeping habits by changing our sleep culture, including discussion about what can be done in schools and the workplace.

Other guests will include Dr. Phillip W. Bale of Glasgow Primary Care; Dr. Barbara Phillips, professor and medical director of the University of Kentucky Sleep Laboratory; and Dr. Mohamed A. Saad, director of the University of Louisville Physicians Sleep Center.

The series is funded in part by the Foundation for a Healthy Kentucky. (Read more.)