Tag Archive for: obesity

Expert Insights into Kidney Cancer Risk Factors and Genetic Testing

Expert Insights into Kidney Cancer Risk Factors and Genetic Testing from Patient Empowerment Network on Vimeo.

What is known about kidney cancer risk factors and genetic testing? Expert Dr. Moshe Ornstein from Cleveland Clinic explains known risk factors for kidney cancer and situations when he recommends genetic testing for patients.

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Transcript: 

Lisa Hatfield:

We have a patient asking if you can speak to a typical patient history associated with kidney cancer and is there a common factor, or I think that they’re asking is there a cause that you see frequently for kidney cancer?

Dr. Moshe Ornstein:

Yeah, this is such a common question, Lisa, because patients want to know I have this cancer, what caused it? And generally, we just don’t know the answer to that. And I tell that to patients, it’s generally not something that somebody did that caused this kidney cancer. We do have known risk factors for kidney cancer, whether it’s obesity, smoking, high blood pressure, chronic kidney disease. So there are certain risk factors and associations, but it’s really difficult for a specific patient to be able to pinpoint this caused the kidney cancer. And I think it’s reassuring for patients to know that as a general rule, it’s not something that a patient did that caused the kidney cancer, and it’s not somebody’s fault that they have the kidney cancer.

Lisa Hatfield:

Okay. Thank you for that. So when you have a patient who comes in with those more unusual presentations, do you recommend that they get some type of genetic testing done, so they can be aware for their family members that maybe they should be screened?

Dr. Moshe Ornstein:

Yeah, absolutely. I mean, if there’s an unusual feature, either a feature associated with tuberous sclerosis complex or something called Birt-Hogg-Dubé, or a young patient with advanced kidney cancer where we don’t expect it, or a patient that shows up with cancer in both of their kidneys and nowhere else, that will trigger us to send the patient to a genetic counselor to do a more thorough family history and talk about what they might be looking for in terms of genetic testing.

Lisa Hatfield:

Okay. Thank you. All right. Another person watching is asking, are there known occupational exposure risk factors for kidney cancer?

Dr. Moshe Ornstein:

This is a great question. You know, we know that with certain cancers, there are classic occupational exposure risks. People want to know, “If I worked in a coal mine, am I more likely to get this kind of kidney cancer? What if I’m a Vietnam veteran and I was exposed to Agent Orange, is this more likely?” Really difficult to find those associations. I would say that probably the biggest ones are going to be, again, smoking, which I don’t know is so much an occupational hazard, although secondhand smoke is a real risk factor for cancers. Asbestos.

So people who worked around a lot of asbestos, that can be a risk factor even for kidney cancer. I know we usually think about it as lung cancer mesothelioma, but definitely for kidney cancer as well in some studies. And then certain forms of gasoline exposure. I will tell you that I’ve taken care of a lot of patients and a lot of people who have kidney cancer and have never been able to isolate an occupational exposure. But looking in the literature, we’re really looking more for asbestos, certain gasoline, secondhand smoke, things like that.


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Understanding Endometrial Cancer Risk: Factors Influencing Incidence and Mortality

Understanding Endometrial Cancer Risk: Factors Influencing Incidence and Mortality from Patient Empowerment Network on Vimeo.

What are endometrial cancer risk factors for patients should know about? Expert Dr. Emily Hinchcliff from Northwestern Medicine discusses endometrial cancer risk factors, incidence and mortality rates, and patient advice to help guard against endometrial cancer.

[ACT]IVATION TIP

“…lifestyle modification is really important here. Obesity is a known risk factor for endometrial cancer. So working with your primary care physician to try to improve your health more generally, especially as it surrounds weight, is really important in terms of endometrial cancer prevention. I also think it’s important to know…that obesity and changing your obesity can impact your cancer’s response to certain therapies, especially with hormonal therapy.”

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Transcript:

Lisa:

Dr. Hinchcliff, for patients wondering about their risk, what are risk factors for endometrial cancer, and what should patients be aware of?

Dr. Emily Hinchcliff:  

So I think that it’s really important to highlight that endometrial cancer is one of the few cancers that is actually increasing in both number and also mortality. The numbers from the American Cancer Society for 2024 are over 70,000 women, or around 70,000 women will be diagnosed, and around 13,000 women will die of their disease. And I think that unlike many cancers where we’re actually making progress, endometrial cancer, the incidence, how many people are getting it is rising. And it’s rising faster in non-white ethnicities and groups.

So as I think about risk factors, I think the important ones to highlight are certainly obesity. This I think is a large driver of why there is increasing incidence of endometrial cancer. This relates to kind of the hormonal regulation. Obesity results in increasing levels of estrogen that disproportionately affect the endometrium. And then similar to that, certain hormonal syndromes where women have irregular or infrequent periods like polycystic ovarian syndrome can also put them at higher risk. More globally, I think age, family history are also risk factors. And then as I mentioned, unfortunately, women who are non-white have a higher risk of endometrial cancer mortality, especially as relates to some of the higher risk endometrial cancer subtypes.

Lisa:

Do you have an activation tip for patients for that question?

Dr. Emily Hinchcliff: 

Yeah, so I think that lifestyle modification is really important here. Obesity is a known risk factor for endometrial cancer. So working with your primary care physician to try to improve your health more generally, especially as it surrounds weight, is really important in terms of endometrial cancer prevention. I also think it’s important to know, given that this is often a patient audience that I’m speaking to, that obesity and changing your obesity can impact your cancer’s response to certain therapies, especially with hormonal therapy. So for women who are diagnosed with early stage endometrial cancer, for example, who may desire fertility preservation or may want to know what they can do to impact their own cancer care, I think that’s a really important point.

I guess I can also just bring up a quick one-liner regarding the recent publication of studies surrounding hair product use. So this is a question that we have been getting asked a lot after the publication of both the study and then the big New York Times article, but there was an NIH study that showed a potential association between hair product chemical straightener use and uterine cancer, especially for those who identify as frequent users. I think that the important key point here is that around 60 percent of the women who reported using hair products self-identified as Black and tend to initiate use earlier, so this is another risk factor that may be important.

Yeah, we’re still learning a lot more about that. Right now, there’s an unclear association in terms of what we should be doing about it.


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Addressing Elevated Gastric Cancer Risks in Asian and Hispanic Communities

Addressing Elevated Gastric Cancer Risks in Asian and Hispanic Communities from Patient Empowerment Network on Vimeo.

 How can higher gastric cancer risks for Asian and Hispanic populations be overcome? Expert Dr. Jun Gong from Cedar-Sinai Medical Center discusses H. pylori risk and screening and advice to patients to be proactive in their care.

[ACT]IVATION Tip

“…for the risk factors that are specific to the Asian and Hispanic populations is to understand the symptoms of H. pylori, which is one of the most common causes of stomach cancer, because they can be very effectively treated with antibiotics over a period of two weeks, oftentimes, and they’re very effective. This can be done at multiple provider levels from the primary care setting to the subspecialist setting. And also to know that symptoms, if they occur in family members that reside with the patient that is infected with h pylori or has stomach cancer, for them to be tested and the importance for their treatment as well.”

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Transcript:

Lisa:

Dr. Gong, what can be done on an individual and systemic level to address the elevated risk for gastric cancer in the Asian and Hispanic populations?

Dr. Jun Gong:

To address the elevated risks for gastric cancer in Asian and Hispanic populations, I think it’s very important to understand what are probably some of the universal risks to both groups. And here, there’s been growing evidence that H. pylori infection affects both Asians and Hispanics and is one of the more pivotal risk factors to address on a systematic level. Here, there have been ongoing research where they’re just identifying H. pylori as a procedure and eradicating it with treatment.

This is usually with antibiotic containing treatment for about two weeks. And this imposes what we call a primary prevention method if we can actually eradicate one of the primary causes of stomach cancer. Is this the best way to address the greatest risk factor on a systematic level for Asians and Hispanics and other ethnic groups at high risk? On an individual level, I think again, this comes to tailoring what the diagnosis is with the respect of ethnicity of the patient and their cultural and their background as well as their familial background. Here, H. pylori, dietary lifestyle, hereditary causes are important to address, to minimize risk for stomach cancer.

And it’s also important to know that on the individual level, that family members that are living with patients with stomach cancer may also have what we call H. pylori incidence around the entire family. So it’s important to advise that sometimes your family members, because of the close living facilities and the shared utilities and restroom and how we dine together, that this shares a familial risk. And oftentimes it may need to be that your family needs to be treated if H. pylori is detected within the family as well.

Lisa:

So if a patient comes in and their family members are concerned, would it be advised that maybe their family members can go see their primary care provider and say, “Hey, my family member has gastric cancer. Will you test me for H. pylori? Is that…would that be a valuable question to ask?

Dr. Jun Gong:

So I think that raises the big question about should we systematically test all high-risk subgroups for H. pylori? And I think the jury is still out on that. There has to be formalized guidelines. What I recommend is family members who are with another family member that’s diagnosed with H. pylori and/or stomach cancer, if they are having any concerning symptoms of H. pylori infection, this is usually abdominal discomfort. It can actually be gastritis type symptoms of acid reflux. If you have any of those symptoms, then those are certainly indications for you to be tested either at the primary care level for H. pylori.

My activation tip for the risk factors that are specific to the Asian and Hispanic populations is to understand the symptoms of H. pylori, which is one of the most common causes of stomach cancer, because they can be very effectively treated with antibiotics over a period of two weeks, oftentimes, and they’re very effective. This can be done at multiple provider levels from the primary care setting to the subspecialist setting. And also to know that symptoms, if they occur in family members that reside with the patient that is infected with h pylori or has stomach cancer, for them to be tested and the importance for their treatment as well.

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How Is Gastric Cancer Screening and Care Impacted by Culture?

How Is Gastric Cancer Screening and Care Impacted by Culture? from Patient Empowerment Network on Vimeo

How can culture impact gastric cancer screening and care? Expert Dr. Jun Gong from Cedar-Sinai Medical Center discusses solutions for improving screening rates and patient advice for reducing barriers.

[ACT]IVATION Tip

“I think one of the most important things is always for providers to be culturally aware that certain ethnic groups may have certain preferences with how news is delivered, how news is handled, how treatment is decided upon.”

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Transcript:

Lisa:

Dr. Gong, how do cultural beliefs and practices impact the prevention, diagnosis, and treatment seeking behavior of individuals with stomach cancer? And how can healthcare providers better address the cultural barriers to care?

Dr. Jun Gong:

Cultural beliefs have a huge impact on access to care in stomach cancer, and I think we can do better with addressing cultural barriers to care. I think one of the innovations here at our center is that we have a center of community outreach and a disparities core here where we recognize that certain cultures and this can expand beyond Asians and Hispanics into all racial groups, that there’s a heavily…there’s an important influence of church in this sector here.

And so what we do is we actively engage leaders in the churches, in the local churches for Asians, Hispanics, and a lot of different other subgroups. And we find this a great, great relationship and partnership to have for promoting awareness and educating patients about resources that we have within a culturally specific location where patients and family members find a great deal of trust in the church.

And we also have other innovations as well. So this is more from…more of a day-to-day lifestyle from a clinical trial, a research perspective here at Cedars, we also have a designated specialist from a diversity and inclusion research group where we actually move along the disease groups from stomach cancer to colon cancer to other cancer types.

And we have this specialist sit in, usually in our weekly meetings. And whenever there is a new study, a new clinical trial, this diversity inclusion specialist will raise the question, what racial groups, ethnic groups will be of interest to hear? And how can we expand outreach and participation in these clinical trials? So these are some of the innovations that I think we can do to address cultural barriers to care.

Lisa:

Dr. Gong, do you have an activation tip?

Dr. Jun Gong:

So, my activation tip is that yes, there are growing and emerging concepts to address cultural barriers. I think one of the most important things is always for providers to be culturally aware that certain ethnic groups may have certain preferences with how news is delivered, how news is handled, how treatment is decided upon.

And additionally, I think it’s important for patients and providers to promote awareness and education in a setting where patients and family members are very comfortable with. This can be the church setting as we recognize the importance of this in the day-to-day lives of many patients and family members across multiple cultures.

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How Can Advanced Prostate Cancer Care Barriers Be Overcome?

How Can Advanced Prostate Cancer Care Barriers Be Overcome? from Patient Empowerment Network on Vimeo.

How can barriers to advanced prostate cancer care be overcome? Expert Dr. Isaac Powell from Karmanos Cancer Institute discusses medical mistrust in the African American community and advice he gives to patients about prostate cancer screening and prevention.

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Transcript:

Lisa Hatfield:

Are there any challenges unique to minority communities that hinder access to advanced prostate cancer treatments and therapies? And do you have thoughts on how these barriers can be effectively addressed?

Dr. Isaac Powell:

I do. First of all, the diagnosis has to be made. And so that’s made by screening, by the PSA testing and digital rectal exams. Now, some people are talking about, well, we don’t need to do the digital rectal exam. That absolutely is not true. You can have a very aggressive cancer and have a normal PSA. We know that the PSA is not 100 percent accurate in diagnosing, predicting that you may have prostate cancer sometimes.

And I’ve had several patients who had normal PSAs, abnormal rectal exams, and as a result, I’m biased with them. If you don’t do the rectal exam and you have a normal PSA, you may miss aggressive cancers. So definitely have your usual rectal exam, excuse me. And once after that, if you have a biopsy, and if it is positive, then again I think that aggressive therapy is the way to go, if you’re in good shape.

Now, people are afraid of cancer. I mean, afraid of surgery. I’ve had surgery, so I can talk to them about what I’ve had and what you go through. Men are also concerned about losing their sexual function and those kinds of things related to the treatment of prostate cancer. And I can tell them that the quality of life is okay after that because we have ways of treating sexual dysfunction, the pill that everybody knows about, as well as injection and penis and ultimately the penile prosthesis. So that can be fixed.

And the other issue of losing control of the urine, that can be fixed as well. And so those are the things I tell people about not specifically among African Americans. There’s the genetic and the biology that I have to discuss, but one of the things that drives these genetic cells is obesity.

Obesity can produce these pro-inflammatory cytokines. So I always advise them to, if they are obese, to reduce their weight and their fat, particularly belly fat. That’s challenging because people have difficulty losing weight. The other thing is exercise. Exercise is a key that I think it is the most important factor in treating many health conditions, exercise. And what exercise does, and this has been studied in breast cancer, it decreases the expression of the genes that I described earlier. In terms of prior driving the cancer and breast cancer, they’ve found it decreases the pro-inflammatory cytokines. I described the tumor necrosis factors IL-6 and IL-8. So that’s important, exercise. So those are the things that I tell patients. And now in terms of advanced disease there are clinical trials that are there.

And we do these trials to decide what’s the best treatment for cancer, even though we don’t have “a cure.” Now, the problem among African Americans is that they don’t trust these clinical trials because of the abuse that African Americans have suffered through slavery and all the other kinds of things when they’ve been treated as less than human, like animals being operated on without having any anesthesia and many other abuses that have occurred. And so there’s this major distrust now that’s very difficult to eliminate in the Black community, especially if there are very few African American doctors to take care of them. So what I think that we have to fix that question of distrust, and that’s going to take a while, but I talk to them always about this mistrust issue, because I can’t see everybody, although we do need more African American doctors and nurses to take care of them and to encourage them to participate in clinical trials and to be seen as a person who is going to be taking care of them in clinical trials, that’s very important.

Often we talk about access to care, but particularly African Americans that mostly live in large cities where there is access to care. But, in terms of one particular example that’s brought up on occasion is what has occurred in Baltimore and other big cities where I talk to an African American, you know Johns Hopkins is right in the middle of the African American community. So it’s not about access again, it’s about mistrust. And I said, “Well, why don’t African Americans go to Johns Hopkins?” Well, she says, “If you walk past Johns Hopkins, they may steal your bodies.” I said, what? I didn’t believe that, but I’ve been reading literature, particularly one called the Medical Apartheid where they talked about African slavery, where they dug up the bodies of slaves to practice the anatomy.

And so that’s where this idea occurred. At night, they would dig up the bodies and do this, and not only in Baltimore, but other cities as well. So again, the mistrust issue is very difficult to resolve because of those issues. And people talk about that, well, I just don’t trust the white healthcare system, period. And don’t want to go until they’re having symptoms, and then they have no choice. They have to go. And by this time, the cancers are more advanced and cannot even prolong life expectancy in those particular patients. So I’m not sure I answered your question in terms of what a person or what I would do to activate participation in the healthcare of advanced disease.

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June 2023 Notable News

June brings many challenges for cancer patients and new knowledge can help fight the disease. Insurance companies have taken the fight to the supreme court to try to avoid paying for cancer screening tests. A shortage of two cancer drugs is having a significant impact on cancer patients in the U.S. Obesity has been found to be a rising risk factor for cancer, affecting men and women differently.

Survey Finds Majority of Cancer Patients and Survivors Would be Less Likely to Get Recommended Screenings if Costs Were Added

Thanks to a provision in the Affordable Care Act (ACA) that requires evidence-based prevention and early detection at no cost to patients with private insurance, we’ve seen improved access to recommended services that detect disease when it is less costly to treat, and chances of survival are greater reports American Cancer Society. A new ruling in the case Braidwood v Becerra, in the US District Court in Texas, is threatening that access for patients. Patients surveyed said that a cost between $100 to $200 for preventative tests would be a burden to them financially and would be a barrier to getting those lifesaving tests. The cost increase incurred can either be from annual screening or lifesaving treatments. Cancer patients already face challenges in finding a provider due to cost. A patient navigator is also a beneficial service for cancer patients and has been shown to help influence better outcomes. The cost of the navigator can be prohibitive for patients. Insurance cutbacks are a matter of life and death for many cancer patients. Click here for more information.

Carboplatin, Cisplatin Chemotherapy Drug Shortages Delaying Some Cancer Treatments in New York

We’re really in an unprecedented situation in the cancer field, said Dr Richard Carvajal, a medical oncologist who helps run Northwell Health Cancer Institute. Carboplatin and cisplatin shortages are delaying treatment, forcing doctors and patients to make tough choices, according to Carvajal reports CBS News. These two drugs are used in 10 to 20% of cancer patient treatment in New York. Doctors are having to give lower doses or fewer doses of this chemotherapy to patients. The National Comprehensive Cancer Network released a study that found 93% of cancer centers in the U.S. are experiencing this shortage reports CBS News. In January, a large plant in India had quality control problems with much of its supply causing this shortage. Doctors must choose who gets treatment and who does not. The FDA is trying to get the cancer drugs sent from China to help correct the shortage. Patients should talk with their physician about their best option. Click here for more information.

Women and Men Face Different Cancers- Depending on Where Fat Falls

To investigate the links between cancer and obesity among men and women, Rask- Anderson and other researchers turned to the UK Biobank, a biomedical database with genetic and health information from more than half a million participants across the UK reports New York Post. The research has shown that all cancers are influenced by obesity except for brain, cervical, and testicular cancers. Obesity causes men to be more at risk for breast, liver, and kidney cancers. For women, obesity causes them to be more at risk for gallbladder, endometrial, and esophageal cancers. An increase in fat accumulation in the abdomen makes women more at risk for esophageal cancers. An increase in total body fat in men cause a higher risk for liver cancer. Postmenopausal women are at a higher risk for breast cancer when they are obese. Obesity is the fastest growing risk factor for cancer. Click here for more information.