Category Archives: Cancer

There’s a life-saving hepatitis C drug. But you may not be able to afford it.

Sovaldi logoBy Julie Appleby
KHN Staff Writer

MAR 03, 2014

This KHN story was produced in collaboration with 

There’s a new drug regimen being touted as a potential cure for a dangerous liver virus that causes hepatitis C.  But it costs $84,000 – or $1,000 a pill.

And that price tag is prompting outrage from some consumers and a scramble by insurers to figure out which patients should get the drug —and who pays for it.

Called Sovaldi, the drug is made by California-based Gilead Sciences Inc. and is the latest in handful of new treatments for hepatitis C, a chronic infection that afflicts at least 3 million Americans and is a leading cause of liver failure. It was approved by the U.S. Food & Drug Administration in December. Continue reading

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App lets you determine your neighborhood’s radon risk

Screen Shot 2014-01-21 at 11.28.29From the Washington State Department of Health

Olympia, January 21, 2014 – Washington residents now have a new online map to check and see if their neighborhood has a geological risk for the cancer-causing gas, radon, using a new state app. The new app is offered by the state Department of Health’s Washington Tracking Network.

Some areas of the state, such as Spokane and Clark counties, are well-known for having higher levels of radon, but the new online map shows that there are some areas around the Puget Sound such as Pierce and King counties that might come as a surprise.  Continue reading

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Nipple aspirator

Nipple aspirate test is no substitute for mammogram – FDA

Consumer Update from the US Food and Drug Administration

ucm378297Many women admit that getting a mammogram is no fun, and may wish there was an easier, more comfortable way to screen for breast cancer in its earliest and most treatable stages.

Some companies today are promoting a test in which a breast pump is used to collect fluid from a woman’s nipple to screen for abnormal and potentially cancerous cells. This test—called a nipple aspirate—is being marketed as the latest and greatest tool in early breast cancer screening, one that is easier, more comfortable and less painful than the mammogram.

However, there is no clinical evidence to support these claims, says David L. Lerner, M.D., a medical officer at the Food and Drug Administration (FDA) and a specialist in breast imaging.

“FDA’s concern is that the nipple aspirate test is being touted as a stand-alone tool to screen for and diagnose breast cancer as an alternative to mammography,” Lerner explains. “Our fear is that women will forgo a mammogram and have this test instead.” This could result in serious health consequences if breast cancer goes undetected, he notes.

FDA is unaware of any valid scientific data to show that nipple aspirate tests, when used on their own, are an effective screening tool for any medical condition, including the detection of breast cancer or other breast disease, Lerner says. Researchers are still studying whether these tests may one day be used, in conjunction with other medical devices, to screen for disease.

In February 2013 FDA issued a warning letter to Atossa Genetics, Inc. that, among other things, informed the company that their test was misbranded in that its labeling was false or misleading. The agency asked the firm to take prompt action to correct the violations addressed in the warning letter. In October 2013, Atossa initiated a voluntary recall to remove the ForeCYTE Breast Health Test from the market.

Unsubstantiated Claims

In addition to stating that the test can help women 18 years and older determine their risk level for breast cancer, Atossa claimed that its test was “literally a Pap smear for breast cancer.” According to FDA medical officer Michael Cummings, M.D., who reviews obstetrical and gynecological devices for the agency, this claim is unsubstantiated.

“The cervical Pap smear has a known clinical benefit supported by extensive clinical studies over many years,” Cummings says. “Its scientific ability to screen for cervical cancer is unquestioned.” The nipple aspiration test has no such evidence supporting it, he attests.

In addition, Lerner explains that if a Pap smear shows abnormal cells of the cervix, there are follow-up procedures that can be done to try to identify the location of those cells, after which a biopsy of the area is possible. With a breast nipple aspirate, if there are abnormal cells, the test does not target where those cells are coming from, so a biopsy may not be possible. Moreover, while the risk of abnormal cervical cells progressing to cancer is known, the risk of abnormal breast cells progressing to cancer is not.

Lerner says the test may produce results that are falsely positive or falsely negative. “False positives are possible because cells can be damaged in the aspiration process and look abnormal,” he notes. “We are even more concerned about false negatives,” he adds. Companies acknowledge that over 90% of their fluid samples may contain either very scant cells or no cells at all. Yet the companies call such results “diagnostically useful” and even conclude that a patient is healthy based on a cell-free sample, he says. “The test may be missing cancers and giving women dangerous false assurance,” Lerner says.

Mammography Still the Best

The mammogram can be uncomfortable for the woman being screened because it compresses the breast to flatten out the breast tissue and increase the clarity of the X-ray image. Still, FDA is not alone in believing that mammography is the most effective method for screening for breast cancer. Other organizations agree, including the American Cancer Society, the American College of Radiology (the professional society of physicians who specialize in medical imaging) and the National Cancer Institute, a division of the National Institutes of Health.

The National Cancer Institute states that screening mammography can help reduce the number of deaths from breast cancer among women ages 40 to 70. The National Comprehensive Cancer Network (NCCN) 2013 guidelines state that the clinical utility of nipple aspiration is still being evaluated and that it should not be used as a breast cancer screening technique.

FDA recommends that women who have received a nipple aspirate test as a form of breast cancer screening should also have a mammogram according to screening guidelines or as recommended by their doctor, and should talk to their health care professional about whether additional tests are needed.

“The bottom line is that women should not rely solely on these nipple aspirate tests for the screening or diagnosis of breast cancer, “Lerner says. “Mammography is still the gold standard.”

This article appears on FDA’s Consumer Updates page, which features the latest on all FDA-regulated products.

Dec. 12, 2013

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“Far too few” Americans being screened for colon cancer, CDC

CRC screeningWhen the cancer is caught early, 90 percent of people with colorectal cancer will be alive five years later, but only 12 percent will survive 5 years if the cancer is already advanced when it’s found.

Yet, one in three Americans who should be screened for colorectal cancer have never been screened, according to a new report from the US Centers for Disease Control.

Here’s the report:

(For a PDF of the report click here.)

Vital Signs – CDC

Colorectal cancer (CRC) is the second leading cancer killer of men and women in the US, following lung cancer.

The US Preventive Services Task Force (USPSTF) recommends three CRC screening tests that are effective at saving lives: colonoscopy, stool tests (guaiac fecal occult blood test-FOBT or fecal immunochemical test-FIT), and sigmoidoscopy (now seldom done).

Testing saves lives, but only if people get tested. Studies show that people who are able to pick the test they prefer are more likely to actually get the test done. Increasing the use of all recommended colorectal cancer tests can save more lives and is cost-effective.

To increase testing, doctors, nurses, and health systems can:

  • Offer all recommended test options with advice about each.
  • Match patients with the test they are most likely to complete.
  • Work with public health professionals to:
    • Get more adults tested by hiring and training “patient navigators,” who are staff that help people learn about, get scheduled for, and get procedures done like colonoscopy.
    • Create ways to make it easier for people to get FOBT/FIT kits in places other than a doctor’s office, like giving them out at flu shot clinics or mailing them to people’s homes.

Problem

Not enough people are getting tested as needed.

About 23 million adults have never been tested.

  • The people less likely to get tested are Hispanics, those aged 50-64, men, American Indian or Alaska natives, those who don’t live in a city, and people with lower education and income.
  • People with lower education and income are less likely to get tested.
  • About 2 of every 3 adults who have never been tested for CRC actually have a regular doctor and health insurance that could pay for the test. Providers and patients do not always know about or consider all of the available tests.
  • The three main tests–colonoscopy, FOBT/FIT, and flexible sigmoidoscopy are all effective at finding cancer early.
  • Doctors often recommend colonoscopy more than other tests. Scientific studies have shown that many people would prefer FOBT/FIT if their health care provider gave them that option.

Currently, most health care providers and systems are not set up to help more people get tested.

  • Many people do not know they need to be tested and are not notified when it is time for them to be tested.
  • Most health care systems rely on doctors to remember to offer CRC tests to their patients. Nurses and other office staff should also talk with patients about getting tested and doctors can be reminded to offer CRC testing whenever patients are due, whether they come in for a routine check-up or when they are sick.
  • Health systems can make testing easier by:
    • Mailing out FOBT/FIT kits that can be completed by the person at home and mailed back, then making sure everyone with a test that is not normal promptly gets a colonoscopy.
    • Mailing out FOBT/FIT kits that can be completed by the person at home and mailed back, then making sure everyone with a test that is not normal promptly gets a colonoscopy.
    • Using a patient navigator to explain how to prepare for the test, how the test is done and to make sure people get to their appointments.

     

    CRC CDC colorectal screening

    Click on image for a larger version.

    SOURCE: Behavioral Risk Factor Surveillance System, 2012

    Choosing the right test

    Click on image for a larger version.

    SOURCE: Vital Signs 2013 and USPSTF

    What can be done:

    Federal government is:

    • Expanding insurance coverage of USPSTF recommended CRC tests at no cost to the patient through the Affordable Care Act.
    • Supporting the use of patient navigators who work directly with people to help them get the preventive tests they need.
    • Helping the Veterans Administration system’s doctors and nurses increase and track CRC testing of its patients in its hospitals and clinics.
    • Improving the delivery of preventive services by measuring CRC testing rates in health centers funded by the Health Resources and Services Administration (HRSA).
    • Using existing CDC screening programs to improve cancer screening rates for everyone, whether insured or not.
    • Identifying CRC screening as a Healthy People 2020 leading health indicator for clinical preventive services.

    State and local public health can:

    • Work with those doctors, health systems and public health professionals who have already greatly increased CRC testing rates.
    • Develop record systems to keep track of and notify those who need to be tested.
    • Promote recommended testing options with the public.
    • Use public health workers and patient navigators to increase testing rates in communities with low testing rates.
    • Work with state Medicaid programs, primary care associations, and Medicare quality improvement organizations to help people get tested and make sure they get additional tests or treatment if needed.

    Doctors, nurses, and health systems can:

    • Offer recommended test options, with advice about each.
    • Match patients with the test they are most likely to complete.
    • Use patient reminder systems to notify patients when it’s time to get a screening test done.
    • Make sure patients get their results quickly. If the test is not normal make sure they get the follow–up care they need.
    • Use patient navigators to help patients get checked.

    Everyone can:

    • Learn about testing options and get the test that is right for them.
    • Know their own family history and any personal risks they may have for CRC.
    • Encourage friends and family members to be tested for CRC.
    • Contact their local health department to learn how they can get tested for CRC.

Science Behind this Issue

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Women’s Health – Week 10: Cervical cancer and HPV

Human Papilloma Virus

Human Papilloma Virus

From the Office of Research on Women’s Health

HPV is a virus that infects your genital region and can cause warts or even cancer. More than 30 types of genital human papillomavirus (HPV) can infect the genital areas of both women and men, including the vulva (area outside the vagina), anus, and the linings of the vagina, cervixrectum, and skin of the penis.

Most HPV infections go away on their own within a year or two. But persistent HPV infections are now recognized as the major cause of cervical cancer and other less common cancers, such as cancers of the vulva, vagina, anus, and penis.

Studies have also found that oral HPV infection is also a strong risk factor for oropharyngeal cancer (cancer of the throat and tongue).

Genital HPV infections are common and are passed from one person to another through sexual contact. The virus infects the skin and mucous membranes. Most people with HPV do not develop symptoms or health problems.

That is why it is very important for women to have regular Pap smear tests to screen for cervical cancer even if they have received an HPV vaccine. The Pap smear can identify abnormal or pre-cancerous changes in the cervix that a health care provider can remove before cancer develops.

HPV Vaccine
A vaccine can now protect females from the four types of HPV that cause most cervical cancers and genital warts. The vaccine is recommended for 11- and 12- year-old girls. It is also recommended for girls and women ages 13 to 26 who have not yet been vaccinated or completed the vaccine series. Vaccination against HPV is available also for boys and men, ages 9 to 26, for prevention of genital warts. Talk to your health care provider for more information.

The types of HPV that can cause cancer are not the same as the types that can cause genital warts. Genital warts usually appear as small bumps or groups of bumps. They can be raised or flat, single or multiple, small or large, and sometimes cauliflower shaped. They can appear on the vulva, in or around the vagina or anus, on the cervix, and on the penis, scrotum, groin, or thigh.

Warts may appear within weeks or months after sexual contact with an infected person or they may not appear at all (even if the person is infected with HPV). If left untreated, genital warts can go away, remain unchanged, or increase in size or number.

Protect yourself
Scientists have shown that condom use may protect you against HPV infection. Condom use has been associated with a lower rate of cervical cancer.

for more information: www.cancer.gov

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State gonorrhea cases up 34 percent

Gonorrhea bacteria - Photo CDC

Gonorrhea bacteria – Photo CDC

From the Washington State Department of Health

The number of gonorrhea cases in Washington is up substantially this year compared to 2012. There have been 3,137 cases through September 2013 compared to 2,350 during the same time in 2012. That’s a 34 percent increase.

Rates have been going up steadily since 2010. Department of Health experts haven’t been able to attribute a specific cause to the uptick. The jump has occurred among men and women in most age groups, but young adults remain the most affected.

Rural and urban counties across Eastern and Western Washington have reported a climb in cases. However, several counties have seen more dramatic upswings, including Spokane, Yakima, Thurston, Kitsap and Benton counties, which are at outbreak levels.

Gonorrhea is the second most common sexually transmitted disease in Washington after chlamydia. It’s spread through unprotected sex with an infected partner. The infection often has no symptoms, particularly among women. If symptoms are present, they may include discharge or painful urination.

Serious long-term health issues can occur if the disease isn’t treated, including pelvic inflammatory disease, infertility and an increased likelihood of HIV transmission.

The department continues to monitor case reports. Local public health officials are actively working with health care providers to ensure that people with gonorrhea and those exposed get appropriate testing and treatment to stop ongoing spread of the disease.

“We’re working closely with local health agencies to actively monitor the rise in cases. We’re especially concerned because of gonorrhea’s resistance to antibiotics used to treat it,” said Mark Aubin, sexually transmitted disease controller for the Department of Health. “It’s important for us to assure every reported case is interviewed so the partners of infected people are identified and receive treatment.”

Despite the increase over the last couple years, Washington rates are still well below the national average.

Health officials urge anyone who is experiencing symptoms, or has a partner that has been diagnosed, to be tested. Routine screenings are recommended for sexually active people.

Prevention methods include consistent and correct use of condoms, partner treatment, mutual monogamy and abstinence.”

To learn more about gonorrhea and find out where you can get tested go to Public Health – Seattle & King County’s Sexually Transmitted Disease webpage.

 

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Women’s health – week 8: Breast cancer screening

From the Office of Research on Women’s Health

Cancer is a term used for diseases in which abnormal cells divide without control and can invade other tissues. Breast cancer is a malignant tumor that starts in cells of the breast. The disease occurs almost entirely in women, but some men develop breast cancer.

Because cancer cells spread by breaking away from the original (primary) tumor and entering the bloodstream or the lymphatic system, breast cancer can spread to almost any other part of the body and be life threatening.

You can help with early detection by knowing your risk factors, including genetic ones, getting regular exams, and having mammograms of your breasts. It is also important to keep in mind that most women who have known risk factors do not get breast cancer.

Also, most women with breast cancer do not have a family history of the disease. If you think you may be at risk, you should discuss your concern with your health care provider. Your health care provider may be able to suggest ways to reduce your risk and can plan a schedule for checkups.

Scientists are still studying the exact causes of breast cancer. Research has shown that women with certain risk factors are more likely than others to develop breast cancer. These factors are:

  • Age: Risk increases with aging.
  • Personal history: Risk increases with previous history of breast cancers. A woman who had breast cancer in one breast has an increased risk of getting cancer in her other breast.
  • Family history: Risk is higher if a woman’s mother, sister, or daughter has had breast cancer. Risk is also higher if her father or brother or other relative (in either her mother’s or father’s family) has had breast cancer.
  • Genetics: Risk increases if there are changes in certain genes, including BRCA1, BRCA2, and others.
  • Childbearing: Risk may increase if a woman never had children or had her first child at an older age. Risk may also increase if a woman had her first period at an earlier age or menopause after 55 years.
  • Menopause: Risk may increase for women who take menopausal hormone therapy withestrogen plus progestin after menopause.
  • Obesity/weight: Risk increases with being overweight or obese after menopause.
  • Race/ethnicity: Risk increases based on a woman’s race/ethnicity. Breast cancer is diagnosed more often in white women than in Latina, Asian, or African American women.
  • Previous treatment with radiation: Risk increases for women who had radiation therapy to the chest (including the breasts) before age 30.
  • Breast density: Risk may increase for older women whose mammograms show more dense tissue than fatty tissue.
  • Physical fitness: Risk increases when a woman is physically inactive throughout her life.
  • Alcohol consumption: Risk increases with increased alcohol consumption. Studies suggest that the more alcohol a woman drinks, the greater her risk.
Diagram showing the breast and mammary glands.

Diagram showing the breast and mammary glands.

Common symptoms of breast cancer include:

  • A lump or thickening in or near the breast or in the underarm area.
  • Nipple tenderness.
  • A change in the size or shape of the breast.
  • A nipple turned inward into the breast.
  • Scaly, red, or swollen skin of the breast, areola, or nipple. Ridges or pitting so that it looks like the skin of an orange.
  • Nipple discharge.

Early breast cancer commonly does not cause pain. Still, you should consult with your health care provider about breast pain or any other symptom that concerns you. Most breast changes are not cancer, but it is important to check out any symptoms as early as possible.

Treatment

Surgery, radiation therapy, hormone therapy, chemotherapy, and biological therapy are all options for treating breast cancer. Be sure to consult with your health care provider before pursuing any option.

for more information: www.cancer.gov
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Women’s Health – Week 7: Breast cancer an overview

From the Office of Research on Women’s Health

Cancer is a term used for diseases in which abnormal cells divide without control and can invade other tissues. Breast cancer is a malignant tumor that starts in cells of the breast. The disease occurs almost entirely in women, but some men develop breast cancer.

Because cancer cells spread by breaking away from the original (primary) tumor and entering the bloodstream or the lymphatic system, breast cancer can spread to almost any other part of the body and be life threatening.

Diagram showing the breast and mammary glands.

Diagram showing the breast and mammary glands.

You can help with early detection by knowing your risk factors, including genetic ones, getting regular exams, and having mammograms of your breasts. It is also important to keep in mind that most women who have known risk factors do not get breast cancer. Also, most women with breast cancer do not have a family history of the disease.

If you think you may be at risk, you should discuss your concern with your health care provider. Your health care provider may be able to suggest ways to reduce your risk and can plan a schedule for checkups.

Scientists are still studying the exact causes of breast cancer. Research has shown that women with certain risk factors are more likely than others to develop breast cancer. These factors are:

  • Age: Risk increases with aging.
  • Personal history: Risk increases with previous history of breast cancers. A woman who had breast cancer in one breast has an increased risk of getting cancer in her other breast.
  • Family history: Risk is higher if a woman’s mother, sister, or daughter has had breast cancer. Risk is also higher if her father or brother or other relative (in either her mother’s or father’s family) has had breast cancer.
  • Genetics: Risk increases if there are changes in certain genes, including BRCA1, BRCA2, and others.
  • Childbearing: Risk may increase if a woman never had children or had her first child at an older age. Risk may also increase if a woman had her first period at an earlier age or menopause after 55 years.
  • Menopause: Risk may increase for women who take menopausal hormone therapy withestrogen plus progestin after menopause.
  • Obesity/weight: Risk increases with being overweight or obese after menopause.
  • Race/ethnicity: Risk increases based on a woman’s race/ethnicity. Breast cancer is diagnosed more often in white women than in Latina, Asian, or African American women.
  • Previous treatment with radiation: Risk increases for women who had radiation therapy to the chest (including the breasts) before age 30.
  • Breast density: Risk may increase for older women whose mammograms show more dense tissue than fatty tissue.
  • Physical fitness: Risk increases when a woman is physically inactive throughout her life.
  • Alcohol consumption: Risk increases with increased alcohol consumption. Studies suggest that the more alcohol a woman drinks, the greater her risk.

Common symptoms of breast cancer include:

  • A lump or thickening in or near the breast or in the underarm area.
  • Nipple tenderness.
  • A change in the size or shape of the breast.
  • A nipple turned inward into the breast.
  • Scaly, red, or swollen skin of the breast, areola, or nipple. Ridges or pitting so that it looks like the skin of an orange.
  • Nipple discharge.

Early breast cancer commonly does not cause pain. Still, you should consult with your health care provider about breast pain or any other symptom that concerns you. Most breast changes are not cancer, but it is important to check out any symptoms as early as possible.

Treatment

Surgery, radiation therapy, hormone therapy, chemotherapy, and biological therapy are all options for treating breast cancer. Be sure to consult with your health care provider before pursuing any option.

for more information: www.cancer.gov
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Seattle hookah bars violating laws banning public smoking, King County health officials say

Public Health – Seattle & King County has found that six Seattle hookah bars are violating the state’s law banning public smoking and ordered them to stop allowing smoking on their premises.

Here’s the announcement from Public Health – Seattle & King County

Six Seattle hookah bars receive order for violating public smoking law

Six hookah bars in Seattle are on notice for violating Washington’s Smoking in Public Places law. Public Health – Seattle & King County sent each of the establishments a Notice and Order on Tuesday, October 1, requiring them to stop allowing smoking.

To protect public health, state law requires that all places of employment and public places are smoke-free.

Health inspectors visited the hookah bars multiple times. They found patrons smoking and each of the bars operating as a public place and/or place of employment.

“Our investigation shows that these hookah bars are violating the law, and endangering the health of their workers and patrons. We are forced to take this enforcement action because they haven’t been responsive to our previous warnings,” said Dr. David Fleming, Director and Health Officer for Public Health – Seattle & King County. “Secondhand smoke is a proven killer, and state law works to protect everyone from this health threat.”

Hookah bars have claimed that they are exempt from the indoor smoking law because they are private clubs. However, smoking is prohibited by law if a club has employees and/or the club is open to the public.

The investigation found that these six bars are all open to the public, operating similarly to night clubs that charge a cover for admission.

Each of the establishments received multiple warnings from inspectors, but they have not complied with Washington law. The Notice and Orders require immediate compliance plus payment of fines and fees.

The fine for each violation is $100, in addition to escalating re-inspection fees after the first warning. Subsequent violations will result in additional steps to ensure that state law is followed, including possible court action.

Hookah is a water pipe commonly used to smoke tobacco. Research shows that hookah smoking is at least as harmful as cigarette smoke, even when mixed with sweet fruit and candy flavors.

The establishments have ten days from receipt of the Notice and Order if they wish to appeal or 30 days to pay the fines and re-inspection fees.

Hookah bars receiving a Notice and Order this week include:

 

Lounge Address
Casablanca Shisha Lounge 1221 S Main St

Da Spot Hookah Lounge

1914 Minor Ave
Medina Hookah Lounge 700 S Dearborn St
The Night Owl 4745 University Way NE
Sahara Hookah Lounge 7523 Lake City Way NE
Seattle Hookah Lounge 4701 Roosevelt Way NE

 

Hookah health threat

Tobacco use remains the number one cause of preventable death and disease in King County, costing nearly 2,000 lives and $343 million dollars in health costs and lost wages locally every year.

  • Tobacco is placed inside the bowl at the top of the hookah.

    Tobacco is placed inside the bowl at the top of the hookah.

    Hookah is a water-pipe commonly used to smoke tobacco, often mixed with sweet fruit and candy flavors.

  • Research shows that hookah smoking is not a safe alternative to cigarettes and that hookah smoke is at least as harmful as cigarette smoke.
  • During a typical 45-minute session of hookah use, a person may inhale as much smoke as smoking 100 cigarettes or more.
  • Hookah smoke contains the addictive drug nicotine, along with tar, carcinogens, and heavy metals.
  • Hookah smoking has been associated with lung cancer, oral cancer, heart disease, respiratory illness, periodontal disease, and low birthweight.
  • Sharing a hookah mouthpiece can transmit infectious diseases, including tuberculosis.

Hookah and youth

Hookah use has seen a rise in popularity, especially among youth. According to the 2012 Healthy Youth Survey, hookah use among King County high school seniors is higher than cigarette use (15% and 12%, respectively).

‘We are very concerned about the high hookah use rates among youth,” said Scott Neal, Tobacco Prevention Program Manager for Public Health – Seattle & King County. “Sweet fruit and candy flavors lure youth and help fuel the misperception that hookah smoking is safer than cigarettes.”

Report smoking law violations

To report violations, visit the Tobacco Prevention Program page for an online form; or text the establishment’s name, date of violation, and brief description of the violation to  206-745-2548.

 

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8 Ways Young Women Benefit From Obamacare – Cosmopolitan

By Phil Galewitz
KHN Staff Writer

This KHN story was produced in partnership with 

number 8You’ve heard people arguing about Obamacare (officially known as The Affordable Care Act or ACA) for months … but you may have tuned it all out, because it’s all so confusing and you don’t even know how — or if — it affects you.

But starting in 2014, the law will require people who can afford insurance to carry it or risk paying a fine, so now’s the time to pay attention.

And the fact is, you may discover that there are lots of benefits you’ll be able to take advantage of. Here’s a quick list of what’s great about the ACA, especially for young women:

  • You can stay on your parents’ health policy until you turn 26. Previously, most insurers did not allow young adults beyond age 21 to stay on their parents’ policies. More than 3 million young adults have gained coverage since this provision went into effect in 2010. Your parents will be charged the same rates as when you were younger. You can be covered by their policy even if you’re married, but the coverage won’t extend to your spouse.
  • You’re entitled to free preventive care, including birth control. Since 2012, nearly 30 million women have benefitted from free preventive services including checkups, screenings for diabetes and HIV, contraceptives and family planning counseling. The law requires plans to cover all FDA-approved birth control methods without co-pays. This includes pills, injectables, implants, intrauterine devices (IUDs), and sterilization procedures. Plans must cover all brand name contraceptives without generic equivalents, or where the generic equivalent is medically inappropriate. Certain religious employers are exempt from the birth control requirement.
  • You may be eligible for government discounts on insurance. Starting Oct. 1, new online health insurance exchanges will go live in every state, selling coverage that will take effect Jan. 1, 2014. The exchanges will allow you to compare prices and benefits to find an insurance plan you can afford that fits your needs; if you still feel you can’t afford it, you can find out whether you’re entitled to a federal tax credit based on your income. The lower your income, the higher the tax credit. You can get the discount at the time you enroll. Find information on your state exchange here.
  • You’ll have maternity coverage, no matter what. You may not know this but only about 12 percent of health plans sold on the individual market currently include coverage for maternity, according to Judy Waxman of the National Women’s Law Center. But starting next year, all individual health plans will have to include 10 essential health benefits including maternity care, as well as hospitalization, prescription drugs, mental health services and preventive services.
  • You can’t be charged more than a guy. In most states, insurers are currently allowed to charge women more than men for individual coverage. According to the National Women’s Law Center, in 30 percent of cases, nonsmoking women were charged more than men who smoked. Such gender rating will be outlawed starting next year.
  • You can’t be rejected for having a “pre-existing condition.” Today, insurers can deny you health insurance if you have a chronic condition such as asthma or diabetes (in which case you’re considered a health risk); if they do accept you regardless of these conditions, they can still charge you more for coverage. But starting next year it will be illegal for them to penalize you this way; health premiums may vary based on three factors only: age, where you live, and whether you’re a smoker.
  • If you are an individual who makes under $16,000 a year, you may be eligible for Medicaid. Medicaid is the state-federal health insurance program for the poor, and it’s being expanded by the law to those whose annual income is under the federal poverty level. However, because the Supreme Court ruled that the expansion is optional for states, only about half of them are participating. Check out this infographic to see if yours is one of them.
  • If you’re a breastfeeding mom, you can pump at work more comfortably. Since 2011, the law has required employers to provide a “reasonable break time” and a private place (not a bathroom) for you to pump breast milk during the workday. The law also requires health plans to cover the costs of breastfeeding equipment and breastfeeding counseling without a copay.

One final note: not everyone will see immediate coverage changes; many of you who get your insurance through your job are in “grandfathered” plans, which are exempt from some of the rules. Ask your company’s health benefits administrator if this is the case for you.

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FDA moves to reduce use of long-acting opioid pain drugs

The US Food and Drug Administration has changed the labeling on long-acting opioids, such as OxyContin, in an effort to limit the use of these drugs to patients with severe refractory pain. Here’s is the Consumer Update from the FDA released today.

FDA Consumer Update

FDA logojpgConsumers and health care professionals will soon find updated labeling for extended-release and long-acting opioid pain relievers to help ensure their safe and appropriate use.

In addition to requiring new labeling on these prescription medications, the Food and Drug Administration (FDA) is also requiring manufacturers to study certain known serious risks when these drugs are used long-term.

“The new labeling requirements and other actions are intended to help prescribers and patients make better decisions about who benefits from the use of these medications. They also are meant to reduce problems associated with their use,” says Douglas Throckmorton, M.D., deputy director of regulatory programs in FDA’s Center for Drug Evaluation and Research.

“Altogether, the actions we’re now announcing are part of FDA’s efforts to make opioids as safe as possible for those who need them,” Throckmorton adds.

He noted that the actions come after careful analysis of new safety information, including reviews of medical literature, and consideration of input from patients, experts and many other interested parties.

How Labeling Will Change

Opioids work by changing the way the brain perceives pain. They are available by prescription as pills, liquids, and skin patches.

Extended-release and long-acting (ER/LA) forms pose a greater safety concern because—as their names suggest—they produce their effects for a longer period, and many contain higher doses compared with immediate release or opioid/non-opioid combination products.

They include, to name a few, long acting versions of opioids such as morphine, oxycodone, and fentanyl.

Currently, labeling on these ER/LA opioids indicate they are for “the relief of moderate to severe pain in patients requiring continuous, around-the-clock opioid treatment for an extended period of time.”

However, the updated indication for when to prescribe and take these medicines will, when finalized, emphasize that other, less potentially addictive, treatment options should be considered first.

FDA is requiring labeling that says the drugs are “indicated for the management of pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate.”

The “limitations of use” portion of the new labeling retains language indicating that the drugs are not intended for use as an “as-needed” pain reliever.

Furthermore, the new labeling adds: “Because of the risks of addiction, abuse and misuse with opioids, even at recommended doses, and because of the greater risks of overdose and death with extended-release opioid formulations, reserve [Tradename] for use in patients for whom alternative treatment options (e.g., non-opioid analgesics or immediate-release opioids) are ineffective, not tolerated, or would be otherwise inadequate to provide sufficient management of pain.”

This new labeling language emphasizes that patients in pain should be assessed not only by their rating on a pain intensity scale, but also based on a more thoughtful determination that their pain—however it may be defined—is severe enough to require daily, around-the-clock, long-term opioid treatment, and for which alternative treatment options are inadequate.

This framework better enables prescribers to make decisions based on a patient’s individual needs, given the serious risks associated with ER/LA opioids, against a backdrop of alternatives such as immediate release (IR) opioids and non-opioid pain relievers.

It allows prescribers to make an assessment of pain relative to a patient’s ability to perform daily activities or enjoy a reasonable quality of life.

FDA-approved labeling of these pain relievers already describes the effects on newborns of exposure to these drugs while in the mother’s womb and warns against use by women during pregnancy and labor and while nursing.

The new labeling, however, will provide more detail and will elevate the risk of neonatal opioid withdrawal syndrome (NOWS) to the most prominent position in labeling—a boxed warning. Symptoms of NOWS may include poor feeding, rapid breathing, trembling, and excessive or high-pitched crying.

Postmarket Studies

Recognizing the need for more scientific data about the benefits and risks of ER/LA opioids when used over long periods, FDA also decided to require drug companies to conduct longer term studies and trials of ER/LA opioid pain relievers on the market.

The companies must evaluate long-term use, with the goal of assessing a variety of known serious risks, including misuse, abuse, addiction, overdose, and death, as well as the risks of developing increasing sensitivity to pain.

Education to Reduce Risk

Following implementation of the safety labeling changes, certain educational materials for patients and health care professionals will be modified to reflect the new labeling for the ER/LA opioid pain relievers.

As part of the new labeling changes, opioid manufacturers also must revise a paper handout patients receive with their prescription.

The ER/LA Opioid Analgesics Risk Evaluation and Mitigation Strategy (REMS) will also be updated after the labeling changes are finalized.

The ER/LA Opioid Analgesics REMS requires manufacturers to make available continuing education courses for health care professionals who prescribe these drugs.

The courses, from accredited sources, teach about risks and safe prescribing and safe use practices of these medications.

“By improving information about the risks of ER/LA opioid pain relievers and by clarifying the populations for whom the benefits outweigh the risks, we aim to improve the safe and appropriate use of these products,” says Throckmorton.

He adds: “This is not the first or last initiative, and we will continue supporting broader efforts to solve the serious public health problems associated with the misuse and abuse of opioids.”

This article appears on FDA’s Consumer Updates page, which features the latest on all FDA-regulated products.

Sept 10, 2013

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Washington teens getting their whooping cough immunizations; HPV vaccinations lag

From the Washington State Department of Health

Vaccination_of_girlImmunization rates for Washington teens improved for some vaccines, while holding steady for others, according to a new national study.

In 2012, 86 percent of teens aged 13–17 in our state got a Tdap booster, according to the National Immunization Survey. That’s up from 75 percent in 2011 and tops the national goal of 80 percent.

Tdap is the vaccine that protects against tetanus, diphtheria and whooping cough (pertussis). The increase is welcome news following the recent whooping cough epidemic in Washington.

“We’re delighted that more teens in our state are protected against whooping cough,” said State Health Officer Dr. Maxine Hayes. “Older kids and teens often spread the disease to babies without knowing it. That’s why it’s so important for teens to get a dose of the Tdap vaccine.”

Over the last couple years, more teen girls are getting all three doses of the HPV vaccine, but fewer are getting the initial shot. About 43.5 percent of Washington girls 13 to 17 received the recommended three doses of the vaccine, up 3.5 percent from 2011.

Yet, only 64.5 percent of girls in the same age group got one dose of the HPV vaccine, a 2 percent decrease over the same time.

In 2012, nearly 15 percent of Washington boys aged 13–17 got the first HPV vaccine dose, up 6 percent from 2011. HPV vaccine was originally licensed only for girls and was made available to boys in October 2011.

This, plus a lack of knowledge by health care professionals and parents on the need and recommendation to vaccinate boys, may be why the rate for boys is lower than girls.

HPV vaccinations are recommended for girls and boys to protect against cervical cancer, genital warts and other types of oral and anal cancers.

Health care professionals should talk with parents about the importance of all kids getting HPV vaccinations starting at age 11 and 12. Kids in this age group have a stronger immune response compared to older kids.

“Parents want what’s best for their kids and want them to live happy, healthy lives,” Hayes said. “They can lower their children’s risk for HPV or cancer by getting them vaccinated.”

Nearly all sexually-active men and women will get at least one type of HPV at some point in their lives. HPV is most common in people in their teens and early 20s. That’s why it’s important for kids to get vaccinated before they start having sex. The vaccine doesn’t protect against any HPV strains someone already has.

Our state’s vaccination rate for two or more doses of chickenpox vaccine rose 8 percent in 2012. The rate for one dose of meningococcal vaccine rose slightly, from 69.4 percent in 2012 to 71.2 percent in 2011.

No-cost vaccines are available to kids up to 19-years-old through health care providers who participate in the state’s Childhood Vaccine Program.

Participating health care providers may charge for the office visit and an administration fee to give the vaccine. People who can’t afford the administration fee can ask for it to be waived.

For help finding a health care provider or an immunization clinic, call your local health agency or the WithinReach Family Health Hotline at 1-800-322-2588.

 

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Teens missing recommended vaccines, Seattle study finds

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By Sharyn Alden, HBNS Contributing Writer
Research Source: Journal of Adolescent Health

‘Health care providers are missing opportunities to improve teens’ vaccination coverage, reports a new study in the Journal of Adolescent Health.

Recommendations for routine vaccination of meningococcal (MCV), tetanus, diphtheria, and acellular pertussis (Tdap) and human papillomavirus (HPV) in adolescents are fairly new and many parents may be unaware of the need for adolescent vaccines.

“Our study found that when adolescents who are vaccine-eligible come to their health care provider for preventive visits, there are missed opportunities for vaccination. Adolescents who come in for non-preventive visits have even greater missed opportunities,” said lead author Rachel A. Katzenellenbogen, M.D., assistant professor of pediatrics at the University of Washington and Seattle Children’s Hospital.

“Our data found that adolescents who have an appointment come into their health care provider’s office and leave without receiving all three recommended vaccines—Tdap, HPV and MCV,” Katzenellenbogen said.

Adolescents need fewer preventive care visits than infants and are a relatively new population to be targeted for vaccination when compared to infants and children, she explained.

Katzenellenbogen and her colleagues analyzed vaccination rates for 1,628 adolescents aged 11- 18 with 9,180 visits to health care providers between 2006 and 2011.

All of the teens in the study were seen at a pediatric clinic in Seattle. During that time frame, 82 percent missed being vaccinated against MCV, 85 percent missed Tdap and 82 percent missed the first dose of HPV1.

“If parents know to expect that their adolescent should receive three vaccines when they turn 11 or 12, they may be more likely to schedule a preventive visit or bring up vaccination with their child’s health care provider during any office visit,” commented Kristen A. Feemster, M.D., assistant professor in the division of infectious diseases at the University of Pennsylvania School of Medicine.

Feemster said she was not surprised that missed opportunities occur because there are many challenges to implanting adolescent vaccine recommendations. “It is more challenging, for example, to establish eligibility for adolescent vaccines—many registries do not yet reliably capture adolescent vaccination.  Providers may have questions or concerns about the recommended schedule, plus adolescents may seek care in alternative locations where it is particularly difficult to establish eligibility.”

The researchers suggest that improved vaccine tracking and screening systems, such as provider prompts through electronic health records or manual flags by nurses or medical assistants, would enable providers to more easily identify those teenagers eligible for vaccines at all visit types.

Health Behavior News Service is part of the Center for Advancing Health

The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.

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What to say when mom or dad has cancer

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The Goodman family has dealt with mom Julie’s cancer diagnosis since 2009. Clockwise from top left are John, Julie, Jack and Lena (Photo by Carrie Feibel/KUHF).

HOUSTON — At any one time, an estimated 2.9 million children have a parent who has, or has had, cancer.

Dozens of studies show that many of these children experience worry and stress, but that good communication can ease their fears and isolation, even up to the point of a parent’s death.

Still, figuring out what to tell the kids – and when – is not an easy decision, and many parents who have cancer get little to no advice from their doctors about how to handle it.

Two hospitals in Houston are tackling the issue with support groups for parents and children. The Lyndon B. Johnson Hospitaland MD Anderson Cancer Centerwork with The Children’s Treehouse Foundation to offer emotional and practical support for families dealing with the disease.

Martha Aschenbrenner, a hospice counselor at MD Anderson, says that a very natural response to a cancer diagnosis is to try to protect children by hiding the facts or keeping them vague. But she urges parents to tell their children what’s happening in age-appropriate ways. Whether Mom or Dad is going to die is usually one of the first things a pre-teen will ask, she says.

“The wrong way to answer the question is ‘No, no, I’m not going to die.’ Because you can’t promise that,” Aschenbrenner says. “A better way that also invites more conversation is: ‘That is not my plan. And I’m going to a hospital where they’re going to give me very strong medicine, and I hope and my plan is I’m going to get better. And I’m going to tell you what happens, so you don’t have to worry that I’m keeping secrets from you. I’m going to keep you informed.’”

The Susan J. Komen Houston Affiliate funds a support group at LBJ, which is part of the publicly-funded Harris Health System, with a two-year grant of $237,500. That means women with breast cancer and their children can benefit from the six weeks of group sessions free of charge. The grant even covers parking charges for participants.

During a recent meeting of the group called Tender Drops of Love, Lindsey Leal, a child-life specialist at LBJ Hospital, explains to kids that parents with cancer sometimes feel sad, but it’s not the kids’ job to cheer them up.

“The thing is sometimes [your parents are] going to feel bad about themselves, and they’re going to feel sad and they’re going to feel angry. And sometimes you’re going to feel sad and you’re going to feel angry. And, is that okay?” Leal asks the group of kids aged six to 12. One boy answers, “No, that’s not helping.”

But Leal counters:  “It is okay. No, it’s not healthy to punch a wall. It’s not healthy to act on your anger. It is healthy to talk about your anger.”

Laura Molina, 9, shows the mask she created expressing the feeling of "sadness." Molina's mother is being treated for inflammatory breast cancer at the Lyndon B. Johnson hospital in Houston, Texas (Photo by Carrie Feibel/KUHF).

Laura Molina, 9, shows the mask she created expressing the feeling of “sadness.” Molina’s mother is being treated for inflammatory breast cancer at the Lyndon B. Johnson hospital in Houston, Texas (Photo by Carrie Feibel/KUHF).

As cancer progresses or retreats, parents need to keep the discussion going, therapists say.

Julie Goodman was diagnosed with colorectal cancer in 2009 at the age of 43. Her daughter Lena was in fourth grade and son Jack was in seventh. After the colorectal cancer spread to her lungs, she had more surgeries and chemo.

But now she’s had six months of clean scans.

“And whenever I come home from that, we just go ‘Yay, mom had clean scans!’ And they’re like ‘Yay, OK, what’s for dinner?’ You know, moving on,” Goodman says. “They may be desensitized a little bit to it now. Mom goes to the doctor, mom comes home, she’s fine.”

Goodman says she still struggles with how much to tell her kids. On the one hand, she wants her children to remember she’s not out of danger, not yet.

But she also loves the fact that they’re not worried anymore, that they don’t think about it every day. Instead, they have what every parent wants: that the everyday concerns be what’s for dinner, and walking the dogs, and homework, and time for bed.

This story is part of a collaboration that includes KUHFNPR and Kaiser Health News.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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