On Breast Cancer Worldwide

This October marks the 25^th annual celebration of Breast Cancer Awareness Month, during which organizations in the U.S. and worldwide will hold events aimed at raising awareness and providing education about breast cancer. In spite of ongoing efforts to inform the public about breast cancer, it continues to be a major health concern worldwide. According to the National Cancer Institute (NCI), in 2010, there will be 209,060 new cases of breast cancer in the United States. Reports from the World Health Organization (WHO) indicate that incidence rates vary worldwide, however as the adoption of “western lifestyles” increase in the developing world, breast cancer has become more common. Due to the lack of adequate diagnosis and treatment facilities in these regions, survival rates are often also significantly lower. In 2004 an estimated 519,000 women died worldwide due to breast cancer, with 69 percent of these deaths occurring in developing nations. By ensuring that information about breast cancer and early detection programs are available, treatment outcomes worldwide can be greatly improved.

Like other types of cancer, breast cancer develops when abnormal cells divide in an uncontrolled fashion and spread to surrounding tissue (metastasize). Breast cancer is a malignant form of tumor growth which can develop in both men and women, but is approximately 100 times less common in men. An estimated one in every eight women will be diagnosed with breast cancer during their lifetime, making it the second most commonly diagnosed cancer after skin cancer in women in the United States. There are many types of breast cancer, but two of the most common are ductal carcinoma, which begins in the cells that line the milk ducts of the breast; and lobular carcinoma, which begins in the lobes or lobules of the breast. Unlike less common forms of breast cancer, including inflammatory breast cancer which is marked by heat, redness, and swelling of the breast, these common types of breast cancer tend to manifest similarly.

The first signs of breast cancer may include a lump in the breast or thickening of breast tissue, change in shape of the breast, changes in the breast or nipple skin, or bloody discharge from the nipple. Tumors in the breasts may be detected during clinical breast exams, mammograms and other imaging tests, or self breast exams. A mammogram is a black-and-white image of the breast similar to an X-ray. Though some recommendations differ, the American Cancer Society suggests that women undergo yearly mammograms beginning at age 40. Though mammography has proven to be an effective screening method and can help ensure early diagnosis of breast cancer, the Centers for Disease Control and Prevention (CDC) indicates that more than 7 million women in the United States have not had a recent mammogram.

Following the identification of a tumor within the breast, a determination must be made regarding how advanced the spread of the cancer is so that it can be effectively treated. The “Stages” into which breast cancer are categorized – from Stage 0, defined by abnormal cells that are not invasive cancer, to Stage IV, defined by cancer which has spread throughout the tissues of the body. The Stages indicate how aggressively the cancer is spreading within the breast, to the surrounding tissue and lymph nodes, and throughout the rest of the body. Depending on the progression of the cancer, treatment options may include chemotherapy and surgery. Chemotherapy is a drug treatment that uses powerful chemicals to slow the growth of cancer in the body or kill off the cancer cells. Though it is effective, chemotherapy, which can produce a number of side effects, including nausea, vomiting, hair loss, and fatigue, is often used in combination with surgical interventions. Breast-sparing surgeries, which aim to remove cancer from the breast while preserving the surrounding tissue; and mastectomies, in which the entire breast is removed, are often employed.

Though breast cancer treatment can be physically and emotionally painful, there are currently over 2.5 million breast cancer survivors in the U.S. and many more around the world. Breast cancer can occur at any age, but the risk of its development increases as an individual gets older. While the cause is still unknown, there are a number of factors linked to an increased risk of developing breast cancer including the presence of certain “breast cancer genes,” a woman’s age, family history, and age at the onset of menstruation and menopause can increase their risk of developing breast cancer. While little can be done about some of these factors, some women with a genetic predisposition to developing cancer have opted to undergo preventative mastectomies to reduce their risk. Individuals can also help to reduce their risk by maintaining a healthy lifestyle.

By ensuring that individuals are made aware of the importance of regular clinical and self breast evaluations and that early detection and diagnosis programs are made available, treatment outcomes can be greatly improved.

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Flooding in Pakistan

Reports indicate that recent flooding in Pakistan has affected the lives of at least 15.4 million people and left a third of the nation – including approximately 7.9 million acres of cultivated land900,000 homes have been destroyed by surges of water, and a reported six million people do not have access to food, shelter, and potable water. In addition, the United Nations indicates that 1,600 have died and more lives are at risk as the threat of water-borne illness continues to rise.

Floods began in late July following a period of particularly heavy monsoon rains and have continued through August. Many have sought shelter in camps established by aid organizations, but public health experts warn that the crowding associated with displaced persons camps could exacerbate the spread of disease. Scabies, a skin infection caused by mites that burrow and cause pimple-like irritation, is becoming increasingly common in the camps. According to some reports, tens of thousands of infected individuals are among the 600,000 people in relief camps set up in Sindh province. In these tented camps which have been established in army compounds, schools, and public buildings, healthcare providers are struggling to contain outbreaks of acute diarrhea, the precursor to fatal cholera.

According to Mark Ward, acting director of the U.S. Agency for International Development’s office for foreign disaster assistance, “When you are dealing with this much water and that many people it [cholera] is almost unavoidable.” In addition, the World Health Organization (WHO) has reported 204,000 cases of acute diarrhea, 263,300 cases of skin diseases, and 204,600 cases of acute respiratory diseases in flood-affected regions. Thousands of cases of suspected malaria have also been documented and the conditions for mosquito-borne as well as water-borne illness are present.

The delivery of treatment for these fast-spreading communicable diseases has been compounded by the lack of adequate clinical facilities. Reports indicate that 200 health facilities were damaged or destroyed. Vaccination programs have been established in Charsadda and Peshawar regions and more than 100,000 children have received polio shots. Despite these efforts, millions, including 3.5 million children are at risk of contracting disease, and require water, shelter, or emergency care. Radio and text messaging campaigns have also been put in place to distribute information about the importance of hand washing and good hygiene.

While funding for humanitarian aid has been limited to date, the UN and other international organizations continue their efforts to garner support. Assuring that food, water, shelter, and medical treatment are available for those who need them is the primary concern of aid organizations currently working in Pakistan. By delivering effective medical treatment in a timely fashion while also working to prevent the spread of diseases, outbreaks can be contained.

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West Nile

West Nile virus (WNV) is an infection transmitted to humans and animals by mosquitoes which have fed on infected birds. According to the Centers for Disease Control and Prevention (CDC), between 1999 and 2008, 28,961 confirmed and probable cases of WNV were reported. Though 80 percent of individuals infected with WNV show no symptoms, approximately one in 150 develop severe illness with symptoms including high fever, vision loss, and paralysis. Though there is no vaccine or cure for WNV, it is important for individuals to have an understanding of how best to protect themselves from infection.

First identified in Uganda in 1937, WNV occurs when Culex pipiens mosquitoes feed on infected birds, which serve as vectors for the virus, and then pass the virus on to humans. WNV cannot be passed from one individual to another through close personal contact, and the primary method of transmission is through the bite of an infected mosquito. Mild infections (West Nile fever) are seen in approximately 20 percent of individuals, and are marked by symptoms including fever, headache, and body aches. Individuals with severe infections (severe West Nile disease) may experience inflammation of the brain (encephalitis) or of the brain and surrounding membranes (meningoencephalitis), and three to 15 percent of WNV infections result in death. According to CDC statistics, in 2009 there were a total of 663 cases of WNV in the United States, and 30 of these resulted in death.

The CDC indicates that WNV is an established seasonal epidemic in North America, beginning in the summer and continuing into the fall. In addition to documented cases in the United States, both sporadic cases and major outbreaks of encephalitis related to WNV have been reported in Africa, West Asia, Australia, Europe, and the Middle East. Recent reports have documented outbreaks in Greece and British Columbia, Canada; as well as in New York, Pennsylvania, and northwestern Indiana.

Like malaria, dengue, and other mosquito-borne illness, rates of WNV infection increase during periods of warm weather when mosquito populations are most active. Torrential rains in early summer and persistent high humidity in many regions of the United States have created the ideal breeding climate for mosquitoes. Experts recommend taking preventative measures to avoid infection including the “5 D’s”:

• Dusk and Dawn – avoid being outdoors during these periods which are when mosquitoes are most active
• Dress – wear clothing that limits exposed skin
• DEET – use repellents containing DEET (picaridin and oil of lemon eucalyptus are other repellant options)
• Drainage – eliminate areas of standing water in which mosquitoes lay eggs.
  

In addition, dead birds, particularly crows, which display signs of illness should be reported to authorities for proper disposal. As health officials continue to track outbreaks of WNV, individuals can take appropriate measures to limit their risk of infection and keep their community healthy.

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Web-Accessibility for People with Disabilities

Though substantial progress has been made to ensure that all individuals with disabilities are afforded the same opportunities as those without, some barriers still remain. While millions of individuals with disabilities currently utilize the Internet to some degree, gaining access to and fully experiencing materials presented on the Internet can be problematic for individuals with certain types of disabilities. Those with motor impairments, low vision or blindness, low hearing or deafness, and/or language or cognitive disabilities often require assistive technologies or devices to access websites. A report from the Disability Statistics Center of the Institute for Health and Aging indicates that at least 2.1 million of the reported 54.4 million Americans with disabilities use the Internet from their homes or on another computer. The American Federation for the Blind states that around 1.5 million of the 7.8 million Americans who experience vision loss use computers, with just under one million reporting regular computer use. Additionally, an estimated 7.8 million people over the age of 15 experience some form of hearing loss, and a report in the American Annals of the Deaf indicates that 63 percent of those who took part in a recent study reported regular computer use. New legislative measures may help to make the web more accessible to any individual with a disability.

The World Wide Web Consortium (W3C) states “not all…disabilities affect access to the Web, but problems with vision, hearing, dexterity and short-term memory can have a significant impact on a person's ability to use online information and services.” Individuals with disabilities frequently employ assistive technologies or make other accommodations to access information online. These may include screen readers, software utilized by individuals with visual impairments which converts information on screen into speech; alternative text (ALT text), HTML tags which provide descriptions of images for blind individuals; and closed captioning, the display of text coinciding with audio content for individuals with low hearing or deafness.

The majority of websites are still primarily inaccessible to individuals with disabilities, and the efforts by others to ensure that they are accessible to people with disabilities have been minimal. A number of “mainstream” websites have instituted accessibility features, including Facebook and YouTube, which have begun implementing changes that will improve the browsing experience of individuals with disabilities. These adaptations include the following:

• Facebook provides an audio captcha alternative to for those using screen readers, as well as an HTML-only version of the website and instructions for increasing font size in a number of web browsers.

• YouTube provides closed captioning options for users with low-hearing or who may not be able to hear or understand the audio portions of videos. However, captions must be added to the video by the individual who uploads it

• Twitter has not yet addressed the issues that prevent its use by many individuals with disabilities. However, AccessibleTwitter offers “a simple, consistent layout and navigation,” “assures that all links are keyboard accessible,” and “uses large default text size and high color contrast.” In addition, the recently introduced service TweetCall allows users to speak their tweets, which are then transcribed to text. For individuals who may have difficulty typing or using a computer, this creates an opportunity for the utilization of Twitter.

To further improve the accessibility of the Internet, Congress recently approved legislation that would set federal standards for the telecommunications industry , including online delivery of information. These new regulations coincide with the 20th anniversary of the Americans With Disabilities Act (ADA), a landmark legislation that helped to ensure equal opportunities and accessibility. Though the ADA has led to vast improvements in many areas, as Representative Edward Markey, D-Mass, noted “The ADA mandated physical ramps into buildings, today, individuals with disabilities need online ramps to the Internet so that they can get to the Web from wherever they happen to be.”

You can evaluate the level of accessibility of a website using the online tool WAVE.

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Using Social Media for Organ Transplantation

Reports indicate that the number of organ donors in the U.S. has decreased in recent years, while the number of patients in need of an organ transplant continues to grow. In 2006, there were 8,019 cadaveric organ donors and 6,732 living donors. Both figures have since decreased, and in 2008 there were only 7,990 cadaveric donors and 6,218 living donors. According to the National Kidney Foundation, 104,748 individuals in the United States are currently awaiting an organ transplant of some type, and more than 4,000 new patients are added to this figure each month. Organs from donors are matched to waiting recipients by a national computer registry called the National Organ Procurement and Transplantation Network (OPTN). In addition, close relatives and family members often undergo testing including tissue matching and blood typing to determine if they are a viable candidate for donation. Many organs, including kidneys, can be transplanted from either living or recently deceased donors, provided they have good kidney function, and low risk for certain disorders including high blood pressure and diabetes.

Transplants using kidneys from both living and cadaver donors are frequently successful, with about 94.9 percent and 97.96 percent of cadaver and living (respectively) donor kidneys still functioning after one year. In spite of the success rate, the wait to receive a transplant, which can often be several years and often requires dialysis and other physically taxing treatments, is too long for some individuals, and a number have chosen to utilize online social media to seek out possible donors. The Baltimore Sun reports that 80,000 people in the United States are currently awaiting kidney transplants, but just over 16,000 were completed last year. For individuals seeking to increase their chances of finding a donor, Annette Whinery, the coordinator of University Medical Center’s living donor program, says that it is becoming common for patients to seek out living donors on their own, often through church, work, family, and friends. Dr. Ngoc L. Thai, director of Allegheny General Hospital’s Center for Abdominal Transplantation, recently completed a transplant surgery in which the donor and recipient connected via Facebook. “It’s the way of the future,” according to Dr. Thai, who says that he expects more patients to turn to social networking websites for help finding donor matches. In addition to Facebook, some patients and their family members have turned to Craigslist and other websites to find possible donors.

Some individuals awaiting transplant and those who have recently received a transplant choose to use social networking websites to tell their story, rather than to ask others to consider donating an organ. Through blogs, Facebook, and Twitter, individuals in need of kidneys and other organs are able to keep others informed. Recent research has shown that people fighting chronic illnesses and those with serious health problems, such as those that might require an organ transplant, are using social media to find information and connect with others with similar ailments. Social networks like the Transplant Trust and Patients Like Me allow patients awaiting transplants, their families, physicians, donors, and others to connect with one another. In a recent study by Teri Browne, PhD, from the University of South Carolina in Columbia, this type of connection was shown to help patients navigate and understand the process of getting a transplant more easily.

According to Dave Bosch, spokesman for the Gift of Hope, an organ and tissue donor network, “Social media has become the way people communicate, very personally, about what’s going on in their life.” Dr. Kenneth Prager, director of clinical ethics and chairman of the Medical Ethics Committee at New York Presbyterian Hospital, notes that Internet appeals for organ donations raise a number of questions of fairness. While Dr. Prager states that “Solicitations undermine the concept of a level playing field,” which is the primary objective of the OPTN, “there is nothing illegal in advertising or using the Web for personal or health reasons. Altruistic organ donors have the legal right to designate recipients.” It is important to note, however, that the sale of kidneys and other organs is illegal, and all donations must be made without compensation.

Though the use social media to address matters related to an individual’s health may seem somewhat unusual, it is a trend that seems to be gaining in popularity. Some experts even argue that the solicitation for kidney and other organ donation on websites like matchingdonors.com, Craigslist, and Facebook may help to encourage individuals to consider donation and benefit the population of individuals in need of organs as a whole.

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On Sunscreen and Skin Cancer

In 1903, Dr. Auguste Rollier opened the world’s first sun clinic at Leysin offering a place where sunlight was seen as a treatment for disease. Well into the 20^th century, tanned skin was not only an indicator of health, but was fashionable as well. In recent years, outdoor tanning as well as the use of tanning beds have drawn attention for their potentially harmful effects. Skin cancer is the most common form of cancer in the United States with nearly one million cases diagnosed each year. Though other risk factors can contribute to the development of skin cancer, one’s exposure to ultraviolet (UV) radiation can speed their progression. By making sure to apply sunscreen, wear protective clothing, and limit time spent in direct sun, individuals can decrease their likelihood of developing skin cancer.

UV rays are a type of invisible radiation that comes from the sun, tanning beds, and sunlamps. There are three kinds of UV light: UVA rays are present year round and penetrate deep into the surface of the skin, damaging the cells beneath and causing signs of aging. Though UVA radiation can contribute to skin cancer, UVB rays, which cause sunburn and tanning of the skin and are more prevalent during the summer months, are also most often responsible for the development of skin cancer. UVC rays, are blocked by the ozone layer, but would cause sunburn with only brief exposure, while prolonged exposure would be fatal. Tanning beds primarily emit UVA radiation, which is the least harmful, but a 2006 study indicated that the use of tanning beds before an individual is 30 years old is associated with a 75 percent increase in melanoma risk.

Excessive UV exposure frequently leads to erythema, or sunburn, as well as causing a darkening and thickening of the outermost layers of the skin, which differs from a sun tan. Chronic exposure to any UV radiation can cause degeneration of the cells, fibrous tissue, and blood vessels of the skin, and may eventually contribute to the development some types of skin cancer. The primary symptom of skin cancer is a mole or other growth on the skin. The “ABCD system” is frequently used to help individuals understand what to look for when determining if a skin growth is cancerous. Asymmetry, when one half of the area is different from the other; Borders, irregular edges to the growth; Color, changes in color from one area to another; and Diameter, when the growth is larger than a pencil eraser; are all indicators that a lesion should be examined by a dermatologist. Some experts also make note of the “E factor” associated with skin cancer development – the Evolution or changing of the lesion.

The two most common types of skin cancer, basal cell and squamous cell carcinomas, also called non-melanoma skin cancers, can be caused by exposure to ultraviolet (UV) light. Though they are often curable, the process of surgical removal can be painful and disfiguring. According to a survey from the American Society for Dermatological Surgery (ASDS), there was a 10 percent increase in the number of surgical procedures related to skin cancer between 2007 and 2009. Melanomas are often malignant and are a more dangerous form of cancer, and 65 to 90 percent of them are caused by UV exposure.

To reduce an individual’s risk of developing skin cancer, experts recommend a number of measures that can be taken, including limiting the amount of time spent outdoors, particularly between 10AM and 4PM when UV exposure is highest in the continental United States. In addition, though it does not completely eliminate an individual’s risk of developing skin cancer, the use of sunscreen can help to decrease the risk. According to a U.S. sunscreen study conducted by Neutrogena, only 18 percent of American adults use sunscreen regularly, and only 48 percent of those reapply sunscreen when needed. Though the American Academy of Dermatology (AAD) suggests that consumers apply enough sunscreen to fill a shot glass, according to Jeffery Dover, president of the ASDS, consumers often do not apply enough for the products to be effective. The AAD reports that individuals frequently do not use enough sunscreen to adequately protect them from UV rays, and suggests the use of products with a sun protection factor (SPF) of at least 15 year round and 30 in the summer. SPF refers to the ability of a product to block UV radiation from reaching the skin, however the amount of protection does not increase proportionally with the SPF number and layering multiple SPFs does not result in protection equal to their sum. In order to ensure that sunscreens are most effective, they should be applied at least 20 minutes prior to sun exposure and only products stating that they provide UVA/UVB or “broad spectrum coverage” should be used.

In order to increase the use of sunscreen, public health officials have begun seeking new ways of increasing sun safety awareness. In one study, researchers found that using text messages to remind individuals to apply sunscreen when going outside, and reapply it following swimming or exercise increased its use. Sun protection has also advanced beyond the standard lotions, creams, and sprays, and now also includes clothing treated to provide UV protection. Most recently, a 10 percent tax was implemented on the use of indoor tanning services, underscoring the fact that even indoor tanning can be hazardous. With these new measures in place and continued improvements in sun protection technologies, researchers hope that it may be possible to prevent some skin cancers from developing.

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On Drug Resistance

As the distribution of medications worldwide advances, individuals gain access to improved treatment options. Among the medications most frequently distributed are antibiotics. Though expanded access to medicines is “clearly desirable,” it can also create “challenges in preserving the efficacy of these drugs.” A recent report from the Center for Global Development (CGD) indicates that antibiotic distribution programs put in place by the World Health Organization, government agencies, and other groups may be contributing to the increased incidence of drug-resistant bacteria. According to Nancy Birdsall, the president of the CGD, “Drug resistance is a serious problem that doesn’t get serious attention.”

Antibiotics and antimicrobial agents are the most effective means of combating infectious disease. However, as a class of drugs, antibiotics are unique in that once an antibiotic is utilized, the bacteria it is intended to fight begin to develop a resistance and the effectiveness of the medication is diminished. According to British researchers who analyzed 24 previous studies, the excessive prescription and use of antibiotics for coughs and flu-like illnesses leads to antibiotic resistance. Studies indicate that the overuse of medications, inconsistent drug quality, and other factors hasten the adaptation of resistance to given antibiotic and antimicrobial agents.

This increased resistance to commonly used antibiotics can result in “superbugs,” such as methicillin-resistant Staphylococcus aureas (MRSA), which is the cause of more than 50 percent of staph infections in US hospitals. Additionally, in the developing world, drug-resistant strains of malaria, tuberculosis, HIV/AIDS, and other diseases are the cause of death for millions of children each year. According to Céire Costello Research Associate at the University of Bristol, “there are some concerns that some common infections are becoming increasingly difficult to treat.” This is seen with increasing frequency in many remote and medically underserved areas of the world where medication dispersal programs are especially prevalent. Reports indicate that 60 to 80 percent of dysentery cases among children in Latin America are “resistant to the drugs recommended to treat it.”

By retaining the medications available now and developing new drugs, experts hope to be able to continue combat bacterial infections effectively. Because of the lengthy development and testing process associated with creating new medications for mass consumption, it is critical to ensure that drug resistance is minimized as much as possible. By urging providers to keep track of which antibiotics they prescribe and how frequently, it may by possible to help slow the rate of drug resistance. It is also essential for clinicians and individuals worldwide, particularly in the developing world, to be aware of the importance of not over prescribing or over using antibiotics.

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