Ask Us Anything About… Cancer Prevalence in Our Community

Description – The video begins inside a hallway in the Penn State Cancer Institute. We start with two males standing next to each other facing each other and the camera. On the left is Scott Gilbert. On the right is Dr. Gene Lengerich, Associate Director of Health Disparities and Engagement here at Penn State Cancer Institute

Scott Gilbert – This is Ask Us Anything About Cancer in our community. I’m Scott Gilbert, thanks for watching today. A new study in the Journal of the American Medical Association spells mixed news about cancer. Overall, it shows, that from 1980 to 2014, the rate of cancer in the United States has dropped. However, in some geographic areas, the opposite is the case. Several types of cancer, in some parts of the country, are on the rise. Also, particular types of cancer, nationwide, for example, liver cancer, on the increase still. Here to give us some answers about this and to talk more about the study is Dr. Gene Lengerich. He is the Associate Director of Health Disparities and Engagement here at Penn State Cancer Institute, which is where we’re standing right now. So, Dr. Lengerich, thanks for being here today.

Dr. Gene Lengerich – Thank you! It’s my pleasure to join you.

Scott Gilbert – Let’s start with what seems to be the good news. You know, like we’ve said, from 1980 to 2014, a 20 percent drop, overall, in cancer rates. That seems to be good news, right?

Dr. Gene Lengerich – That is very good news, and we should all be celebrating that fact, that that’s happening. And we really – we’re really excited about that, because of all the prevention, early detection, the treatment that has gone on to make that happen. The research that’s underpinned that has just been instrumental to making that happen.

Scott Gilbert – So, let’s back up a step and talk about the methodology too. This, I understand, is – this study is based on information from the National Center for Health Statistics. Can you talk a bit about more, how this data was compiled and derived, even though, of course, you weren’t directly involved, but I know you’ve studied it extensively.

Dr. Gene Lengerich – Yeah, this data is – is extensively from the public health system, specifically from the National Center for Health Statistics, and they have the responsibility, in this country, for collecting and amassing all of the various health data that – that goes on across the country. And, particularly in this case, they primarily used mortality data. So anytime there’s a person that dies, there is a recording of the person’s death and what led to that – what led to that death. So, it is a very systematic and complete system, that leads the – that gives us these data. They then took that and merged it with a lot of other data, as well. Census data, for example, to tell us how many people are living in each of the counties that they examined. As well as some other issues were important, as well, such as poverty rates and the demographics of the population, and the education level, as well, within that area.

Scott Gilbert – You’re watching, Ask Us Anything About Cancer in our community form Penn State Health, Milton S. Hershey Medical Center. I’m Scott Gilbert, alongside Dr. Gene Lengerich, and we welcome your questions, whether you’re watching this video live here on Thursday, you can add your questions to the comments section, or even if you’re watching it on playback, feel free to still add your questions in the comments section, and we’ll track down Dr. Lengerich and get you an answer to those questions. As I mentioned before, despite that 20 percent overall decrease in cancer rates, there is still, what are described as cancer clusters, across the country, where several types of cancer are on the increase. First of all, before we talk about that in detail, can you – we hear the word, cancer cluster, a lot. Is there an accepted definition of that for scientists, such as yourself?

Dr. Gene Lengerich – Well, there is an accepted definition. The definition has to do with observation that these mortality rates are high in particular geographic areas, and those areas then congregate. And there are a lot of different statistical techniques we can do to observe that, to generate those data, and be able to see where those look – those occur. It’s really important to do that, because we don’t want to make statements about areas that don’t have the statistical support behind them.

Scott Gilbert – And there are some very interesting, I guess you call them heat maps, in this study, where you see this type of cancer is very prevalent, for example, across the southern tier, or maybe along the Mississippi River, but not elsewhere. Whereas other types of cancer are more prevalent elsewhere. Where do you begin in trying to get answer as to why those disparities exist?

Dr. Gene Lengerich – Well, there’s lots of reasons that those disparities exist. One is just sort of the underlying population that may live in that area. They may have higher behavioral risks that put them at risk for that. You had mentioned lung cancer, for example, the smoking prevalence is very important in lung cancer, for example. Then also there’s the issue of sort of access to healthcare. And whether or not they have – people in that area have that kind of access, to avail themselves of early detection or treatment by high-quality teams that really have the latest drugs and therapies available to them.

Scott Gilbert – So, let’s drill down a bit in here to Central Pennsylvania. What does this report say about the cancer types that are most prevalent in this area? Some of the concerns that kind of rise to the top for you?

Dr. Gene Lengerich – Yeah, well, there were a couple that did stand out. Again, this was a nationwide study, so we really have a hard time drilling down specifically to the small Central Pennsylvania area within the entire U.S., but there are a couple of areas that do look important. One had to do with pancreatic cancer. And that appeared to be a bit higher than elsewhere in the – in the country. I guess one of the things that really bothered me when I looked at this, also, was the issue of lung cancer. And even though the rate wasn’t particularly high, our decrease over that time period was not as great as what I would have liked to have seen that. And I think that we know that issue’s related to, again, smoking and some of the screening effects, are really important in our area. Our area is a largely rural area, where access to care is important and not available to everybody.

Scott Gilbert – The number one cancer killer across the country, over that 24-year period, was lung cancer. Number two, colorectal cancer, number three, breast cancer. What do we know about why those rates are so high compared to – compared to others?

Dr. Gene Lengerich – Well, first of all, the lung cancer, of course that is being driven largely by the smoking prevalence. We have made great progress in that, here at Penn State, as well as across the country, and really has dropped the rate of smoking among – among people in Central Pennsylvania. That’s been a big driver. And I guess there’s been a big difference between men and women in that area, as well. So the women seem to take a little bit longer to decrease the prevalence among themselves, and so now we’re seeing that decrease in mortality, which is a big benefit, as well. The second you mentioned was colorectal cancer. Colon cancer is – is really the number two killer, and it shouldn’t be.

Scott Gilbert – It’s so preventable!

Dr. Gene Lengerich – It is so preventable with early detection through fecal tests or through colonoscopy. And we’re really, here at the Cancer Institute, as elsewhere, really trying to make great strides to improve that across our Central Pennsylvania area, and we can talk about that in a bit. The third is breast cancer, and, of course, that’s an incredibly important one. When we drill down and look at our own data, we see significant differences from county to county in Central Pennsylvania. And that’s of particular concern. Some of our more rural areas have these lower incidence rates, which may be counterintuitive, but really the reason is is that the utilization of screening, mammography, clinical breast exams, is not as prevalent as what it ought to be. And so we do see lower detection rates in some those rural areas.

Scott Gilbert – Finding as many in those spots.

Dr. Gene Lengerich – Exactly! And then we get — and then what happens is they get diagnosed at a later stage, when they’re – when they’re not as treatable, and it’s more difficult to treat at that point in time.

Scott Gilbert – You’re watching Ask Us Anything About Cancer in our community from Penn State Cancer Institute. I’m Scott Gilbert, talking with Dr. Gene Lengerich. And we’re taking your questions as well, so feel free to add them to the comment field below this Facebook post, whether you’re watching this as a live video right now, or if you’re watching on playback, we’ll make sure that we get that information up there for you. Some types of cancer are on the rise across the country, according to this report from the Journal of the American Medical Association. One of them is liver cancer. It, apparently, those cases are up by 88 percent, from about 3.6 to 6.8 deaths per 100,000 people. Is that statistically significant?

Dr. Gene Lengerich – Oh, not only significant, but it’s very important. Yes, liver cancer is rising, both incidents, as well as mortality. And it is of particular concern. One of the population groups that it’s very prevalent among is the Latino and Hispanic population. And it is very much more common among that group than among other groups as well. We recently did a study wherein released the results of looking -producing the first-ever report on Latino-Hispanic cancer incidents across the state of Pennsylvania. And we found some similar results, as well, but that is a really important issue, not only in the entire state of Pennsylvania, but also within the Central Pennsylvania, particularly within our rural area.

Scott Gilbert – So, we have these numbers now about what – about what the cancer numbers are from the last 24 years. 19.5 million cancer deaths. We’re seeing the breakdown, geographically, type of cancer, how can we turn these results, how can researchers, scientists, physicians, turn these numbers into results in the future, to try to drive these rates lower?

Dr. Gene Lengerich – Yeah, well, I think that there are really three – three approaches to this. One is, first of all, it’s data. And this report is a great example of that sort of utilization of data. We’re doing the same thing here at the Penn State Cancer Institute; we’re drilling down within the Central Pennsylvania area, to really identify the hotspots, to identify the particular groups of people that may have issues. Like I said before, we had released that first-ever report on the burden of cancer among Latinos in Pennsylvania. So we’re really trying to use those data to drill down, to inform where we’re looking at. As I mentioned, another example of that is looking at the – the incidents of breast cancer, and how we see differences. 50 percent differences from one county to a neighboring county, and that really is a puzzle for us and something that we’re investigating. So using data is really the first – first piece. Then the second thing is that we really need a sort of a community and population-based approach to cancer prevention and control. So, one of the things that we do, closely, is we work with our – our state partners, particularly the Department of Health, they have a comprehensive cancer plan that we’re very involved with. We work very closely with community-based partners, and one of our strategies is deploying community health workers. This is sort of a new strategy that’s come on board for cancer prevention and control, but it’s individuals who have a passion and a – a passion and a trust among our community members, because this can’t be seen as just a researcher’s or a physician’s problem, it really needs to be the community’s issue, as well.

Scott Gilbert – Makes good sense.

Dr. Gene Lengerich – Yeah. And then the – and then really the third thing that we really have to do is look at evidence-based prevention, treatment, and control programs. So, Penn State Cancer Institute’s very involved in research projects. So, for example, we have just finished a five-year study where we were testing a community-based intervention to increase physical activity and nutrition among rural members of the [inaudible] area here at Penn State, and found that that’s a significant improvement. So we’re trying now to roll that out into a larger population base. But it’s really about utilizing evidence-based approaches to increase the cancer prevention and control. Among Latinos, for example, we’ve been very active in looking at how they interact with each other, how they can provide social support on the issue of colon cancer screening. And then – and then the issue of diagnosis and treatment is incredibly important, as well. So, we can’t stress enough that if there is a question, if there is an issue, that – that people get to a qualified, highly-qualified team of physicians and healthcare providers to work that up in a complete fashion. We’re very active in the area of treatment studies, as well. And so the Penn State Cancer Institute offers a lot of opportunity for individuals to – to avail themselves or to be interested — to find out about what the latest treatments are.

Scott Gilbert – I want to go back to the issue of cancer screening, because I would think that someone can see these numbers and say, well, it’s simple, we need to screen more people for cancer, but then there’s also the – the issue of possibly over screening too. Doing unnecessary tests. How do you strike that balance? Hey, when trying to come up with – with policy and best practices for – for those on the clinical side, you know, how do you try to strike that balance as to what makes for proper and best practices in screening?

Dr. Gene Lengerich – Yeah, it’s an incredibly important question, because, like you said, we don’t want to over screen individuals to diagnose something that may not be a problem that may cause a lot of anxiety and worry then for individuals as well. So, it is an important balance that we have to strike. So, first of all, there’s the individual basis. So, what is the patient’s preference for screening? And that may be a bit different for individuals, and how they – how they perceive their health care and what they want to take advantage of. A second is, of course, the healthcare provider’s advice and guidance and recommendations then, as well, and that’s critically important. That’s guided, largely, by recommendations that come from bodies across the U.S. For example, the U.S. Preventative Services Task Force, The American Cancer Society, and other groups issue recommendations. Not so much for individual patients, but more at a group level. And that’s always an important factor then to take into account, as well. And then there are times when that physician and the patient want to modify those – those recommendations then, as well, and that becomes an important discussion that they have, as well.

Scott Gilbert – Well, you’ve been watching Ask Us Anything About Cancer in our community from Penn State Health Milton S. Hershey Medical Center. If you’re just tuning in for this video, I invite you to watch it on playback; it will be posted on our Facebook page indefinitely. Go back, check that out, feel free to add any questions that you might have to the comment field, and, like I said before, we’ll track down Dr. Lengerich and get some answers for you. If you liked what you saw here on this video, I encourage you to share it to help get the word out and get the information about this important issue out to the entire community. I want to thank Dr. Gene Lengerich, he’s Associate Director of Health Disparities and Engagement here at the Penn State Cancer Institute. Thanks for your time today. We appreciate you watching this edition of, Ask Us Anything About from Penn State Health.