Tag: deaths and fatalities

New study suggests Black women should be screened earlier for breast cancer | CNN

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CNN
 — 

A new study on breast cancer deaths raises questions around whether Black women should screen at earlier ages.

An international team of researchers wrote in the study, published Wednesday in the journal JAMA Network Open, that clinical trials may be warranted to investigate whether screening guidelines should recommend Black women start screening at younger ages, around 42 instead of 50.

The US Preventive Services Task Force – a group of independent medical experts whose recommendations help guide doctors’ decisions – recommends biennial screening for women starting at age 50. The Task Force says that a decision to start screening prior to 50 “should be an individual one.” Many medical groups, including the American Cancer Society and Mayo Clinic, already emphasize that women have the option to start screening with a mammogram every year starting at age 40.

Even though Black women have a 4% lower incidence rate of breast cancer than White women, they have a 40% higher breast cancer death rate.

“The take-home message for US clinicians and health policy makers is simple. Clinicians and radiologists should consider race and ethnicity when determining the age at which breast cancer screening should begin,” Dr. Mahdi Fallah, an author of the new study and leader of Risk Adapted Cancer Prevention Group at the German Cancer Research Center in Heidelberg, Germany, said in an email.

“Also, health policy makers can consider a risk-adapted approach to breast cancer screening to address racial disparities in breast cancer mortality, especially the mortality before the recommended age of population screening,” said Fallah, who is also a visiting professor at Lund University in Sweden and an adjunct professor at the University of Bern in Switzerland.

Breast cancer screenings are typically performed using a mammogram, which is an X-ray picture taken of the breast that doctors examine to look for early signs of breast cancer developing.

“Guidelines for screening actually already do recommend basing a woman’s time to initiate screening on the risk of developing cancer, though race and ethnicity have not been traditional factors that go into these decisions,” Dr. Rachel Freedman, a breast oncologist at Dana-Farber Cancer Institute, who was not involved in the new study, said in an email.

The American Cancer Society currently recommends that all women consider mammogram screenings for breast cancer risk starting at the age of 40 – and for women 45 to 54, it’s recommended to get mammograms every year. Those 55 and older can switch to screening every other year if they choose.

But “we are in the process of updating our breast cancer screening guidelines, and we are examining the scientific literature for how screening guidelines could differ for women in different racial and ethnic groups, and by other risk factors, in a way that would reduce disparities based on risk and disparities in outcome,” Robert Smith, senior vice president for cancer screening at the American Cancer Society, who was not involved in the new study, said in an email. “We are examining these issues closely.”

The American Cancer Society’s recommendations appear to align with the findings in the new study, as the research highlights how screening guidelines should not be a “one-size-fits-all policy,” but rather help guide conversations that patients and their doctors have together.

“We, here at the American Cancer Society, strongly recommend that all women consider a screening mammogram from the age of 40 onwards, and that means having a discussion with their doctor,” said Dr. Arif Kamal, the American Cancer Society’s chief patient officer, who was not involved in the new study.

“The authors highlight that age 50 can be a little late,” Kamal said about the study’s findings on when to begin breast cancer screening. “We are in agreement with that, particularly for women who may be at slightly higher risk.”

The researchers – from China, Germany, Sweden, Switzerland and Norway – analyzed data on 415,277 women in the United States who died of breast cancer in 2011 to 2020. That data on invasive breast cancer mortality rates came from the National Center for Health Statistics and was analyzed with the National Cancer Institute’s SEER statistical software.

When the researchers examined the data by race, ethnicity and age, they found that the rate of breast cancer deaths among women in their 40s was 27 deaths per 100,000 person-years for Black women compared with 15 deaths per 100,000 in White women and 11 deaths per 100,000 in American Indian, Alaska Native, Hispanic and Asian or Pacific Islander women.

“When the breast cancer mortality rate for Black women in their 40s is 27 deaths per 100,000 person-years, this means 27 out of every 100,000 Black women aged 40-49 in the US die of breast cancer during one year of follow-up. In other words, 0.027% of Black women aged 40-49 die of breast cancer each year,” Fallah said in the email.

In general, for women in the United States, their average risk of dying from breast cancer in the decade after they turn 50, from age 50 to 59, is 0.329%, according to the study.

“However, this risk level is reached at different ages for women from different racial/ethnic groups,” Fallah said. “Black women tend to reach this risk level of 0.329% earlier, at age 42. White women tend to reach it at age 51, American Indian or Alaska Native and Hispanic women at age 57 years, and Asian or Pacific Islander women later, at age 61.”

So, the researchers determined that when recommending breast cancer screening at age 50 for women, Black women should start at age 42.

Yet “the authors didn’t have any information on whether the women included in this study actually had mammographic screening and at what age. For example, it is possible that many women in this study actually had screening during ages 40-49,” Freedman, of the Dana-Farber Cancer Institute, said in her email.

“This study confirms that the age of breast cancer-mortality is younger for Black women, but it doesn’t confirm why and if screening is even the main reason. We have no information about the types of cancers women developed and what treatment they had either, both of which impact mortality from breast cancer,” she said.

The harm of starting mammograms at a younger age is that it raises the risk of a false positive screening result – leading to unnecessary subsequent tests and emotional stress.

But the researchers wrote in their study that “the added risk of false positives from earlier screenings may be balanced by the benefits” linked with earlier breast cancer detection.

They also wrote that health policy makers should pursue equity, not just equality, when it comes to breast cancer screening as a tool to help reduce breast cancer death rates.

Equality in the context of breast cancer screening “means that everyone is screened from the same age regardless of risk level. On the other hand, equity or risk-adapted screening means that everyone is provided screening according to their individual risk level,” the researchers wrote. “We believe that a fair and risk-adapted screening program may also be associated with optimized resource allocation.”

The new study is “timely and relevant,” given the overall higher mortality rate for breast cancer in Black women and that Black women are more likely to be diagnosed at a younger age compared with other ethnic groups, Dr. Kathie-Ann Joseph, surgical oncologist at NYU Langone’s Perlmutter Cancer Center and professor of surgery and population health at the NYU Grossman School of Medicine, said in an email.

“While some may argue that earlier screening may lead to increased recalls and unnecessary biopsies, women get recalled for additional imaging about 10% of the time and biopsies are needed in 1-2% of cases, which is quite low,” said Joseph, who was not involved in the new study.

“This has to be compared to the lives saved from earlier screening mammography,” she said. “I would also like to point out that while we certainly want to prevent deaths, earlier screening can have other benefits by allowing women of all racial and ethnic groups to have less extensive surgery and less chemotherapy which impacts quality of life.”

Breast cancer is the most common cancer among women in the United States, except for skin cancers. This year, it is estimated that about 43,700 women will die from the disease, according to the American Cancer Society, and Black women have the highest death rate from breast cancer.

Even though Black women are 40% more likely than White women to die from the disease, Kamal of the American Cancer Society said that the disparity in deaths is not a result of Black women not following the current mammogram guidelines.

Rather, implicit bias in medicine plays a role.

“In the United States, across the country, there are not differences in mammogram screening rates among Black women and White women. In fact, across the entire country, the number is about 75%. We see about 3 in 4 women – Black, White, Hispanic, and Asian – are on time with their mammograms,” Kamal said.

Yet there are multiple timepoints after a patient is diagnosed with breast cancer where they may not receive the same quality of care or access to care as their peers.

“For example, Black women are less likely to be offered enrollment in a clinical trial. That is not because of a stated difference in interest. In fact, the enrollment rate in clinical trials is equal among Black women and White women, if they’re asked,” Kamal said.

“What we have to understand is where the implicit and systemic biases held by patients and their caregivers and their families may exist – those that are held within health systems and even policies and practices that impede everyone having fair and just access to high quality health care,” he said.

Additionally, Black women have nearly a three-fold increased risk of triple-negative breast cancers. Those particular type of cancers tend to be more common in women younger than 40, grow faster than other types of invasive breast cancer and have fewer treatment options.

Black women also tend to have denser breast tissue than White women. Having dense tissue in the breast can make it more difficult for radiologists to identify breast cancer on a mammogram, and women with dense breast tissue have a higher risk of breast cancer.

But such biological differences among women represent just a small part of a much larger discussion around racial disparities in breast cancer, Kamal said.

“There are systemic issues, access to care issues that really go beyond biology,” he said. “The reality is cancer affects everybody and it does not discriminate. Where the discrimination sometimes occurs is after the diagnosis, and that’s really what we need to focus on.”

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For nearly 50 years, only Black men caddied The Masters. One day, they all but vanished | CNN

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CNN
 — 

History never forgets a champion. When you win one of sport’s biggest titles, you become immortal.

Win multiple times and your legacy is even greater. To think of The Masters is to think of Jack Nicklaus, the most successful champion in the major’s history with six wins, and Arnold Palmer, who donned the winner’s green jacket four times in just six years at Augusta National.

And yet for decades, two former champions with a combined nine wins lay buried in unmarked graves.

Willie Peterson caddied Nicklaus’ first five victories, while Nathaniel “Iron Man” Avery was on the bag for all four of Palmer’s triumphs. Avery’s headstone was only installed at Augusta’s Southview Cemetery, in Georgia, in 2017, 32 years after his death. Three years later, a 10-minute drive away at Cedar Grove Cemetery, Peterson – who died in 1999 – received his.

They were just two of Augusta National’s original caddie corps, all of them Black men who, from the inaugural edition of the tournament in 1934, guided golfers around the fabled course.

Every subsequent year for almost half a century, they would play substantial – sometimes pivotal – roles in the destination of the green jacket.

The stories of the original group of Augusta caddies almost always began in the same place: Sand Hills.

Located just three miles from The Masters venue, the historically Black district lay adjacent to Augusta Country Club. There, local kids between 10 and 12 years old could earn a wage carrying the bag for members.

Around 90% of Augusta National’s original caddie corps grew up in the Sand Hill neighborhood, according to Leon Maben, vice president of the board of directors at Augusta’s Lucy Craft Laney Museum of Black History.

Eventually, many would hop across Rae’s Creek to begin work at Augusta National. Or as Ward Clayton, author of “Men on the Bag: The Caddies of Augusta National,” terms it: they “graduated.”

Palmer looks over his shoulder as he sits with a group of caddies during the 1965 Masters.

“They were just looking for a buck,” Clayton told CNN. “They weren’t aiming at the outset to become the greatest caddies in the world, but they did – that’s what they became.

“It wasn’t as much of an age thing as it was just your ability. You had to learn to how to act around adults, how to read greens, how to tell guys what clubs to hit, what their yardage was, and how to read people.

“You had to become a little bit of an amateur psychologist … you had to read them right away, from the first hole.”

There was strong incentive for graduating. A “good bag” at Augusta National would pay up to $5, Maben said, offering $20 for a particularly lucrative day’s labor.

For Jariah “Jerry” Beard, caddie for 1979 Masters champion Fuzzy Zoeller, it meant he could earn as much in a day as his parents could in a week working at the city’s John P. King mill.

If caddying was an education, then Willie “Pappy” Stokes was its headmaster.

Having grown up on the very grounds Augusta National was built on, a 12-year-old Stokes was hired to provide water to workers constructing the club. During bad weather, the youngster closely studied how rain streamed across the terrain, always trickling towards the course’s lowest point: Rae’s Creek.

That realization formed the basis of Stokes’ ability to read greens with near-perfect accuracy, a knowledge he imparted to budding students at Saturday morning “caddie school.”

At just 17-years-old, Stokes helped Henry Picard to the 1938 Masters title. He would retire after helping four different players to five wins at Augusta and having sealed his status as “The Godfather” of caddies.

Stokes watches on as Ben Hogan edges closer to his first Masters title in 1951. Stokes would caddy again for Hogan when he won his second green jacket in 1953.

Stokes’ knowledge trickled down to those that followed, epitomized by Beard in 1979. To this day, Zoeller remains the only golfer to win The Masters on his first attempt, as Beard steered the debutant around Augusta “like a blind man with a seeing-eye dog.”

And they were Zoeller’s words, not Beard’s, relayed by the American in “Loopers: The Caddie’s Long Walk,” a 2019 film co-produced by Clayton.

Maben often joked with Beard, who died in March aged 82, that Zoeller ought to give him his green jacket.

“These guys were ahead of their time,” Maben said. “They knew Augusta National like the back of their hand and were able to direct a golfer without any type of instrument like today’s caddies (use).

“They didn’t have no book to go by or no instrument to say how the wind was blowing that day, anything like that. They were the best at what they did.”

Beard helps Zoeller line up a putt at the 1979 Masters.

And as with “The Godfather,” caddie nicknames were par for the course.

Tommy “Burnt Biscuits” Bennett, on the bag for Tiger Woods’ first Masters in 1995, got his moniker after an attempt as a child to steal biscuits being baked on his Grandma’s wooden stove ended with him badly scalding himself, according to ESPN.

Then there was John H. “Stovepipe” Gordon, Frank “Marble Eye” Stokes, and Matthew “Shorty Mac” Palmer. Avery’s “Iron Man” title had multiple stories as to its origin, according to Clayton, one being that he inadvertently cut off a finger while playing golf with a hatchet and another that he injured a hand playing around with powerful firecrackers.

John H.

But Clayton has a clear favorite in the nickname department: Willie “Cemetery” Perteet, former caddie for President Dwight D. Eisenhower. The story, as recounted by Clayton, goes as follows.

Caddie by day, jazz band drummer in downtown Augusta by night, Perteet was leaving a gig one evening when he was jumped by a gang brandishing knives. The group had been gathered by the caddie’s ex-girlfriend, who was “terrifically hurt” after he had ended the relationship.

Hospitalized by his injuries, Perteet later returned to consciousness – but not in a hospital bed. Instead, he awoke in a refrigerated bay, staring into the horrified eyes of a mortician.

“The doctor evidently gave him too much medication and they thought he was dead,” Clayton explained.

“So all the caddies give him the nickname ‘Dead Man.’ President Eisenhower, right at the outset, said, ‘I don’t really like that title. We’re just going to call you Cemetery.’”

Though those who worked the bag were often close with the golfers they paired with, there was an enduring divide – social, as caddies, and racial, as Black men in America.

Only allowed to play the course on the days Augusta National was closed to members, caddies were “considered a lower class,” despite the respect for their craft, Clayton said. Maben, having spoken to many of the original caddies, agreed.

“That’s during segregation, Jim Crow period, and Black men was downgraded in society, called boy, n***er and all that,” Maben said.

“The way I analyze it, from a lot of the conversations I had, they knew their place at that time in society.”

In 1990, TV executive Ron Townsend became the first Black member admitted to Augusta National, 15 years after Lee Elder had become the first Black golfer to compete at The Masters.

Elder won four times on the PGA Tour.

By the time Townsend arrived, most of Augusta’s original caddie corps had disappeared. For the first 48 years at The Masters, golfers had to employ the services of the club’s caddies, but from 1983 onwards, they could bring their own.

Part of the reason lay in events at the previous year’s tournament, when a miscommunication led to some caddies missing a morning tee time. Several golfers used the incident as leverage in their bid to persuade The Masters to allow players to bring the caddies they employed year-round on the PGA Tour.

Clayton believes the arrival of Tour caddies was a matter of when, not if. “There’s no doubt that there was still a large, large group of excellent caddies at Augusta National. But the depth of those caddie ranks were not as great as what the players wanted,” he said.

“It would just have been nice if it was done in a more seamless manner versus what occurred.”

Caddies old and new at the 1983 Masters.

Regardless of the cause, the impact was profound. The 1983 Masters saw the first White caddies walk the greens at the major, with just 19 Black caddies on the bag, Clayton said.

Peterson was furious after entering the caddy facility to find his trusty No. 1 locker had been taken by an unknowing “Tour caddie.” The matter was quickly resolved, but the outgoing caddies were distraught – a pain felt both emotionally and financially.

“They felt like their jobs were being taken from them,” Clayton explained. “They didn’t have a lot of time for these guys coming in from the outside.”

Within a decade, less than 10 of the original caddie corps remained, he added.

“It was not nice the way they went out,” Carl Jackson, caddie for Ben Crenshaw, told CNN.

“It was a hard thing for all the guys because many of them were really good caddies and had experience about that golf course. At least 25-30 of those pros should not have let their caddies go.”

Yet Jackson’s story at Augusta National would not end for another 40 years.

Like many others, Jackson had begun working at Augusta Country Club before graduating to Augusta National in 1958 to learn his trade under Stokes. He arrived with the nickname “Skillet” because he supposedly couldn’t throw a baseball hard enough to break an egg.

In 1976, he paired with Crenshaw for the first time. For renowned putter “Gentle Ben” and the soft-spoken Jackson, green-reader extraordinaire, the partnership was a match made in heaven. After finishing runner-up on their first outing together, in 1984 Crenshaw clinched a two-shot victory over Watson to seal his maiden major title.

Jackson and Crenshaw formed a formidable partnership.

Crenshaw and Jackson would celebrate a second green jacket in 1995. It marked a hugely emotional victory for the Texan golfer, whose mentor Harvey Penick had died just before the tournament, leaving him in “shambles,” Jackson said.

When Crenshaw tapped home his winning putt, the duo shared a long hug on the green. Almost 20 years later to the day, the pair would repeat the gesture when – after their 39th outing – they retired together at the 2015 Masters.

The pair’s friendship lies at the heart of a forthcoming documentary on Jackson’s life, “Rise Above.”

“That’s how America ought to be,” Jackson says in the film. “The Black man taking care of the White man and the White man taking care of the Black man.’”

For Jackson, the core message of the documentary is about respect.

“If you’re righteous, you’re righteous. If you’re unrighteous, you’re gonna be a hater anyway.”

Jackson and Crenshaw embrace on the 18th green after their final hole together at The Masters.

Clayton will be at Augusta National this week, overseeing content for Masters.com, keeping a close eye on the men in the white jumpsuits and green hats carrying the clubs of those vying for the 2023 green jacket.

He will do so with as comprehensive a knowledge of the history of the club’s caddies as any in attendance. Yet prior to researching his 2004 book, mythic stories of “The Godfather,” “Cemetery,” and Augusta’s original caddie core were just that to him – myths. And that troubled Clayton.

“That was my effort, to tell their stories,” he said. “Because I thought they played a vital, vital role in making that club what it is and also helping golfers win … they deserved their attention.

“A lot of them aren’t with us any longer. That number is diminishing every year and they should be honored or remembered in a way that tells the story of who they are.”

The legacy of The Masters' original caddies lives on at Augusta National.

Preserving and spreading those stories is an ongoing mission. Clayton helped get the headstones for Avery and Peterson, with Palmer and Nicklaus also involved for their respective caddies.

This year, the Lucy Craft Laney Museum will put the legacy of Augusta’s Black caddies – quite literally – center stage.

Twice a month at the museum, supplementing its regular tours, the “Men on the Bag Experience” will see the stories of three original Augusta caddies – Stokes, Perteet, and Peterson – acted out in a play.

At the end of each performance, at least two original caddies – or “living legends” as Maben refers to them – will emerge from the audience to host an on-stage Q&A. Each will be immortalized in a sports trading card, stylized with their picture, story, and stats, to be signed and distributed to patrons as they leave the show.

Maben rarely calls them caddies. It’s almost always “living legends,” “superstars” or, most commonly of all, “champions.”

And history never forgets a champion.

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FDA approves first over-the-counter version of opioid overdose antidote Narcan | CNN

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CNN
 — 

With drug overdose deaths continuing to hover near record levels, the US Food and Drug Administration on Wednesday approved for the first time an over-the-counter version of the opioid overdose antidote Narcan.

“The FDA remains committed to addressing the evolving complexities of the overdose crisis. As part of this work, the agency has used its regulatory authority to facilitate greater access to naloxone by encouraging the development of and approving an over-the-counter naloxone product to address the dire public health need,” FDA Commissioner Dr. Robert Califf said in a statement.

“Today’s approval of OTC naloxone nasal spray will help improve access to naloxone, increase the number of locations where it’s available and help reduce opioid overdose deaths throughout the country. We encourage the manufacturer to make accessibility to the product a priority by making it available as soon as possible and at an affordable price.”

Dr. Rahul Gupta, director of the White House’s Office of National Drug Control Policy, said accessibility is key to ensuring that the Narcan nasal spray saves lives.

“It’s really important that we continue to do everything possible in our power to make this life-saving drug available to anyone and everyone across the country,” Gupta said.

The White House drug czar said businesses, such as restaraunts and banks, and schools will be encouraged to purchase over-the-counter naloxone.

“We will encourage businesses, restaurants, banks, construction sites, schools, others to think about this – think about it as a smoke alarm or a defibrillator, to make it as easily accessible, because it’s not just you. It could be your neighbor, it could be your family, your friend, a person at work or school who might need it, ” Gupta said.

The nasal spray will come in a package of two 4-milligram doses, in case the person overdosing does not respond to the first dose. However, the drug’s maker, Emergent BioSolutions, says most overdoses can be reversed with a single dose. The product could be given to anyone, even children and babies.

The nasal spray is expected to be available for purchase in stores and online by late summer, Emergent said Wednesday.

More than a million people have died of drug overdoses in the two decades since the US Centers for Disease Control and Prevention began collecting that data. Many of those deaths were due to opioids. Deaths from opioid overdoses rose more than 17% in just one year, from about 69,000 in 2020 to about 81,020 in 2021, the CDC found.

Opioid deaths are the leading cause of accidental death in the US. Most are among adults, but children are also dying, largely after ingesting synthetic opioids such as fentanyl. Between 1999 and 2016, nearly 9,000 children and adolescents died of opioid poisoning, with the highest annual rates among adolescents 15 to 19, the CDC found.

Nearly every state in the US has standing orders that allow pharmacists or other qualified organizations to provide the medication without a personal prescription to people who are at risk of an overdose or are helping someone at risk, but making it available over the counter can make it easier for people to access the opioid antidote.

Research shows that wider availability could save lives as opioid overdoses have skyrocketed in recent years – much of it due to synthetic opioids like illicitly made fentanyl.

Emergent President and CEO Robert Kramer hailed the FDA’s decision as a “historic milestone.”

“We are dedicated to improving public health and assisting those working hard to end the opioid crisis – so now with leaders across government, retail and advocacy groups, we must work together to continue increasing access and availability, as well as educate the public on the risks of opioid overdoses and the value of being prepared with Narcan Nasal Spray to help save a life,” Kramer said in a statement.

Narcan works by blocking the effects of opioids on the brain and restoring breathing. For the most effectiveness, it must be given as soon as signs of overdose appear.

The drug works on someone only if there are opioids in their system. It won’t work on any other type of drug overdose, but it won’t have adverse effects if given to someone who hasn’t taken opioids.

Naloxone reverses an overdose for up to about 90 minutes, but opioids can stay in the system for longer, so it’s still important to call 911 after giving the drug.

People given naloxone should be watched carefully until medical help arrives and monitored for another two hours.

About 1.2 million doses of naloxone were dispensed by retail pharmacies in 2021, according to data published by the American Medical Association – nearly nine times more than were dispensed five years earlier.

Emergent said it does not have information on how much OTC Narcan will cost.

Harm reduction experts say the price of naloxone has inhibited its accessibility to people who need it most. And although the cost will probably drop as it becomes available over the counter, they say it will probably still be out of reach for many.

“We’re not going to be able to ramp up naloxone distribution in a game-changing way until we get a better handle on the price,” said Nabarun Dasgupta, a scientist at the University of North Carolina’s Injury Prevention Research Center who studies drugs and infectious diseases. “There’s the promise on paper versus on the street, and it’s going to come down to the dollars and cents.”

Separate changes to grant funding by both the CDC and the Substance Abuse and Mental Health Services Administration will make it easier for states and local health departments to buy naloxone, he said.

Gupta said the Biden administration is asking the drugmakers to keep the price of the antidote low.

“That’s one of the things that the president has been very clear: that we’ve got to make sure that these life-saving medications, as well as treatment, is accessible across no matter where you live, rural or urban, rich or poor. We want to make sure this is accessible across broad swaths of people,” he said.

However, experts said the most meaningful work in the fight against the devastating outcomes of the drug overdose epidemic will come with ongoing emphasis on treatment for opioid use disorder and other harm-reduction strategies.

“While enabling people to access quality treatment for substance use disorders is critical, we must also acknowledge that people need to survive in order to have that choice,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse, said in January.

Caleb Banta-Green, principal research scientist at the University of Washington’s Addictions, Drug & Alcohol Institute, has described naloxone as the “gateway drug” to a conversation about what substance use disorder is.

“It’s a conversation starter. It’s life-saving for the individual. It’s not a game-changer at the population level,” he said. “We need to do more. And we need to use treatment medications – methadone and buprenorphine – which are far higher overdose preventive approaches.”

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US maternal death rate rose sharply in 2021, CDC data shows, and experts worry the problem is getting worse | CNN

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CNN
 — 

As women continue to die due to pregnancy or childbirth each year in the United States, new federal data shows that the nation’s maternal death rate rose significantly yet again in 2021, with the rates among Black women more than twice as high as those of White women.

Experts said the United States’ ongoing maternal mortality crisis was compounded by Covid-19, which led to a “dramatic” increase in deaths.

The number of women who died of maternal causes in the United States rose to 1,205 in 2021, according to a report from the National Center for Health Statistics, released Thursday by the US Centers for Disease Control and Prevention. That’s a sharp increase from years earlier: 658 in 2018, 754 in 2019 and 861 in 2020.

That means the US maternal death rate for 2021 – the year for which the most recent data is available – was 32.9 deaths per 100,000 live births, compared with rates of 20.1 in 2019 and 23.8 in 2020.

The new report also notes significant racial disparities in the nation’s maternal death rate. In 2021, the rate for Black women was 69.9 deaths per 100,000 live births, which is 2.6 times the rate for White women, at 26.6 per 100,000.

The data showed that rates increased with the mother’s age. In 2021, the maternal death rate was 20.4 deaths per 100,000 live births for women under 25 and 31.3 for those 25 to 39, but it was 138.5 for those 40 and older. That means the rate for women 40 and older was 6.8 times higher than the rate for women under age 25, according to the report.

The maternal death rate in the United States has been steadily climbing over the past three decades, and these increases continued through the Covid-19 pandemic.

Questions remain about how the pandemic may have affected maternal mortality in the United States, according to Dr. Elizabeth Cherot, chief medical and health officer for the infant and maternal health nonprofit March of Dimes, who was not involved in the new report.

“What happened in 2020 and 2021 compared with 2019 is Covid,” Cherot said. “This is sort of my reflection on this time period, Covid-19 and pregnancy. Women were at increased risk for morbidity and mortality from Covid. And that actually has been well-proven in some studies, showing increased risks of death, but also being ventilated in the intensive care unit, preeclampsia and blood clots, all of those things increasing a risk of morbidity and mortality.”

The American College of Obstetricians and Gynecologists previously expressed “great concern” that the pandemic would worsen the US maternal mortality crisis, ACOG President Dr. Iffath Abbasi Hoskins said in a statement Thursday.

“Provisional data released in late 2022 in a U.S. Government Accountability Office report indicated that maternal death rates in 2021 had spiked—in large part due to COVID-19. Still, confirmation of a roughly 40% increase in preventable deaths compared to a year prior is stunning new,” Hoskins said.

“The new data from the NCHS also show a nearly 60% percent increase in maternal mortality rates in 2021 from 2019, just before the start of the pandemic. The COVID-19 pandemic had a dramatic and tragic effect on maternal death rates, but we cannot let that fact obscure that there was—and still is—already a maternal mortality crisis to compound.”

Health officials stress that people who are pregnant should get vaccinated against Covid-19 and that doing so offers protection for both the mother and the baby.

During the early days of the pandemic, in 2020, there was limited information about the vaccine’s risks and benefits during pregnancy, prompting some women to hold off on getting vaccinated. But now, there is mounting evidence of the importance of getting vaccinated for protection against serious illness and the risks of Covid-19 during pregnancy.

The Covid-19 pandemic also may have exacerbated existing racial disparities in the maternal death rate among Black women compared with White women, said Dr. Chasity Jennings-Nuñez, a California-based site director with Ob Hospitalist Group and chair of the perinatal/gynecology department at Adventist Health-Glendale, who was not involved in the new report.

“In terms of maternal mortality, it continues to highlight those structural and systemic problems that we saw so clearly during the Covid-19 pandemic,” Jennings-Nuñez said.

“So in terms of issues of racial health inequities, of structural racism and bias, of access to health care, all of those factors that we know have played a role in terms of maternal mortality in the past continue to play a role in maternal mortality,” she said. “Until we begin to address those issues, even without a pandemic, we’re going to continue to see numbers go in the wrong direction.”

Some policies have been introduced to tackle the United States’ maternal health crisis, including the Black Maternal “Momnibus” Act of 2021, a sweeping bipartisan package of bills that aim to provide pre- and post-natal support for Black mothers, including extending eligibility for certain benefits postpartum.

As part of the Momnibus, President Biden signed the bipartisan Protecting Moms Who Served Act in 2021, and other provisions have passed in the House.

In the United States, about 6.9 million women have little or no access to maternal health care, according to March of Dimes, which has been advocating in support of the Momnibus.

The US has the highest maternal death rate of any developed nation, according to the Commonwealth Fund and the latest data from the World Health Organization. While maternal death rates have been either stable or rising across the United States, they are declining in most countries.

“A high rate of cesarean sections, inadequate prenatal care, and elevated rates of chronic illnesses like obesity, diabetes, and heart disease may be factors contributing to the high U.S. maternal mortality rate. Many maternal deaths result from missed or delayed opportunities for treatment,” researchers from the Commonwealth Fund wrote in a report last year.

The ongoing rise in maternal deaths in the United States is “disappointing,” said Dr. Elizabeth Langen, a high-risk maternal-fetal medicine physician at the University of Michigan Health Von Voigtlander Women’s Hospital. She was not involved in the latest report but cares for people who have had serious complications during pregnancy or childbirth.

“Those of us who work in the maternity care space have known that this is a problem in our country for quite a long time. And each time the new statistics come out, we’re hopeful that some of the efforts that have been going on are going to shift the direction of this trend. It’s really disappointing to see that the trend is not going in the right direction but, at some level, is going in the worst direction and at a little bit of a faster rate,” Langen said.

“In the health care system, we need to accept ultimate responsibility for the women who die in our care,” she added. “But as a nation, we also need to accept some responsibility. We need to think about: How do we provide appropriate maternity care for people? How do we let people have time off of work to see their midwife or physician so that they get the care that they need? How do all of us make it possible to live a healthy life while you’re pregnant so that you have the opportunity to have the best possible outcome?”

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Most men with prostate cancer can avoid or delay harsh treatments, long-term study confirms | CNN

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CNN
 — 

Most men who are diagnosed with prostate cancer can delay or avoid harsh treatments without harming their chances of survival, according to new results from a long-running study in the United Kingdom.

Men in the study who partnered with their doctors to keep a close eye on their low- to intermediate-risk prostate tumors – a strategy called surveillance or active monitoring – slashed their risk of the life-altering complications such as incontinence and erectile dysfunction that can follow aggressive treatment for the disease, but they were no more likely to die of their cancers than men who had surgery to remove their prostate or who were treated with hormone blockers and radiation.

“The good news is that if you’re diagnosed with prostate cancer, don’t panic, and take your time to make a decision” about how to proceed, said lead study author Dr. Freddie Hamdy, professor of surgery and urology at the University of Oxford.

Other experts who were not involved in the research agreed that the study was reassuring for men who are diagnosed with prostate cancer and their doctors.

“When men are carefully evaluated and their risk assessed, you can delay or avoid treatment without missing the chance to cure in a large fraction of patients,” said Dr. Bruce Trock, a professor of urology, epidemiology and oncology at Johns Hopkins University.

The findings do not apply to men who have prostate cancers that are scored through testing to be high-risk and high-grade. These aggressive cancers, which account for about 15% of all prostate cancer diagnoses, still need prompt treatment, Hamdy said.

For others, however, the study adds to a growing body of evidence showing that surveillance of prostate cancers is often the right thing to do.

“What I take away from this is the safety of doing active monitoring in patients,” said Dr. Samuel Haywood, a urologic oncologist at the Cleveland Clinic in Ohio, who reviewed the study, but was not involved in the research.

Results from the study were presented on Saturday at the European Association of Urology annual conference in Milan, Italy. Two studies on the data were also published in the New England Journal of Medicine and a companion journal, NEJM Evidence.

Prostate cancer is the second most common cancer in men in the United States, behind non-melanoma skin cancers. About 11% – or 1 in 9 – American men will be diagnosed with prostate cancer in their lifetime, and overall, about 2.5% – or 1 in 41 – will die from it, according to the National Cancer Institute. About $10 billion is spent treating prostate cancer in the US each year.

Most prostate cancers grow very slowly. It typically takes at least 10 years for a tumor confined to the prostate to cause significant symptoms.

The study, which has been running for more than two decades, confirms what many doctors and researchers have come to realize in the interim: The majority of prostate cancers picked up by blood tests that measure levels of a protein called prostate-specific antigen, or PSA, will not harm men during their lifetimes and don’t require treatment.

Dr. Oliver Sartor, medical director of the Tulane Cancer Center, said men should understand that a lot has changed over time, and doctors have refined their approach to diagnosis since the study began in 1999.

“I wanted to make clear that the way these patients are screened and biopsied and randomized is very, very different than how these same patients might be screened, biopsied and randomized today,” said Sartor, who wrote an editorial on the study but was not involved in the research.

He says the men included in the study were in the earliest stages of their cancer and were mostly low-risk.

Now, he says, doctors have more tools, including MRI imaging and genetic tests that can help guide treatment and minimize overdiagnosis.

The study authors say that to assuage concerns that their results might not be relevant to people today, they re-evaluated their patients using modern methods for grading prostate cancers. By those standards, about one-third of their patients would have intermediate or high-risk disease, something that didn’t change the conclusions.

When the study began in 1999, routine PSA screening for men was the norm. Many doctors encouraged annual PSA tests for their male patients over age 50.

PSA tests are sensitive but not specific. Cancer can raise PSA levels, but so can things like infections, sexual activity and even riding a bicycle. Elevated PSA tests require more evaluation, which can include imaging and biopsies to determine the cause. Most of the time, all that followup just isn’t worth it.

“It is generally thought that only about 30% of the individuals with an elevated PSA will actually have cancer, and of those that do have cancer, the majority don’t need to be treated,” Sartor said.

Over the years, studies and modeling have shown that using regular PSA tests to screen for prostate cancer can do more harm than good.

By some estimates, as many as 84% of men with prostate cancer identified through routine screening do not benefit from having their cancers detected because their cancer would not be fatal before they died of other causes.

Other studies have estimated about 1 to 2 in every five men diagnosed with prostate cancer is overtreated. The harms of overtreatment for prostate cancer are well-documented and include incontinence, erectile dysfunction and loss of sexual potency, as well as anxiety and depression.

In 2012, the influential US Preventive Services Task Force advised healthy men not to get PSA tests as part of their regular checkups, saying the harms of screening outweighed its benefits.

Now, the task force opts for a more individualized approach, saying men between the ages of 55 and 69 should make the decision to undergo periodic PSA testing after carefully weighing the risks and benefits with their doctor. They recommend against PSA-based screening for men over the age of 70.

The American Cancer Society endorses much the same approach, recommending that men at average risk have a conversation with their doctor about the risks and benefits beginning at age 50.

The trial has been following more than 1,600 men who were diagnosed with prostate cancer in the UK between 1999 and 2009. All the men had cancers that had not metastasized, or spread to other parts of their bodies.

When they joined, the men were randomly assigned to one of three groups: active monitoring or using regular blood tests to keep an eye on their PSA levels; radiotherapy, which used hormone-blockers and radiation to shrink tumors; and prostatectomy, or surgery to remove the prostate.

Men who were assigned monitoring could change groups during the study if their cancers progressed to the point that they needed more aggressive treatment.

Most of the men have been followed for around 15 years now, and for the most recent data analysis, researchers were able get follow-up information on 98% of the participants.

By 2020, 45 men – about 3% of the participants – had died of prostate cancer. There were no significant differences in prostate cancer deaths between the three groups.

Men in the active monitoring group were more likely to have their cancer progress and more likely to have it spread compared with the other groups. About 9% of men in the active monitoring group saw their cancer metastasize, compared with 5% in the two other groups.

Trock points out that even though it didn’t affect their overall survival, a spreading cancer isn’t an insignificant outcome. It can be painful and may require aggressive treatments to manage at that stage.

Active surveillance did have important benefits over surgery or radiation.

As they followed the men over 12 years, the researchers found that 1 in 4 to 1 in 5 of those who had prostate surgery needed to wear at least one pad a day to guard against urine leaks. That rate was twice as high as the other groups, said Dr. Jenny Donovan of the University of Bristol, who led the study on patient-reported outcomes after treatment.

Sexual function was affected, too. It’s natural for sexual function to decline in men with age, so by the end of the study, nearly all the men reported low sexual function, but their patterns of decline were different depending on their prostate cancer treatment, she said.

“The men who have surgery have low sexual function early on, and that continues. The men in the radiotherapy group see their sexual function drop, then have some recovery, but then their sexual function declines, and the active monitoring group declines slowly over time,” Donovan said.

Donovan said that when she presents her data to doctors, they point out how much has changed since the study started.

“Some people would say, ‘OK, yeah, but we’ve got all these new technologies now, new treatments,’ ” she said, such as intensity-modulated radiation therapy, brachytherapy and robot-assisted prostate surgeries, “but actually, other studies have shown that the effects on these functional outcomes are very similar to the effects that we see our study,” she said.

Both Donovan and Hamby feel the study’s conclusions still merit careful consideration by men and their doctors as they weigh treatment decisions.

“What we hope that clinicians will do is use these figures that we’ve produced in these papers and share them with the men so that newly diagnosed men with localized prostate cancer can really assess those tradeoffs,” Donovan said.

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Medical tourism to Mexico is on the rise, but it can come with risks | CNN

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CNN
 — 

One of the four Americans who were kidnapped in Mexico last week was traveling for medical tourism, a friend said. A growing number of US residents are traveling internationally to seek more affordable medical care, more timely care or access to certain treatments or procedures that are unapproved or unavailable in the United States.

Latavia “Tay” Washington McGee, 33, drove to Mexico with Shaeed Woodard, Zindell Brown and Eric Williams for cosmetic surgery that was scheduled to take place Friday, according to a close friend of Washington McGee’s who did not want to be identified.

The four Americans were found Tuesday near the border city of Matamoros, officials said. Washington McGee and Williams were found alive, and Woodard and Brown were found dead, a US official familiar with the investigation told CNN. Investigators are still piecing together what happened after they were abducted.

Medical tourism takes people all over the world, including to Mexico, India and Eastern Europe. Violence against medical tourists is generally thought to be rare, but the US Centers for Disease Control and Prevention warns about other risks such as quality of care, infection control and communication challenges with medical staff.

“It’s on the daily, without a doubt. There are people going daily to get this kind of stuff done,” said Dr. Nolan Perez, a gastroenterologist in Brownsville, Texas, which is across the border from Matamoros. “Whether it’s primary care provider visits or dental procedures or something more significant, like elective or weight loss surgery, there’s no doubt that people are doing that because of low cost and easier access.”

One study published in the American Journal of Medicine estimated that fewer than 800,000 Americans traveled to other countries for medical care in 2007, but by 2017, more than 1 million did.

More current estimates suggest that those numbers have continued to grow.

“People travel because there may be a long waiting time, wait lists or other reasons why they can’t get treatment as quickly as they would like it. So they explore their options outside the United States to see what’s available,” said Elizabeth Ziemba, president of Medical Tourism Training, which provides training and accreditation to international health travel organizations.

Also, “price is a big issue in the United States. We know that the US health care system is incredibly expensive,” she added. “Even for people with insurance, there may be high deductibles or out-of-pocket costs that are not covered by insurance, so that people will look based on price for what’s available in other destinations.”

The most common procedures that prompt medical tourism trips include dental care, surgery, cosmetic surgery, fertility treatments, organ and tissue transplants and cancer treatment, according to the CDC.

“With Mexico and Costa Rica, it’s overwhelmingly dental and cosmetic surgery. However, certain countries are known for specialties. For example, in Singapore, stem cell and oncology is huge. In India, South India and Chennai Apollo hospitals does incredible work with hip and knee surgeries,” said Josef Woodman, founder of Patients Beyond Borders, an international health care consulting company.

“In Eastern Europe, a lot of people from the UK – but also people from the United States – travel to Hungary, Croatia and Turkey for everything from dental to light cosmetic surgery,” he said.

Mexico is the second most popular destination for medical tourism globally, with an estimated 1.4 million to 3 million people coming into the country to take advantage of inexpensive treatment in 2020, according to Patients Beyond Borders.

Matamoros – where officials said the four kidnapped Americans were found – is “not considered a primary medical travel destination,” Woodman said, “largely because there are no internationally accredited medical centers/specialty clinics there or in the immediate region.”

Mexico City, Cancun and Tijuana are more frequented and reliable destinations in the country, Woodman said.

On average, Americans can save 40% to 60% across the most common major procedures received by medical tourists in Mexico, according to an analysis of 2020 health ministry data conducted by Patients Beyond Borders.

Woodman said that violence against medical tourists was extremely rare, but he added that “price shopping” – searching for the cheapest location for a procedure – is a “blueprint for trouble,” namely substandard medical care.

Medical tourism can be dangerous, depending on the destination and the person’s condition.

“There are the complexities of traveling if you have a medically complex situation. There are fit-to-fly rules. And your health care providers should take into consideration the impact of traveling if you have orthopedic injuries or issues,” Ziemba said.

“The quality of care may be an unknown,” she said. “It may be that the quality of care is not up to the standards that you would like. So there’s a bit of an unknown there, and then the last thing I would say is, if something goes wrong, what’s going to happen?”

Perez said he commonly manages complications from medical tourism in his practice.

“There are a lot of bad outcomes. There are a lot of infections and a lot of botched procedures gone wrong, and patients have to come back to the United States and then have a revision of the surgery,” he said. “So it’s really unfortunate.”

Yet Ziemba added that there can be benefits to medical tourism, including that someone could receive a service that they need faster overseas than locally.

“And price: If you simply can’t afford the out-of-pocket costs of health care in the United States, and assuming the risks involved, it may make much more sense for you financially to travel outside the United States,” she said.

Medical tourism is not just for people traveling around the world. Many living along the US-Mexico border, where access to health care can be scarce, cross into Mexico for care.

The Rio Grande Valley, at the southernmost point of Texas, is considered to be a medically underserved area. The region has some of the nation’s highest rates of comorbidities, including obesity and diabetes, and one of the lowest physician-to-patient ratios.

There is a “dire need” for health care professionals along the border, Perez said.

“There are not as many doctors given our big and our growing population down here. So the demands on primary care doctors and specialists are very high because there are not enough of us for this population,” he said. “So that’s one reason why people end up going to Mexico to visit with physicians, because of easier access.”

People interested in medical tourism can take some steps to help minimize their risk, the CDC says.

Those planning to travel to another country for medical care should see their health care provider or a travel medicine provider at least four to six weeks before the trip and get international travel health insurance that covers medical evacuation back to the United States.

The CDC advises taking copies of your medical records with you and checking the qualifications of the providers who will be overseeing your medical care. Also, make sure you can get any follow-up care you may need.

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Report shows ‘troubling’ rise in colorectal cancer among US adults younger than 55 | CNN

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CNN
 — 

Adults across the United States are being diagnosed with colon and rectal cancers at younger ages, and now 1 in 5 new cases are among those in their early 50s or younger, according to the American Cancer Society’s latest colorectal cancer report.

The report says that the proportion of colorectal cancer cases among adults younger than 55 increased from 11% in 1995 to 20% in 2019. There also appears to be an overall shift to more diagnoses of advanced stages of cancer. In 2019, 60% of all new colorectal cases among all ages were advanced.

“Anecdotally, it’s not rare for us now to hear about a young person with advanced colorectal cancer,” said Dr. William Dahut, chief scientific officer for the American Cancer Society. For example, Broadway actor Quentin Oliver Lee died last year at 34 after being diagnosed with stage IV colon cancer, and in 2020, “Black Panther” star Chadwick Boseman died at 43 of colon cancer.

“It used to be something we never heard or saw this, but it is a high percentage now of colorectal cancers under the age of 55,” Dahut said.

Although it’s difficult to pinpoint a cause for the rise in colorectal cancers among younger adults, he said, some factors might be related to changes in the environment or people’s diets.

“We’re not trying to blame anybody for their cancer diagnosis,” Dahut said. “But when you see something occurring in a short period of time, it’s more likely something external to the patient that’s driving that, and it’s hard not to at least think – when you have something like colorectal cancer – that something diet-related is not impossible.”

The new report also says that more people are surviving colorectal cancer, with the relative survival rate at least five years after diagnosis rising from 50% in the mid-1970s to 65% from 2012 through 2018, partly due to advancements in treatment.

That’s good news, said Dr. Paul Oberstein, a medical oncologist at NYU Langone Perlmutter Cancer Center, who was not involved in the new report. The overall trends suggest that colorectal cancer incidence and death rates have been slowly declining.

“If you look at the overall trends, the incidence of colon cancer in this report has decreased from 66 per 100,000 in 1985 to 35 per 100,000 in 2019 – so almost half,” Oberstein said.

“Changes in the mortality rate are even more impressive,” he said. “In 1970, which was a long time ago, the rate of colorectal cancer death was 29.2 per 100,000 people, and in 2020, it was 12.6 per 100,000. So a dramatic, over 55% decline in deaths per 100,000 people.”

Colorectal cancer is the second most common cause of cancer death in the United States, and it is the leading cause of cancer-related deaths in men younger than 50.

Dahut said the best way to reduce your risk of colorectal cancer is to follow screening guidelines and get a stool-based test or a visual exam such as a colonoscopy when it’s recommended. Any suspicious polyps can be removed during a visual exam, reducing your risk of cancer.

“At the ACS, we recommend if you’re at average risk, you start screening at age 45,” Dahut said. “Usually, then your subsequent screening is based on the results of that screening test.”

For the new report, researchers at the American Cancer Society analyzed data from the National Cancer Institute and the US Centers for Disease Control and Prevention on cancer screenings, cases and deaths.

The researchers found that from 2011 through 2019, colorectal cancer rates increased 1.9% each year in people younger than 55. And while overall colorectal cancer death rates fell 57% between 1970 and 2020, among people younger than 50, death rates continued to climb 1% annually since 2004.

“We know rates are increasing in young people, but it’s alarming to see how rapidly the whole patient population is shifting younger, despite shrinking numbers in the overall population,” Rebecca Siegel, senior scientific director of surveillance research at the American Cancer Society and lead author of the report, said in a news release. “The trend toward more advanced disease in people of all ages is also surprising and should motivate everyone 45 and older to get screened.”

Some regions of the United States appeared to have higher rates of colorectal cancers and deaths than others. These rates were lowest in the West and highest in Appalachia and parts of the South and the Midwest, the data showed. The incidence of colorectal cancer ranged from 27 cases per 100,000 people in Utah to 46.5 per 100,000 in Mississippi. Colorectal cancer death rates ranged from about 10 per 100,000 people in Connecticut to 17.6 per 100,000 in Mississippi.

There were some significant racial disparities, as well. The researchers found that colorectal cancer cases and deaths were highest in the American Indian/Alaska Native and Black communities. Among men specifically, the data showed that colorectal cancer death rates were 46% higher in American Indian/Alaska Native men and 44% higher in Black men compared with White men.

The report also says that more left-sided tumors have been diagnosed, meaning an increasing percentage of tumors are happening closer to the rectum. The proportion of colorectal cancers in that location has steadily climbed from 27% in 1995 to 31% in 2019.

“Historically, we’ve been worried more about the tumors on what we call the right side,” said NYU Langone’s Oberstein.

“But the incidence increasing, especially among young people, seems to be happening not only in those worse tumors but the ones that we think are not as bad,” he said, referring to left-sided tumors. “It’s raising questions about whether something is changing about the risks and the future people who are going to get colon cancer.”

Looking forward, the researchers estimate that there will be 153,020 colorectal cancer cases diagnosed in the US this year and an estimated 52,550 colorectal cancer deaths, with 3,750 of them – or 7% – among people younger than 50.

“These highly concerning data illustrate the urgent need to invest in targeted cancer research studies dedicated to understanding and preventing early-onset colorectal cancer,” Dr. Karen Knudsen, CEO of the American Cancer Society, said in the news release. “The shift to diagnosis of more advanced disease also underscores the importance of screening and early detection, which saves lives.”

The report’s findings, including the rise in colorectal cancer in younger adults, are “troubling,” Dr. Joel Gabre, an expert in gastrointestinal cancers at Columbia University Irving Medical Center, said in an email.

“It reflects other recent published findings demonstrating a rising incidence of colorectal cancer in young people. Most concerning to me, however, is a lack of clear cause and patients being diagnosed late. I think this is an area where more funding for research is needed to understand this really concerning rise,” wrote Gabre, who was not involved in the report.

Gabre says he knows what it’s like to look into his young patients’ eyes and tell them they have colorectal cancer, and “it’s devastating.”

“They have young families and so much of their life ahead of them. That’s why I encourage my patients who are age 45 years and older to get screened,” Gabre said. “I also encourage people to let their doctor know if they have a family history of colon cancer. There is genetic testing we can do to identify some at-risk patients early before they develop cancer.”

The findings highlight the importance of colorectal cancer screening, Dr. Robin Mendelsohn, gastroenterologist and co-director of the Center for Young Onset Colorectal and Gastrointestinal Cancers at Memorial Sloan Kettering Cancer Center, said in an email.

“The age to start screening was recently decreased to 45, which will help in an effort to screen more people, but we still need to understand more why we are seeing this increase which is something we are actively looking into,” wrote Mendelsohn, was not involved in the new report.

Mendelsohn says she has seen an increase in advanced colorectal cancers and diagnoses among her younger patients, and she says to watch for symptoms such as rectal bleeding, abdominal pain and changes in bowel habits.

“Until we understand more, it is important that patients and providers recognize these symptoms so they can be evaluated promptly,” she said. “And, if you are at an age to get screened, please get screened.”

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Among seniors, Black men more likely to die after surgery than their peers, new study suggests | CNN

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CNN
 — 

Among older patients, Black men may have a higher chance of dying within 30 days following surgery than their peers, according to a new study.

The study, published Wednesday in the medical journal BMJ, suggests that this inequity could be driven by outcomes following elective surgery, for which death was 50% higher for Black men than for White men – information that can be helpful for physicians as they plan procedures for patients.

Previously, separate research published in 2020 came to similar findings among children, showing that, within 30 days from their surgeries, Black children were more likely to die than White children.

“While a fair bit is known about such inequities, we find in our analyses that it’s specifically Black men who are dying more, and they are dying more after elective surgeries, not urgent and emergent surgeries,” study lead Dr. Dan Ly, assistant professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at the University of California, Los Angeles, said in a news release.

“Our findings point to possibilities such as poorer pre-optimization of co-morbidities prior to surgery, delays of care due to structural racism and physician bias, and worse stress and its associated physical burden on Black men in the United States,” Ly said in the news release.

Researchers at the University of California, Los Angeles analyzed Medicare data on more than 1.8 million beneficiaries, ages 65 to 99, who underwent one of eight common surgical procedures. The data came from 2016 to 2018, and the researchers examined how many patients died during their hospital stay or within 30 days after surgery.

The researchers found that dying after surgery overall was higher in Black men compared with White men, White women, and Black women. Dying after surgery was 50% higher for Black men than for White men after elective surgeries, the data suggest, but for non-elective surgeries, there was no difference between Black and White men, although mortality was lower for women of both races.

Among the Black men in the study, about 3% of them died following surgery overall compared with 2.7% of White men, 2.4% of White women and 2.2% of Black women. These differences were relatively larger for elective surgeries, and appeared within a week after surgery and persisted for up to 60 days after surgery, the researchers found. In a separate analysis, the researchers found that Hispanic men and Hispanic women showed a lower overall mortality than Black men.

“Our study has shed light on the fact that Black men experience a higher death rate after elective surgery than other subgroups of race and sex. Further research is needed to understand better the factors contributing to this observation, and to inform efforts to develop interventions that could effectively eliminate such disparity,” Dr. Yusuke Tsugawa, the senior author of the study and associate professor of medicine at UCLA David Geffen School of Medicine, said in an email.

The study did not explore what could be driving the disparity but Tsugawa said that “several factors” could potentially play a role.

“The structural racism may at least partially explain our findings. For example, Black patients living in neighborhoods with predominantly Black residents tend to live close to hospitals that lack resources to provide high quality healthcare,” Tsugawa said in the email. “It is possible that Black men in particular face especially high cumulative amounts of stress and allostatic load, which refers to the cumulative burden of chronic stress and life events, potentially leading to a higher death rate after surgery among this population.”

The new study “validates” that racial inequities exist in health care, said Dr. Georges Benjamin, executive director of the American Public Health Association, who was not involved in the study.

“Obviously it’s concerning when you see such a large disparity,” Benjamin said, referring to the differences in how many patients died after surgery in the study findings.

“Here’s another example that these disparities are real, and I think it helps inform people – physicians, health systems, providers of care – that the disparity is already there,” he said. “So, when they’re looking at providing surgical care to their patients, they should be informed that, statistically, some of their patients may not do well 30 days out after surgery, and so they need to put extra care in both providing care and understanding the health status of those patients when they go to surgery.”

The new study findings also raise many questions about health systems and what happens when a patient is discharged home after surgery and their ability to safely recover from a procedure, said Dr. Utibe Essien, assistant professor of medicine at the David Geffen School of Medicine at UCLA, who was not involved in the study.

“As a generalist, I’m really thinking about that part as well and how we can engage with our surgical colleagues to make sure our patients who are from underrepresented groups are leading healthy lives after they’ve gone under the knife so to speak,” Essien said, adding that more research could help determine which types of elective surgeries may have seen more significant disparities than other types – and what would be needed to reduce the disparities.

“Would we find something different with more rare, complicated surgeries? It’s possible and that goes back to the type of hospitals where patients are getting their care,” Essien said.

“How close is a hospital really connected to an academic medical center that knows the latest and greatest surgical procedures? Do they have the technology to be able to do some really innovative and safe work?” he said. “Looking into ways at the hospital level that we can address these disparities, I think, is going to be important.”

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11 minutes of daily exercise could have a positive impact on your health, large study shows | CNN

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Sign up for CNN’s Fitness, But Better newsletter series. Our seven-part guide up will help you ease into a healthy routine, backed by experts.



CNN
 — 

When you can’t fit your entire workout into a busy day, do you think there’s no point in doing anything at all? You should rethink that mindset. Just 11 minutes of moderate-to-vigorous intensity aerobic activity per day could lower your risk of cancer, cardiovascular disease or premature death, a large new study has found.

Aerobic activities include walking, dancing, running, jogging, cycling and swimming. You can gauge the intensity level of an activity by your heart rate and how hard you’re breathing as you move. Generally, being able to talk but not sing during an activity would make it moderate intensity. Vigorous intensity is marked by the inability to carry on a conversation.

Higher levels of physical activity have been associated with lower rates of premature death and chronic disease, according to past research. But how the risk levels for these outcomes are affected by the amount of exercise someone gets has been more difficult to determine. To explore this impact, scientists largely from the University of Cambridge in the United Kingdom looked at data from 196 studies, amounting to more than 30 million adult participants who were followed for 10 years on average. The results of this latest study were published Tuesday in the British Journal of Sports Medicine.

The study mainly focused on participants who had done the minimum recommended amount of 150 minutes of exercise per week, or 22 minutes per day. Compared with inactive participants, adults who had done 150 minutes of moderate-to-vigorous aerobic physical activity per week had a 31% lower risk of dying from any cause, a 29% lower risk of dying from cardiovascular disease and a 15% lower risk of dying from cancer.

The same amount of exercise was linked with a 27% lower risk of developing cardiovascular disease and 12% lower risk when it came to cancer.

“This is a compelling systematic review of existing research,” said CNN Medical Analyst Dr. Leana Wen, an emergency physician and public health professor at George Washington University, who wasn’t involved in the research. “We already knew that there was a strong correlation between increased physical activity and reduced risk for cardiovascular disease, cancer and premature death. This research confirms it, and furthermore states that a smaller amount than the 150 minutes of recommended exercise a week can help.”

Even people who got just half the minimum recommended amount of physical activity benefited. Accumulating 75 minutes of moderate-intensity activity per week — about 11 minutes of activity per day — was associated with a 23% lower risk of early death. Getting active for 75 minutes on a weekly basis was also enough to reduce the risk of developing cardiovascular disease by 17% and cancer by 7%.

Beyond 150 minutes per week, any additional benefits were smaller.

“If you are someone who finds the idea of 150 minutes of moderate-intensity physical activity a week a bit daunting, then our findings should be good news,” said study author Dr. Soren Brage, group leader of the Physical Activity Epidemiology group in the Medical Research Council Epidemiology Unit at the University of Cambridge, in a news release. “This is also a good starting position — if you find that 75 minutes a week is manageable, then you could try stepping it up gradually to the full recommended amount.”

The authors’ findings affirm the World Health Organization’s position that doing some physical activity is better than doing none, even if you don’t get the recommended amounts of exercise.

“One in 10 premature deaths could have been prevented if everyone achieved even half the recommended level of physical activity,” the authors wrote in the study. Additionally, “10.9% and 5.2% of all incident cases of CVD (cardiovascular disease) and cancer would have been prevented.”

Important note: If you experience pain while exercising, stop immediately. Check with your doctor before beginning any new exercise program.

The authors didn’t have details on the specific types of physical activity the participants did. But some experts do have thoughts on how physical activity could reduce risk for chronic diseases and premature death.

“There are many potential mechanisms including the improvement and maintenance of body composition, insulin resistance and physical function because of a wide variety of favorable influences of aerobic activity,” said Haruki Momma, an associate professor of medicine and science in sports and exercise at Tohoku University in Japan. Momma wasn’t involved in the research.

Benefits could also include improvement to immune function, lung and heart health, inflammation levels, hypertension, cholesterol, and amount of body fat, said Eleanor Watts, a postdoctoral fellow in the division of cancer epidemiology and genetics at the National Cancer Institute. Watts wasn’t involved in the research.

“These translate into lower risk of getting chronic diseases,” said Peter Katzmarzyk, associate executive director for population and public health sciences at Pennington Biomedical Research Center in Baton Rouge, Louisiana. Katzmarzyk wasn’t involved in the research.

The fact that participants who did only half the minimum recommended amount of exercise still experienced benefits doesn’t mean people shouldn’t aim for more exercise, but rather that “perfect shouldn’t be the enemy of the good,” Wen said. “Some is better than none.”

To get up to 150 minutes of physical activity per week, find activities you enjoy, Wen said. “You are far more likely to engage in something you love doing than something you have to make yourself do.”

And when it comes to how you fit in your exercise, you can think outside the box.

“Moderate activity doesn’t have to involve what we normally think of (as) exercise, such as sports or running,” said study coauthor Leandro Garcia, a lecturer in the school of medicine, dentistry and biomedical sciences at Queen’s University Belfast, in a news release. “Sometimes, replacing some habits is all that is needed.

“For example, try to walk or cycle to your work or study place instead of using a car, or engage in active play with your kids or grand kids. Doing activities that you enjoy and that are easy to include in your weekly routine is an excellent way to become more active.”

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Beware the budget butt lift, regulators warn amid social media-inspired boom | CNN

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In hindsight, Nikki Ruston said, she should have recognized the red flags.

The office in Miami where she scheduled what’s known as a Brazilian butt lift had closed and transferred her records to a different facility, she said. The price she was quoted – and paid upfront – increased the day of the procedure, and she said she did not meet her surgeon until she was about to be placed under general anesthesia.

“I was ready to walk out,” said Ruston, 44, of Lake Alfred in Central Florida. “But I had paid everything.”

A few days after the July procedure, Ruston was hospitalized due to infection, blood loss, and nausea, her medical records show.

“I went cheap. That’s what I did,” Ruston recalled recently. “I looked for the lowest price, and I found him on Instagram.”

People like Ruston are commonly lured to office-based surgery centers in South Florida through social media marketing that makes Brazilian butt lifts and other cosmetic surgery look deceptively painless, safe, and affordable, say researchers, patient advocates, and surgeon groups.

Unlike ambulatory surgery centers and hospitals, where a patient might stay overnight for observation after treatment, office-based surgery centers offer procedures that don’t typically require an inpatient stay and are regulated as an extension of a doctor’s private practice.

But such surgical offices are often owned by corporations that can offer discount prices by contracting with surgeons who are incentivized to work on as many patients per day as possible, in as little time as possible, according to state regulators and physicians critical of the facilities.

Ruston said she now lives with constant pain, but for other patients a Brazilian butt lift cost them their lives. After a rash of deaths, and in the absence of national standards, Florida regulators were the first in the nation to enact rules in 2019 meant to make the procedures safer. More than three years later, data shows deaths still occur.

Patient advocates and some surgeons – including those who perform the procedure themselves – anticipate the problem will only get worse. Emergency restrictions imposed by the state’s medical board in June expired in September, and the corporate business model popularized in Miami is spreading to other cities.

“We’re seeing entities that have a strong footprint in low-cost, high-volume cosmetic surgery, based in South Florida, manifesting in other parts of the country,” said Dr. Bob Basu, a vice president of the American Society of Plastic Surgeons and a practicing physician in Houston.

During a Brazilian butt lift, fat is taken via liposuction from other areas of the body – such as the torso, back, or thighs – and injected into the buttocks. More than 61,000 buttock augmentation procedures, both butt lifts and implants, were performed nationwide in 2021, a 37% increase from the previous year, according to data from the Aesthetic Society, a trade group of plastic surgeons.

As with all surgery, complications can occur. Miami-Dade County’s medical examiner has documented nearly three dozen cosmetic surgery patient deaths since 2009, of which 26 resulted from a Brazilian butt lift. In each case, the person died from a pulmonary fat embolism, when fat entered the bloodstream through veins in the gluteal muscles and stopped blood from flowing to the lungs.

No national reporting system nor insurance code tracks outcomes and patient demographics for a Brazilian butt lift. About 3% of surgeons worldwide had a patient die as a result of the procedure, according to a 2017 report from an Aesthetic Surgery Education and Research Foundation task force.

Medical experts said the problem is driven, in part, by having medical professionals like physician assistants and nurse practitioners perform key parts of the butt lift instead of doctors. It’s also driven by a business model that is motivated by profit, not safety, and incentivizes surgeons to exceed the number of surgeries outlined in their contracts.

In May, after a fifth patient in as many months died of complications in Miami-Dade County, Dr. Kevin Cairns proposed the state’s emergency rule to limit the number of butt lifts a surgeon could perform each day.

“I was getting sick of reading about women dying and seeing cases come before the board,” said Cairns, a physician and former member of the Florida Board of Medicine.

Some doctors performed as many as seven, according to disciplinary cases against surgeons prosecuted by the Florida Department of Health. The emergency rule limited them to no more than three, and required the use of an ultrasound to help surgeons lower the risk of a pulmonary fat clot.

But a group of physicians who perform Brazilian butt lifts in South Florida clapped back and formed Surgeons for Safety. They argued the new requirements would make the situation worse. Qualified doctors would have to do fewer procedures, they said, thus driving patients to dangerous medical professionals who don’t follow rules.

The group has since donated more than $350,000 to the state’s Republican Party, Republican candidates, and Republican political action committees, according to campaign contribution data from the Florida Department of State.

Surgeons for Safety declined KHN’s repeated interview requests. Although the group’s president, Dr. Constantino Mendieta, wrote in an August editorial that he agreed not all surgeons have followed the standard of care, he called the limits put on surgeons “arbitrary.” The rule sets “a historic precedent of controlling surgeons,” he said during a meeting with Florida’s medical board.

In January, Florida state Sen. Ileana Garcia, a Republican, filed a draft bill with the state legislature that proposes no limit on the number of Brazilian butt lifts a surgeon can perform in a day. Instead, it requires office surgery centers where the procedures are performed to staff one physician per patient and prohibits surgeons from working on more than one person at a time.

The bill would also allow surgeons to delegate some parts of the procedure to other clinicians under their direct supervision, and the surgeon must use an ultrasound.

Florida’s legislature convenes on March 7.

Consumers considering cosmetic procedures are urged to be cautious. Like Ruston, many people base their expectations on before-and-after photos and marketing videos posted on social media platforms such as Facebook, Snapchat, and Instagram.

“That’s very dangerous,” said Basu, of the American Society of Plastic Surgeons. “They’re excited about a low price and they forget about doing their homework,” he said.

The average price of a buttocks augmentation in 2021 was $4,000, according to data from the Aesthetic Society. But that’s only for the physician’s fee and does not cover anesthesia, operating room fees, prescriptions, or other expenses. A “safe” Brazilian butt lift, performed in an accredited facility and with proper aftercare, costs between $12,000 and $18,000, according to a recent article on the American Society of Plastic Surgeons’ website.

Although Florida requires a physician’s license to perform liposuction on patients who are under general anesthesia, it’s common in the medical field for midlevel medical practitioners, such as physician assistants and nurse practitioners, to do the procedure in office settings, according to Dr. Mark Mofid, who co-authored the 2017 Aesthetic Surgery Education and Research Foundation task force study.

By relying on staffers who don’t have the same specialty training and get paid less, office-based surgeons can complete more butt lifts per day and charge a lower price.

“They’re doing all of them simultaneously in three or four different rooms, and it’s being staffed by one surgeon,” said Mofid, a plastic surgeon in San Diego, who added that he does not perform more than one Brazilian butt lift in a day. “The surgeon isn’t doing the actual case. It’s assistants.”

Basu said patients should ask whether their doctor holds privileges to perform the same procedure at a hospital or ambulatory surgery center, which have stricter rules than office surgery centers in terms of who can perform butt lifts and how they should be done.

People in search of bargains are reminded that cosmetic surgery can have other serious risks beyond the deadly fat clots, such as infection and organ puncture, plus problems with the kidneys, heart, and lungs.

Ruston’s surgery was performed by a board-certified plastic surgeon she said she found on Instagram. She was originally quoted $4,995, which she said she paid in full before surgery. But when she arrived in Miami, she said, the clinic tacked on fees for liposuction and for post-surgical garments and devices.

“I ended up having to pay, like, $8,000,” Ruston said. A few days after Ruston returned home to Lake Alfred, she said, she started to feel dizzy and weak and called 911.

Paramedics took her to an emergency room, where doctors diagnosed her with anemia due to blood loss, and blood and abdominal infections, her medical records show.

“If I could go back in time,” she said, “I wouldn’t have had it done.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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