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Concerned about the courts, some states and universities are stockpiling abortion drugs | CNN

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CNN
 — 

With an eye on the courts, a growing number of Democratic-led states are stockpiling the pills that can be used for a medication abortion, the most common form of the procedure in the US.

The officials want to be prepared, in case US District Judge Matthew Kacsmaryk’s decision to suspend the US Food and Drug Administration’s approval of mifepristone goes through, so medication abortions would still be available in their states for some period of time. But they’re taking different approaches to the idea.

New York Gov. Kathy Hochul announced Tuesday that her state’s Department of Health would buy 150,000 doses of misoprostol, the other of the two drugs typically used in a medication abortion.

Misoprostol can be used off-label for an abortion, without mifepristone, but patients often have to use more of it. It would not be covered by the court case, and if Kacsmaryk’s decision stands, the New York City’s Health Department tweeted, it will change to using this medication only.

“Medication abortion continues to be available at our Sexual Health Clinics and NYC Health + Hospitals locations. Should mifepristone become unavailable, we will continue to make medication abortion accessible to all in NYC by shifting to a misoprostol-only treatment regimen,” the tweet said.

The state says the 150,000 doses should represent a five-year supply of pills.

“Anti-choice extremists have shown that they are not stopping at overturning Roe, and they are working to entirely dismantle our country’s reproductive health care system, including medication abortion and contraception,” Hochul said. “New York will always be a safe harbor for abortion care, and I am taking action to protect abortion access in our State and continue to lead the nation in defending the right to reproductive autonomy.”

California is also stocking up on misoprostol.

“While California still believes Mifepristone is central to the preferred regimen for medication abortion, the State negotiated and purchased an emergency stockpile of Misoprostol in anticipation of Friday’s ruling by far-right federal judge Matthew Kacsmaryk to ensure that California remains a safe haven for safe, affordable, and accessible reproductive care,” Gov. Gavin Newsom’s office said in a release Monday.

California plans to purchase up to 2 million pills through CalRx, a state initiative set up to make drugs more affordable.

The governor’s office said the state now has more than 250,000 pills on hand, which it purchased for about $100,000.

California said it shared the terms of its purchase agreement with other members of the Reproductive Freedom Alliance, a nonpartisan coalition of 21 governors who are committed to protecting reproductive rights, and who might also be interested in taking such action.

Another member of that alliance, Washington Gov. Jay Inslee, announced last week that his state bought a three year-supply of mifepristone, the drug at the center of Kacsmaryk’s ruling.

Inslee directed the state Department of Corrections – which has a pharmacy license and is legally able to buy medications – to buy the drug last month, he said, and the shipment was delivered March 31. The University of Washington also purchased 10,000 doses.

Lawmakers are introducing a bill to authorize officials to distribute or sell the medication to licensed providers throughout the state.

“This Texas lawsuit is a clear and present danger to patients and providers all across the country. Washington will not sit by idly and risk the devastating consequences of inaction,” Inslee said. “Washington is a pro-choice state, and no Texas judge will order us otherwise.”

In the meantime, its attorney general, Bob Ferguson, is helping lead a multistate lawsuit to protect access to mifepristone.

On Friday, the same day Kacsmaryk’s ruling came down, a federal judge in Washington ordered the US not to make any changes that would restrict access to mifepristone in the territories that brought the lawsuit: 17 states and the District of Columbia.

On Monday, Massachusetts Gov. Maura T. Healey announced that at her request, the University of Massachusetts and health care providers have also taken action to stockpile doses of mifepristone.

The governor’s office said last week that the university bought about 15,000 doses of mifepristone, enough to cover the commonwealth for about a year, and the pills are expected to arrive this week. Local health care providers have agreed to buy more, and the government agreed to set aside $1 million to pay for those doses.

The Massachusetts governor also signed an executive order confirming protections for medication abortion under existing law.

“Here in Massachusetts, we are not going to let one extremist judge in Texas turn back the clock on this proven medication and restrict access to care in our state,” Healey said. “The action we are taking today protects access to mifepristone in Massachusetts and protects patients and providers from liability. In Massachusetts, we stand for civil rights and freedom. We will always protect access to reproductive health care, including medication abortion.”

Danco Laboratories, the manufacturer of the brand-name version of mifepristone, says that orders for the drug have increased substantially in recent months and are significantly higher than they were at this time last year.

Demand for mifepristone is up across all types of customers, including clinics, pharmacies and individual providers, said Abby Long, Danco’s director of public affairs. But Massachusetts is the only state that has requested an especially large number of pills from the company.

Maine Gov. Janet Mills, who called the Texas decision “reckless” and a “fundamental assault on women’s rights,” said Monday that her administration is evaluating its options, “including procuring mifepristone if needed, to protect access to medication abortion for Maine women.”

The Connecticut governor’s office said Wednesday that it is also monitoring the situation.

Oregon Gov. Tina Kotek’s office said in an email Wednesday that she has directed the Oregon Health Authority to “explore all available avenues for ensuring Oregon is prepared should Mifepristone become less available. That includes evaluating the supply of Mifepristone and Misoprostol and consulting with providers to better understand the potential impact on the provision of abortion and reproductive health care and what additional support might be necessary.”



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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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Cancer screenings could be back to normal after millions missed during Covid-19 pandemic | CNN

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CNN
 — 

Millions of people across the United States missed routine cancer screenings during the second year of the Covid-19 pandemic, with the prevalence of screening for breast, cervical and prostate cancers in the previous year falling anywhere from 6% to 15% between 2019 and 2021, according to a new study from the American Cancer Society.

“We were thinking there would be a rebound in late 2020,” said Dr. William Dahut, chief scientific officer of the American Cancer Society. “We were surprised to see the continued increase in the number of folks not getting their screenings.”

But more recently, it appears that people are starting to return to routine screenings at rates seen before the pandemic, separate research suggests.

Rates of screening for breast, cervical and colon cancers may have returned to normal, according to more recent data published last week in the journal Epic Research, which is owned by the health care software company Epic.

“As screening rates returned to normal from the drop we previously reported, rates of cancer diagnosis returned to normal as well,” Dr. Chris Alban, a clinical informaticist at Epic Research, wrote in an email.

“We haven’t seen evidence that the screenings missed during the pandemic resulted in worsened patient outcomes, though we plan to monitor this trend to see whether it holds over time,” he said. “The recommended intervals between screenings for a given cancer can be several years, so evidence of advanced cancers can take a long time to appear.”

Due to the declines in cancer screenings as well as barriers to accessing treatment in the early days of the pandemic, not only did physicians nationwide worry that screening and treatment delays led to patients arriving at their offices with advanced cancer, some anecdotally reported seeing upticks in advanced cancers at the time.

The prevalence of screening for breast, cervical and prostate cancers did not return to pre-pandemic levels in 2021, the second year of the Covid-19 pandemic, according to the American Cancer Society’s new study, published Thursday in the Journal of Clinical Oncology.

The study included data on more than 60,000 adults in the United States who were eligible for screening for breast, cervical, prostate and colorectal cancers between 2019 and 2021. The data came from the US Centers for Disease Control and Prevention’s National Health Interview Survey.

The researchers found that between 2019 and 2021, the overall prevalence of eligible adults who completed screening in the previous year fell 6% for breast cancer, 15% for cervical cancer and 10% for prostate cancer. That means there were about 1 million fewer people who got screened for breast cancer, 4.4 million fewer screened for cervical cancer and about 700,000 fewer screened for prostate cancer.

“These declines have significant public health implications as they are expected to lead to more advanced stage cancer diagnosis in the future,” the researchers wrote.

The prevalence of screening for colorectal cancer was unchanged, the researchers found.

The growing popularity of at-home colon cancer screening tests probably offset any decline in colorectal cancer screenings, they wrote.

The researchers also found some racial differences, as the Asian community had the largest declines in breast, cervical and prostate cancer screenings.

“These findings are especially concerning as cancer is the leading cause of death in both Asian American men and women,” wrote the researchers, all from the American Cancer Society.

Dahut said that anyone who missed a routine cancer screening during the early days of the pandemic should catch up now.

“Even in the best of times, the number of folks who are screened is far too low,” he said. “Go ahead and follow the guidelines, get screened when appropriate, and the outcomes will be better.”

The Epic Research study involved data on 373,574 cancer diagnoses entered in patients’ charts in the US between January 2018 and December 2022.

The data came from 190 health care organizations that use software from Epic for their electronic health records. Together, these organizations represent 1,123 hospitals and more than 22,500 clinics, and they agreed to contribute to the de-identified data set, meaning no individual patient can be identified within the data.

The data showed a clear decrease in cancer cases early in the pandemic, which correlates with a decline in screening, but screening rates appeared to return to normal last year, as did cancer detection rates. The data also did not appear to show a significant rise in new diagnoses of advanced cancers through the end of last year.

It’s “good news” that the data demonstrate a return to pre-Covid rates of cancer screening, Dr. Arif Kamal, the American Cancer Society’s chief patient officer – who was not involved in the Epic Research study – wrote in an email. He called the new data intriguing but emphasized that more time is needed to determine whether or when rates of advanced cancers may increase due to missed screenings. It could take years.

“Conclusions regarding whether advanced cancer rates have increased due to missed screenings are a bit premature to reach. This is because cancer takes years to develop, and the resulting effect of missed cancers cannot be known after only a few years,” Kamal said.

“We remain hopeful that as cancer screening rates have returned to baseline, that the two years of missed screenings will not have a long-lasting effect on cancer incident or mortality,” he said. “But more time will tell.”

The data from Epic Research’s study is encouraging, as it suggests that more advanced cancers are not being seen, Dr. David Cohn, chief medical officer for the Ohio State University Comprehensive Cancer Center, wrote in an email.

“Whether this holds up over the next few years is yet to be seen,” he added.

Cohn, a practicing gynecologic oncologist who was not involved in either new study, said that he is “always concerned” about a decrease in screening rates and the resulting impact on later cancer diagnoses.

Yet “these data suggest that folks are getting back to the core business of screening,” he said, “such that these data will hopefully hold up over the next few years without seeing an increase in later diagnoses.”

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Don’t serve Girl Scout cookies with a side of shame | CNN

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Editor’s Note: Dr. Katie Hurley, author of “No More Mean Girls: The Secret to Raising Strong, Confident and Compassionate Girls,” is a child and adolescent psychotherapist in Los Angeles. She specializes in work with tweens, teens and young adults.



CNN
 — 

It’s Girl Scout cookie season again, which means young female entrepreneurs are outside your favorite stores and community centers selling you the latest flavors and old favorites.

While this program that helps girls learn and practice important leadership skills remains the largest girl-led entrepreneurial program in the world, cookie season can also include unwelcome messaging about calorie counting, restricted eating and diet culture.

During the course of the selling season, and even just in a single shift, girls are likely to hear negative comments about weight, body image and disordered eating from both customers and passersby. While many comments are passed off as humor, a seemingly benign joke about needing to exercise more to “earn” a Thin Mint isn’t as innocent as it might seem.

“We know that children can internalize body image concerns as young as 3 to 5 years old, so it’s important to keep in mind how we talk about our bodies and the food we eat in front of children very early on,” said Dr. Nicole Cifra, an attending physician in the division of adolescent medicine at Children’s Hospital of Philadelphia.

“We also know that dieting is a major risk factor for developing an eating disorder, so minimizing talk about diets or restricting certain food groups is beneficial,” she added.

Although a single comment isn’t likely to trigger an eating disorder, repeated exposure to diet talk can have an effect on the thought patterns girls develop around eating and body image.

“There’s a cumulative effect of kids getting these messages directly,” said Oona Hanson, parent coach and founder of the Facebook community, Parenting without Diet Culture. “One individual customer is not solely responsible for internalized messages that lead to disordered eating, but all adults play a role in the messaging kids hear around diet culture and positive body image.”

What might feel like a humorous way to deflect a cookie purchase in the moment could do more harm than anticipated. It’s probably not the only negative commentary the young entrepreneurs hear during a shift. Given that over 200 million boxes of cookies are sold each year, that’s a lot of girls fending off a lot of snarky remarks about bathing suit season or earning the confection through extra workouts or starvation.

If you’re inclined to crack a joke because you just don’t want the cookies, consider taking a moment to engage a Girl Scout in conversation about their business model and where the funds land. This gives these young businesswomen a chance to practice public speaking while sharing what they’re learning. Chances are you might even learn that you can make a cookie donation through the “Cookie Share” program. My family likes to buy some for our home and send some via Cookie Share to United States troops.

Charlotte Markey, author of “The Body Image Book for Girls,” notes that it is nearly impossible to address every negative comment heard in the background of cookie sale booths. “Some of this is so commonplace that if we take every single comment seriously, we spend too much energy on it,” Markey said.

However, there are steps parents, educators and Girl Scout troop leaders can take to mitigate some of this negative messaging so that girls don’t internalize it.

“The best thing that troop leaders and parents can do for their kids is to model their own healthy body image,” said Dr. Cheri Levinson, associate professor in the department of psychological and brain sciences at the University of Louisville and director of the university’s Eating Anxiety Treatment Lab. “It’s also important to talk about all of the good things that bodies do for us — like letting us hug people, dance or pet our pets.”

Practicing gratitude as it relates to our bodies is a powerful way to reframe thinking away from unrealistic expectations or negative thoughts about our bodies and toward being mindful of the many ways our bodies carry us through our days.

Kids are always listening.

“One of the most important things is not to talk negatively about your body or food in front of kids,” Levinson said. When we talk kindly to ourselves, she noted, they learn to do the same.

Balanced eating includes having treats at times and taking the time to enjoy the foods we consume. When adults label foods or eating choices as “good” or “bad” and “healthy” or “unhealthy,” kids get the message some foods are either off-limits or harmful. This can create feelings of shame around eating, particularly when sweets are restricted to these categories.

“One thing troop leaders can do is talk about the joy around food by sharing their favorite combinations of cookies,” Hanson said. “This tips the scales in the direction of creating a balanced relationship with food.”

It might be tempting to ignore the commentary and simply move on, but if girls are hearing diet culture talk, they need to talk about it with a trusted adult.

“I recommend having an open line of communication about these topics. Talking to children about the media they consume or comments they hear from others related to body image can be helpful in giving them a space to process the information they’re receiving,” Cifra said.

One way to do this is to debrief the girls after the shift ends. A troop leader can say, “We heard a few jokes and comments about diets and not eating cookies. I wonder how you felt when you heard those things?” This opens the door to a discussion about negative body comments and how girls can reframe their thinking.

There might be times when an adult has to step in and gently redirect another adult who is making uncomfortable comments, but girls can also take the opportunity to use their voices to stand up to diet talk.

Assertiveness is an essential leadership skill, and countering unwanted commentary with positive messaging is one way to help girls sharpen their skills. Plan ahead to come up with some talking points to use if they encounter any negative messaging. Phrases like “We love our cookies and they only come around once a year!” or “Gift a box to our troops — we know they love our cookies!” change the tone from negative to hopeful while empowering the girls to speak up for a cause they believe in.

Cookie season does only come around once a year, and the dollars earned from these sales go directly back to the local and regional troops to fund activities for the girls throughout the year. Whether you donate the cookies to someone else or pick up a box of favorites to enjoy yourself, your purchase empowers up-and-coming leaders. So go ahead and grab those Thin Mints while you still can.

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