Shementé Jones knew something wasn’t right. Her back hurt. She felt pain during sex.

She said she kept telling her doctor something was wrong.

Her doctor told her, “Just wash your underwear in Dreft,” Jones said, referring to a brand of detergent.

Within months of that 2016 appointment, Jones, who lives in a suburb of Jackson, Mississippi, was diagnosed with stage 3 cervical cancer. She underwent a hysterectomy then weeks of radiation therapy.

“I ended up fine,” said Jones, now 43. “But what about all the other women?”

The question is especially pertinent in Jones’ home state, which had the nation’s second-highest age-adjusted cervical cancer mortality rate, 3.4 deaths per 100,000 women and girls annually from 2016 through 2020, behind only Oklahoma, according to National Cancer Institute data. And, for non-Hispanic Black women such as Jones, the rates in the state are even higher — 3.7 deaths per 100,000 people. This all translates to about 50 avoidable deaths of Mississippi women from cervical cancer each year in this largely rural state.

Health care experts said such a high death rate from a cancer that is preventable, detectable, and successfully treatable when found early is a warning sign about the general state of health care in Mississippi.

“They desperately need help there,” said Otis Brawley, a professor of oncology at Johns Hopkins School of Medicine and an expert on health disparities. “Political leadership is incredibly important in turning this around, and in Mississippi, the political leadership don’t give a damn.”

Despite the beauty of Mississippi, from the rolling hills of the Natchez Trace to white-sand beaches on the Gulf of Mexico, and the cultural renown of its famous musicians and storytellers, the state’s reputation is marred by its high rates of poverty. People who live there are accustomed to being the butt of jokes, but it hurts.

“Often Mississippi gets represented poorly,” said Mildred Ridgway, an OB-GYN at the University of Mississippi Medical Center in Jackson.

Recently the state has reeled from crisis after crisis. As recently as March, tornadoes and other severe weather killed more than two dozen people and caused extensive damage. Last year, the water in Jackson, the state capital, was undrinkable for months because of treatment plant failures.

On just about any measure of health, Mississippi ranks near or at the bottom. Nationally, an estimated 10% of people under 65 lack health insurance, but in Mississippi it is about 14%. Deaths from cardiovascular disease, diabetes, cancer, and many other illnesses are among the highest per capita in the country.

The high rates of poverty contribute to the high cervical cancer mortality, health experts said. About 19% of Mississippians — nearly 1 in 5 — live in poverty, while nationally it is about 13%.

“If I had to pinpoint what that’s from, it’s from lack of education,” said Ridgway, referring to a lack of knowledge about regular cervical cancer screening, which the U.S. Preventive Services Task Force recommends every three years for women 21 to 65.

But it likely goes far beyond that, many health experts said. Doctors may be less likely to stress preventive care to less educated women and women of color, studies suggest.

“There’s a big difference in the quality of care,” said Rajesh Balkrishnan, a professor of public health at the University of Virginia who has extensively studied oncology care in Appalachia and other underserved areas.

In her case, Jones said, she could not get her doctor’s office to return her calls in a timely manner. She was concerned about her symptoms.

“I felt I wasn’t listened to. I called her more than she called me,” Jones said of her doctor. “I was going to my appointments, and I was ignored.”

And getting access to any care — let alone quality, culturally competent care from providers who acknowledge a patient’s heritage, beliefs, and values during treatment — may be difficult.

Most of the state’s 82 counties are rural. The average travel distance to a grocery store is 30 miles, and half the population lives in a county that is considered medically underserved, said Letitia Thompson, a vice president in Mississippi for the American Cancer Society.

Low-income rural residents often lack reliable transportation, she said, and even if they own a vehicle, they lack gas money. They often can’t find — or pay for — someone to take care of their children so they can go to the doctor. Women with low-paying jobs often lack the time to drive to a clinic in a distant town, or the ability to take off from work without losing pay.

“Women who work and take care of children often have a huge burden of responsibility,” Ridgway said. “They don’t have time or the money.”

Many also don’t have insurance. While the Affordable Care Act has lowered the uninsured rate in Mississippi, an estimated additional 88,000 Mississippians could have coverage through Medicaid if the state expanded eligibility for the federal-state insurance program for low-income Americans. But the state is one of 10 that have not agreed to expand coverage to more adults.

Mississippi Gov. Tate Reeves, a Republican up for reelection this year, is opposed to expansion. His Democratic challenger, Brandon Presley, a second cousin of the music legend Elvis, favors it. Polls show Presley lagging Reeves.

Without expansion of Medicaid, people who have low incomes are often left to decide between forgoing insurance and purchasing a policy through the Affordable Care Act marketplace if they cannot get insurance through employment. Even if they qualify for subsidized marketplace plans, they may face high deductibles or copayments for visits, health experts said. That often means going to the doctor only when sick. Preventive care becomes a luxury.

“You save your health care dollars for when you are sick or your kids are sick,” said Thompson, of the American Cancer Society.

But regular medical care can make all the difference with cervical cancer. Pap tests have long helped detect abnormal cervical cells that could turn malignant. Brawley said the test is “one of the best” cancer screening tests because of its accuracy.

In 2006, vaccines to prevent cervical cancer were first approved by the FDA. The vaccines guard against the common sexually transmitted infection called the human papillomavirus, which causes nearly all cervical cancers. The HPV vaccine is most effective when administered before a person has become sexually active; the federal recommendation is to get the shots by age 12.

Only a handful of places in the U.S. — including Hawaii, Rhode Island, Virginia, Puerto Rico, and the District of Columbia — require the vaccines to attend school. California has pending legislation that initially would have required that middle schoolers get the shots, but the bill has since been watered down to recommend them instead.

Mississippi does not require the vaccine, and the state has had the lowest share of fully vaccinated teens by a large margin for years. Fewer than 39% of teens there were up to date on HPV vaccination as of 2022, according to the CDC, compared with an estimated 63% nationally.

Thompson said she thinks many parents are hesitant to have their children vaccinated because they believe it would encourage sexual activity.

“This is an anti-cancer vaccine,” Thompson said.

Krista Guynes, director of the women’s health program at the Mississippi State Department of Health, said the state has several efforts underway to better inform women about the need for screening. It also has clinics for uninsured women. In partnership with the National Cancer Institute and University of Mississippi Medical Center, she said, the health department is conducting a study to evaluate risk and look for new biomarkers in women undergoing screening for cervical cancer.

As for Jones, she considers herself lucky to have survived stage 3 cancer.

“I would just like to say to every woman, ‘Get the vaccine.’ The vaccine will make the difference, so they won’t have to be told, ‘I’m sorry, you have cancer.’”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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When it comes to cancer treatments, most people are familiar with chemotherapy, radiation and surgery. 

Yet there is another emerging, lesser-known therapy that is showing promising results in treating blood cancers.

With CAR T-cell therapy, the patient’s T-cells are taken from the blood, engineered to attack cancer cells and then infused back into the patient’s body through an IV, Dr. Noopur Raje told Fox News Digital.

Raje is the director of Multiple Myeloma at Mass General Cancer Center, which is a member of the Mass General Brigham system. Mass General Brigham has a Gene and Cell Therapy Institute that helps advance gene and cell therapies like CAR-T.

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"I think it's made a big change in people's lives and how we take care of people," she told Fox News Digital in an interview. 

"It's one of the most personalized ways of taking care of some of the blood-related cancers."

At Mass General, Raje and her team treat patients with multiple myeloma, a rare form of blood cancer that attacks the plasma cells. 

Most of their patients are between 60 and 70 years old, she said.

CAR stands for chimeric antigen receptors, which are proteins that enable T-cells to target the tumor antigens produced by cancer cells.

T-cells are a type of white blood cell that helps to fight germs and prevent disease, per the Cleveland Clinic.

There are currently six CAR T-cell therapies that are FDA-approved to treat leukemia, lymphomas, multiple myeloma and other blood cancers.

"We are taking our patients’ T-cells, which are the immune cells, and then activating them and putting a chimeric antigen receptor (CAR), which can recognize a protein on a cancer tumor," Raje said.

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Because Raje treats multiple myeloma, her team started off by doing studies against a protein called BCMA, which is found in cancerous plasma cells.

The re-engineered T-cells continue multiplying in the body, so they can seek out and kill more tumor cells, the doctor said.

"We are seeing extremely high response rates, between 82% and 100%," she told Fox News Digital. "Now we need to do a better job of maintaining that response."

Before CAR T-cell therapy, Raje said, patients were started on a treatment and then stayed on it for an indefinite length of time.

"This is the first time that patients are getting a ‘one-off’ treatment, and then we're just watching them with no more treatment at all," she said.

While the treatment can be a little "involved" at the beginning, Raje said, once it’s complete the patient receives no new therapies for up to three years.

"And I have some patients who are on no treatment for way longer than that, which is a big advancement," she added.

"Obviously, we need to do better — we need to cure people," Raje said. 

"We're not quite there, but the next step is to start the treatment earlier, so we can start seeing more control of the disease over a longer period of time."

As of now, the FDA has approved CAR T-cell therapy as a "last resort" when the disease has persisted through all other available treatments; but Raje hopes that soon, it will be available to patients earlier in the course of their cancers.

CAR T-cell therapy is expensive — costing anywhere from $500,000 to $1,000,000, per WebMD. Raje pointed out, however, that many insurance plans cover at least some of the cost. It is also covered by Medicare.

"I think one has to start looking at the time saved in terms of quality of life in not coming back to the hospital and not being on any other meds," she said.

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There is some risk of side effects for those receiving CAR T-cell therapy, primarily a condition called cytokine release syndrome (CRS). It can occur when the immune system responds too aggressively to infection.

"When the CAR T-cell kills the tumor, it produces a bunch of proteins, and when it does that, it can make you quite sick," Raje said.

"But as we've used more and more of these therapies, we've gotten pretty good at managing this, and we have the antidotes for these kinds of toxicities," she added.

Another potential side effect is a condition called ICANS, or immune effector-mediated neurotoxicity. 

"With this, people can get confused, sometimes to the extent that they can actually go into a deep coma," Raje said. "It's important to recognize and treat these conditions earlier."

Sandy Caterine, a retired accountant who lives in Rye, New Hampshire, was part of a clinical trial for CAR T-cell therapy. 

She was diagnosed with multiple myeloma in August 2019. 

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"It kind of came out of nowhere," Caterine told Fox News Digital. "In retrospect, maybe I had a couple of little symptoms."

Caterine had experienced some back pain, fatigue and nausea, but initially chalked it up to dehydration. 

When the symptoms didn’t go away on their own, she saw her primary care physician and got some blood tests, which led to her diagnosis.

"I had never even heard of multiple myeloma," Caterine said. "All I heard was that it was incurable and no one could predict what the life expectancy might be."

For several months, Caterine was on a regimen of numerous drugs, infusions and radiation, none of which fully resolved her cancer. Then she learned about the clinical trial for CAR T-cell therapy.

"Sandy has what is known as high-risk disease, based on the genetics of the cancer," said Raje. "This usually doesn’t have good outcomes, but Sandy had a great response to the trial."

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Caterine, who is 62, did experience the CRS illness as a side effect, which caused her to endure nausea, fatigue, fever and disorientation. 

She remained in the hospital for 15 days.

"It took me a while to get my strength back," she said. "I do remember them taking very good care of me."

Caterine has gotten periodic bone marrow scans every three months since her infusion.

"So far, there has been no sign of the disease," she said. 

"Dr. Raje told me the hope was that it would work for two to three years, and I am already over two years."

Caterine’s experience has helped her appreciate each day more than she did before, she told Fox News Digital.

"These are two years that I never thought I would get when I was first diagnosed," she said. 

"It's just great that I can continue to live my life and be with my family."

CAR T-cell therapy started out for use in leukemia, later branching out to other blood cancers like lymphoma and multiple myeloma. 

Raje is hopeful that the treatment eventually will become available for other types of cancers, including cancers of the breast, colon and brain.

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"We have an ongoing study where we are looking at CAR T-cell therapy in glioblastoma, a type of brain cancer, which we would have never thought of doing early on," she said. 

"And we have a whole host of new CARs coming down the pike against different antigens."

The doctor emphasized the significance of teaching the body’s own immune cells to fight against cancer cells.

"In my mind, it's probably the most personalized way of being able to take care of your own disease, which is amazing," she said.

Tras una cirugía de emergencia para extirpar el tumor, junto con sus ovarios, útero, trompas de Falopio y apéndice, Hughes contó que vio una publicación en Instagram en la que una mujer con cáncer uterino relacionaba su condición con alisadores químicos para el cabello.

“Casi me desmayo”, dijo desde su casa en Smyrna, Georgia.

Cuando tenía unos 4 años, su madre comenzó a aplicarle un alisador químico, o “relajante”, en el cabello cada seis u ocho semanas. “Quemaba y olía terrible”, recordó Hughes. “Pero era parte de nuestra rutina para ‘lidiar con mi cabello'”.

La rutina continuó hasta que fue a la universidad y conoció a otras mujeres negras que llevaban el cabello de forma natural. Pronto, Hughes dejó de usar alisadores.

Las presiones sociales y económicas han llevado durante mucho tiempo a las niñas y mujeres negras a alisar su cabello para cumplir con los estándares de belleza eurocéntricos. Pero los alisadores químicos tienen un olor desagradable, son costosos y a veces causan quemaduras dolorosas en el cuero cabelludo. Y ahora hay cada vez más evidencia de que podrían ser un riesgo para la salud.

Los alisadores pueden contener carcinógenos, como agentes liberadores de formaldehído, ftalatos y otros compuestos que alteran el sistema endócrino, según estudios de los Institutos Nacionales de Salud. Estas sustancias químicas pueden imitar las hormonas del cuerpo y se han vinculado con cánceres de seno, útero y ovario, muestran investigaciones.

Investigadores y médicos especializados en cáncer dicen que la aplicación frecuente y de por vida de alisadores químicos en el cabello y el cuero cabelludo de mujeres afroamericanas podría explicar por qué los cánceres relacionados con hormonas afectan de manera desproporcionada a mujeres negras en comparación con mujeres blancas.

“Lo que hay en estos productos es perjudicial”, dijo Tamarra James-Todd, profesora de epidemiología en la Escuela de Salud Pública T.H. Chan de Harvard, quien ha estudiado productos alisadores por los últimos 20 años.

James-Todd cree que los fabricantes, legisladores y médicos deberían advertir a los consumidores que los alisadores podrían causar cáncer y otros problemas de salud. Pero los reguladores han sido lentos en actuar, los médicos se han mostrado reacios a tomar la causa, y el racismo continúa dictando los estándares de moda que dificultan que las mujeres dejen los alisadores, productos tan adictivos que son conocidos como “crema adictiva” (“creamy crack”).

Michelle Obama alisó su cabello cuando Barack era presidente porque creía que los estadounidenses “no estaban preparados” para verla con trenzas, dijo la ex primera dama después de dejar la Casa Blanca. El ejército de los Estados Unidos todavía prohibía estilos populares de cabello negro, como rastas y trenzas, mientras el primer presidente negro del país estaba en el cargo.

En 2019, California se convirtió en el primer estado de casi 20 en prohibir la discriminación basada en el cabello. El año pasado, la Cámara de Representantes de los Estados Unidos aprobó una legislación similar, conocida como la Ley CROWN (Creating a Respectful and Open World of Natural Hair). Sin embargo, el proyecto de ley fracasó en el Senado.

La necesidad de legislación destaca los desafíos que enfrentan las niñas y mujeres negras en la escuela y en el lugar de trabajo.

“Tienes que elegir tus batallas”, dijo Ryland Gore, cirujana oncológica con sede en Atlanta. Gore informa a sus pacientes con cáncer de mama sobre el mayor riesgo de cáncer debido a los alisadores. A pesar de su conocimiento, Gore continúa usando alisadores químicos en su propio cabello, como lo ha hecho desde que tenía unos 7 años.

“Tu cabello cuenta una historia”, dijo.

En las conversaciones con sus pacientes, Gore a veces también habla sobre cómo las mujeres afroamericanas solían tejer mensajes en sus trenzas sobre la ruta a seguir en el Underground Railroad mientras buscaban la libertad de la esclavitud.

“Es simplemente una discusión profunda”, que abarca cultura, historia e investigación sobre las prácticas de estilo de peinados actuales, dijo. “Los datos están ahí fuera. Por lo tanto, se les debe advertir a los pacientes, y luego pueden tomar una decisión”.

La primera pista de una conexión entre los productos para el cabello y problemas de salud surgió en la década de 1990. Los médicos comenzaron a ver signos de madurez sexual en bebés y niñas negras que desarrollaban senos y vello púbico después de usar champús que contenían estrógeno o extracto placentario. Cuando las niñas dejaban de usar el champú, el desarrollo del cabello y los senos retrocedían.

Desde entonces, James-Todd y otros investigadores han vinculado compuestos químicos en productos para el cabello con una variedad de problemas de salud más prevalentes entre las mujeres negras, desde la pubertad temprana hasta el parto prematuro, la obesidad y la diabetes.

En los últimos años, los investigadores se han enfocado en una posible conexión entre los alisadores químicos y los cánceres relacionados con hormonas, como el que desarrolló Hughes, que tienden a ser más agresivos y mortales en las mujeres negras.

Un estudio de 2017 encontró que las mujeres blancas que usaban alisadores químicos tenían casi el doble de probabilidades de desarrollar cáncer de seno que aquellas que no los usaban. Debido a que la gran mayoría de las participantes negras del estudio usaban alisadores, los investigadores no pudieron probar efectivamente la asociación en mujeres negras, según afirmó la autora principal, Adana Llanos, profesora asociada de epidemiología en la Escuela de Salud Pública Mailman de la Universidad de Columbia.

Los investigadores lo probaron en 2020.

El llamado Sister Study (Estudio de las Hermanas), una importante investigación del Instituto Nacional de Ciencias de la Salud Ambiental sobre las causas del cáncer de mama y enfermedades relacionadas, hizo el seguimiento de 50,000 mujeres estadounidenses cuyas hermanas habían sido diagnosticadas con cáncer de mama y que estaban libres de cáncer cuando se inscribieron. Independientemente de la raza, las mujeres que informaron haber usado alisadores en el año anterior tenían un 18% más de probabilidades de ser diagnosticadas con cáncer de mama. Aquellas que usaron alisadores al menos cada cinco a ocho semanas tenían un 31% más de riesgo de ese cáncer.

Casi el 75% de las hermanas negras usaron alisadores en el año anterior, en comparación con solo el 3% de las hermanas blancas no hispanas. Tres cuartas partes de las mujeres negras también informaron haber usado alisadores cuando eran adolescentes, y el uso frecuente de alisadores químicos durante la adolescencia aumentó el riesgo de cáncer de mama premenopáusico.

En 2021, un análisis de los datos del Sister Study mostró que las hermanas que usaban frecuentemente alisadores o productos para el alisado tenían el doble de riesgo de cáncer de ovario. Otro análisis, en 2022, encontró que el uso frecuente aumentaba en más del doble el riesgo de cáncer de útero.

Después de que los investigadores descubrieron la relación con el cáncer de útero, algunos pidieron cambios en las políticas y otras medidas para reducir la exposición a los alisadores.

“Es hora de intervenir”, escribió Llanos y sus colegas en un editorial que acompañó el análisis del cáncer de útero. Aunque reconocen la necesidad de más investigaciones, lanzaron un “llamado a la acción”.

Nadie puede afirmar que el uso de alisadores permanentes causará cáncer, dijo Llanos en una entrevista. “Así no funciona el cáncer”, dijo, señalando que algunos fumadores nunca desarrollan cáncer de pulmón, a pesar de que el tabaquismo es un factor de riesgo conocido.

El corpus de investigación sobre los alisadores para el cabello y el cáncer es más limitado, dijo Llanos, quien dejó de usar alisadores químicos hace 15 años. Pero preguntó retóricamente: “¿Necesitamos investigar durante otros 50 años para saber que los alisadores químicos son perjudiciales?”.

Charlotte Gamble, ginecóloga oncológica cuya práctica en Washington, D.C., incluye a mujeres negras con cáncer de útero y ovario, dijo que ella y sus colegas ven los hallazgos del estudio sobre el cáncer de útero como dignos de una exploración más profunda, pero aún no deberían discutirse con los pacientes.

“Aún tengo mis dudas”, dijo. “Se necesita mucha más información”.

Mientras tanto, James-Todd y otros investigadores creen que han construido un sólido corpus de evidencia.

“Hay suficientes cosas que sí sabemos como para comenzar a tomar medidas, desarrollar intervenciones, proporcionar información útil a los médicos, pacientes y al público en general”, dijo Traci Bethea, profesora asistente en la Oficina de Salud de las Minorías e Investigación sobre Disparidades en Salud de la Universidad de Georgetown.

La responsabilidad de regular los productos de cuidado personal, incluidos los alisadores químicos para el cabello y las tinturas, que también se han vinculado con cánceres relacionados con hormonas, recae en la Administración de Alimentos y Medicamentos (FDA).

Sin embargo, la FDA no somete los productos de cuidado personal al mismo proceso de aprobación que utiliza para alimentos y medicamentos. La FDA solo restringe 11 categorías de productos químicos utilizados en cosméticos, mientras que las preocupaciones sobre los efectos en la salud han llevado a la Unión Europea a restringir al menos 2,400 sustancias.

En marzo, las representantes Ayanna Pressley (demócrata de Massachusetts) y Shontel Brown (demócrata de Ohio) pidieron a la FDA que investigara la posible amenaza para la salud que representan los alisadores químicos. Un representante de la FDA dijo que la agencia lo investigaría.

Los peinados naturales están resurgiendo entre las niñas y mujeres negras, pero muchas siguen dependiendo de la “crema adictiva”, según Dede Teteh, profesora asistente de salud pública en la Universidad Chapman.

Teteh tuvo su primer alisado permanente a los 8 años y ha luchado por dejar los alisadores de adulta. Ahora usa trenzas estilo “locs”. Hace poco, consideró alisarse químicamente el cabello para una entrevista de trabajo académica porque no quería que su cabello “fuera un obstáculo” cuando se presentara ante profesores blancos.

Teteh lideró un proyecto de investigación sobre la salud del cabello llamado “The Cost of Beauty” (El Costo de la Belleza) publicado en 2017. Ella y su equipo entrevistaron a 91 mujeres negras en el sur de California. Algunas reaccionaron de manera “combativa” ante la idea de dejar los alisadores y afirmaron que “todo puede causar cáncer”.

Sus reacciones reflejan los desafíos que enfrentan las mujeres negras en Estados Unidos, dijo Teteh.

“No es que la gente no quiera escuchar información relacionada con su salud”, dijo. “Pero quieren que la información se comparta de manera empática con la difícil situación de ser negra aquí en los Estados Unidos”.

Kara Nelson de KFF Health News colaboró con este informe.

Este artículo fue producido por KFF Health News, que publica California Healthline, un servicio editorialmente independiente de la  California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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The World Health Organization (WHO) released its official statement this week on the potential health risks of aspartame, with a committee classifying the non-sugar, low-calorie sweetener as "possibly carcinogenic to humans."

Many industry experts, however, are speaking out in defense of aspartame, which is commonly used in diet sodas, chewing gum, some dairy products and many other low-calorie foods and beverages.

The International Agency for Research on Cancer (IARC), a cancer-focused organization within WHO, was the agency that called out the sweetener’s potential cancer risk.

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The IARC uses five different levels of cancer risk: Group 1, "carcinogenic to humans"; Group 2A, "Probably carcinogenic to humans"; Group 2B: "Possibly carcinogenic to humans"; Group 3, "Unclassifiable as to carcinogenicity in humans"; and Group 4, "Probably not carcinogenic to humans."

Aspartame was placed in Group 2B based on "limited evidence" of causing cancer in humans and animals — particularly a type of liver cancer, the press release stated.

In the same announcement, the Joint Expert Committee on Food Additives (JECFA), another group within WHO, seemed to contradict the IARC’s classification.

"JECFA also considered the evidence on cancer risk, in animal and human studies, and concluded that the evidence of an association between aspartame consumption and cancer in humans is not convincing," the press release stated.

The acceptable daily intake (ADI) of aspartame remains 40 milligrams per kilogram of body weight, JECFA also said. That amount is the equivalent of nine cans of 12-ounce diet soda per day for a 150-pound person.

(The FDA recommends an even higher ADI, at 50 milligrams per kilogram of body weight.)

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"Our results do not indicate that occasional consumption should pose a risk to most consumers," Dr. Francesco Branca, director of the Department of Nutrition and Food Safety at the WHO, stated during a press conference in Geneva.

Dr. Mona S. Jhaveri, a biotech scientist and cancer researcher in Ridgefield, Connecticut, told Fox News Digital that the likelihood of getting cancer depends on the types and the number of carcinogens that one is exposed to, as well as genetic factors. 

"Carcinogens can work either alone or in combination with other substances," she said. 

Often, she added, "people who are subject to multiple carcinogens can increase their risk of getting cancer exponentially."

Many industry experts maintain that aspartame is still safe for consumption — including the FDA, which released a statement refuting the cancer risk.

"The FDA disagrees with IARC’s conclusion that these studies support classifying aspartame as a possible carcinogen to humans," the statement read. 

"FDA scientists reviewed the scientific information included in IARC’s review in 2021 when it was first made available and identified significant shortcomings in the studies on which IARC relied."

"We note that JECFA did not raise safety concerns for aspartame under the current levels of use and did not change the acceptable daily intake (ADI)."

Additional agencies, including the European Food Safety Authority and Health Canada, have also deemed aspartame to be safe at the current recommended levels, the FDA added.

"Aspartame is one of the most studied food additives in the human food supply," the FDA stated. 

"FDA scientists do not have safety concerns when aspartame is used under the approved conditions."

Dr. Arnold Baskies, a New Jersey-based surgical oncologist and past chairman of the National Board of Directors of the American Cancer Society — he's also a member of the Coalition for Safe Food and Beverage Choices Expert Advisory Committee — pointed out that the WHO agencies, IARC and JECFA, reviewed previous research. They did not review new evidence.

"The WHO Joint Expert Committee on Food Additives’ (JECFA) review says that aspartame is safe for human consumption," Baskies said in a statement provided to Fox News Digital. "JECFA is the authoritative international agency when it comes to food safety."

The FDA relies on JECFA’s assessments as part of its process of determining the safety and risks of foods and beverages, Baskies noted.

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"It is irresponsible to needlessly scare or confuse people," he said. "If there was any cause for concern, they would have adjusted the current acceptable daily intake (ADI)."

The Calorie Control Council (CCC) in Atlanta, Georgia, also spoke out in defense of aspartame as a safe food additive.

"The JECFA ruling not only confirms the four decades of science concluding aspartame is safe, but also provides real-life ‎context around the safe consumption of this ingredient," said Robert Rankin, president of the CCC, in a statement sent to Fox News Digital.

Any risk is highly unlikely given the JECFA’s guidelines for recommended daily intake, Rankin also said.

"The average 150-pound person would need to consume about 14 12-oz. cans of diet beverages or about 74 packets of aspartame-containing tabletop sweetener every day over the course of their life to raise any safety concern," Rankin said.

"Obviously, that level of consumption is not realistic or recommended, nor is it ‎aligned with the intended use of these ingredients."

Regarding IARC describing aspartame as "possibly cancer-causing," Rankin stated that IARC is not a regulatory agency or food safety authority, and said that its classification is "misleading, inaccurate and [constitutes] fearmongering."

He said, "IARC looks for substances that could potentially cause cancer without considering actual dietary intake, and has found many things, such as drinking hot water and working at night, to be probably carcinogenic."

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"It is not only wrong, but potentially damaging to certain populations to position IARC’s report alongside true scientific and regulatory agencies like JECFA, the Food and Drug Administration, and the European Food Safety Authority," Rankin added.

Dr. Ernest Hawk, head of the Division of Cancer Prevention and Population Sciences at The University of Texas MD Anderson Cancer Center, also spoke to Fox News Digital about aspartame’s safety.

"IARC classified aspartame as ‘possibly carcinogenic to humans’ based on limited evidence for cancer in humans and experimental animals, and limited evidence that it might behave as a carcinogen," he said. 

"Because all of the evidence was limited, aspartame was added to WHO’s list of possible carcinogens."

The list begins with 126 agents known to be carcinogenic in humans (including tobacco and alcohol) and 94 agents that are "probably carcinogenic" — followed by 322 agents that are "possibly carcinogenic," Hawk explained.

"Aspartame will now be included in that final group, but keep in mind that none of those have been convincingly proven to cause cancer," he added.

The FDA, the National Cancer Institute, the American Institute for Cancer Research and the American Cancer Society all have evaluated the same evidence in the past, and all of them concluded that there was no clear evidence that artificial (non-nutritive) sweeteners cause cancer when consumed at typical levels, Hawk said.

While he believes that the WHO agencies did a careful review and have the public’s best interest in mind, Hawk called for additional research on the long-term health risks of consuming non-sugar sweeteners.

The FDA and other health agencies do not agree that aspartame is a cancer risk, so some medical professionals recommend using sugar instead of artificial sweeteners.

"Although it’s approved by regulatory bodies, potential risk factors are associated with preferring aspartame over sugar," noted Jhaveri.

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"Sensitivities or allergies to aspartame can result in adverse reactions, and excessive consumption may contribute to weight gain due to heightened cravings for sweet edibles," she said.

For some people, aspartame may cause physical symptoms that include headaches, dizziness, digestive ailments and allergic responses, Jhaveri noted.

"Avoiding aspartame when possible and opting for natural sugars in fruits and vegetables is prudent," she said. 

In May, the WHO advised against the use of non-sugar sweeteners like aspartame for the purposes of controlling body weight or lowering the risk of non-communicable diseases.

"Replacing free sugars with NSS does not help with weight control in the long term," said Branca, the WHO’s director for nutrition and food safety, in a press release at the time. 

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For the general public, Hawk recommended "paying attention to the science" as it continues to develop regarding the possible health consequences of artificial sweeteners.

"In the meantime, continue to work on consistently eating a balanced, healthy diet that contains whole foods that are high in nutrient density," he suggested.

People with a rare inherited disorder called phenylketonuria (PKU) should avoid aspartame, medical experts say.

Those with PKU don’t have the enzyme to break down an amino acid called phenylalanine, so it builds up in the body. 

Consuming foods and drinks with aspartame can cause dangerous levels of phenylalanine that can lead to serious health issues, according to the Mayo Clinic’s website.

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Aspartame-containing products will include a warning on the label stating "PHENYLKETONURICS: CONTAINS PHENYLALANINE." 

Anyone with PKU should avoid any food or drink with this warning.

The reasons can vary, from quality control failures at manufacturing plants to surging demand, including significant interest that has at times squelched availability of drugs taken for weight loss.

But the problem is not easily fixed. Most active pharmaceutical ingredients are made in China, and boosting production in the U.S. is not like flipping a switch. Many of the drugs in short supply are generics made in India, where regulators often find serious production lapses. So what to do? Along with a colleague, Marta Wosińska, a senior fellow in economic studies at The Brookings Institution, has three ideas to alleviate shortages of generic sterile injectable medicines, in particular. They suggest the U.S. government should provide incentives to upgrade facilities and create a buffer inventory. But they also argue hospital purchasing is in need of an overhaul. We discussed the possibilities; our conversation has been lightly edited. 

I’ve been writing about drug shortages on and off for many years, but the problem never goes away. And now, it seems even worse. Obviously, something has to change. But what exactly has been lacking with our policies to date?

Continue to STAT+ to read the full story…

The most common type of gynecologic cancer in the U.S. has been on the rise in recent years — and there’s no standard screening for it.

Uterine cancer will affect about 66,200 women in 2023 in the U.S. — and around 13,000 will die from the disease, per the American Cancer Society (ACS).

"While we are seeing a downward trend in overall cancer cases, uterine cancer is one of the few types where we're seeing an upward trend," said Dr. Brian Slomovitz, director of gynecologic oncology and co-chair of the Cancer Research Committee at Mount Sinai Medical Center in Miami Beach, Florida, in an interview with Fox News Digital.

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"We’re anticipating that the number of deaths in the United States due to uterine cancer is soon going to outnumber the deaths due to ovarian cancer," he added.

To help raise awareness, the International Society of Gynecologic Cancer announced the first-ever Uterine Cancer Awareness Month in June.

Slomovitz — who also serves as chair of the Uterine Cancer Awareness Month initiative — spoke to Fox News Digital about the state of uterine cancer and what women need to know.

The terms "uterine cancer" and "endometrial cancer" are often used interchangeably, but there is a difference, Slomovitz said.

A vast majority of these types of cancers occur in the outer and inner layers of the uterus, known as the endometrium — hence the term "endometrial cancer."

About 4% to 5% of the cancers occur in the muscle of the uterus. These are known as uterine sarcomas.

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"Sarcomas are aggressive diseases with a tremendously high death rate," Slomovitz explained. "But all of them fall in the category of uterine cancers."

Obesity is the biggest risk factor for uterine cancer, Slomovitz said.

"Fat tissue increases the amount of estrogen in the body, and endometrial cancer is a hyper estrogenic," he explained. "It stimulates the lining of the uterus to the point of uncontrolled proliferation into cancer."

Overweight women (with a body mass index of 25 to 29.9) have twice the risk of developing uterine cancer as women at a healthy weight, the ACS website states.

Obese women (BMI of 30 or higher) have three times the risk.

Those with diabetes, which is closely related to obesity, are also at a higher risk.

A less common risk factor could be polycystic ovarian syndrome (PCOS), which is a hormonal disorder that can lead to enlarged ovaries and the formation of cysts. 

PCOS leads to elevated estrogen levels and lower progesterone levels, which can raise the risk of endometrial cancer, according to the American Cancer Society (ACS) website.

Some hereditary syndromes can make women more susceptible to uterine cancer.

"One of those is Lynch syndrome, which was often associated with colorectal cancer," said Slomovitz.

"We know that half the women who develop cancer from Lynch syndrome develop endometrial cancer."

Age is also a risk factor, as most patients are diagnosed in their 50s and 60s, the doctor said.

"The increase in cases may be due to obesity, but we're also seeing longer life expectancy," he noted. "The older people get, the more likely that they are to get endometrial cancer, obviously."

While other cancers have specific, recommended screenings — such as mammograms for breast cancer and colonoscopies for colorectal cancer — there are no pre-symptomatic screenings for uterine cancers, per the Centers for Disease Control and Prevention (CDC).

The Pap smear (Pap test) checks for cervical cancer and precancerous cells in the cervix, but does not screen for uterine cancer.

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The most common sign or symptom of uterine cancer is abnormal bleeding, Slomovirz said.

"Most uterine cancer patients have postmenopausal bleeding as an early sign or symptom — however, that's not the case for everyone," he said.

In premenopausal women, it can be more difficult to determine what constitutes "abnormal" bleeding, the doctor noted. 

"They shouldn't just assume it's changes in their menstrual cycle," he said. 

In the absence of a formal screening process, Slomovitz stressed the need to recognize symptoms and take quick action.

"We need to better educate patients to come see their doctors sooner if they have symptoms," he told Fox News Digital. 

In addition to bleeding, other symptoms may include pelvic pain or pelvic pressure.

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"We always tell people that if they have symptoms that are worsening or if they persist after 10 to 14 days, they should come in to see their doctor just to make sure everything's OK," Slomovitz said.

"We're still seeing a large number of patients who are diagnosed with advanced and recurrent disease."

The diagnosis process typically starts with an ultrasound to take images of the uterus, followed by a tissue biopsy — either to diagnose or rule out the disease, said Slomovitz.

In cases of advanced cancer, patients will usually get additional tests — such as chest X-rays, CT scans, MRIs or PET scans — to determine if the disease has spread.

"It traditionally spreads through the lymphatic system, which means lymph nodes can be enlarged," Slomovitz explained. "It can also spread to the liver or the lungs through the blood system."

In patients who have had endometrial cancer in the past, a gynecologic oncologist will instruct them that for any future symptoms, recurring cancer must be ruled out. 

"They're cancer patients — so even in the non-specific symptoms, it's worthy of seeing their oncologist again to make sure it's not coming back," Slomovitz said.

In women who are diagnosed with uterine cancer, one of the first steps is usually a hysterectomy, which is the removal of the uterus.

"Eighty percent of women are cured with a hysterectomy," Slomovitz said.

To further minimize risk, the doctor said medical professionals will often do lymph node sampling as well to make sure the cancer hasn't spread.

"But for the additional 20% of patients who have advanced or recurrent disease, systemic therapies are needed," he said. "We need to do better with treatment options for uterine cancer."

For these aggressive cases, the systemic therapies have been chemotherapy or hormonal therapy, which uses progesterone to slow down tumor growth.

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This year, Slomovitz said, some breakthrough studies have shown that immunotherapy can be given in the first-line management of the disease.

Immunotherapy treatments work by helping the immune system to slow, stop or destroy cancer cells. It’s shown to be effective for lung cancer, oral cancer and melanoma, the doctor pointed out.

At the American Society of Clinical Oncology conference in May 2023, researchers presented promising results for a new class of drugs called antibody-drug conjugates (ADCS), a targeted therapy for treating cancer, Slomovitz said.

Future studies will continue to look at these types of targeted drugs.

"One of my career goals is to use immunotherapy and targeted therapy to eliminate the need for chemotherapy and its associated toxicities and side effects," Slomovitz said.

Another "groundbreaking" advancement Slomovitz is particularly excited about is molecular classification, which divides uterine cancers into four different subtypes — thus allowing for more precise, personalized treatment options.

"We're in a very exciting time," he said. "There are some game-changing studies that are coming out, as we try to fill this unmet need to help our patients live longer."

Algunos médicos e investigadores que están interesados en un enfoque más individualizado para encontrar tumores problemáticos se muestran escépticos y plantean preguntas sobre los datos y el razonamiento detrás del cambio radical del Grupo de Trabajo de Servicios Preventivos de Estados Unidos con respecto a sus pautas de 2016.

“La evidencia para que todas comiencen a los 40 no es convincente”, dijo Jeffrey Tice, profesor de medicina en la Universidad de California-San Francisco.

Tice es parte del equipo de investigación del estudio WISDOM, que tiene como objetivo, en palabras de Laura Esserman, cirujana de cáncer de seno y líder del equipo, “hacer pruebas de manera más inteligente, no probar más”. Esserman lanzó el estudio en curso en 2016 con el objetivo de adaptar las pruebas de detección al riesgo de una mujer, y poner fin al debate sobre cuándo iniciar las mamografías.

Los defensores de un enfoque personalizado enfatizan los costos de la detección universal a los 40, no en dólares, sino en resultados falsos positivos, biopsias innecesarias, sobretratamiento y ansiedad.

Las pautas provienen del Grupo de Trabajo de Servicios Preventivos de Estados Unidos, parte del Departamento de Salud y Servicios Humanos (HHS) federal, un panel independiente de 16 expertos médicos voluntarios que se encargan de ayudar a guiar a los médicos, aseguradoras de salud y legisladores.

En 2009, y de nuevo en 2016, el grupo presentó el aviso actual, que elevó la edad para comenzar la mamografía de rutina de 40 a 50 años e instó a las mujeres de 50 a 74 a hacérselas cada dos años.

Las mujeres de 40 a 49 años que “le otorgan un mayor valor al beneficio potencial que a los daños potenciales” también deberían someterse al procedimiento de detección, dijo el grupo de trabajo.

Ahora, el grupo ha publicado un borrador de una actualización de sus directrices, recomendando la detección para todas las mujeres a partir de los 40 años.

“Esta nueva recomendación ayudará a salvar vidas y evitará que más mujeres mueran debido al cáncer de mama”, dijo Carol Mangione, profesora de medicina y salud pública en UCLA, quien presidió el panel.

Pero la evidencia no es clara. Karla Kerlikowske, profesora de la UCSF que ha estado investigando la mamografía desde la década de 1990, dijo que no vio una diferencia en los datos que justificara el cambio. Dijo que la única forma en que podía explicar las nuevas pautas era un cambio en el panel.

“Son diferentes miembros del grupo de trabajo”, dijo. “Interpretaron los beneficios y los daños de manera diferente”.

Sin embargo, Mangione citó dos puntos de datos como impulsores cruciales de las nuevas recomendaciones: el aumento de la incidencia de cáncer de mama en mujeres más jóvenes, y modelos que muestran la cantidad de vidas que podrían salvar las pruebas de detección, especialmente entre las mujeres negras.

No hay evidencia directa de que evaluar a mujeres de 40 años salve vidas, dijo. La cantidad de mujeres que murieron de cáncer de mama disminuyó de manera constante desde 1992 hasta 2020, debido en parte a una detección más temprana y a mejores tratamientos.

Pero los modelos predictivos que construyó el grupo de trabajo, basados en varias suposiciones en lugar de datos reales, encontraron que expandir la mamografía a mujeres de 40 años podría evitar 1.3 muertes adicionales por cada 1,000 en esa cohorte, dijo Mangione. Lo más crítico, agregó, es que un nuevo modelo que incluye solo mujeres negras mostró que se podría salvar 1.8 por 1,000.

Un aumento anual del 2% en la cantidad de personas de 40 a 49 años diagnosticadas con cáncer de mama en el país entre 2016 y 2019 alertó al grupo de trabajo sobre una tendencia preocupante, dijo.

Mangione lo llamó un “salto realmente considerable”. Pero Kerlikowske lo llamó “bastante pequeño” y Tice lo llamó “muy modesto”: percepciones contradictorias que subrayan cuánta subjetividad está involucrada en la ciencia de las pautas de salud preventiva.

A los miembros del grupo de trabajo los designa la Agencia para la Investigación y la Calidad de la Atención Médica del HHS, y cumplen mandatos de cuatro años. El nuevo borrador de las pautas está abierto para comentarios públicos hasta el 5 de junio. Después de incorporar los comentarios, el grupo de trabajo planea publicar su recomendación final en JAMA, la revista de la Asociación Médica Estadounidense.

Cerca de 300,000 mujeres serán diagnosticadas con cáncer de mama en el país este año, y morirán más de 43,000 por este mal, según proyecciones del Instituto Nacional del Cáncer. Muchos consideran que expandir la detección para incluir a mujeres más jóvenes es una forma obvia de detectar el cáncer antes y salvar vidas.

Pero los críticos de las nuevas pautas argumentan que hay verdaderas concesiones.

“¿Por qué no empezar al nacer?”, ironizó Steven Woloshin, profesor del Instituto de Políticas de Salud y Práctica Clínica de Dartmouth. “¿Por qué no todos los días?”.

“Si no hubiera inconvenientes, eso podría ser razonable”, dijo. “El problema son los falsos positivos, que dan mucho miedo. El otro problema es el sobrediagnóstico”. Algunos tumores de mama son inofensivos y el tratamiento puede ser peor que la enfermedad, enfatizó.

Tice estuvo de acuerdo en que el sobretratamiento es un problema subestimado.

“Estos cánceres nunca causarían síntomas”, dijo, refiriéndose a ciertos tipos de tumores. “Algunos simplemente retroceden, se encogen y desaparecen, son de crecimiento tan lento que una mujer muere de otra cosa antes de que causen problemas”.

Las pruebas de detección tienden a encontrar cánceres de crecimiento lento que tienen menos probabilidades de causar síntomas, dijo. Por el contrario, las mujeres a veces descubren cánceres letales de crecimiento rápido poco después de haberse realizado mamografías que salieron normales.

“Nuestro fuerte sentimiento es que una sola talla no sirve para todos y que debe personalizarse”, dijo Tice.

WISDOM, que significa “Mujeres informadas para evaluar según las medidas de riesgo”, evalúa el riesgo de las participantes a los 40 mediante la revisión de los antecedentes familiares y la secuenciación de nueve genes. La idea es comenzar con mamografías periódicas de inmediato para las mujeres de alto riesgo mientras que esperar para las de menos.

Las mujeres negras no hispanas tienen más probabilidades de hacerse mamografías de detección que las mujeres blancas no hispanas. Sin embargo, tienen un 40% más de probabilidades de morir de cáncer de seno y de que les diagnostiquen cánceres mortales a edades más tempranas.

El grupo de trabajo espera que las mujeres negras se beneficien más de la detección temprana, dijo Mangione.

No está claro por qué las mujeres negras tienen más probabilidades de sufrir cánceres de mama más letales, pero las investigaciones apuntan a disparidades en el tratamiento.

“Las mujeres negras no obtienen un seguimiento de las mamografías tan rápido ni un tratamiento adecuado tan rápido”, dijo Tice. “Eso es lo que realmente impulsa las discrepancias en la mortalidad”.

También continúa el debate sobre la detección en mujeres de 75 a 79 años. El grupo de trabajo optó por no pedir pruebas de detección de rutina en el grupo de mayor edad porque un estudio observacional no mostró ningún beneficio, dijo Mangione. Pero el panel emitió un llamado urgente para investigar si las mujeres de 75 años o más deberían hacerse una mamografía de rutina.

Los modelos sugieren que evaluar a las mujeres mayores podría evitar 2,5 muertes por cada 1,000 mujeres en ese grupo de edad, más de las que se salvarían al expandir la evaluación a las mujeres más jóvenes, apuntó Kerlikowske.

“Siempre decimos que las mujeres mayores de 75 años deberían decidir junto con sus médicos si se hacen mamografías, según sus preferencias, valores, historial familiar y de salud”, dijo Mangione.

Tice, Kerlikowske y Woloshin argumentan que lo mismo es cierto para las mujeres de 40 años.

Esta historia fue producida por KFF Health News, que publica California Healthline, un servicio editorialmente independiente de la California Health Care Foundation.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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This story can be republished for free (details).

Some doctors and researchers who are invested in a more individualized approach to finding troublesome tumors are skeptical, raising questions about the data and the reasoning behind the U.S. Preventive Services Task Force’s about-face from its 2016 guidelines.

“The evidence isn’t compelling to start everyone at 40,” said Jeffrey Tice, a professor of medicine at the University of California-San Francisco.

Tice is part of the WISDOM study research team, which aims, in the words of breast cancer surgeon and team leader Laura Esserman, “to test smarter, not test more.” She launched the ongoing study in 2016 with the goal of tailoring screening to a woman’s risk and putting an end to the debate over when to get mammograms.

Advocates of a personalized approach stress the costs of universal screening at 40 — not in dollars, but rather in false-positive results, unnecessary biopsies, overtreatment, and anxiety.

The guidelines come from the federal Department of Health and Human Services’ U.S. Preventive Services Task Force, an independent panel of 16 volunteer medical experts who are charged with helping guide doctors, health insurers, and policymakers. In 2009 and again in 2016, the group put forward the current advisory, which raised the age to start routine mammography from 40 to 50 and urged women from 50 to 74 to get mammograms every two years. Women from 40 to 49 who “place a higher value on the potential benefit than the potential harms” might also seek screening, the task force said.

Now the task force has issued a draft of an update to its guidelines, recommending the screening for all women beginning at age 40.

“This new recommendation will help save lives and prevent more women from dying due to breast cancer,” said Carol Mangione, a professor of medicine and public health at UCLA, who chaired the panel.

But the evidence isn’t clear-cut. Karla Kerlikowske, a professor at UCSF who has been researching mammography since the 1990s, said she didn’t see a difference in the data that would warrant the change. The only way she could explain the new guidelines, she said, was a change in the panel.

“It’s different task force members,” she said. “They interpreted the benefits and harms differently.”

Mangione, however, cited two data points as crucial drivers of the new recommendations: rising breast cancer incidence in younger women and models showing the number of lives screening might save, especially among Black women.

There is no direct evidence that screening women in their 40s will save lives, she said. The number of women who died of breast cancer declined steadily from 1992 to 2020, due in part to earlier detection and better treatment.

But the predictive models the task force built, based on various assumptions rather than actual data, found that expanding mammography to women in their 40s might avert an additional 1.3 deaths per 1,000 in that cohort, Mangione said. Most critically, she said, a new model including only Black women showed 1.8 per 1,000 could be saved.

A 2% annual increase in the number of 40- to 49-year-olds diagnosed with breast cancer in the U.S. from 2016 through 2019 alerted the task force to a concerning trend, she said.

Mangione called that a “really sizable jump.” But Kerlikowske called it “pretty small,” and Tice called it “very modest” — conflicting perceptions that underscore just how much art is involved in the science of preventive health guidelines.

Task force members are appointed by HHS’ Agency for Healthcare Research and Quality and serve four-year terms. The new draft guidelines are open for public comment until June 5. After incorporating feedback, the task force plans to publish its final recommendation in JAMA, the Journal of the American Medical Association.

Nearly 300,000 women will be diagnosed with breast cancer in the U.S. this year, and it will kill more than 43,000, according to National Cancer Institute projections. Expanding screening to include younger women is seen by many as an obvious way to detect cancer earlier and save lives.

But critics of the new guidelines argue there are real trade-offs.

“Why not start at birth?” Steven Woloshin, a professor at the Dartmouth Institute for Health Policy and Clinical Practice, asked rhetorically. “Why not every day?”

“If there were no downsides, that might be reasonable,” he said. “The problem is false positives, which are very scary. The other problem is overdiagnosis.” Some breast tumors are harmless, and the treatment can be worse than the disease, he said.

Tice agreed that overtreatment is an underappreciated problem.

“These cancers would never cause symptoms,” he said, referring to certain kinds of tumors. “Some just regress, shrink, and go away, are just so slow-growing that a woman dies of something else before it causes problems.”

Screening tends to find slow-growing cancers that are less likely to cause symptoms, he said. Conversely, women sometimes discover fast-growing lethal cancers soon after they’ve had clean mammograms.

“Our strong feeling is that one size does not fit all, and that it needs to be personalized,” Tice said.

WISDOM, which stands for “Women Informed to Screen Depending On Measures of risk,” assesses participants’ risk at 40 by reviewing family history and sequencing nine genes. The idea is to start regular mammography immediately for high-risk women while waiting for those at lower risk.

Black women are more likely to get screening mammograms than white women. Yet they are 40% more likely to die of breast cancer and are more likely to be diagnosed with deadly cancers at younger ages.

The task force expects Black women to benefit most from earlier screening, Mangione said.

It’s unclear why Black women are more likely to get the most lethal breast cancers, but research points to disparities in cancer management.

“Black women don’t get follow-up from mammograms as rapidly or appropriate treatment as quickly,” Tice said. “That’s what really drives the discrepancies in mortality.”

Debate also continues on screening for women 75 to 79 years old. The task force chose not to call for routine screening in the older age group because one observational study showed no benefit, Mangione said. But the panel issued an urgent call for research about whether women 75 and older should receive routine mammography.

Modeling suggests screening older women could avert 2.5 deaths per 1,000 women in that age group, more than those saved by expanding screening to younger women, Kerlikowske noted.

“We always say women over 75 should decide together with their clinicians whether to have mammograms based on their preferences, their values, their health history, and their family history,” Mangione said.

Tice, Kerlikowske, and Woloshin argue the same holds true for women in their 40s.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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This story can be republished for free (details).

Every day, more than 9,500 people in the U.S. are diagnosed with skin cancer, according to the Skin Cancer Foundation, a New York City-based nonprofit. 

Early detection and treatment is the key to a positive outcome, doctors say — and performing regular self-exams is the best way to catch the warning signs.

The Skin Cancer Foundation recommends checking your skin from head to toe at least once a month.

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"A change to a mole, a sore that won’t heal or a new growth may be a warning sign of skin cancer," said Dr. Nandini Kulkarni, medical director of surgical oncology for Inspira Health in Vineland, New Jersey.

"By conducting regular skin checks, you will become familiar with the pattern of moles, blemishes, freckles and other marks on your skin," she said. 

"When you notice a change, you should see your dermatologist."

Keep an eye out for any new, expanding or changing growths, spots or bumps on the skin, says the American Cancer Society.

Other warning signs include a sore that bleeds and/or doesn’t heal after several weeks, a rough or scaly patch of skin, a wart-like growth, or an irregularly shaped or colored mole.

"The letters A-B-C-D-E can help you remember what to look for," said Dr. Kulkarni.

These include:

A - Asymmetry 

B - Borders (irregular, raised)

C - Color (especially change in color of a prior mole)

D - Diameter (larger than a pencil eraser)

E - Evolving changes

The best time to do a skin self-exam is after a shower or bath, according to Dr. Kulkarni. 

For consistency, do the exam the same way each time. 

Choose a well-lit room and use both a full-length mirror and a hand mirror to ensure that nothing gets missed, the doctor said.

SKIN CANCER CHECKS AND SUNSCREEN: WHY THESE (STILL) MATTER VERY MUCH FOR GOOD HEALTH

In addition to the more obvious areas, such as the face, arms, legs and sides, remember to check hidden spots like between the fingers, the soles of the feet and the scalp.

"If needed, ask someone for help when checking your skin," Dr. Kulkarni suggested. 

"This can help with hard-to-see areas like your back and scalp."

"Skin cancer can occur anywhere on the body, even areas that are not exposed to the sun," said Dr. Kulkarni.

When examining your scalp, she suggests using a comb or blow-dryer to move your hair as you look so you can see more clearly.

The experts agree that self-exams should be a supplement to regular checks at the dermatologist, not a replacement.

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"Although you might become proficient at noticing changes to moles, freckles and other marks on your skin, differentiating between benign and malignant skin conditions takes years of training and practice," said Dr. Kulkarni. 

She recommends seeing a dermatologist at least once a year, or more frequently if you have specific concerns about changes to your skin.

​​To read more pieces in Fox News Digital's "Be Well" series, click here.

Dieciocho meses después de que April Adcox se enterara de que tenía cáncer de piel, el pasado mes de mayo, regresó por fin a la Universidad Médica de Carolina del Sur en Charleston para recibir tratamiento.

Para entonces, la zona rojiza a lo largo de la línea del cabello había pasado de ser un círculo de 2 pulgadas a cubrirle casi toda la frente. Supuraba líquido y le dolía.

“La verdad es que esperaba morir de esto, porque pensaba que eso era lo que tenía que pasar”, afirmó la mujer de 41 años, madre de tres hijos y residente en Easley, Carolina del Sur.

Adcox se había reunido por primera vez con los especialistas del centro médico a finales de 2020, después de que una biopsia diagnosticara un carcinoma basocelular. La operación para extirpar el cáncer requeriría varios médicos, le dijeron, incluido un neurocirujano, debido a lo cerca que estaba de su cerebro.

Pero Adcox no tenía seguro. Había perdido su trabajo en una fábrica de automóviles en los primeros días de la pandemia y, en el momento del diagnóstico, sentía pánico ante la complejidad de la operación y la perspectiva de una factura elevada. En lugar de seguir el tratamiento, intentó camuflar la zona cancerosa en expansión durante más de un año con sombreros y flequillos largos.

Si hubiera padecido cáncer de mama o de cuello uterino, probablemente habría tenido derecho a cobertura por una ley federal que amplía el Medicaid a los pacientes de bajos ingresos diagnosticados con esos dos tipos de cáncer.

Para las mujeres con otros tipos de cáncer, así como para casi todos los hombres, las opciones son escasas, especialmente en Carolina del Sur y los otros 11 estados que aún no han implementado la expansión de Medicaid, según oncólogos y expertos en política sanitaria que estudian el acceso a la atención.

Los estudios demuestran que, a veces, los adultos sin seguro retrasan la atención, lo que puede perjudicar las probabilidades de supervivencia. Pero que los pacientes obtengan un seguro para cubrir el tratamiento se parece un poco al juego de la ruleta, es decir, depende de dónde vivan y del tipo de cáncer que padezcan.

“Es muy aleatorio; creo que eso es lo más desgarrador”, afirmó el doctor Evan Graboyes, cirujano de cabeza y cuello, y uno de los médicos de Adcox. “Vivir o morir de cáncer no debería depender del estado en el que vives”.

La Ley de Cuidado de Salud a Bajo Precio (ACA) dio a los estados la opción de ampliar Medicaid para cubrir a más personas. Poco después de la aprobación de la ley, sólo el 2,6% de los adultos de 18 a 64 años con un nuevo diagnóstico de cáncer carecían de seguro en los estados de Medicaid ampliado frente al 7,8% en los estados sin expansión, según un estudio publicado en JAMA Oncology en 2018.

Investigadores de la Sociedad Americana del Cáncer, que realizaron el análisis, estiman que unas 30,000 personas sin seguro son diagnosticadas con cáncer cada año.

Pero en todos los estados, los pacientes sin seguro, de bajos ingresos, con cáncer de mama o de cuello uterino pueden obtener cobertura, incluso si no califican para Medicaid.

Los adultos con cáncer detectado a través del Programa Nacional de Detección Temprana de Cáncer de Mama y de Cuello Uterino pueden inscribirse en Medicaid durante la duración de su tratamiento contra el cáncer, gracias al activismo y la legislación federal que comenzó hace más de tres décadas.

En 2019, se inscribieron 43,549 pacientes con estos tipos de cáncer, según un informe de la Oficina de Rendición de Cuentas del Gobierno (GAO) publicado en 2020.

“Si te diagnostican cáncer de mama o de cuello uterino, tienes suerte”, dijo la doctora Fumiko Chino, oncóloga radioterapeuta del Memorial Sloan Kettering Cancer Center de Nueva York, que estudia el acceso y los costos del tratamiento del cáncer. “De no ser así, puedes enfrentar obstáculos importantes”.

El importe total facturado a la aseguradora durante el año siguiente a un diagnóstico de cáncer puede ser abultado. Por ejemplo, los costos en 2016 ascendieron a un promedio de $168,730 por cáncer de pulmón y $137,663 por cáncer colorrectal, según un estudio de 2022 que calculó las reclamaciones a la aseguradora por varias neoplasias malignas comunes diagnosticadas en pacientes con seguro privado.

Dado que los adultos sin seguro pueden tener dificultades para pagar la atención preventiva, su cáncer puede no ser identificado hasta que esté avanzado, por lo que es más costoso para el paciente y el sistema de salud, explicó Robin Yabroff, autor del estudio en JAMA Oncology y vicepresidente científico de la Sociedad Americana del Cáncer.

Los pacientes que no pueden obtener ayuda financiera a través de un centro de la red a veces acumulan deudas médicas, utilizan tarjetas de crédito o lanzan campañas de recaudación de fondos en internet, dijo Yabroff. “Nos cuentan historias de personas que hipotecan sus casas para pagar el tratamiento del cáncer”.

Los pacientes de cáncer pueden adquirir un seguro a través del mercado de seguros de salud de ACA. Pero a menudo deben esperar hasta el período de inscripción regular al final del año, y esos planes de salud no entran en vigor hasta el comienzo del año siguiente.

Esto se debe a que la ley federal fue diseñada para animar a la gente a inscribirse cuando están sanos, lo que ayuda a controlar los costos, señaló MaryBeth Musumeci, profesora de política y gestión de la salud en la Universidad George Washington en Washington, DC. Si un nuevo diagnóstico te calificara para la nueva cobertura, dijo, “entonces se incentivaría a la gente a permanecer sin seguro mientras están sanos y piensan que no van a necesitar cobertura”.

Mientras tanto, el acceso a la cobertura de Medicaid para pacientes de bajos ingresos con cáncer de mama y de cuello uterino, es una historia de éxito que se remonta a una ley de 1990 que creó el programa nacional de cribado de mama y cuello de útero. Las mamografías empezaron a recomendarse de forma generalizada en la década de 1980, y los activistas presionaron para llegar a más personas desfavorecidas, explicó Katie McMahon, directora de políticas de la Red de Acción contra el Cáncer de la Sociedad Americana del Cáncer.

Sin embargo, una investigación demostró que algunos adultos sin seguro tenían dificultades para recibir atención por los cánceres detectados a través de los cribados, dijo McMahon. Una ley del año 2000 permitía a los estados extender Medicaid a estas personas, y en 2008 los 50 estados y el Distrito de Columbia ya lo habían hecho, según el informe de la GAO de 2020.

Para otros enfermos de cáncer, una de las vías de cobertura que les quedan, según Chino, es reunir los requisitos para la discapacidad a través de la Administración de la Seguridad Social, tras lo cual pueden solicitar Medicaid. La agencia federal tiene una larga lista de criterios para los pacientes con cáncer. También cuenta con el programa Compassionate Allowances, (Beneficios por Compasión), que ofrece revisiones más rápidas para pacientes con determinadas afecciones médicas graves, incluidos cánceres avanzados o agresivos.

Aunque las normas varían, muchos pacientes no califican hasta que la enfermedad se ha extendido o el cáncer requiere al menos un año de tratamiento intenso, explicó Chino. Esto supone un dilema para las personas que no tienen seguro pero padecen cánceres curables.

“Para tener derecho a Medicaid, tengo que esperar a que mi cáncer sea incurable”, dijo, “lo cual es muy deprimente”.

Por ejemplo, el programa de Beneficios por Compasión no incluye el carcinoma basocelular, y sólo cubre el cáncer de cabeza y cuello si se ha extendido a otras partes del cuerpo o no puede extirparse quirúrgicamente.

Adcox dijo que antes de su operación de 12 horas, el pasado mes de junio, su solicitud de ayuda económica a la Universidad Médica de Carolina del Sur estaba aún pendiente. Alguien del hospital calculó que su factura ascendería a $176,000 y le preguntó cuánto podía adelantar. Consiguió reunir $700 con la ayuda de sus seres queridos.

Pero pudo optar a una ayuda económica y no ha recibido ninguna factura, salvo de un proveedor externo de servicios de laboratorio. “Se acabó”, exclamó Adcox. Desde entonces ha recibido radioterapia y se someterá a más operaciones reconstructivas. Pero ya no tiene cáncer. “No me ha matado. No me mató”.

Aun así, no todo el mundo encuentra una red de seguridad.

Brian Becker, de El Paso, Texas, no tenía seguro ni trabajo cuando supo que padecía leucemia mielógena crónica en el verano de 2021, según contó Stephanie Gamboa, su ex mujer y madre de su hija pequeña. Su médico oncólogo le exigió un pago por adelantado, dijo, y tardó varios meses en pedir prestado el dinero suficiente.

Empezó la quimioterapia al año siguiente y, con el paso de los meses, perdió peso y se debilitó, volviendo a urgencias con infecciones y un empeoramiento de la función renal, explicó Gamboa. La última vez que su hija vio a su padre, “no podía levantarse de la cama. Era literalmente piel y huesos”, dijo Gamboa.

Becker inició los trámites para solicitar prestaciones por incapacidad. El mensaje de texto que envió a Gamboa, y que ella compartió con KHN, decía que la revisión de su solicitud comenzó en junio de 2022 y se esperaba que durara seis meses.

La carta de denegación, fechada el 4 de febrero de 2023, llegó más de un mes después de la muerte de Becker en diciembre, a los 32 años. Decía en parte: “Basado en una revisión de sus condiciones médicas, usted no califica para beneficios en esta reclamación”.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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