Tag: health disparities

Why Are Women of Color More at Risk for Lupus?



Español

As a senior at Florida A&M University, Sharon Harris had been juggling a full course load, three jobs and other demands of college life when she started to feel sick.

She visited the doctor and went to the hospital emergency room for gastrointestinal problems, and healthcare providers (HCPs) thought she might have Crohn’s disease. The medication she received didn’t help, but she powered through to make it to graduation.

When Harris’ mother came to her graduation ceremony, she asked her daughter about the butterfly-like rash on her cheeks and nose. Harris hadn’t noticed, but assumed it was related to stress. She’d ask her HCP in Detroit the next time she went home.

Once home, the provider ordered blood work, which came back positive for markers of
discoid lupus and systemic lupus erythematosus (SLE). Harris said she’ll always remember that day — February 4, 2002 — as the moment her life changed.

Read: FAQs About Lupus >>

Since then, Harris has become a local and national advocate for people with lupus, founding
Lupus Detroit and working with other organizations to support patients through physical, mental and financial difficulties related to the disease. She continues the work despite her own health struggles, including a 2015 stroke and stage 5 kidney failure.

“Lupus is a very serious autoimmune disease that can lead to other autoimmune diseases, and I’ve been diagnosed with additional ones,” Harris said. “A common problem is that there isn’t a single test that can diagnose lupus, and it’s been reported it takes patients
years to get an accurate diagnosis. That’s a long wait when a person’s hair is falling out; their joints and bones are aching; and they’re fatigued, have brain fog and have kidneys that are failing. It takes a toll on a patient’s mental health, finances, body, family life, emotions, work life and social life.”

Why are women of color more likely to get lupus?

Systemic lupus erythematosus (SLE) is the most common form of lupus, and the general term “lupus” typically refers to SLE. An autoimmune disease, lupus attacks connective tissue in the body, and it can strike every organ system.

Discoid lupus, the diagnosis Harris received, is a type of lupus called
cutaneous lupus erythematosus (CLE), known mostly for the presence of a “malar rash” or “butterfly rash” on the face. Lupus patients can have both SLE and CLE.

Women make up 9 out of 10 lupus cases, with Black/African American, Native American/Alaska Native and Asian Americans representing 4 out of 10 of the estimated SLE cases in the United States, while Hispanic and Latino patients make up 2 out of 10 cases. Black/African American women with lupus die up to 13 years younger than white women with lupus.

Dr. Joy Buie, M.D., vice president for research with the
Lupus Foundation of America, said there are multiple reasons for high rates of SLE and worse outcomes among people of color.

“When we think about
disparities in general, we have to think about social conditions and the social context in which people live,” Buie said. “We know communities of color have been disenfranchised within the United States, and specifically thinking about Black and African American women, we know those conditions have had negative implications for health. Psychosocial stressors, structural racism, financial disadvantages, economic instability and lack of educational opportunities feed into susceptibility for developing any disease.”

Buie also oversees the foundation’s health equity work, which includes research on lupus and racial health disparities. The foundation cites studies indicating how Black lupus patients were more likely to have negative experiences with healthcare systems, such as
rushed communication and lack of trust in providers, or more difficulty accessing care due to a lack of transportation or insurance or living farther away from specialists. Black people living with lupus were also more likely to lose their jobs after being diagnosed, possibly because of the severity of their disease, which made it harder for them to maintain employment.

While
1 in 5 American women have positive antinuclear antibodies, or ANA — key markers for lupus — not all will develop the disease. Buie cites epigenetics — the way your environment and behavior can affect how your genes work — as having an effect on the development of lupus among women of color.

Lack of sleep, obesity, smoking, viruses and bacteria have also been associated with increased lupus risk, and Buie said some research shows that exposure to
silica, a chemical found in the environment and used in many commercial products like skincare products and cleaners, can be a contributor.

“It’s genetics, it’s hormones, it’s the environment — the intersection of those factors all play a role in developing lupus,” Buie said. “What’s problematic with this disease is that it’s not a visible disease. It’s quite invisible. You can look at a person and not even tell they’re sick. That’s the challenge of living with a disease like lupus.”

As Harris experienced, getting a correct diagnosis can also take time because lupus can show up differently in each individual. One person might have rash and joint inflammation while someone else could have kidney and heart disease. Even after diagnosis, disease management can be challenging if patients don’t have access to the right specialists and treatments as a result of financial concerns, location or lack of education about the disease.

“There is hope”

Buie is optimistic, however, that change could be on the horizon. The Lupus Foundation of America recently launched a project to predict who might get lupus to help prevent it in others. Researchers will follow family members of people with lupus over time to see what changes occur and who eventually develops the disease. The data can then be used to identify at-risk individuals and offer lifestyle changes and treatments to help prevent the disease or stop its progression.

As for Harris, she’s worked hard to not let lupus destroy her dreams. In addition to launching Lupus Detroit, she also worked as a public relations director for the Lupus Alliance of America, Michigan Indiana Affiliate. She earned a master’s degree in public policy and hopes to write a book in the future.

Her advocacy has also taken her places she never imagined. During her tenure at the Autoimmune Association, she testified at an FDA hearing about the high cost of lupus medication. She was tickled by a brief moment of fame when she appeared in an article about rapper Snoop Dogg’s daughter, Cori Broadus, who’s also living with lupus.

“An average day for me involves getting physically stronger,” Harris said. “I use my time researching all things autoimmune disease and looking for additional resources. Just because I have a treacherous disease, it doesn’t mean I want to be complacent and rest on my laurels.”

Although Harris is waiting for a kidney transplant, her advocacy and the work of researchers could deliver a brighter future for those with lupus or those at risk.

“Know there is hope,” Buie said. “There are medications approved by the FDA in the last 20 years to treat lupus, and so many more treatments in the pipeline. There’s even conversation about opportunities for a cure. Lupus doesn’t have to be a death sentence, but the key is to get the right healthcare team in place and find ways to take control of your health.”

This educational resource was created with support from GSK, Merck and Novartis.

From Your Site Articles

Related Articles Around the Web



Source link

Disparidades y la EPOC – HealthyWomen



English

Casi 16 millones de estadounidenses viven con algún diagnóstico de enfermedad pulmonar obstructiva crónica, o EPOC. Millones más ni siquiera saben que la tienen.

COPD Foundation, una organización sin fines de lucro que promueve la investigación, defensa de derechos y concientización para luchar contra la EPOC y condiciones similares, estima que el número de estadounidenses que padecen EPOC llega a los 30 millones y algunos de ellos tienen diagnósticos erróneos de otras condiciones respiratorias (tal como el asma).

Las
EPOC incluyen varias enfermedades pulmonares crónicas, tales como el enfisema y la bronquitis. Dificultad para respirar es el síntoma más frecuente de las EPOC y las personas que las padecen también pueden experimentar fatiga continua y tos crónica con o sin mucosidad. Otros síntomas pueden incluir sibilancia o respiración ruidosa, dificultad para respirar en reposo o mientras se hace ejercicio y dolor de pecho.

Aunque la mayoría de casos de EPOC
los causa fumar cigarrillos, la asociación de las EPOC con el cigarrillo es una de las razones por las cuales la enfermedad se diagnostica poco, dijo Jean Wright, M.D., MBA, directora ejecutiva de COPD Foundation.

“Hay la idea equivocada de que las EPOC son exclusivamente enfermedades de fumadores o que solo afectan a personas de edad avanzada”, dijo Wright. “Individuos más jóvenes pueden tener EPOC sin siquiera saberlo. Las EPOC pueden ocurrir por muchos factores, incluyendo exposiciones medioambientales, infecciones durante la niñez, exposiciones a químicos o a polvo en el lugar de trabajo o la genética. Fumar es la causa número uno de las EPOC, pero también hay muchas otras”.

¿Quiénes son más afectados por las EPOC?

Ciertos grupos tienen un mayor riesgo de desarrollar EPOC y tienen peores desenlaces clínicos con la enfermedad. Los factores que afectan las tasas de EPOC incluyen:

Entorno rural o urbano: De los casi 16 millones de estadounidenses que viven con diagnóstico de EPOC, 2 millones viven en áreas que se clasifican como rurales. Las tasas de hospitalización y de consultas en salas de emergencia para las EPOC son mayores también en áreas rurales.

“Estas personas frecuentemente tienen un acceso limitado a atención médica y especializada para EPOC, tal como programas de rehabilitación pulmonar”, dijo Wright. “Las personas que viven en áreas rurales frecuentemente tienen más estrés financiero, lo cual limita su acceso a atención médica de buena calidad”.

Antecedentes raciales: Personas de raza negra, indígenas estadounidenses y nativos de Alaska tienen mayores índices de EPOC que las personas de raza blanca, mientras que las personas asiáticas e hispanas tienen menores índices de EPOC que sus contrapartes de raza blanca, y es posible que la genética juegue un papel importante en el desarrollo de EPOC. Tasas altas de otras condiciones médicas, tales como la diabetes, presión arterial alta y el asma, que son más frecuentes en ciertas razas, también pueden contribuir con las disparidades raciales de las EPOC.

Algunos estudios sugieren que personas que fuman cigarrillos mentolados con EPOC tienen síntomas más graves que las personas que fuman cigarrillos no mentolados. Investigaciones también han demostrado conexiones entre la comercialización dirigida de cigarrillos mentolados a comunidades de raza negra y 8 de cada 10 fumadores estadounidenses de raza negra consumen cigarrillos mentolados.

Determinantes sociales de la salud: Personas que no cuentan con un título de educación superior y que tienen menores ingresos tienen una mayor incidencia de EPOC. Otras causas de disparidades médicas pueden asociarse a desventajas producidas por obstáculos sistémicos de la atención médica o trabajos u hogares en áreas con mayores niveles de contaminantes medioambientales que podrían contribuir a mayores tasas de EPOC en ciertas poblaciones.

El sexo o género: Las mujeres son más propensas a tener EPOC que los hombres y más mujeres mueren por EPOC que los hombres. Esto podría ocurrir por las vías respiratorias más pequeñas de las mujeres, los efectos de hormonas tales como el estrógeno, la comercialización de tabaco dirigida a mujeres y una falta de diagnósticos debido a un menor reconocimiento de la enfermedad en las mujeres.

La edad: Los diagnósticos y las tasas de mortalidad son mayores para pacientes de mayor edad. Más de 8 de cada 10 muertes de EPOC ocurren en personas de más de 65 años.

La orientación sexual o identidad de género: Se están reportando mayores tasas de EPOC para personas de la comunidad LGBTQ+, con estudios que sugieren una correlación con mayores tasas de consumo de cigarrillo en las comunidades LGBTQ+.

Vivir con EPOC

Aunque no hay cura para las EPOC, existen tratamientos que son útiles para mejorar la calidad de vida, haciendo que sea importante obtener un diagnóstico preciso lo antes posible.

Personas que experimentan los síntomas que se mencionaron antes, en especial si fuman actualmente o lo hicieron en el pasado, pueden pedir a su proveedor de atención médica (HCP, por sus siglas en inglés) una prueba para detectar EPOC. Personas que han tenido una exposición significativa a contaminación del aire también deberían considerar someterse a estas pruebas.

Los proveedores de atención médica probarán la función pulmonar de los pacientes mediante una prueba de espirometría, lo cual implica respirar en un tubo adherido a una máquina. La máquina, conocida como un espirómetro, calculará cuánto aire exhalas en un segundo y cuánto exhalas en total. También podrían requerirse pruebas adicionales para confirmar un diagnóstico, tales como rayos equis o TC.

Tratamientos, tales como esteroides, biofármacos, inhaladores y nebulizadores, pueden ser útiles para minimizar los síntomas de las EPOC, dando a los pacientes más libertad para respirar y más energía. Si bien los tratamientos no revertirán las lesiones pulmonares existentes, estos pueden hacer que sea más fácil para los pacientes realizar sus actividades cotidianas. Los tratamientos también pueden ser útiles para reducir las hospitalizaciones y otras consultas médicas que resultarían de dificultad para respirar u otros problemas.

Se recomienda mucho a los pacientes con EPOC que dejen de fumar cigarrillos tradicionales o electrónicos si no lo han hecho ya. Mantenerse al día con las vacunaciones puede ser útil para que los pacientes eviten más lesiones respiratorias por enfermedades tales como la gripe o la neumonía.

Las personas que viven con EPOC también deberían considerar programas de rehabilitación pulmonar, los cuales proporcionan un apoyo integral en un entorno clínico y serán útiles para manejar los aspectos físicos y mentales de su condición. Un programa podría incluir ejercicios físicos, un plan nutricional, consejería de la salud mental y administración de medicamentos.

En casos más graves, podrían requerirse procedimientos quirúrgicos para remover tejido pulmonar lesionado o los pacientes podrían tener que llevar con ellos oxigenoterapia.

“Entre más pronto se diagnostique a alguien con EPOC, más pronto recibirá la atención que necesita”, dijo Wright. “Tratar EPOC en las primeras etapas puede ser útil para reducir el progreso de la enfermedad. La EPOC frecuentemente empeora con el tiempo, pero con el tratamiento adecuado, la enfermedad puede manejarse de mejor forma”.

Este recurso educativo se preparó en colaboración con COPD Foundation y con el apoyo de Regeneron y Sanofi.

From Your Site Articles

Related Articles Around the Web



Source link

Why Are Endometrial Cancer Rates Rising?



Venus* never forgot the advice her OB-GYN gave her after she went through menopause.

“If you ever have any kind of bleeding, see a doctor.”

Those words came to mind in February 2022 when Venus noticed a small amount of blood even though she was no longer getting periods. She quickly scheduled an appointment with her primary care physician.

That physician ordered an ultrasound, and when it came back, he told her she had no reason to worry — she didn’t have cancer. A few days later, however, Venus decided to ask for a second opinion during her routine OB-GYN appointment.

That provider ordered a biopsy. Within a week, Venus learned she had endometrial cancer.

Endometrial cancer on the rise

Endometrial cancer occurs when cancer cells enter the endometrium, or the lining of the uterus. Also known as uterine cancer, endometrial cancer is the
most common reproductive cancer among women or people assigned female at birth.

It’s also one of the few cancers with a rising mortality and diagnosis rate, with cases increasing about 1% each year in white women and 2%-3% each year in women in all other racial and ethnic groups. The American Cancer Society estimates that more than 67,000 new cases are diagnosed each year, and that 13,250 women each year will die from endometrial cancer.

Postmenopausal women are most at risk, with 60 being the average age of diagnosis. Black women are more likely to be diagnosed with endometrial cancer than white women — and they’re more likely to die from it.

Read: Why Are Black Women More Likely to Die from Endometrial Cancer? >>

Researchers have been working to figure out why endometrial cancer rates are rising for all women, and why
Black women have worse outcomes. One possible explanation may be that obesity rates have been rising since 1990. And obesity is a major risk factor for endometrial cancer, since fat tissue can increase estrogen levels.

Another factor researchers think could be connected to rising rates of endometrial cancer worldwide relates to lower birth rates and women giving birth for the first time at older ages. That’s because pregnancy and producing breast milk are protective factors against endometrial cancer.

One major discovery was that
two rare but aggressive forms of endometrial cancers called serous carcinoma and carcinosarcomaare more likely to be diagnosed in Black women than white women. And these cancers lead to worse outcomes than other forms of endometrial cancer. Black women also often have other factors that make their cancers more difficult to treat. They are more likely to have a subtype of uterine cancer with a specific mutation that is less likely to benefit from treatment. Almost 70% of Black patients had this higher-risk subtype, while just 35% of white patients did. In addition, Black women’s tumors often have fewer mutations. Tumors with fewer mutations are less likely to respond to certain forms of immunotherapy, meaning Black patients benefit less from these treatments that are highly effective for others.

“Serous carcinoma and carcinosarcoma are more aggressive types of uterine or endometrial cancers,” said Jayne Morgan, M.D., physician and healthy equity expert. “Having more aggressive types of endometrial cancer and cancers that have less opportunity to respond to immunotherapy are two factors making this cancer more deadly for Black women.”

Social determinants of health that can lead to worse outcomes for all conditions can also play a role in rising endometrial cancer diagnoses and mortality rates. A lack of access to healthcare because of socioeconomic factors like income, education and type of job, plus mistrust of the healthcare system, can lead to misdiagnosis or delayed diagnosis. So, by the time cancer is discovered, it could be at an advanced stage.

Obesity, Type 2 diabetes and lifestyles that don’t include a lot of physical activity can also raise the risk of developing endometrial cancer.

Know the symptoms of endometrial cancer

“The most common symptom of uterine cancer is abnormal vaginal bleeding,” Morgan said. “Certainly if you’re past menopause, if you’re having vaginal bleeding, that should be an alarm.”

Other symptoms can include heavier menstrual bleeding, more frequent periods, bleeding between periods and thickening of the uterine lining. Morgan said any lasting pelvic pain or pressure, unintended weight loss or urinary issues like frequent urination and difficulty urinating could also be warning signs.

“There are certain things women should look out for and think, ‘Oh, this could be something more serious,’” Morgan said. “[I’m] not saying it’s definitely endometrial cancer, but it’s something that could be a sign or a signal that they need to get this checked out more.”

A circle of support

Venus knows she could have been among the rising number of Black women with an advanced stage diagnosis.

Because she listened to her OB-GYN’s instructions about postmenopausal bleeding and sought a second opinion when she was told she didn’t have cancer, her healthcare providers (HCPs) were able to catch her endometrial cancer early — at stage IA. She had a full hysterectomy to remove her uterus but didn’t have to have chemotherapy. She’s been in remission ever since and sees her HCP every six months to make sure the disease hasn’t come back.

“I was blessed that I had that OB-GYN appointment scheduled,” Venus said. “As much as I appreciated the primary care doctor trying to move the process along, you shouldn’t give a diagnosis about cancer just by an ultrasound.”

Venus later learned that the primary care doctor was using a screening tool focused on the thickness of the uterine lining to determine whether a biopsy would be needed. Kemi Doll, M.D., a gynecologic oncologist with the University of Washington School of Medicine and founder of ECANA: Endometrial Cancer Action Network for African-Americans, led a study saying this tool often misses endometrial cancer in Black women.

Although Venus felt physically healthy after her diagnosis and surgery, the ordeal took a toll on her mental health. It was also difficult when her trusted OB-GYN and surgeon left the practice she used, and she had to find new providers.

Venus said ECANA was a significant source of support when she reached out and joined the organization late last year. When Venus found another HCP, she was comforted to learn that her new provider had worked with Doll in the past.

Venus has also found strength sharing her story to help other women gain more awareness about endometrial cancer.

“If you’re a woman who’s gone through menopause and you see any bleeding, make an appointment immediately,” she said. “Don’t put it off. If you’re only offered an ultrasound, ask for a biopsy. I’m so glad my gynecologist pushed for that. Only by the grace of God am I here to be able to talk about what I experienced.”

*Last name withheld for privacy reasons

This educational resource was created with support from Merck.

From Your Site Articles

Related Articles Around the Web



Source link

Racial Disparities in Lung Cancer Screening



Ayanay Ferguson knew something just wasn’t right with her body when she returned from vacation with her husband in April 2021.

“I had swollen ankles and shortness of breath,” recalled Ferguson, 50, an Atlanta-area clinical psychologist.

She initially thought her symptoms were from post-vacation fatigue and her weight. As her symptoms lingered, she booked a telehealth appointment with a doctor, who advised her to get her heart checked. An EKG in an emergency room at a nearby hospital came back normal, but a medical resident was concerned enough about some of her lab work results to look into it further.

“He said he had just read an article about how that particular blood test did not elevate in African Americans, when there was, in fact, an issue, and that’s what kept him looking for stuff,” remembered Ferguson. “That’s why he ordered a CT chest scan.”

The CT scan showed what was later found to be a cancerous mass in her right lung. The diagnosis: stage 3Anon-small cell adenocarcinoma. “I had cancer cells in some of my lymph nodes,” she says.

Read: Understanding the Different Types of Lung Cancer >>

The lung cancer diagnosis was a shock for Ferguson, who’d never been a cigarette smoker and did not have a family history of the disease, but she agreed to the aggressive treatment plan her thoracic surgeon ordered. The plan was for her to have surgery to remove the mass and four rounds of chemotherapy. Three years later, Fergurson proudly reports being cancer-free.

A growing body of research reveals that, as a Black person, she is especially lucky to have beaten the disease that kills more than 125,000 Americans a year — more than breast, colon and prostate cancers combined. Lung cancer is more difficult to treat in its advanced stages, so early detection through screening greatly increases a person’s chance of survival. Yet racial disparities exist.

Studies have found that Black lung cancer patients were 15% less likely than white patients to be diagnosed early and they had the lowest five-year survival rate of any racial group. Black Americans tended to develop lung cancer at higher rates and at younger ages than their white counterparts, despite smoking fewer cigarettes on average. According to the American Lung Association, the disease claimed the lives of more than 14,000 Black Americans in 2021, the most recent year for available data.

Addressing persistent disparities in lung cancer early diagnosis and survival rates is central to the work being carried out by Melinda Aldrich, M.D., an associate professor at Vanderbilt University Medical Center. The groundbreaking 2019 study she co-authored with five colleagues found that screening eligibility guidelines exclude Black smokers more than other people of other races. The healthcare industry has been slow to respond to the growing push to change that, including medical insurance companies that determine what is considered preventive care and covered at low or no cost.

Aldrich’s research found that the U.S. Preventive Services Task Force (USPSTF), the government group that sets screening guidelines, required that a person had to be between 55 and 80 years old and have smoked the equivalent of a pack a day for 30 years to qualify for a life-saving early detection screening known as a low-dose CT scan. In addition to these criteria, a person needs to be either a current or former smoker, and former smokers need to have quit within the prior 15 years. Aldrich’s analysis of more than 84,000 adult smokers revealed that under that criteria, Black patients at relatively high risk of lung cancer were being disproportionately excluded from the eligible screening pool. More than 2 out of 3 Black smokers who were diagnosed with lung cancer did not meet the age and smoking history criteria at the time of their diagnosis.

“Based on those guidelines, we saw that of people who were diagnosed with lung cancer, 68% of African American individuals … would not have been eligible for lung cancer screening. And this is in contrast to 44% of white Americans who would not be eligible,” she said. “So, [there are] strong racial disparities in terms of eligibility and who’s able to get in the door to be screened.”

The work of Aldrich and her co-authors was cited in a 2021 decision by the USPSTF to make two changes that have nearly doubled the number of people eligible for lung cancer screening — lowering the age from 55 to 50 and reducing the number of smoking history pack years from 30 to 20.

“They didn’t do exactly what we proposed: something that might be considered controversial, which is making a race-specific change in the guidelines,” she said. “They made the guideline changes for everyone. So, actually, the disparities remain. They just made more people eligible.”

Aldrich said raising awareness about the screening test that has been widely available for well over a decade now is critical to helping improve outcomes and survival rates for lung cancer patients, especially Black patients. Still, she said, the medical industry needs to answer the call to go a step further to allow more people to qualify for early screening based on additional risk factors, such as race and ethnicity and family history. “If you have a history of smoking, talk to your doctor about whether you’re eligible for lung screening,” advised Aldrich. “We also need to remove the stigma associated with smoking; we should unite the community rather than associating blame.”

Ferguson said that although race-specific screening guideline changes most likely would not have helped in her case as a nonsmoker, she supports the shift to expand screening eligibility. “I don’t care if you are 30 or 70. If you smoked every day for 10 years or more, you should be able to say to your doctor, ‘I want a lung cancer screening’ and get it,” she said. “It’s money spent on the front end and money saved on the back end. And more importantly, it’s going to save more lives.”

This educational resource was created with support from Merck.

From Your Site Articles

Related Articles Around the Web



Source link

Desigualdades raciales en las examinaciones de cáncer de pulmón



Ayanay Ferguson sabía que algo no estaba bien con su cuerpo cuando regresó de vacaciones con su esposo en abril de 2021.

“Mis tobillos estaban hinchados y tenía dificultades para respirar”, recuerda Ferguson, de 50 años, una psicóloga clínica del área de Atlanta.

Inicialmente pensó que sus síntomas eran fatiga causada por las vacaciones y su peso. Puesto que sus síntomas persistieron, programó una consulta de telesalud con un doctor que le recomendó que haga que evalúen su corazón. Un ECG en una sala de emergencias en un hospital cercano mostró resultados normales, pero un residente médico tenía preocupaciones acerca de algunos resultados de sus pruebas de sangre y recomendó evaluaciones adicionales.

“Dijo que acababa de leer un artículo acerca de cómo esa prueba de sangre específica no mostraba resultados anormales para afroamericanos, cuando había en realidad un problema y eso fue lo que le motivó a seguir haciendo evaluaciones”, recuerda Ferguson. “Por eso solicitó una TC del pecho”.

La TC mostró algo que después se descubrió que era una masa cancerosa en su pulmón derecho. El diagnóstico:Adenocarcinoma no microcítico de etapa 3A. “Tenía células cancerosas en algunos de mis ganglios linfáticos”, dijo.

Lee: Entender los varios tipos de cáncer de pulmón >>

El diagnóstico de cáncer de pulmón fue una sorpresa para Ferguson que nunca había fumado cigarrillos ni tenía antecedentes familiares del trastorno, pero estuvo de acuerdo con el plan agresivo de tratamiento que solicitó su cirujano torácico. El plan consistía en la remoción de la masa con una cirugía y cuatro rondas de quimioterapia. Tres años después, Fergurson con orgullo reporta no tener cáncer.

Cada vez más investigaciones revelan que, al ser una persona de raza negra, es especialmente afortunada por haber vencido a ese trastorno que mata a más de 125,000 estadounidenses al año, más que los cánceres de mama, colon y próstata en conjunto. El cáncer de pulmón es más difícil de tratar en etapas avanzadas, así que una detección temprana a través de examinaciones mejora en forma importante las probabilidades de supervivencia de una persona. Sin embargo, existen desigualdades raciales.

Estudios demuestran que pacientes de cáncer de pulmón de raza negra tienen un 15% menos probabilidades que pacientes de raza blanca de recibir diagnósticos tempranos y tienen la menor tasa de supervivencia a cinco años que cualquier otro grupo racial. Los estadounidenses de raza negra tienden a desarrollar cáncer de pulmón a mayores tasas y a menores edades que sus contrapartes de raza blanca, a pesar de fumar menos cigarrillos en promedio. Según la American Lung Association [Asociación estadounidense del pulmón], el trastorno tomó las vidas de más de 14,000 estadounidenses de raza negra en 2021, el año más reciente para el cual hay datos disponibles.

Abordar las desigualdades persistentes de diagnósticos tempranos y de tasas de supervivencia de cáncer de pulmón es el tema central del trabajo realizado por Melinda Aldrich, M.D., una profesora adjunta del Vanderbilt University Medical Center [Centro médico de la universidad Vanderbilt]. El revolucionario estudio de 2019 que realizó en colaboración con cinco colegas determinó que las pautas de elegibilidad de las examinaciones excluyen a fumadores de raza negra más que a otras personas de otras razas. La industria de la atención de la salud ha reaccionado con lentitud a la presión cada vez mayor para cambiar eso, incluyendo las compañías de seguros médicos que determinan qué se considera atención preventiva con cobertura a un costo reducido o en forma gratuita.

La investigación de Aldrich demostró que el Equipo de trabajo de servicios preventivos de EE.UU. (USPSTF, por sus siglas en inglés), el grupo gubernamental que establece las pautas de las examinaciones, requería que una persona tenga entre 55 y 80 años y haya fumado el equivalente a un paquete al día durante 30 años para ser elegible para una examinación vital de detección temprana conocida como TC de dosis bajas. Además de esos criterios, una persona debe ser fumadora o exfumadora y las personas exfumadoras deben haber dejado de fumar hace 15 años o menos. El análisis de Aldrich de más de 84,000 fumadores adultos reveló que bajo esos criterios, los pacientes de raza negra que tienen un riesgo relativamente alto de cáncer de pulmón estaban siendo excluidos desproporcionadamente del grupo elegible para examinaciones. Más de 2 de cada 3 fumadores de raza negra que recibieron diagnósticos de cáncer de pulmón no cumplían con los criterios de edad y de antecedentes de consumo de cigarrillos cuando recibieron su diagnóstico.

“En función de esas pautas, vimos que de las personas que recibieron diagnósticos de cáncer de pulmón, el 68% de personas afroamericanas … no cumplían con los requisitos para las examinaciones de cáncer de pulmón. Y esto contrasta con el 44% de estadounidenses de raza blanca que tampoco serían elegibles”, dijo. “Así que, [hay] desigualdades raciales importantes en términos de la elegibilidad y de quien tiene acceso a las examinaciones”.

El trabajo de Aldrich y sus colegas que escribieron el estudio se mencionó en una decisión de 2021 del USPSTF por el cual se implementaron dos cambios que casi duplicaron el número de personas elegibles para examinaciones de cáncer de pulmón, al reducir la edad de 55 a 50 años y al reducir el número de años-cajetilla de 30 a 20 en lo que se refiere a los antecedentes de consumo de cigarrillos.

“No hicieron exactamente lo que propusimos: algo que se puede considerar controversial, es decir, hacer un cambio para una raza específica en las pautas”, dijo. “Hicieron los cambios de la pauta para todos. Así que, de hecho, las desigualdades siguen existiendo. Simplemente hicieron que más personas sean elegibles”.

Aldrich dijo que concientizar acerca de las examinaciones que han estado ampliamente disponibles por más de una década es crítico para ayudar a mejorar los resultados y las tasas de supervivencia para pacientes de cáncer de pulmón, especialmente para pacientes de raza negra. A pesar de eso, dijo, la industria médica debe responder el llamado de dar otro paso para permitir que personas sean elegibles para examinaciones tempranas en función de factores de riesgo adicionales, tales como raza, etnicidad y antecedentes familiares. “Si tienes un historial de consumo de cigarrillos, habla con tu doctor acerca de tu elegibilidad para examinaciones pulmonares”, recomendó Aldrich. “También debemos remover el estigma asociado con el cigarrillo; deberíamos unir a la comunidad en vez de tratar de encontrar culpables”.

Ferguson dijo que aunque cambios de las pautas de examinaciones para su raza específica muy probablemente no lo hubiesen ayudado porque no es fumadora, apoya el cambio para incrementar la elegibilidad para las examinaciones. “No importa si tienes 30 o 70 años. Si fumaste todos los días durante 10 años o más, deberías poder decirle a tu doctor, ‘quiero una examinación de cáncer de pulmón’ y deberías obtenerla”, dijo. “Es dinero que se gasta en forma preventiva, pero que ahorra gastos mayores en tratamientos. Y más importante, eso salvará más vidas”.

Este recurso educativo se preparó con el apoyo de Merck.

From Your Site Articles

Related Articles Around the Web



Source link

Why Are Obesity Treatments Hard to Get?



When Oprah Winfrey announced in late 2023 that she’s taking weight-loss medication, it raised a lot of questions: Which drug is she taking? How long will she take it? What role should medicines play in reducing obesity?

How to pay for the drug was not likely a concern for the billionaire media mogul. But for many Americans living with obesity cost is a central concern when it comes to treatment.

Treatment for obesity has a long history, with a range of options, from preventive services and nutrition counseling to medications and surgery. Insurance coverage for this full range of obesity treatments varies by state, as do Medicaid benefits designed for people with lower incomes.

Watch: Obesity Is a Complex Disease with a Variety of Treatments >>

What’s behind rising obesity rates?

According to the most recent CDC data, 4 out of 10 adults in the U.S. are living with obesity, a rate that’s up from 3 out of 10 two decades ago.

The trends are even worse for some marginalized groups, like people with lower incomes, people living in rural areas and Black and Latinx communities. In addition to genetics, social determinants of health play a large role in determining risk of obesity.

“In underserved communities where toxic chronic stress and access to cheap, salty, sugary food are high, whether they have access to these medications or not, addressing obesity is challenging without policies to support healthier living in these neighborhoods,” according to Lisa Fitzpatrick, M.D., MPH, MPA, professorial lecturer at the George Washington University Milken School of Public Health.

Read: Social Determinants of Health, Health Disparities and Health Equity >>

Food is Medicine policies, designed to improve access to healthy food and reduce food deserts, are important and should be expanded, according to Fitzpatrick. But she points to challenges that include uneven access, limited awareness, and lack of structured long-term ways to figure out what the impact of these policies will be on chronic health conditions such as diabetes and heart disease.

“If you provide periodic food for people, is this enough to improve their health and keep them healthy?” Fitzpatrick asked.

Along with the nation’s increasing weight is a growing recognition among medical professionals that obesity is a medical condition that increases health risks, such as heart disease, diabetes, liver disease and some cancers, among other conditions.

At the same time as these shifts, newer anti-obesity medications (AOMs) have gained attention — and gotten FDA approval for use as a weight-loss treatment, not just treatment of diabetes or other diseases. Combined with lifestyle changes, AOMs can reduce body weight by as much as one-third. And research has shown that AOMs combined with lifestyle changes result in more weight loss than lifestyle changes alone.

But the promise of obesity medications can run into a brick wall: health insurance.

Barriers to access to obesity treatments

Health insurers don’t always cover weight-loss medications or other treatments for obesity. When they do, they often impose limitations and hurdles, such as having to prove that other treatments have failed before they’ll approve a new medication.

If you lose or switch your health insurance because of a job change, you’ll likely have to start the process all over again, which can keep you from being able to access medication or other needed services. If you become eligible for Medicare at age 65, you may lose access completely because Medicare does not cover weight-loss medications, except when prescribed specifically to prevent specific conditions, a recent coverage change.

Even with coverage, patients typically have to pay a share of the cost through copayments or coinsurance, which can be a few hundred per month. Without insurance coverage, AOMs can cost patients as much as $30,000 per year out-of-pocket.

Joy Tashjian, RN, BSN, has insurance but it doesn’t cover weight-loss medications.

She’s lost 25 pounds — about 1.5 pounds per week — since starting tirzepatide last November. Tashjian pays $550 out-of-pocket each month for the medicine.

“I’m very grateful that I’m able to afford it,” she said. “I can’t tell you what a difference the drug has made.”

Tashjian said she’s been overweight since age 5. She’s tried many diets since, starting at age 7, but only ever lost about a pound a month. This medication lets her lose weight without feeling intense hunger or experiencing constant “food noise.”

Though Tashjian does not have high blood pressure or cholesterol, diabetes, or other physical health issues associated with obesity, she said she has complex PTSD as a result of her weight.

“I was bullied, constantly receiving negative feedback from adults, teachers and supervisors — through my adult life, too,” she said. “I keep wondering how different my life would have been if this drug was available when I was growing up.”

Rachel*, 52, has health insurance coverage for her AOM because she has a diabetes diagnosis, a condition her medication is approved for. But she faces other challenges as a result of insurance rules.

Rachel’s health plan won’t let her re-order the drug until she uses the last injection. When she reorders, she bumps into supply shortages, leading to weeks of delay between doses. She said she’s gained weight back after initial losses, which her doctor thinks is because of her uneven access to the medicine.

According to experts, these medications are not designed for intermittent use. Once people stop taking an AOM, they can expect to regain the weight they had lost in relatively short order.

Fitzgerald said she worries that most people are unlikely to be able to take AOMs for life, which may be necessary to get the benefits. The risk of interrupted access to drugs points to an even greater need to pair medications with strategies such as a healthy diet and exercise.

“The medications should be seen as an [addition] to a lifestyle plan to prevent chronic health conditions, not just obesity,” Fitzpatrick said. “My hope is that many who benefit from these medications will simultaneously embrace lifelong prevention strategies, which admittedly is tough to do in our society. This way, if for some reason the medication is no longer available or tolerated for some reason, the person has a foundation to support continued healthy living.”

Another obstacle to obesity treatment is a healthcare provider shortage. Not only are specially trained obesity medicine specialists few and far between, more than 100 million Americans do not have access to a regular source of primary care.

“As with most health issues, primary care providers are the gateway to healthcare access so [obesity treatment] can be added to a long list of services for which people struggle with inadequate access,” Fitzpatrick said.

This educational resource was created with support from Eli Lilly, a HealthyWomen Corporate Advisory Council member.

*Name has been changed for privacy.

From Your Site Articles

Related Articles Around the Web



Source link