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By John Schieszer
Medical Minutes 

Higher cancer rates in Alaska Natives

Also: Stem cell treatment for shoulders, elbows


November 1, 2019

Better cancer screening may be warranted for Alaska Natives

Greater efforts are needed to improve cancer screenings for Alaska Natives, according to federal health officials. The nation’s American Indian and Alaska Native (AI/AN) population faces higher risk of many cancers than white Americans, with considerable variation among regional groups, according to a new study published in the journal, Cancer Epidemiology, Biomarkers & Prevention.

“Our data show that the American Indian and Alaska Native population has substantially higher rates for some cancers than white Americans, including lung, liver, kidney, colorectal and stomach cancers. Cancer incidence rates for many cancers also differ by geographic area,” said the study lead author, Stephanie C. Melkonian, PhD, who is an epidemiologist at the Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.

Melkonian said that geographic differences in cancer rates may be due to environmental, behavioral, or socioeconomic factors that differ for each group by area. However, most U.S. cancer statistics present American Indians and Alaska Natives as one large group. “Nationally aggregated data presents an incomplete picture because it obscures geographic differences in cancer incidence rates,” said Melkonian.

Melkonian and colleagues assessed data from the CDC’s National Program of Cancer Registries and the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program from the years 2010 to 2015. The researchers linked data from these cancer registries to Indian Health Services patient registration databases to identify cancer cases in the AI/AN population in six geographic areas: the Northern Plains, Alaska, Southern Plains, Pacific Coast, East, and Southwest regions.

Among men, the study showed that liver cancer was more than twice as common in the AI/AN population than in whites. Kidney and stomach cancer incidences were significantly higher for AI/AN men than white men in four out of six AI/AN regions. Among women, liver cancer incidence was more than three times higher for the AI/AN population than for whites. AI/AN women also had higher rates of lung, colorectal, kidney, cervical and stomach cancer.

“The data shows that the prevalence of certain cancer risk factors varies geographically, and is higher in the American Indian/Alaska Native population in some regions. Some important cancer risk factors include obesity, commercial tobacco use, and viral hepatitis,” Melkonian said. “However, some of the regional differences we discovered through our updated data were of most interest.”

Despite decreasing trends in colorectal cancer incidence, rates of colorectal cancer were higher in the AI/AN population in most regions, with the highest being in the Northern Plains, Southern Plains and Alaska. Overall, breast cancer rates were lower for AI/AN women than for white women, however, significant variation occurred across the country. The East, Southwest and Pacific Coast had much lower breast cancer rates for AI/AN women, while Alaska and the Southern Plains had considerably higher rates than white women.

Melkonian said the study indicates the importance of studying regional variations in cancer incidence in the AI/AN population in order to ensure a complete understanding of these groups’ cancer burden and identify where to implement targeted public health action. “These data can guide us on how to design tailored interventions to screen for and prevent many of these common cancers,” she said.

Do stem cell treatments for shoulders and elbows work?

Don’t believe all the hype you read about stem cell treatments. In some cases, it may be a total waste of money. The utilization of stem cell therapies for augmentation of tissue healing has far outpaced the supporting scientific and clinical data, largely due to aggressive marketing that has led to widespread and often inappropriate use of cell therapy approaches in the United States, according to researchers. Two critical reviews in the Journal of Shoulder and Elbow Surgery examine the current status of biologic approaches for common shoulder and elbow problems. The authors discuss areas where the current evidence base is weak or controversial and recommend where further studies are required.

There is significant interest in biologic treatment options to improve healing and reduce symptoms more rapidly in elbow and shoulder injuries, such as osteoarthritis, tendinopathy, ligament injuries, and other inflammatory conditions. However, there is uncertainty among physicians and patients about what works and what does not since many of these treatments are still unproven.

A large number of patient-specific factors affect the composition and biologic activity of products, including age, sex, medical comorbidities, concomitant medications, and genetic and epigenetic factors. These variables, as well as unpredictability of the biologic product, are then added to the variability of the underlying pathology being treated.

The authors review several biologic agents, including platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), and mesenchymal stromal cells (MSCs) derived from adipose tissues, in order to provide medical specialists and their patients with up-to-date clinical data and stimulate further research in this important and growing area of musculoskeletal medicine. They conclude that these treatments have great potential based on laboratory studies demonstrating a positive effect of these materials on the basic biology of tissue healing. However, the clinical data for their use in both shoulder and elbow pathologies are very limited. The authors point out that a serious limitation is the significant variability and heterogeneity among these biologic formulations.

Rotator cuff tears occur in more than 20% of the general adult population, with a progressively higher incidence as age increases, while shoulder osteoarthritis has been estimated to affect up to 33% of individuals over 60.

Author Bio

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John Schieszer is an award-winning national journalist and radio and podcast broadcaster of The Medical Minute.

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