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INFORMATION FOR

Cancer Prevention Month 2021

February 15, 2021
  • 00:00Support for Yale Cancer Answers
  • 00:02comes from AstraZeneca, dedicated
  • 00:05to advancing options and providing
  • 00:07hope for people living with cancer.
  • 00:10More information at astrazeneca-us.com.
  • 00:14Welcome to Yale Cancer Answers with
  • 00:16your host doctor Anees Chagpar.
  • 00:18Yale Cancer Answers features the
  • 00:20latest information on cancer care by
  • 00:23welcoming oncologists and specialists
  • 00:24who are on the forefront of the
  • 00:26battle to fight cancer. This week,
  • 00:28it's a conversation about outcomes research
  • 00:30in kidney cancer with Doctor Michaela Dinan.
  • 00:32Doctor Dinan is an
  • 00:34associate professor in chronic disease
  • 00:36Epidemiology at the Yale School of
  • 00:38Public Health and Doctor Chagpar
  • 00:40is a professor of surgical oncology
  • 00:43at the Yale School of Medicine.
  • 00:46Michaela, maybe we can start
  • 00:48off by you telling us a little
  • 00:50bit more about yourself and
  • 00:52what exactly you do.
  • 00:53I call myself a cancer outcomes or
  • 00:55health services researcher so people
  • 00:57aren't always familiar with cancer
  • 00:59outcomes or health services research.
  • 01:01They tend to be more familiar with
  • 01:03basic or clinical Cancer Research.
  • 01:05Basic Cancer Research relates to
  • 01:07studies done in a lab with cancer cells,
  • 01:10either in a Petri dish or in animals
  • 01:12where researchers can directly manipulate
  • 01:14and study cancer cells to learn
  • 01:16more about basic biology of cancer.
  • 01:19And then, clinical Cancer Research refers
  • 01:21to when advances in basic science are
  • 01:24being translated into actual medical
  • 01:25tests or treatments and are then
  • 01:28tested in humans to see if they work.
  • 01:30My focus of research health services
  • 01:32is the part that comes
  • 01:35after this, after a new medical
  • 01:37treatment or diagnostic tool is
  • 01:38found to work in clinical trials,
  • 01:41I study how it actually gets
  • 01:43used in the real world.
  • 01:44You have to remember that only around 3% of
  • 01:48patients are treated on a clinical trial.
  • 01:50And other people who take part
  • 01:52in clinical trials are not like
  • 01:54the general cancer population.
  • 01:56In order to be enrolled in a clinical trial,
  • 01:58you have to be healthy enough to
  • 02:01qualify for participation and every
  • 02:02clinical trial has a set of very strict
  • 02:04inclusion and exclusion criteria.
  • 02:06And if you don't meet every single one,
  • 02:09you can't participate as you can imagine,
  • 02:11the vast majority of patients who receive
  • 02:13treatment are not part of a clinical trial,
  • 02:16so trial participants don't look
  • 02:18like everyone else who gets treatment
  • 02:20for their cancer in the real world.
  • 02:22Many people that are not included
  • 02:24in trials are often older adults.
  • 02:26People who have other medical
  • 02:28conditions or people who don't live
  • 02:31near an academic Medical Center or
  • 02:33who can't make all the extra visits
  • 02:35that are often required,
  • 02:37or people that don't otherwise want to
  • 02:39participate in trials for some reason.
  • 02:41Health Services Research,
  • 02:42which is what I do,
  • 02:44looks at how cancer treatments
  • 02:46happen quote in the real world.
  • 02:48So for example,
  • 02:49we get to ask questions like how is
  • 02:52cancer treated within the entire
  • 02:54country as opposed to just one center?
  • 02:56Who has access to new treatments?
  • 03:01What are the outcomes associated
  • 03:03with these new treatments?
  • 03:04How much does it cost to
  • 03:06get these treatments?
  • 03:07And are there racial or economic or
  • 03:09other disparities in access to cancer care?
  • 03:17Wow, I mean that sounds so relevant
  • 03:19because when you think
  • 03:22about the subpopulation, as you say,
  • 03:24who get treated on clinical trials
  • 03:27being so small and yet the outcomes
  • 03:29of those clinical trials are
  • 03:32applied to the entire population,
  • 03:34it seems to be particularly important
  • 03:36to see what happens out there in
  • 03:39the real world on patients who
  • 03:42may not have looked exactly like
  • 03:44the people who were in the trials.
  • 03:48Yes, that's exactly right.
  • 03:49And the other point about clinical
  • 03:51trials is that they tend to be
  • 03:53highly controlled settings, right?
  • 03:54So patients who are participating
  • 03:56in a clinical trial not only have
  • 03:58they gone through the litany
  • 03:59of inclusion exclusion criteria
  • 04:00that I've already mentioned,
  • 04:02just to be enrolled,
  • 04:03but once they are enrolled they are very
  • 04:05closely monitored and followed in
  • 04:07terms of their treatment and their
  • 04:09outcomes that someone is
  • 04:11keeping a very watchful eye on them.
  • 04:13This is very different from a patient
  • 04:15in the real world who's kind of
  • 04:17coming into and going out of the
  • 04:19healthcare system on a regular
  • 04:21basis and may not be being followed
  • 04:22as closely.
  • 04:25So tell us a little bit more about
  • 04:27your more recent research and what
  • 04:29you've been doing in this realm.
  • 04:32Sure, right now
  • 04:35I currently have a study funded by
  • 04:37the National Cancer Institute to look
  • 04:40at oral Anti cancer agent utilization
  • 04:42in patients with kidney cancer.
  • 04:45So kidney cancer, like most cancers,
  • 04:48can either be early stage or
  • 04:50more advanced stage.
  • 04:52Stage refers to how far a cancer has
  • 04:56spread throughout a person's body.
  • 04:58So for kidney cancer, early stage
  • 05:00disease is confined to the kidney.
  • 05:03Whereas for advanced or metastatic disease,
  • 05:05the disease has learned to travel
  • 05:07through the bloodstream and has
  • 05:09spread to other parts of the body,
  • 05:11such as the lungs, bones or brain.
  • 05:15So early stage disease is typically treated
  • 05:18with a surgery or if it's small enough,
  • 05:23or in an elderly or unhealthy person,
  • 05:24it is sometimes just observed.
  • 05:26Advanced kidney cancer for most
  • 05:29patients is not curable.
  • 05:31However,
  • 05:31the treatments for advanced kidney cancer
  • 05:34have improved dramatically in recent years.
  • 05:36One of the biggest changes has
  • 05:38been the development of these oral
  • 05:40cancer treatments or pills that
  • 05:42target kidney cancer to help shrink
  • 05:44or delay its growth.
  • 05:46These oral cancer treatments have been
  • 05:49allowing people to live years longer,
  • 05:51even for people who have what
  • 05:54traditionally would have been
  • 05:55considered incurable kidney cancer.
  • 05:58However,
  • 05:58these oral treatments are relatively
  • 06:00new to kidney cancer.
  • 06:02The first oral agents for kidney
  • 06:05cancer became available or were
  • 06:07approved by the FDA in 2005 and 2006,
  • 06:10but with many similar treatments
  • 06:12having been discovered since then.
  • 06:15In fact now
  • 06:17the 10 first new drugs approved
  • 06:19for kidney cancer in recent years,
  • 06:217 out of 10 were oral agents.
  • 06:25The interesting thing about oral
  • 06:27anti cancer agents is that they
  • 06:29represent a shift from how cancer
  • 06:31treatment used to be delivered.
  • 06:33So as most folks know, cancer treatment
  • 06:36used to be almost always intravenous
  • 06:39or given by injection at the hospital.
  • 06:43So you know it required patients to
  • 06:45come to a cancer hospital or clinic
  • 06:47in order to receive treatment.
  • 06:49However,
  • 06:49oral agents are picked up by the
  • 06:52patient from the pharmacy and taken home,
  • 06:54and unlike intravenous treatments,
  • 06:55these oral agents are not taken
  • 06:58in front of a medical staff.
  • 06:59Instead,
  • 07:00they are taken at home by the patients
  • 07:02when patients come to a cancer clinic
  • 07:04and receive an intravenous chemotherapy,
  • 07:06obviously, the doctors know that
  • 07:08they're getting the treatment there.
  • 07:10The same is not necessarily
  • 07:11true for oral agents,
  • 07:13however.
  • 07:13Patients can forget to take
  • 07:15their medications.
  • 07:16They can forget or delay
  • 07:17refilling their prescriptions.
  • 07:18They may not follow the
  • 07:20instructions as to when and how
  • 07:22to take their medications exactly,
  • 07:24or they may choose to stop taking
  • 07:26their medication altogether,
  • 07:27particularly if they are concerned that
  • 07:29they might be having side effects from it,
  • 07:31or if the cost of filling the
  • 07:34prescription is too high.
  • 07:35So my current research has been
  • 07:37looking at the use of these oral anti
  • 07:40cancer agents and kidney cancer.
  • 07:41I'm looking at things like
  • 07:43who are receiving them.
  • 07:45Are there any racial or economic
  • 07:46disparities in access to these drugs?
  • 07:48Are patients doing as well as they did in
  • 07:51clinical trials when taking these drugs?
  • 07:53Because like we were just talking about,
  • 07:55when a patient when these drugs were
  • 07:57being first studied in a clinical trial,
  • 07:59they were being studied in a
  • 08:01highly controlled setting,
  • 08:02whereas now in the real world,
  • 08:04patients are on their own,
  • 08:06taking them at home,
  • 08:07and then finally,
  • 08:09I'm interested in questions
  • 08:10like can patients
  • 08:12afford to continue taking these
  • 08:13drugs based on the cost?
  • 08:15Those all sound like really
  • 08:17interesting questions.
  • 08:18What have you found?
  • 08:22What's interesting is that we have
  • 08:25found that by 2015 a little over 1/3
  • 08:28of patients with kidney cancer with
  • 08:30renal cell carcinoma specifically,
  • 08:32which is a subset of kidney cancer,
  • 08:35were receiving an oral anti cancer
  • 08:38agent for their advanced kidney cancer.
  • 08:41We know that previous studies have
  • 08:44shown that black patients have
  • 08:46had about a 10% worse mortality
  • 08:48associated with kidney cancer,
  • 08:50and we know that this
  • 08:52difference is not improved with
  • 08:54the introduction of these
  • 08:55oral anti cancer agents.
  • 08:57We wanted to see if access to these drugs
  • 09:00was a potential driver of these disparities.
  • 09:03Surprisingly,
  • 09:03when we looked we didn't see any difference
  • 09:06in access to these drugs by race,
  • 09:09ethnicity or any other indicators
  • 09:11of socioeconomic status.
  • 09:12However,
  • 09:12we did see decreased use in these
  • 09:15oral agents in patients who were
  • 09:17unmarried, patients who were living
  • 09:19in the South, and patients who
  • 09:22were in older age groups and in
  • 09:24this specific patient population
  • 09:26that means patients who
  • 09:29were in the age group 80 plus.
  • 09:32We were surprised to see that
  • 09:34access to these drugs was not
  • 09:36different by race or ethnicity,
  • 09:38so we next wanted to see if something
  • 09:40else could be driving disparities in
  • 09:42kidney cancer outcomes that we know exist.
  • 09:45So we looked at adherence to these
  • 09:47medications and what we observed
  • 09:49was that about half of the patients
  • 09:51we studied were adhering to the
  • 09:53medication during the first
  • 09:55three months of their treatment.
  • 09:57So we were interested in the patients
  • 09:58who live in areas with
  • 10:00high levels of poverty were much less
  • 10:02likely to take their medication almost
  • 10:04half as likely as those who did not
  • 10:07live in high poverty neighborhoods.
  • 10:09Also,
  • 10:09we found that patients that had to pay more
  • 10:12than $200 a month for their medications
  • 10:15they were about 30% less likely
  • 10:17to be adherent as compared to
  • 10:18patients paying less than $200
  • 10:20a month for their medication.
  • 10:22So when we take a step back from all this,
  • 10:26what we think we're seeing is
  • 10:28that although poor patients are
  • 10:30able to start these drugs because
  • 10:32we're not seeing any difference
  • 10:34in their initiation,
  • 10:35they may not be able to continue to
  • 10:38take them or to continue to take them
  • 10:41as often as they are prescribed,
  • 10:44because we're seeing decreases in
  • 10:46the adherence to these drugs and
  • 10:49that could be affecting the
  • 10:51differential outcomes that
  • 10:53we know exist in patients with kidney cancer.
  • 10:55So when you control
  • 10:58for socioeconomic status and
  • 11:01you look at the impact on race
  • 11:04did you find that that was a
  • 11:07driver that
  • 11:10mediated the relationship
  • 11:11between race and outcomes?
  • 11:15I think that
  • 11:21is a good interpretation of
  • 11:22what we're seeing, right?
  • 11:23So I think what you're asking is,
  • 11:26when you look at everything
  • 11:28in the same model,
  • 11:30we're seeing that yes,
  • 11:32poverty is driving this measure
  • 11:34of adherence, but we're not
  • 11:36seeing an association with race,
  • 11:38but I think what you're
  • 11:40getting at, which is correct,
  • 11:42is that the kind of
  • 11:44interaction between race and poverty,
  • 11:46those are two very closely
  • 11:49related.
  • 11:53So yes, seeing an association
  • 11:55in one might be attenuating
  • 11:57the association in the other.
  • 12:00Did you look at that?
  • 12:03The reason I ask is
  • 12:07because we've seen a similar thing
  • 12:10across a number of disease sites.
  • 12:12I did a study just recently
  • 12:15looking at breast cancer survivors
  • 12:17and their use of endocrine therapy,
  • 12:21which is also an oral agent that
  • 12:24women take for at least five years
  • 12:27and very similar to your findings,
  • 12:30did not find that there was
  • 12:33necessarily a difference by race,
  • 12:35which we had thought might have been
  • 12:37a factor when looking at whether
  • 12:40people took these medications,
  • 12:42but we we were looking at the question
  • 12:45of did you not take this medication
  • 12:48as prescribed due to cost and we
  • 12:51thought there may be a
  • 12:54racial disparity in terms of that.
  • 12:56But when we looked at it,
  • 12:58we didn't find a racial disparity
  • 13:01but really found a
  • 13:02difference very much as you say
  • 13:05in terms of poverty and in terms of
  • 13:08whether or not people had insurance.
  • 13:11I'm wondering if
  • 13:14you controlled for poverty
  • 13:17and whether we still see a
  • 13:19difference in outcomes between black
  • 13:21patients and Caucasian patients.
  • 13:23So in our city we did not
  • 13:26see a difference by race,
  • 13:28but we did see a difference by poverty.
  • 13:31So by both indicators of poverty and
  • 13:34race were in the model and the
  • 13:38association by race, as you said,
  • 13:41for your city was not significant where it
  • 13:44was for the indicators of poverty level.
  • 13:48Does that make sense?
  • 13:49So even though they were
  • 13:50both in the model race,
  • 13:51we did not find an association with race,
  • 13:54but we did with poverty,
  • 13:55and I guess the point that I was
  • 13:57trying to make earlier is that
  • 13:59we know you that
  • 14:01unfortunately, in this country,
  • 14:04poverty differentially impacts folks
  • 14:12by race and ethnicity.
  • 14:14This is such an
  • 14:16interesting conversation,
  • 14:17but we need to take a short
  • 14:19break for a medical minute.
  • 14:21Please stay tuned to learn more
  • 14:24about cancer prevention with
  • 14:25my guest Doctor Michaela Dinan.
  • 14:27Support for Yale Cancer Answers
  • 14:29comes from AstraZeneca, working
  • 14:31to eliminate cancer as a cause of death.
  • 14:34Learn more at astrazeneca-us.com.
  • 14:38This is a medical minute
  • 14:40about colorectal cancer.
  • 14:41When detected early,
  • 14:42colorectal cancer is easily treated
  • 14:45on highly curable and as a result
  • 14:47it's recommended that men and women
  • 14:50over the age of 50 have regular
  • 14:52colonoscopies to screen for the disease.
  • 14:55Tumor gene analysis has helped
  • 14:57improve management of colorectal
  • 14:58cancer by identifying the patients
  • 15:01most likely to benefit from
  • 15:03chemotherapy and newer targeted agents,
  • 15:05resulting in more patient
  • 15:07specific treatments.
  • 15:08More information is available
  • 15:10at yalecancercenter.org.
  • 15:11You're listening to Connecticut Public Radio.
  • 15:15Welcome
  • 15:15back to Yale Cancer Answers.
  • 15:18This is doctor Anees Chagpar and
  • 15:20I'm joined tonight by my guest Doctor
  • 15:23Michaela Dinan and we're talking
  • 15:25about cancer prevention and more,
  • 15:28specifically, right before the break
  • 15:31Michaela you were telling
  • 15:32us about your research
  • 15:34looking at disparities that we
  • 15:36see in outcomes between African
  • 15:38American patients and Caucasian
  • 15:40patients with regards to kidney
  • 15:43cancer and renal cell cancer.
  • 15:45In particular,
  • 15:46you were looking specifically
  • 15:49then at oral agents and found that really
  • 15:53race was not a driver of adherence,
  • 15:56but really poverty was, so a
  • 15:59couple of questions.
  • 16:00Has anybody gone back and looked at the
  • 16:04correlation between race and outcomes?
  • 16:07That kind of drove your research to
  • 16:11begin with and took a step back and said
  • 16:15uncoupling that from poverty is
  • 16:18it really poverty
  • 16:19that is the driver of those outcomes,
  • 16:23or is it really race and the poverty
  • 16:27by association with nonadherence
  • 16:29is a separate issue?
  • 16:33Yeah, so the overall question of
  • 16:36why is there differential outcomes for
  • 16:39patients of black race with kidney cancer?
  • 16:42That's a bigger question and the studies
  • 16:45that have looked at that question
  • 16:47some of them have certainly
  • 16:50included measures of poverty in them and
  • 16:53have still found a significant association
  • 16:55between race and outcomes as well.
  • 16:57You're right and
  • 16:59our study was specifically a
  • 17:03subset of that question.
  • 17:05Because we were specifically
  • 17:07interested in
  • 17:09how are oral anti cancer agents either
  • 17:12contributing or not contributing to this
  • 17:15kind of pre observed disparity that
  • 17:18we've seen in kidney cancer patients?
  • 17:21So because oral anti cancer agents
  • 17:24were a relatively knew technology
  • 17:27in the kidney cancer space,
  • 17:29we wanted to see whether or not
  • 17:33they were contributing
  • 17:35to an attenuation of
  • 17:37this disparity in outcomes,
  • 17:39or whether it was contributing
  • 17:41to a potential widening of
  • 17:44these disparities in outcomes.
  • 17:46Because
  • 17:47previous research of both mine
  • 17:50and other folks looking at the
  • 17:53emergence of medical technologies
  • 17:55and cancers has shown that
  • 17:57sometimes it can go either way.
  • 18:00It can either help mitigate disparities
  • 18:03or sometimes it can help widen disparities
  • 18:06if there's
  • 18:07an additional element of decreased
  • 18:09access for certain populations.
  • 18:12The other question that
  • 18:14I had was when we were talking earlier
  • 18:17before the break about the whole
  • 18:20concept of health services research,
  • 18:22one of the really important points you
  • 18:25made is that health services
  • 18:28research really looks at real world
  • 18:30outcomes as opposed to trials.
  • 18:33And clinical trials sadly do not necessarily
  • 18:38include the population at large,
  • 18:41and so when we think about clinical trials,
  • 18:46particularly with oral agents
  • 18:48for kidney cancer,
  • 18:50did those include African American patients,
  • 18:54and were the outcomes in those
  • 18:58African American patients equivalent
  • 19:01to Caucasian patients?
  • 19:04I mean, could that partly explain
  • 19:07some of these disparities as well?
  • 19:09That's a great question,
  • 19:12and again, it points to a broader
  • 19:15issue where clinical trials in
  • 19:18general struggle to be representative
  • 19:21of the general population,
  • 19:24and there are certainly efforts
  • 19:26to make those clinical trials more
  • 19:29representative of the general population.
  • 19:31But that's something that continues to be
  • 19:38addressed and certainly race is 1
  • 19:41area where there have been efforts
  • 19:43to make them more representative.
  • 19:46I think 1 area where trials continue to
  • 19:48struggle with their representativeness
  • 19:50is with older populations,
  • 19:53and I think that's something that's
  • 19:55particularly relevant to cancer
  • 19:57patients because a lot of cancers tend
  • 20:00to have median age of diagnosis
  • 20:03for the 65 plus patient population,
  • 20:06and yet those people tend to be very
  • 20:10under represented in trials.
  • 20:13For instance,
  • 20:14I think one great example of this is
  • 20:19with an you emerging medical
  • 20:21technology which is relevant to
  • 20:24kidney cancer but also other
  • 20:27cancers are immunotherapies
  • 20:29or immune checkpoint inhibitors.
  • 20:31And again,
  • 20:32older folks in those clinical
  • 20:34trials are under represented and
  • 20:37yet there's this kind of assumption
  • 20:40that these immune checkpoint inhibitors
  • 20:43are going to be less toxic than
  • 20:45the standard or previously
  • 20:49used cytotoxic chemotherapies.
  • 20:51And so you know,
  • 20:52a lot of physicians have been operating
  • 20:55under the assumption that the toxicity
  • 20:59profiles of these immune oncology
  • 21:02agents is less than traditional
  • 21:04therapies and so have been more
  • 21:07willing to give these therapies
  • 21:09to older patients and yet it's
  • 21:11not really based on clinical trial
  • 21:14data because that clinical trial
  • 21:16data doesn't readily exist,
  • 21:18and so one of the things I'm interested
  • 21:20in potentially looking at in the
  • 21:24future is real world utilization of
  • 21:26these drugs in patients who were again
  • 21:29not going to be represented and in
  • 21:32standard trials and whose outcomes,
  • 21:34whose toxicity profiles may look very
  • 21:37different than what is typically
  • 21:39seen in a trial.
  • 21:41I think that
  • 21:43it's so important,
  • 21:45especially when we think about the
  • 21:47fact that these drugs may affect
  • 21:50different people differently, right?
  • 21:52I mean, I think we've seen this even
  • 21:55in the cardiology world back in the
  • 21:58day when only men were included in
  • 22:01some of the the heart attack trials
  • 22:04and we realized that women's
  • 22:07heart attacks present differently
  • 22:09than men's heart attacks and
  • 22:11drugs may affect different
  • 22:13genders differently,
  • 22:14and similarly we may find that
  • 22:16there are differences based
  • 22:18on race and other things,
  • 22:20and so trying to tease out what really
  • 22:24is at the root of these disparities,
  • 22:28it really does require some as you call
  • 22:31it real world kind of investigation.
  • 22:35Yes, and this is all
  • 22:39so relevant right now in the times
  • 22:43of COVID-19 where we have this very big need
  • 22:49to get vaccines approved and treatments
  • 22:52approved as quickly as possible.
  • 22:54But again, we already know that COVID-19
  • 22:58is affecting
  • 23:02minority racial and ethnic patients
  • 23:04differently than it is white patients.
  • 23:08We know that there's differential
  • 23:11outcomes.
  • 23:15we know that there are differential outcomes.
  • 23:28Covid is affecting
  • 23:31minority patients much more severely
  • 23:34than it is Caucasian patients.
  • 23:36What I think is really important,
  • 23:39thinking about COVID-19 is that
  • 23:41you know the clinical trials
  • 23:44that were done really did have a
  • 23:47reasonably robust representation of
  • 23:49minority patients
  • 23:52and so it's led us to believe
  • 23:55that the vaccines should work equally
  • 23:58efficaciously for minority patients.
  • 24:01For African American patients,
  • 24:03as it should for Caucasian patients.
  • 24:06But bringing it back to kind
  • 24:09of health services
  • 24:11research and real world science is
  • 24:14this vaccine hesitancy
  • 24:17and the fact that we're seeing,
  • 24:20at least by anecdote, that
  • 24:23there may be more reluctance
  • 24:25to really embrace the vaccine
  • 24:28amongst African Americans,
  • 24:30who sadly are the most affected and who
  • 24:35probably could use the vaccine the most.
  • 24:41So how do you
  • 24:42address that in terms
  • 24:46of trying to understand
  • 24:50data from clinical trials
  • 24:52are applied in the real
  • 24:54world?
  • 24:56Yeah, it's an interesting
  • 24:57conundrum.
  • 24:59I think that in terms of people's
  • 25:03willingness to take a vaccine,
  • 25:05their willingness to kind of accept data
  • 25:08from clinical trials as relevant to them
  • 25:11I think that that largely depends on the
  • 25:14messaging and inconsistent messaging.
  • 25:17I think that part of the problem is that
  • 25:21some of these issues
  • 25:24are incredibly entrenched and
  • 25:26systemic issues that are longstanding
  • 25:29for some of these populations, right?
  • 25:31And so
  • 25:34they're not specific to necessarily
  • 25:36one vaccine or one trial,
  • 25:37but generations of a health care
  • 25:40system that hasn't necessarily always acted
  • 25:43in their best interest, right?
  • 25:46So I think just going forward
  • 25:49a consistent message of
  • 25:51representation for everyone
  • 25:53concerned for everyone,
  • 25:54I think is going to be really important
  • 25:57and I think that that's true of Covid.
  • 26:01I think that's true of cancer,
  • 26:04because one of the issues that we're
  • 26:06talking about today is cancer
  • 26:08prevention and some of the most important
  • 26:11factors for cancer prevention are things
  • 26:14that have been long known as perhaps
  • 26:17one area where there's not been a
  • 26:19ton of really large steps and advances, but
  • 26:24things like not smoking things like
  • 26:28maintaining a healthy weight,
  • 26:29eating a healthy diet
  • 26:31these are kind of the standards of
  • 26:34cancer prevention across the board,
  • 26:36and again, it's certain
  • 26:38messaging to different
  • 26:40populations to make sure that
  • 26:42they are receiving the message.
  • 26:44Make sure that they understand
  • 26:46how important it is.
  • 26:48It is something that needs to be considered.
  • 26:53I think your point about
  • 26:56systemic racism and the
  • 26:58absolutely important tragedies that
  • 27:00have happened in the US health
  • 27:03care system over centuries really,
  • 27:05that has propagated the lack
  • 27:08of trust for minority populations
  • 27:10in clinical trials is going to
  • 27:13be a hard mountain to climb,
  • 27:16but I think it is so important,
  • 27:19particularly when we think about not
  • 27:22only therapeutics and but as you say,
  • 27:25about prevention.
  • 27:26Whether we're talking about Covid
  • 27:28or whether we're talking about
  • 27:31cancer and so really thinking about all
  • 27:34of the ways that we can prevent cancer,
  • 27:38February being Cancer Prevention Month,
  • 27:40have we seen any impact in terms
  • 27:43of really driving forward
  • 27:45some of those behaviors?
  • 27:47Some of those primary prevention
  • 27:50techniques that all of us know about
  • 27:53in terms of cancer prevention.
  • 27:56Are we making a dent?
  • 27:59I think so.
  • 28:03There's a long way
  • 28:05to go and I think there's a lot more
  • 28:08to be done in those
  • 28:10primary areas that you mentioned.
  • 28:12But for a lot of cancers we do see
  • 28:15that the incidence of cancer is going down,
  • 28:17not for all of them, but
  • 28:20for some of them. Smoking
  • 28:21related cancers to some extent
  • 28:23it kind of fluctuates a little bit,
  • 28:26but for sure we're seeing
  • 28:27some improvements there.
  • 28:31One of the easiest things to do
  • 28:32for younger boys and girls is
  • 28:34to make sure that they received
  • 28:36their HPV vaccinations in
  • 28:38the terms of cancer prevention,
  • 28:40and certainly since
  • 28:42the HPV vaccination has come on the scene,
  • 28:45we've certainly seen decreases
  • 28:46in HPV related cancers associated
  • 28:48with utilization of that vaccine.
  • 28:51And then the other area is that
  • 28:53we're seeing this kind of
  • 28:56increase in the number of cancer survivors,
  • 28:59so even folks who are unfortunate to
  • 29:02receive a diagnosis, cancer survival
  • 29:04for many cancers is going up as well,
  • 29:07and I think some of that you
  • 29:09know a lot of that,
  • 29:11is attributable to these advances
  • 29:14in diagnostic or treatment technologies.
  • 29:16But to some extent as well
  • 29:18people trying to,
  • 29:20you know, reduce or quit smoking,
  • 29:22eat healthier diets,
  • 29:23maintaining a healthy body weight.
  • 29:25All of these things are
  • 29:27only going to help.
  • 29:29Doctor Michaela Dinan is an associate
  • 29:31professor of chronic disease Epidemiology
  • 29:33at the Yale School of Public Health.
  • 29:36If you have questions,
  • 29:37the address is canceranswers@yale.edu
  • 29:39and past editions of the program
  • 29:41are available in audio and written
  • 29:43form at yalecancercenter.org.
  • 29:45We hope you'll join us next week to
  • 29:47learn more about the fight against
  • 29:50cancer here on Connecticut Public Radio.