Healthcare in S.C.

Welcome to This Week in
South Carolina. I’m Gavin Jackson. Healthcare costs
continue to rise several rule hospitals have
clothes and South Carolina continues to rank
near the bottom when it comes to overall health
of its citizens. But the release of a new cancer
report and a rise in medical technology shows
there is reason to be hopeful. South Carolina is
ranked thirty six in the country for health care
by U.S. News. Things like medical access, health care
quality and public health factor into the score.
Despite being ranked the fourteenth most obese
state and having fewer rural healthcare
facilities. A new report looks at cancer rates
in South Carolina as a bright spot for the
Palmetto State. The South Carolina Cancer Alliance
released a twenty year trend report on incidents,
mortality and survival which showed more people
are surviving lung, breast, prostate and colon
cancers in South Carolina. The only cancer that has
seen increased mortality rates is Melanoma. The
skin cancer that is the fifth most commonly
diagnosed cancer. Not all cancer can be
prevented, but there are steps people can take to
limit the risks, regular checkups for those with a
family history of cancer are important as our
lifestyle factors such as limiting some exposure to
unprotected skin, quitting smoking, drinking alcohol
in moderation, eating healthy and being
physically active. Chronic diseases like cancer,
heart disease and diabetes are the leading
causes of death and disability in the United
States. And treating them account for ninety
percent of the nation’s three point three
trillion dollars in healthcare costs, which
are covered in part by ever increasing insurance
premiums that continue to climb to record levels.
While insurance costs continue to rise, the amount of
rural hospitals in South Carolina has shrunk in
places including Bamberg, Winnsboro, Bennettsville
and Barnwell over the past nine years. And a
shortage of primary care doctors exists in every
county except one in our state. Meanwhile nurse
practitioners and physician assistants have
been approved to provide more services to fill the
increasing gap. Joining us to discuss the
state health care in South Carolina is Doctor
Romela Petrosyan a South Carolina of Medical
Association Resident, Fellow Physician and also
an American Medical Association Delegate. And
from the Arnold School of Public Health at the
University of South Carolina Dr Anthony Alberg
is here to discuss the twenty year cancer report.
Thank you both for being here. Dr. Alberg I want to
start off with you looking at this big
report that came out. Tell us some of the top
line numbers that we saw in this twenty year study.
I just want to mention one of them is that we
did see the mortality rate decrease by
eighteen percent. So it sounds like some good
news in this report. There is some good news. So I
would start by just saying you know we all know
that cancer is a fearsome disease. And and so many
lives have been touched of South Carolinians and
nationally friends, family members that have likely
been touched by all the viewers by the by cancer.
And one of the tools that we use to tackle cancer
is to have serve public health surveillance to
track the currents of disease. And we’re very
fortunate here in South Carolina have an
excellent cancer registry that provided the data
for this report. So we now have twenty good
years of data. And you’re correct the the news is
very favorable overall. We see a small
decrease in the risk of developing disease about
three percent and about eighteen percent decrease
in the risk of dying from cancer overall. So I think
that reflects the work of many, if there’s been a
big national investment in the war on
cancer and so prevention, screening and medical
treatments have all contributed to to this
decrease. So when we look at that the prevention
screening obviously I think one of the factors
to is what the reduction of people smoking
cigarettes as well. Yes so if we look at the causes
of cancer we now know that cigarette smoking
causes about forty eight percent of all cancer
deaths in the United States. Many people know
that smoking causes lung cancer but it actually
causes thirteen different kinds of cancer and so is
a major takes a major toll on the cancer burden.
And the fact that smoking rates have been
decreasing is a major contributor to this. So
anything we can do on the prevention side is really
going to decrease the amount of people who
develop that disease and therefore die from the
disease. And when we talk about
those rates you know there’s still some big
numbers unfortunately behind those rates. Twenty
six thousand people a year in South Carolina
are diagnosed with invasive cancer. And
nearly ten thousand die from the disease. Those
are pretty sobering, terrifying and frankly
annoying numbers that we have to deal with. But we
all know some affected like you’re saying. What
can we do? What can these viewers do at home who are
watching do that to help maybe prevent their
chances of becoming diagnosed or dying from
cancer? That’s a great question and we now have
based on the advances in understanding of cancer
causation. We now have many tools at our
disposal, cigarette smoking is one of them. So
preventing children from ever taking up cigarette
smoking is a big benefit. And any addicted smoker
can lower their risk of developing cancer by
quitting at any time in their life. It’s never too
late and there’s good therapies available
medical therapies as well as counseling for people
who need help to do that. That’s also a policy area
where our legislators can help by increasing
cigarette taxes, increasing the minimum
legal age of access to cigarettes it’s something
many states are doing nationally and we should
definitely take a look at. Other risk factors,
alcohol drinking is a major risk factor for
several cancers. So the the guideline is to minimize
if someone drinks alcohol, to not drink too much.
Well it’s two drinks a day for men, one drink a
day for women is the recommended maximum level
there. Avoiding ultraviolet
radiation, so that’s sunlight or from
tanning beds, as a way to prevent a skin cancer. And
one of the sobering messages in this report
was the increase in Melanoma skin cancer is
increasing in South Carolina. And that’s a way
we can tackle that. Other ways to prevent
cancer there’s now, infections can cause
cancer. And we now have a major cancer prevention
break through with the availability of an HPV
vaccine that can prevent several different
time types of cancer. Unfortunately in South
Carolina the uptake of that vaccine has been far
too low. So we really need to educate our parents
and our youth to have that vaccine
routinely administered in pediatric practices. So
those are some of the, weight management is
another big issue. So a crosscutting risk factor
for many types of cancers is obesity. So maintaining a
healthy weight is also very important. And then
diet has been looked at extensively. And I think
the take home message for me that I would take from
a very large body of evidence is that it’s
pretty clear people who eat more fresh fruits and
vegetables have a lower risk of developing cancer.
So a lot of good messages, messages there and I
want to go we’ll get back to talking about
cigarette smoking along with lung cancer. But Doctor, I
want to ask you about this too. When we look at those
numbers twenty six thousand people a year
diagnosed, that’s twenty six thousand people a year
that are having conversations with
doctors like you about cancer and their
diagnoses. What’s it like, you having these
discussions with patients that might have might
have a blip on you know as a CT Scan or something like
that. What what’s the reaction been? Are people
feeling more optimistic these days because of the
advancements in in treatment? And you know
maybe catching an earlier screening?
Absolutely! And it’s really the reaction that
we’re getting from patients is very variable.
And is very dependent based on their level of
medical knowledge or understanding or
potentially having of a family member or friend
who has been diagnosed with a similar condition
before. And they sometimes no what to anticipate.
With new advances that have really come out in
this arena there is definitely a lot more
hope in terms of really specializing in
identifying the individual genetic marker
set. It may identify certain
types of cancer and then finding bio markers
that can be used to be for more individualized
targeting of cancer. And well for us and even
the oncologist specialist is always very difficult
to determine what the expectancy would be for
our patients. So it’s been because of so many
different therapies that are now coming out and
the advances that we’ve seen and
previously the expectancy of colon cancer was less
than a year. And now we’re looking at approximately
two and a half years and and it might be even
longer depending on the new medications that
are coming out and more immune modulating
medications rather than chemotherapy for instance.
Yeah because with breast cancer too, I mean you can
detect you know with that if you have a family
history obviously but also of genetic markers
are really helpful helpful in determining
your risk factor for developing breast cancer
as well, right? Yes. One of the maybe the reasons we’ve
seen maybe a decline perhaps in some of these?
That’s a great question. So breast cancer’s a
really interesting example where you seen a
contribution of factors to lower the mortality
rate. In fact, though we don’t have a lot of
prevention strategies for breast cancer. But it’s
early detection. So mammography screening and
the the technology continues to evolve for
imaging of breasts and at detecting
lesions early. You mentioned genetic risk
for cancer. And I think that’s very important
because we talk about prevention but not
everybody’s at the same risk from birth. So we
have germline or inherited mutations that
might be president that really predispose to
cancer. And BRCA One and BRCA Two genes are ones
where there’s no mutations that can
for a high risk for breast cancer. So getting
tested for those, if one’s from a
family where there seems to be a lot of breast
cancer risks seen about getting tests, the genetic
testing done. And then going under more
active surveillance for detecting the cancer,
breast cancer early as a major tool. And and
there’s been dramatic decreases in breast
cancer mortality. That’s a contribution of the
screening. And it’s also a contribution of the
advances in treatments that Romela’s been
mentioning. I kind of just want to go back to
something you said Doctor Alberg about
Melanoma. I mean we saw these rates drop in all
these other cancers except Melanoma. And it’s
increased by what six point five percent of men
twenty two percent of women. You know this story
started in nineteen ninety six,
people started knowing about the benefits of
sunscreen and what you need to start doing and
sunscreen’s become more and more prevalent in a lot
of our daily products. What do you think is driving
this this increase in Melanoma if we know that
you know we’re at increased risk of you
know exposures skin skin cancer and people are
dying at the rate of a hundred forty six a year.
You know is this something we just don’t think about, or it’s
only in sun for a couple minutes a day, no big
deal or I got one sun burn, no big deal? What what
what’s what’s the miscommunication here? I
think it it’s it’s a it’s a great question, Gavin.
Because you’re assuming that everyone understands
that information and I don’t think we’re doing a
great job in terms of getting the message out
for what the risks of sun exposure are, where you
live in society where being tan is valued by
many. And that leads to incentives to go to a
tanning bed, salons and expose oneself and that’s
part of what’s driving this increased risk.
That’s particularly among white females younger
teenage adolescent young adult and
there’s policies that can be taken to limit
access to tanning beds by age, and to make sure that
there’s warnings for anybody who’s using
tanning beds that’s a major risk factor, and
then getting the message out. I think parents of
young children are an important target group
for the message to start early in life with
protecting an infant and young child from over
exposure to the sun, including sunscreens,
avoiding sunlight at peak hours and sun protective
clothing and so on. And then in particular you know
it’s not everyone’s at equal risk of skin cancer.
It’s people, some people who burn easily and are
more fair complexions would be at greatest risk
and they’re the ones that we really need to be
reaching with these prevention messages. Yeah
it’s not like my mother’s generation when they’re
outside you know just getting that full blaze sun on
the face, iodine on their skin to get darker. But
we know better than that these days. But it’s still is
kind of disconcerting to see those rates going up.
And I do want to stick with you Anthony about
kind of looking at another fascinating data point
from your study from the study that that points to
a huge drop in mortality rates for black men when
it comes to cancer and them surviving better.
They they still high rates of of mortality but
they’re surviving better. So I’m wondering you know
when you see something like that how do you incorporate
that into maybe what you what you take away
from this entire report? What you do with this
trend data overall? That’s another great question,
Gavin. So we did break the the rates down by
population subgroups particularly male, female,
black, white and then the real story emerged when
we broke it down by by gender and racial, ethnic
groups. So black males is the group that you’re
asking about now. And I should say that the news
was favorable for all those groups overall.
Mostly that we saw
downward trends for the for the most part in in
all those groups. So that’s the good news. The
bad news is that the rates in African American
men were highest to start back in the late
nineteen nineties. And even despite the declines
experienced by all groups, they remained by far the
highest in African American males now. And so
that’s that’s very concerning for why that
is. And for me one of the take
home messages is it’s not all about racial ethnic
group either. Because in fact, the risk of
developing cancer was lowest in black females.
So it’s it’s not entirely about race. Now that’s the
risk of developing cancer. Black females did have
higher rates of mortality than than white females.
But I think what we’re doing with this so in
Public Health we’re action oriented. We look at the
data and and and and inspect these findings.
And then we’re called to action. So what’s happened
now is the African American males have been,
are they going to be the source of a new report
that’s going to be released in about a month
from now. That’s under the leadership of the South
Carolina Cancer Alliance. And I would just mention
that group if any listeners are interested
in helping in the fight against cancer in South
Carolina, that’s a very worthwhile group. And all
are welcome at the table in that group whether
from oncologist down to cancer survivors to
interested community members. I’m more
interested in getting everyone involved. But but
in that report we’re drilling down more what
cancers are driving those higher rates and thinking
about planning for for what needs to be tackled?
What information do we need to really identify
the root causes and therefore address the
inequities around this? So doctors that’s actually maybe
you you also take away from this study too. You
see this trend data and you talk to your patients
and you might be you know talking to a black female
or white female. But it’s it’s maybe difficult to
get more males into to see doctors. I think
that’s kind of the average overall,
traditional problem. So essentially you say, ‘Hey
you know you should talk to your husband about
this or your brother because he might be at
greater risk for developing lung cancer,
because they still have high rates.’ Is that what
you guys do when you see data like this as well? In
when seeing data like this I I think it really
encourages us to ask more of those questions
whenever we’re seeing our patients learning more
about them. We ask about their family history,
asking them about very social factors that might
contribute to their potentially developing
cancer. Sometimes we do screenings for instance
for colon cancer of everyone who’s fifty
years or older regardless of their
family history should have a colonoscopy. And
that’s a recommendation that we really strongly
encourage and whether it be the patient that we’re
seeing, it’s it’s it’s definitely a conversation
that we we have with them to then encourage your
family members to come in. And sometimes if they
have a very trustworthy and wonderful
relationship with us, they’re more likely to then
bring in their other family members into those
visits. Especially if you have family history and and
all these worrisome issues. And I want to kind
of jump back to to lung cancer because I’m
interested you know with vaping coming on the
scene now. This I’m guessing wasn’t a big
factor in this report at the time because this ended twenty
fifteen twenty sixteen. So I’m interested
to see what you will, what we’ll be seeing going
forward. Because you know obviously vaping is seen
as a way for smokers to kind of quit smoking. And
there’s also data shows that smokers also
vape and smoke cigarettes at the same time.
And we’re also seeing an increase in teenagers
getting addicted to nicotine through vaping, a
whole a whole generation of of teenagers that wouldn’t
have smoked cigarettes probably otherwise are
now getting addicted to nicotine. So I’m wondering
Doctor, I mean, are you guys paying attention to that
especially we look at lung cancer rates and those
rates dropping? Could there be potential for
them to start rising in the future? So that’s a really
interesting question. In in in asking it you
really raised the complex issues around this. So
aside from the current outbreak of severe
respiratory illness that we’re in now, which
complicates matters even further. There’s the whole
issue of youth vaping verses the potential
vaping as a smoking cessation device that
could help people to quit combustible tobacco
cigarettes. So let’s focus on the youth
first. Because I think that’s getting at the
long term implications of your question. So I think
CDC has a great message the Centers for Disease
Control and Prevention around vaping. Safer
doesn’t mean safe. So what do we know about E-
cigarettes. We know that they contain toxic metals
that cause cancer. We know that they contain
a host of chemicals other than nicotine, the
health effects of which are unknown but have a
toxicity profile that would lead one to
believe that there are long term health risks.
And that includes even short term bio markers,
increased oxidative stress, increased
inflammation, like you would see with
combustible tobacco cigarettes but less. And
that’s the the key here that there are toxins in
these products. They’re not safe but the idea is
that they are potentially safer than combustible
tobacco cigarettes. And likely to be so even
despite this outbreak. So you’ve got youth getting
addicted to E. cigarettes. And then the
big question is well what happens to them with
relation to combustible tobacco cigarettes? In my
mind that’s been the big question. And there’s a
clear answer to that question now. Youth who
use E-cigarettes who’ve never smoked cigarettes,
if you compare youth who vape versus non
users of any tobacco product, youth who vape
are four times more likely on average to go
on the smoke combustible tobacco cigarettes. So
right there that seals the deal for me. It’s it’s
a not a winning situation aside from the health
risks of vaping itself, aside from the nicotine
addiction and adverse effects to the developing
brain, you’re also getting a pipeline of a
generation of new smokers. And you can then
therefore we can all draw the inferences what
that means to long term lung cancer rates and
remember those twelve other cancers also caused
by by cigarette smoking. I want to incorporate
smoking but a different form of smoking but medicinal
marijuana is basically the the big discussion
we’ve been having in South Carolina.
They’re still trying to debate this legislation
that’s been stuck in the State House for a while.
Still seems bogged down, not really too optimistic
for where we might go next year. But doctor what are
the benefits that we do see in some other states
that have legalized? What what what’s the
motivation I guess from medical professionals to
say, ‘Hey you know this is another form of of
treatment that can help people with with pain
from cancer? Absolutely and we and there have
been medical studies that look at chronic pain,
that looked at nausea from chemotherapy, that
looked at spasticity from multiple sclerosis that’s
kind of one of the potential conditions in
which the marijuana may be helpful. The South
Carolina Medical Association doesn’t
really, is not for or against clinical marijuana.
What we really are trying to emphasize is we need
more studies and more robust clinical data to
actually make appropriate decisions and
whether to recommend this to patients or not.
Within the FDA marijuana is classified as a
schedule one drug. And there are some
medications for example, Marinol that has been
approved for by the FDA for treatment of
anorexia in AIDS patients. So that’s
appropriately dosed medication that has been
studied and we we know has
has has proven some effectiveness. So we’re
not against prescribing Marinol. But we’re
wanting to actually have more information on
whether this would be safe for patients. As
physicians we all decided that it’ll do no harm.
And if we’re going to be recommending or
prescribing a medication we would need to know
what kind of interactions that it might have with
other medications that that they have. Whether
it’s they can we can have a
some adverse effects on their mental health and
have addiction potential down the
line. And a lot of those questions we don’t have
the full answers to. And it’s also very difficult
to do dose marijuana. And that’s really the aspect
of it for each prescription we write
there’s a particular dosage, a particular
maximum and as side effects that we
anticipate but that that’s very difficult to
actually say about marijuana at this point.
That’s a lot of different tools in the arsenal there. But we
have about five minutes left and there’s so much
more talk about the state of South Carolina health
care. But one of the interesting things I
found while I was doing this, I mean because when we talk about
cancer, we talk about chronic
diseases. And there’s several other chronic
diseases that contribute to what to ninety
percent of the nation’s three point three
trillion dollars in healthcare costs annually
are contributed to chronic diseases like cancer, like
heart disease and diabetes.
So I’m wondering you know, again we talk about what
needs to be done. But then there’s also the direct
correlation to why our health insurance premiums
keep going up. And I’m wondering doctor, you know
are people putting this together are they
realizing, ‘Hey maybe we you start living
healthier lifestyles because of we’re all paying
higher insurance premiums. I just saw that the
average cost of health insurance for a family
costs twenty thousand dollars a year. Employers
pay most of that but people are pretty much paying
like six thousand dollars worth of that. It doesn’t
seem sustainable with a good overall growth of
insurance costs and you know healthcare costs.
Because yes we might be surviving longer but it’s
expensive to treat these chronic diseases.
So I think that’s an interesting question and
I can’t speak to a lot of the details. But I guess
there has been through the Affordable Care Act
for example incentivized preventive care. So there
were incentives and good reimbursement for cancer
screening, something we talked about for smoking
cessation, counseling and and medications. I think
incentivizing the preventive side would
reap large dividends down the line. Yeah we also see
from the AARP that twenty seven percent of
adults under sixty five have stopped taking
medications because it costs. So what do, when we look at the
South Carolina Medical Association what
are they trying to maybe push with the legislative
agenda when it comes to prescription drug costs? Because
I know some states are looking at you know
boards to overlook what what’s driving these
costs up. And that’s definitely on our agenda
for the the year twenty twenty to to take a
closer look at that. We don’t have a
specific stance on that at this point. I’m also on
the Council of American College of Physicians and
I know that currently they’re also working on a
a movement to envision a better healthcare system
for for the United States. So on the SCMA
side I know its it’s it’s in the works and we’re
hoping to take a better look at that from
the SCMA side as well. Really quickly, I mean. I’m
wondering how rural health care is also being
affected here because hospitals are closing.
Are we seeing you know again maybe people making the
decision maybe not to drive to the hospital
because of being so far away there’s no longer a
rural hospital in their town perhaps? Anyone speak
to that? Well I can I can tell you
that’s a a really good question because rural
cancer care within the cancer community, oncology
community is a major priority now. It’s really
common that at the radar screen at the
federal level to the National Cancer Institute
that there are disparities that occur in
the rural setting. And how can we
address that issue? So I think it’s a problem. I
think it’s a, and the current healthcare
environment is working against that in a way. But
I think with attention being paid and use of
telemedicine, telehealth devices and so on that we
can appropriately reach out but again it’s gonna
take a data driven intentional strategy to
help solve that problem. And we have to add to
that also had legislature looking at
physician assistants and nurse practitioners and
really revamping their but ability to actually reach
out to those areas as well. There
is no longer a geographic limitation to physician
assistants that are being supervised by a physician.
And there is an agreement regarding scope of
practice that they would have to
come together with with their supervising
physician that then would be would have to be
accepted by the Board of Medical Examiners to move
forward. Yeah a lot of movement there. That’s a little too
and also such…Just a big takeaway message. Be
active. Stop drinking. Stop smoking. Be active and eat
right. Guys thank you so much from the
Kennedy Greenhouse Studio on the campus of the
University of South Carolina. I’m Gavin

Daniel Yohans

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