Thursday, November 7, 2013

Key Informant Interviews Begin


Blog Post 8
One of the goals of my practicum was to interview registrars from other catchment regions in order to get first hand accounts from the people responsible for maintaining the Pacific registries.  The first registrar interviewed was from the Northern Marianas Islands. The interview covered the following questions:
o   Are private clinics compliant with timely reporting of cancer cases?
o   What are the CNMI’s screening guidelines for cervical cancer? For colorectal cancer?
o   In what ways could the registrar strengthen its services?
o   Could it advocate for more community outreach or encourage a different way for health professionals to approach cancer screening and diagnosis or increase its staff?
o   Is there a problem with underreporting?
o   Does the registrar collaborate with medical referral when keeping track of patients sent off-island or does the report come directly from the hospital providing the service?
Key parts of the interview will probably shed some light on the issues and successes of each districts registry.
Another applicable issue that was brought up in my time at the registry is the Certificate of Need (CON).  The National Conference of State Legislatures (NCSL) use CONs to validate the necessity of a particular program. As stated by the NCSL, “Certificate of Need (C.O.N.) programs are aimed at restraining health care facility costs and allowing coordinated planning of new services and construction.  Laws authorizing such programs are one mechanism by which state governments seek to reduce overall health and medical costs.” This is a very important hurdle when trying to bring in new screening programs in the pacific what comes to mind most is the idea to introduce a colorectal cancer-screening program.

Saturday, October 19, 2013

Cancer Epidemiology Conference


I attended the lecture series on Gene Environment Interaction in Human Cancer Development at JABSOM. Lecturers from across the country presented on topics from the Impact of Host Susceptibility Factors on Tobacco Carcinogen Metabolism and Lung Cancer Risk to the Interaction between Tobacco Smoking and Genetic Susceptibility on Risk a& Survival of Bladder Cancer. The presentation that I found particularly appropriate to the field of epidemiology was presented by NCI’s, Dr. Nathan Rothman. He presented on the Gene-environment Interactions in Studies of Occupational, Environmental, and Tobacco-related Bladder Cancer. He really just told an investigative story that started with identifying a higher OR of bladder cancers in Northern states in the US. He then went on to explain that at the time they attributed this to varying NAT2 acetylation rates among people in this region of the country. However, it was determined that this could not be the sole cause of such an increased risk. In the end, a multitude of contributing factors from smoking to exposure to aromatic amines which activate/deactivate the p53 gene to an acidic urine environment to nocturia all contributed to this population being at greater risk.

Inside the Journal Club


A lot has happened since starting this blog and as such I have decided to explain everything in two parts. A few weeks ago I attended a Cancer epidemiology Journal Club that reviewed the following research paper and a corresponding newspaper article. The paper entitled, Incidence of Breast Cancer With Distant Involvement Among Women in the United States, 1976 to 2009 by R.H. Johnson, F.L. Chien, and A.B. Bleyer published in February 2013 and its newspaper review Advanced cancer in Young Women by Judy Peres reported that their was an increase in breast cancer incidence in women 25- to 39- years of age. This was based on data collected from SEER 9, SEER 13, and SEER 18, which represent 9.5%, 15%, and 28% of the US population since 1975, 1992, and 2009, respectively. For the most part, incidence rates for localized and regional breast cancers amongst all age groups, young and old, remained constant across the decades. However, in women diagnosed with breast cancers found in distal regions from the primary site, incidence has nearly from 1.53 per 100,000 in 1976 to 2.90 per 100,000 in 2009. In the 25- to 39- year old age group it was also reported that women with tumors that that women with ER+/PR- status (estrogen and progesterone receptor status) displayed a higher annual percent change (8.89) when compared with women with ER+/PR+ status (8.15), women with ER-/PR- status (5.44), and ER-/PR+ status (-0.51).
The paper raised some healthy discussion in the group. The debate included possible exposure and risk factors that people in the community may have encountered. They then went on to offer evidence of whether their proposed factors matched up with the timeline of disease. In addition, errors in the analysis of the data were discussed. Suggestions included: misidentification of a tumor’s primary site in older records, changing standards in stage classification, and the risk of drawing such damning conclusions when dealing with such a small sample size of young women with breast cancer. 

Sunday, September 15, 2013

Day 5 (Sep. 13): Sorting through the Data

This week I was confronted by the full magnitude of the data and the responsibility needed to safeguard information that may lead to any misinterpretation in reporting statistics. Looking over data from Hawai'i: Cancer Facts & Figures 2010 (a sourcebook for planning & implementing programs for cancer prevention & control) I wanted to begin to narrow down the types of cancers I would focus on during this practicum. Two of my practicum objectives hoped to acquire a working knowledge of data use in assessing preferred screening and treatment plans for a certain region. At the moment, I am trying to determine which cancer site would be appropriate for assessing screening and treatment plans. At first glance, breast cancer in females or colorectal cancers offer both a diversity of screening techniques and treatment courses which may differ between regions.

Day 4 (Sep.12): Fact Sheet on the Hawai'i Tumor Registry

  • Program Name: University of Hawai’i Cancer Center – Tumor Registry
  • Located at 1236 Lauhala Street, Ste. 508 Honolulu, HI 96813
  • Who is included in the registry?
    • All reportable neoplasms in the catchment area (in some cases this includes benign tumors because some lead to mortality despite non-malignancy)
  • Operating budget:
    • $1.3 million
  • Funding Source:
    • National Cancer Institute (NCI) - Surveillance Epidemiology and End Result (SEER) program
  • Services:
    •  ID, collect, and maintain cases that come across Hawai’i (some may or may not be resident in Hawai’i)
    • Tissue Repository for collected neoplasm cases
    • Interstate collaborative efforts across registries
  • Information sources:



Wednesday, September 11, 2013

Day 3 (Sep. 9): Accreditation, Ethics, and the Tissue Repository

Ethics plays an important role in medical practice and research. As of 2009, the UHCC- tumor registry has 203,500 diagnosed cases on record dating back to 1960. This extensive collection of data can easily be overlooked as a study group, but if there is anything that today has taught me, it is that each human subject is entitled to a quality of care that will offer them a superior level of protection from harm, exploitation, and breach of privacy. UH and its various "silos" of IRBs are seeking accreditation by the Association for the Accreditation of Human Research Protection Program (AAHRPP). This would place the associated institutions amongst a small group of universities, hospitals, pharmaceutical companies, etc. that offer peer-set best practice standards of measurement based on federal human subject protection regulations that undergoes routine self-regulation and self-evaluation. Understanding the standard of service expected will be important as I start my CITI training on the protection of patient privacy, beneficence, and the importance of consent.

Thursday, September 5, 2013

Day 2 (Sep.5): Looking Back to Plan for the Future

Some people say that there are never any truly new ideas. So, with this in mind, I've been looking into assessments in years past of Pacific tumor registries; specifically at the work that came out of the Pacific Health Dialog's Journal of Community Health and Clinical Medicine for the Pacific. I most recently finished the article- Cancer Incidence in Four Pacific Countries: Tonga, Fiji Islands, Cook Islands, and Niue. The article helped me begin to understand three things.  
1) Socioeconomic standards (in some part influenced by cultural history) dictate the quality and efficiency of information storage and assessment.
2) Prevalence of certain cancers can be influenced by a regions underlying issues (eg. citizens may be more susceptible hosts for infection) which is in turn linked to the quality and diversity of its health services.
3) In many cases, cancer may not be the direct result of a genetic predisposition for abnormality. It may be due to the influence of environmental stimuli.
Finally, I looked at lectures brought into educate the staff on everything from Human Anatomy & Physiology to Game Theory in Life to Statistical Analysis. After one lecture (Human Anatomy of the Cardiovascular System), I can definitely conclude that they will be a valuable informational source.