Despite remarkable advances in detection and treatment of colorectal cancer, it remains the second-largest cause of cancer mortality in the United States. This statistic looms despite the fact that colorectal cancer is one of the most treatable cancers there is because early detection, thus cure, is entirely possible.
What makes this unique among the other cancers for which we have screening tools is that prevention is also possible. This is because we can identify and remove premalignant lesions before they become cancer. So what accounts for the stark contrast between this grim statistic and our known ability to prevent, detect and cure this cancer? Lack of screening. The most common signs and symptoms of early colon cancer are — nothing at all. That’s why we so strongly recommend screening for colorectal cancer.
Current guidelines recommend colorectal cancer screening for adults between the age of 50 and 75. This may start earlier for those at higher risk (family history of colorectal cancer, chronic inflammatory bowel disease, polyposis syndromes or patients of African-American descent).
After the age of 75, we recommend screening on an individual basis. There are a variety of recommended screening tests. The gold standard is the colonoscopy, which provides both screening and prevention. Not only can it detect early stage cancers, but also precancerous lesions called polyps, can be removed to potentially prevent a cancer from developing.
Last year more than 23,000 patients were seen for high blood pressure as part of a visit with a doctor in one of Rush’s outpatient practices. By the end of the year, 75 percent of this group brought their blood pressure into a healthy range.
This great news was among data about various clinical measures just released this week. The turnaround puts Rush University Medical Group, known as RUMG*, in the top 10 percent of physicians who treat hypertension nationwide, according to the National Committee for Quality Assurance, a non-profit organization that promotes health care quality. More importantly, it means that more than 17,000 of Rush’s patients significantly have reduced their risk of heart attack and stroke, and of dying from these preventable conditions.
High blood pressure, or hypertension, is known to be a silent killer, because people often don’t notice they have high blood pressure. Far too many are at risk: According to the Centers for Disease Control and Prevention, about one in three people in the United States (75 million) have high blood pressure, and only about half (54 percent) have their blood pressure under control.
In retrospect, it seems like it was the dark ages. When I was a medical resident at Rush in the mid-’70s, hepatology had few therapies and even less ability to change the course of chronic liver disease.
We had neomycin for hepatic encephalopathy (a complication of advanced liver disease that affects your behavior, mood, speech and other neurologic functions); corticosteroids for autoimmune hepatitis (liver inflammation), and diuretics for ascites and edema (swelling in the abdomen and legs). That was about it.
However, I was fortunate to have three attending hepatologists (unusual for any medical center in those days): A.W. (Bill) Holmes, John Payne and Richard B. Capps. I was struck by how smart they were and how they could glean so much information from a patient’s history and physical examination. Perhaps as important, each had a sense that liver disease would continue to grow as a specialty, and that bright new things were on the horizon. How right they were.
Testing and diagnosis have been key parts of this wild ride I am currently on.
Like most women, I dreaded the idea of having to take time out of my busy schedule to get a mammogram.
In my career as a media relations expert covering breast cancer stories, I have filmed many mammograms.
They looked uncomfortable and unpleasant.
The doctors and technicians are so nice and make such a huge effort to make it seem less scary, but let’s be real. Who wants to have their breasts examined and squished in a machine? Definitely not me.
So, when it was time for me to schedule my first mammogram, I wasn’t really up for it. I could have made every excuse to put it off or ignore it.
I had a good excuse, too! I just had an unrelated major surgery and was recovering from it. I had a huge abdominal scar that hurt and was still healing, and I had just started back at work. Did I really want to be back in the hospital for more tests and procedures? I just wasn’t in the mood to do it, and I didn’t want to take the time off to get a mammogram.
Many of us want to begin the new year fresh. Clean slate. Except that … it’s the same you.The calendar may have changed, but you are still you. You may have the best of intentions to get healthier, find a new job, or create more time with your kids, and yet you just can’t get off the launchpad or can’t stick with a new resolution.
So what about trying something different this year?First step.Don’t do anything.Just be.If this sounds unique, it is.
“Right now, tune your attention into where you are located in this moment.You might be reading this at your office, on your phone, in transit or at home.Just get a sense of your environment. Now deliberately place your awareness on your breath. Allow your attention to rest on your breath. You are not trying to make anything happen. Just notice inhaling and exhaling.If you can feel the rise and fall of your chest or expansion of your lower belly, then guess what?You are in your body.Welcome to this moment.You are practicing mindfulness.By purposely placing attention on the present moment nonjudgmentally, awareness arises.If the breath isn’t a comfortable area for your body you could place your attention on sensations in your feet — feel them on the floor.”
When I was 5, my family migrated from Mexico, to Little Village — a predominantly Mexican immigrant neighborhood on the West Side of Chicago. Despite my parents working several jobs, our family’s limited income made us eligible for public benefit programs. These programs were a lifeline and provided us with access to healthy food and medical care and enabled my parents to take care of us and keep us healthy.
My experience as an immigrant and living in Little Village influenced my decision to pursue a career in health care. As a senior community engagement coordinator at the Rush Alzheimer’s Disease Center, I’m responsible for planning and implementing the Latino education and recruitment efforts for Alzheimer’s disease research. Specifically, I work with older adults, family caregivers and community organizations in Latino and immigrant communities throughout the city. Beyond my work at the RADC, I am very involved in several Rush-wide efforts to reduce health inequities on the West Side and make our institution more immigrant friendly.
Many people are unaware that if a parent of a newborn child in Illinois feels unable or unwilling to keep their baby, he or she can bring the infant to a hospital, emergency medical facility or police or fire station and legally and anonymously relinquish the baby. The baby will be given any needed medical care and then placed with an adoption agency for permanent placement with an adoptive family. More than 125 babies in Illinois have been surrendered safely in this way since the state passed the Abandoned Newborn Infant Protection Act in 2001 to reduce the risk of a parent under extreme stress harming a newborn.
My son Francis is the 127th of these babies. My husband, John, and I are immensely grateful to be his parents, and to the Safe Haven law for giving babies like our Frankie a chance at a wonderful life.
My family’s Safe Haven story started when we signed up with a local adoption agency to adopt a newborn. We were expecting a more traditional type of adoption, when an expectant mom decides to make an adoption plan and selects a family for her child while she is still pregnant.
I began my medical training in 1986, just a year after HIV, the virus that causes AIDS, was first identified. Already, nearly 25,000 people had died of AIDS in the U.S. alone, and to date more than 650,000 people in just this country have died with an AIDS diagnosis.
In the early part of my career as an infectious disease specialist treating patients with HIV and AIDS, I expected that I would see every person for whom I provided care die. We could prolong their life to some degree, get them through certain infections, but at some point they would progress and die of AIDS.
That’s no longer the case at all. We’ve made extraordinary advances in treating and preventing HIV infection and AIDS in what for medicine is a very short amount of time. As we observe the 30th annual World AIDS Day on Dec. 1, it’s a good time to consider the current state of AIDS prevention and treatment, how far we’ve come, and how much work remains.
Know your status
This year’s theme for World AIDS Day is “Know your status.” In the U.S., guidelines from the federal Centers for Disease Control and Prevention recommend that all sexually active people who are from 13 to 64 years of age get at least one HIV test in their lifetime. Persons at higher risk — gay and bisexual men, transgender women who have sex with men and injection drug users — are candidates for annual testing.
Currently, approximately 36.7 million people are living with HIV worldwide. In 2016 (the most recent year for which data is available), 1.8 million people worldwide were infected with the virus, according to UNAIDS.
In the United States at the end of 2015, approximately 1.12 million people were estimated to be living with HIV infection, with about 162,500 of them undiagnosed, the CDC reports. In 2016, nearly 40,000 people were newly diagnosed with HIV infection in the U.S. The good news is that this number is lower than the nearly 45,000 people that were infected in 2010, but that number still is too high.
In Chicago, 23,824 people were living with HIV in 2016, and 839 people were diagnosed with the infection that year, according to the Chicago Department of Public Health. We are making progress: That number is the lowest we’ve had in a year since 1990.
People at risk for HIV infection should be tested because earlier treatment improves outcomes, and treatment that reduces the presence of HIV to undetectable levels in their blood reduces transmission of the virus. It’s also a way for at-risk people who are HIV negative to learn about PrEP (pre-exposure prophylaxis) –the use of antiviral drugs to prevent HIV infection.
In the mid-1990s, before we had effective antiretroviral therapy, we only were able to add about eight years of life to people who were HIV-infected. There were a lot of people dying and it was a difficult time to be a physician. In 2010, an infected 20-year-old person in the developed world can expect to live another 55 years, nearly a normal lifespan, according to UNAIDS.
When we are able to identify HIV-positive individuals and treat them to bring their HIV down to undetectable levels and maintain undetectable levels, the chance of them transmitting the virus to someone else is zero. A European study followed 888 heterosexual and same-sex male couples, in which one partner was infected but their HIV levels were suppressed for at least six months and the other partner wasn’t infected. They found that after more than 58,000 sex acts without a condom, there was no documented transmission of HIV to the uninfected partner.
Overall, in the United States a person’s risk of HIV infection in his or her lifetime is one in 99, the CDC estimates. However, this risk is not uniformly distributed. HIV is affecting a large part of our community, especially on the West Side of Chicago and among minority populations. Black men are the most affected ethnic group, with a one in 20 lifetime risk of HIV infection, and black and Latino men who have sex with men have a one in two and one in four lifetime risk, respectively. (These estimates come from the CDC.)
People who test HIV negative but are at significant risk for HIV infection should be offered HIV pre-exposure prophylaxis (PrEP). Taking the drug Truvada once daily can reduce the risk of HIV acquisition by more than 90 percent.
Rush is doing its part
Because the West Side communities we serve are at higher risk of HIV infection, Rush has implemented protocols to test for the virus among our patients. Since March of 2015, we’ve had an opt-out HIV testing program in our emergency department based on CDC guidelines. Through this past July, we’ve tested 19,569 people,and 142 of them tested positive, including 47 who were newly diagnosed and 13 with acute HIV (a condition that occurs in the first few weeks after infection and causes flulike symptoms).
Early this year, we expanded our testing program to three primary care clinics, two on our main near West Side campus and one in Lincoln Park which have performed 1,232 tests through October, with two positive results. We plan to expand this program to other clinics in 2019.
We are also working on an initiative to create an alert to prompt clinicians to consider HIV PrEP in at-risk persons.
As difficult as it was to live through the early part of the HIV epidemic, it was also incredible to contribute to the advances that have made HIV into a chronic treatable disease and no longer a death sentence. The collaboration between physicians, scientists, patients, and activists was unprecedented and were critical to these advances. I’m proud to have spent my career at Rush, an institution that has been at the forefront of HIV research via our ongoing participation in the NIH-funded AIDS Clinical Trials Group Network since 1987.
Beverly Sha, MD, is an infectious disease specialist at Rush University Medical Center.