Connections - May 2014
A Message from the President
Indoor Use of E-Cigarettes Still Exposes Non-Users to Nicotine
RPCI early research helping to shed light on the real facts of e-devices
Electronic cigarettes, on the market for only about seven years now, have rapidly become a billion-dollar industry, with many users relying on the expectation that vaping poses significantly less harm than smoking tobacco cigarettes and may even help them to kick their nicotine addiction for good.
In this short interval, the Health Behavior team at Roswell Park has become a leading source of information on these new products, conducting experiments and analyses that are answering many important questions about e-cigarettes and how they affect users or others exposed to their emissions — questions that can only be answered by high-quality research.
A new international study led by RPCI Assistant Professor of Oncology Maciej Goniewicz, PhD, PharmD, first reported on in this May 3 New York Times story, found that variable-voltage e-cigarettes can expose users to higher levels of formaldehyde, a chemical known to cause cancer, than traditional cigarettes do; the higher the voltage, the more toxic the e-cigarette. The research was also highlighted in a New York Times editorial drawing attention to possible risks for e-cigarette users, and cited by a group of U.S. senators who urged the U.S. Food and Drug Administration to take a close look at these findings as it refines its draft regulations to govern marketing of the products.
Key findings from other studies on e-cigarettes led by Dr. Goniewicz and Richard O’Connor, PhD, Director of the RPCI Tobacco Research Laboratory, are:
- Nearly 80 percent of smokers who use e-cigarettes believe the devices are less harmful than traditional cigarettes, and 85 percent were using them to help them quit smoking
- Secondhand e-cigarette emissions are not harmless; while overall secondhand emissions from the devices are lower than what we see with regular cigarettes, e-cigarettes generate similar levels of toxic compounds such as formaldehyde and acrolein
- E-cigarettes can leave significant amounts of nicotine and other toxicants behind on surfaces such as glass, floors, walls, windows, wood and metal when used indoors, potentially increasing exposure to carcinogens
- While labeling of nicotine content on e-cigarette refill solutions evaluated in one study was accurate in most cases, packaging may mislead users; nicotine was even found in some refill solutions labeled as nicotine-free
These studies are some of the first peer-reviewed research on e-cigarettes, and together they provide guidance that will help both users and policymakers to make informed decisions about these products.
It’s important to note that this is a young and still-developing field, and there are many questions yet to be answered. In other words, the jury is still out on the overall health impacts of e-cigarettes and whether they can be a safe and effective tool for smoking cessation.
“There is reason to be hopeful about their potential to reduce the disease burden caused by tobacco,” Andrew Hyland, PhD, Chair of the RPCI Department of Health Behavior, said May 12 in testimony before the New York State Senate Health Committee, advocating for legislation to make e-cigarettes subject to existing state laws on smoking. “The best thing a smoker can do is to quit completely, but short of that, if a smoker switched completely to an electronic cigarette, they are probably significantly reducing their health risk.”
Important questions linger, too, about the risks — especially to young children — of direct exposure to e-cigarette liquids and the potential for the devices to be a gateway to smoking.
“There is reason to be very concerned about potential unintended consequences of electronic cigarettes and their marketing,” notes Dr. Hyland.
– Donald L. Trump, MD, FACP
President & CEO
Institute Input Key to Design of New System for Detecting Oral Cancers
Roswell Park faculty members including Gal Shafirstein, DSc, and Abraham Kuriakose, MD, worked with biophotonics manufacturer Zenalux Biomedical Inc. to design a system for detecting oral cancers at an early stage. The Institute’s Head & Neck/Plastic & Reconstructive Surgery/Dental Oncology & Maxillofacial Prosthetics Center will be the first site to implement that system, the Zenascope IM1.
More Patients Can Benefit from High-Dose IL-2, Roswell Park Study Finds
A study led by Thomas Schwaab, MD, PhD, found that patients with metastatic kidney cancer — even those with chronic renal impairment — can tolerate and benefit from a treatment called high-dose interleukin-2 (HDIL-2) immunotherapy. RPCI’s inpatient IL-2 clinic is one of the few high-volume centers for this therapy in the nation.
RPCI Awarded New Contract to Provide Cessation Support Programs Across Region
The Institute was recently awarded a five-year, $1.5 million contract to operate the Western New York Tobacco Health System Change Center. The Center will help health-care providers in Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans and Wyoming counties to implement policies and programs designed to help patients quit using tobacco products.
More Money Needs to be Spent on Tobacco Control
By Senator Mark Grisanti
A lot can change in 50 years. Five decades ago, the Ford Mustang had just been introduced, the Beatles had their first number one hit in the United States and everyone was doing the Twist.
On Jan. 11, 1964, another milestone was reached, this one in the area of public health. The U.S. Surgeon General published a report that, for the first time, established a scientific link between smoking and life-threatening diseases such as cancer, helping the public see through the tobacco industry’s lies and laying the groundwork for the next 50 years of efforts to reduce the burden of tobacco on this country.
At that time, the U.S. smoking rate was 42 percent. Today, it’s less than half that at about 19 percent. We’ve made progress against tobacco, but this work is not finished. There are still 43 million smokers in this country and more than 3,000 kids try their first cigarette each day.
New York’s primary mechanism for tobacco prevention, the New York State Tobacco Control Program, which works to keep kids from using tobacco and help smokers quit, has lost 50 percent of its funding over the past few years despite the state collecting $2 billion annually in tobacco generated revenues.
Since 2007, state funding for the program has been cut in half, to a meager $39.3 million, despite the Center for Disease Control’s recommendation that New York spend $254 million annually on the Tobacco Use Prevention and Control Program.
New York has dropped from 5th to 21st among states’ per capita spending on tobacco control. Recently, an independent evaluator of the program recommended that funds for the program be increased to $85 million, with subsequent steps to meet the CDC standard.
Funding cuts mean fewer ads, less cessation therapy and a reduction in critical programming and outreach to keep kids from starting to smoke. Roswell Park Cancer Institute administers the state’s Quitline, which provides free nicotine replacement therapies to smokers who are trying to quit. Roswell Park and the Quitline have been directly impacted by funding reductions, reporting a 40 percent drop in calls to the Quitline and other program cuts. I have introduced legislation, S. 5462-B, which would allocate a small percentage of tobacco tax revenues incrementally over a 10-year period to the Tobacco Control Program and bring funding levels in line with the recommendations of the Centers for Disease Control by 2025.
Such funding would pay for itself in the short term by reducing smoking-related health care costs and provide a return on investment long term that is 10-fold.
It is time to finish the job we started in 1964 to reduce the burden of tobacco on our nation. We can’t afford to wait another 50 years.
Pediatric Patients Find Comfort In Gabe’s Chemo Duck
A cancer diagnosis can be scary – especially for the youngest patients. For many children, learning to understand and cope with a new environment and treatment procedures can be daunting. Thanks to generous donations to Carly’s Club at Roswell Park, Gabe’s Chemo Duck can be offered to pediatric patients to help them feel more comfortable along their cancer journey.
Created by a mother for her son, Gabe, when he was diagnosed with cancer at a young age, Gabe’s Chemo Duck is a soft stuffed animal that helps children cope with their diagnosis and treatment. Each child who receives a Chemo Duck is encouraged to role-play with medical procedures that they themselves may undergo by using features such as the chemotherapy port, feeding tube, splint or temporary brace.
Brandee Aquilino, PsyD, MA, Medical Psychologist for the Department of Pediatrics, helps pediatric patients and their families adjust to the diagnosis and treatment of childhood cancer. Dr. Aquilino provides Gabe’s Chemo Ducks to patients who would most benefit from a cuddly companion, like seven-year-old patient Luke.
“The Chemo Duck helps me to be brave when I have chemo and all sorts of different medicine,” said Luke. “Plus, he is always by my side when I have to have different medical procedures.”
Roswell Park faculty members regularly share their expertise with major national media outlets and oncology publications. Some recent examples:
Dr. Maciej Goniewicz to The New York Times: “Looking at ingredients (of e-cigarette solutions) is one thing, and very important. But to have a comprehensive picture, you have to look at the vapor.”
Dr. Mary Reid to MedPage Today: “No screening tests are perfect. But while we gain more understanding on how to implement lung cancer screening to optimize the benefits and minimize the risks, we must consider the tens of thousands of lives that can be saved with annual CT screening in high-risk populations.”
Dr. Thomas Schwaab to Medscape: “Current targeted treatments all treat kidney cancer well in that they prolong regression, but none of them have a truly curative aspect to them. Our clinical results continue to be impressive in this otherwise lethal disease.”
Fraternal Order of Eagles
The Fraternal Order of Eagles operates by the motto “people helping people.” Fittingly, the organization is also a longtime supporter of Roswell Park Cancer Institute’s goal to find cancer cures and save lives.
Since the early 1990s, The Eagles have given more than $120,000 to support the cutting-edge cancer research and patient-care programs at RPCI. Most recently, the organization gave a $3,000 grant to Thomas Schwaab, MD, PhD, an Associate Professor of Oncology in the departments of Urology and Immunology at RPCI, for his metastatic renal cell carcinoma study, which aims to combine therapies to more effectively treat kidney cancer.
“The Fraternal Order of Eagles motto is ‘people helping people.’ Roswell Park Cancer Institute epitomizes this ethic, and we will support it in anyway we can,” said Mary Stoldt, past New York State President and current Secretary for the organization’s Depew-Lancaster Auxiliary.
The Fraternal Order of Eagles is an international nonprofit organization that was founded in 1898 for members to unite fraternally in the spirit of liberty, truth, justice, and equality, to make human life more desirable by lessening its ills and promoting peace, prosperity, gladness and hope. The organization founded Mother’s Day and served as driving force in founding Social Security Program. Learn more about The Eagles here.
Scott Hamilton at The Ride Opening Ceremony
Join thousands of members of The Ride, Roswell Park Cancer Institute and survivor communities on Friday, June 27 for the Opening Ceremony featuring an inspirational message from Olympic gold medalist and cancer survivor Scott Hamilton. Ride Day will take place on June 28, and routes will sell out soon, so don’t delay — register today!
Dr. Brecher’s Retirement Reception
After nearly 40 years of caring for pediatric cancer patients in Western New York, Dr. Martin Brecher will retire. Come celebrate and honor the impact he’s made in cancer care with us on Wednesday, June 18, from 5:00 to 6:30 pm in Kaminski Park at RPCI.
Dr. Brecher joined the staff of RPCI in 1975 and has treated thousands of children and adolescents with pediatric cancer since. In 1987, he was named Acting Chief at RPCI, and in 1990 he was appointed Chairman of Pediatrics at RPCI and Division Chief of Pediatric Hematology-Oncology at Women & Children’s Hospital of Buffalo. Learn how you can honor Dr. Brecher’s legacy here.
Now through November 30, Sephora in the Walden Galleria has selected Roswell Park Cancer Institute to be a part of its Values Inside Out program. As the chosen organization for this program, Sephora in the Walden Galleria will raise funds for Teens Living with Cancer (TLC) at Roswell Park. Help support TLC through the Values Inside Out program by donating at the Sephora registers or online. Click here for more info.
On Friday, August 8, Carly’s Club at Roswell Park Cancer Institute will host the third annual party of the summer! Come dressed in your best yellow outfit and get ready to say, “Hello Yellow” with this year’s theme. Guests will enjoy a full evening of open bar, gourmet cuisine from Buffalo’s premier restaurants, music, dancing and a chance to win great prizes, including a car! All proceeds from the event will support Carly’s Club, patient-care programs and pediatric cancer research at Roswell Park. Click here to get tickets and learn more!
Make a splash for childhood cancer cures at Carly’s Crossing on Sunday, August 10.This unique open-water swim event is the only one of its kind in Western New York and features three different course options. Sign up today to participate and help support pediatric cancer research and patient-support programs through Carly’s Club at Roswell Park. Learn more and register at CarlysCrossing.org.
Too Hot to Be Safe — The New York Times
Learning From the Experts — The Buffalo News
Melanoma Monday — WNLO-TV CW23
Roswell Study Needs More Volunteers — WGRZ-TV Channel 2
FDA Proposes New Rules for E-Cigarettes — WBFO-FM 88.7
Vaping & Hookahs and Health — WBEN 930
FDA to Ban E-Cigarette Sales to Minors — MedPage Today
Insufficient Vitamin D Linked to Prostate Cancer in Blacks – Black Press USA
See more RPCI headlines at roswellpark.org/media/in-the-news
FDA expands use of HPV in cervical screening
Last month the Food and Drug Administration (FDA) approved the use of the Cobas HPV test as a primary screening test for cervical cancer, meaning that it can be used in place of the current Pap test screening.
Nearly all cervical cancers are caused by infection with certain types of Human Papillomavirus (HPV). Routine Pap tests collect cells from the cervix to detect cell abnormalities that can lead to cancer. The new test detects the actual DNA of 14 high-risk HPV types, and specifically identifies HPV 16 and HPV 18, two strains of the virus that account for 70 percent of cervical cancers. The test can also provide information about a woman’s risk for developing cervical cancer.
"The new DNA test just approved by the FDA for cervical cancer detection is an incredibly promising development," said RPCI’s Stacey Akers, MD, gynecologic oncologist. "It appears to be at least as effective as Pap testing in detecting cervical cancers, and indications are that it may both decrease unnecessary testing and improve the cost-effectiveness of cervical cancer screening. At this point the current clinical guidelines will remain unchanged, but we may see them revised in the next couple of years as we get a clearer picture of the comparative effectiveness of the two tests."
CT Screening for Lung Cancer: Will Everyone Be Covered?
Early detection has been credited for many of the gains we have seen in breast, prostate and colon cancer survival. Unfortunately, lung cancer has not seen similar results due to the lack of an effective screening tool — until now.
The National Lung Screening Trial, a trial sponsored by the National Cancer Institute that analyzed different methods of detecting lung cancer, found a 20 percent reduction in deaths among current and former heavy smokers over age 55 who were screened using CT scans, compared to those screened using chest X-rays.
Additionally, the U.S. Preventive Services Task Force (USPSTF) reviewed research and data on lung cancer screening and concluded that utilizing CT scans for lung cancer screening would be beneficial. This recommendation is significant, as the USPSTF is an independent panel of primary care providers responsible for reviewing scientific evidence and developing recommendations for primary care clinicians and health systems on behalf of the federal government. Its recommendations are integral to the implementation of the Affordable Care Act (ACA) and insurance coverage decisions. Health plans offered on the insurance exchanges created through the ACA must follow the USPSTF recommendations.
Despite evidence demonstrating that there is a benefit to screening for those at high risk of developing lung cancer, a Center for Medicare and Medicaid Services (CMS) advisory panel on coverage determinations has recommended against providing this coverage.
If this recommendation stands, private insurers will be required to cover the exam in 2015 but CMS would not be obligated to cover it for Medicare and Medicaid recipients. This would, essentially, create a two-tiered system where patients with private insurance get screened for lung cancer and Medicare and Medicaid patients do not get screened.
The determination is not yet final, since the recommendation is non-binding. CMS will release a proposed coverage decision in November and a final national coverage determination by February 2015.