THE EVER-PRESENT CHALLENGES OF BREAST CANCER DETECTION AND TREATMENT: HOW DO WE COMBAT THEM?4/10/2022 By: Neha Mani
In 2013, I remember seeing a photograph in The New York Times. A Ugandan girl, Edith Kemigisha, sobbed as she saw the inside of a wooden coffin lined with printed flowers and white lace—no matter how pretty the encasing, the sight brought to terribly vivid detail how metastatic breast cancer had taken the life of her mother (Grady, 2013). She was my age. The eerie tone of the article lingered in my mind: all of the stories in the article seemed to imply that if only her mother had been diagnosed sooner, treated sooner, then maybe she’d still be alive. Breast cancer disproportionately impacts women of color from impoverished backgrounds. Every year, there are more than two million cases of breast cancer per year, accounting for 24.2% of cancer cases in women—the highest incidence of all varieties of cancer with a global mortality rate of 6.6% (Barrios, 2022). Lower and middle-income countries (LMIC) bear 60% of new breast cancer cases and 70% of breast cancer-related deaths worldwide (Barrios, 2022). Most notably, LMIC has worse five-year survival rates for breast cancer than high-income countries (HIC) by at least 25% (Rivera-Franco & Leon-Rodriguez, 2018). Perhaps we should more specifically ask the question of why early detection is lacking in LMIC before we begin to understand how to address the resulting healthcare inequity. Naturally, these grim statistics simply stem from poorly developed women’s medical infrastructure, particularly with regard to early detection and treatment of cancer, in countries with already underfunded healthcare systems (Rivera-Franco & Leon-Rodriguez, 2018). For example, in India, there is a lack of routine breast cancer screenings and diagnostics which, compounded with a cultural reluctance to improve women’s healthcare, culminate in poor outcomes (Rivera-Franco & Leon-Rodriguez, 2018). A lack of cultural awareness and stigma fuels an already growing vacancy in women’s healthcare (Cousins, 2018). While it is difficult to change a culture in a short period of time, it is easier to address the more tangible need for easily accessible mammographic scans with advancements in technology. One new development is a more user-friendly, accessible, technologically integrated breast exam device produced by UE LifeSciences (Cousins, 2018). This hand-held device, iBreastExam, employs ceramic sensors to accurately detect variations in breast tissue texture in only five minutes with all of the results uploaded to a smartphone app (Cousins, 2018). Additionally, this technology is both pain and radiation-free as well as $16-19 cheaper than a mammogram, all facets encouraging more patients to follow-up on this crucial check-up (Cousins, 2018). Mihir Shah, a co-founder and CEO of the company, has brought iBreastExam to state-assisted screening campaigns, most notably one in Maharashtra for 250,000 women (Cousins, 2018). In just a few hours, someone could be trained to administer exams using this device, thereby saving thousands of women precious time, money, and heartache (Cousins, 2018). Early detection is one half of the battle; treatment is the other. One of the most important advances in breast cancer treatment has been the development of anti-HER2 therapies—drugs like trastuzumab target the human epidermal growth factor receptor 2 (HER2) on the surface of cancerous cells (Vu & Claret, 2012). A notable barrier to universal treatment access is cost, the newest breast cancer treatments being especially expensive. For example, in India, trastuzumab costs anywhere between $173,825 and $275,523 rupees ($2,486 to $3,940) for annual treatment—this cost far exceeds what many can afford and thus prevents people from seeking out medical care (Gupta, et al. 2020). Yet, if physicians focused on crafting more universally applicable regimens of chemotherapy, radiation, and surgery in a cost-effective, remissive (or, potentially “curable”) way, then maybe we’d see lower mortality rates in LMIC. So, the question remains—if these kinds of revolutionary devices and treatments exist in the market today, how come the statistics seem reluctant to budge? Where is the impact of advancements in early oncological detection on a global scale (i.e., not simply from a one-off clinical interaction or campaigns, but rather systemic changes in early detection)? Now with technology like iBreastExam infiltrating the commercial healthcare system, there is a demand for such tools to find their way into more public hospitals and clinics—those sectors of healthcare are where the statistics lie. The first step to more equitable healthcare is technology that adapts medicine to varying environments but the next one is even more crucial—access. It seems counterintuitive, but the push for the latest treatments may actually be harming treatment access in LMIC to begin with, as we’ve seen with the economic barriers posed by trastuzumab (Barrios, 2022). Hopefully, as we begin to recognize the fallacies in global healthcare, we’d see more women lining up outside clinics for screenings and physicians addressing their issues effectively, presenting them with viable options for their social circumstances. It is a haunting reminder that, perhaps, one of those women would have been Jolly Komurembe, Edith Kemigisha’s mother. References https://www.sciencedirect.com/science/article/pii/S0960977622000303 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5802601/ https://www.uelifesciences.com/ibreastexam https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3376449/ https://www.nytimes.com/2018/08/28/opinion/detect-breast-cancer-developing-countries-asia.html https://www.cancer.gov/types/breast/research#:~:text=Approved%20drugs%20include%3A,advanced%20or%20metastatic%20breast%20cancer. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7051799/ https://www.nytimes.com/2013/10/16/health/uganda-fights-stigma-and-poverty-to-take-on-breast-cancer.html
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 BY: ELAINE LEE (CC'23) Almost a year into the COVID-19 pandemic, the situation in the United States is turning grim. Dropping temperatures are pushing gatherings indoors where lower ventilation increases infection risks. With the upcoming holidays, millions of people are traveling home despite the warnings of CDC guidelines. Together, these events could spell trouble for the country. Coronavirus infections are already rising in every part of the country. To make matters worse, misinformation about COVID-19 thrives on the internet, further hampering the U.S’s pandemic response. In response to conflicting information about wearing masks and social distancing, we, a team of Columbia professors, postdocs, postgrads, and undergrads, started Wearing is Caring in March 2020. Since July, we’ve been publishing science-based mask guidelines. In a time like this, it is more important than ever for members of the general public to stay safe. Here are some of our most important findings: Why should I wear a mask? Throughout the pandemic, different studies have reported different numbers on the rate of asymptomatic infection. However, whatever the true asymptomatic rate may be, all of the studies can agree on one thing: anyone can get infected with the coronavirus, infect friends and family, and show no symptoms. As a result, even those who don’t feel sick need to take precautions like wearing masks and social distancing. How do I wear a mask? To wear a mask properly and maximize its level of protection, there are many aspects to consider, from material to design. One of the aspects we want to emphasize is mask fit. While wearing a mask is important to stop the spread of the coronavirus, wearing a mask that fits is also crucial. While it is true that an N95 mask has a higher filtration ability than a cloth mask, badly fitting N95s provide far less protection than a surgical mask or cloth mask with a good fit. Ultimately, fit makes all the difference between a piece of cloth and a properly working mask. For more information on how to properly wear a mask, visit our website. What about face shields? Face shields have emerged as a potential alternative to masks. However, even though they add eye protection not provided by masks, they’re not a perfect replacement. Like the plexiglass glass barrier at Chipotle, face shields are good sneeze guards. They catch the large droplets that you’re exposed to when someone coughs in your face. However, they don’t block smaller aerosols from moving in through the gaps. To maximize protection, face shields can be worn with masks. They cannot, however, be worn instead of masks. For many Americans, the holidays will be marked by empty chairs and spotty Zoom calls instead of turkey dinners with loved ones. We are devastated that people are being forced to forgo the comfort of friends and family, especially during trying times like these. However, until a vaccine is available next year, we have to continue taking these precautions. From the bottom of our hearts, we thank you for all the sacrifices you have made––and will continue to make-––to protect your community, and wish you a safe and happy thanksgiving. To learn more about WearingisCaring, visit their website at WearingPPEisCaring.org! References: https://www.cdc.gov/coronavirus/2019-ncov/community/large-events/considerations-for-events-gatherings.html https://www.npr.org/sections/coronavirus-live-updates/2020/11/23/938096720/millions-of-americans-traveling-for-thanksgiving-ignoring-cdc-advice https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html https://www.cnn.com/2020/09/01/business/coronavirus-myths-social-media-doctors-trnd/index.html https://www.cebm.net/covid-19/covid-19-what-proportion-are-asymptomatic/ https://www.cbsnews.com/news/covid-vaccine-astrazeneca-ceo-says-december-january/  By: Mayeesa Rahman (BC'23)
Since its first reported case in November 2019, the novel coronavirus (COVID-19) has undoubtedly changed the lives of millions across the globe. According to the Centers for Disease Control and Prevention (CDC), more than 1.3 million people worldwide have died as a result of the virus, while others have faced hospitalization, job loss, and food and resource deficits. Another less-publicized consequence of the pandemic is its effect on international humanitarian organizations. International humanitarian relief agencies and non-governmental organizations, such as Doctors Without Borders or CARE, work independently of the government to serve social or political goals such as humanitarian or environmental causes worldwide. One particular aspect of NGOs that has been detrimentally impacted by COVID-19 is their ability to provide relief to refugees. The Office of the United Nations High Commissioner for Refugees reports that the number of forcibly displaced people around the globe, 68.5 million, is the highest level of human displacement ever recorded. This figure includes 25.4 million refugees, an unprecedented number that indicates that the global refugee crisis persists alongside the pandemic. Many refugees are not granted access to government support for unemployed citizens. Consequently, they are forced to rely on humanitarian organizations for cash assistance and employment. Efforts to contain the pandemic have strained the budgets of humanitarian organizations worldwide, significantly affecting their ability to aid refugees. A recent survey in Jordan by the World Health Organization (WHO), for instance, showed that 35% of Syrian refugees lack a sufficient source of income and do not have a job to return to when pandemic restrictions are ultimately lifted. Furthermore, refugees also face a disproportionate risk of exposure to the virus due to the conditions in which they live. Many live in densely populated refugee camps, where social distancing is difficult to maintain and sanitation conditions are severely lacking. A large proportion of refugees, such as the Rohingya Muslims who currently reside in Bangladesh - a third-world nation with one of the highest tuberculosis (TB) incidences in the entire world - have previously contracted TB, which increases their chances of contracting COVID-19 and makes them less likely to recover. Medical resources in refugee camps are also very limited, to the extent that the WHO reports that a coronavirus outbreak would totally overwhelm hospitals in just 58 days. Refugees are also often stigmatized by the general public in the countries to which they have been displaced, compounding their fear of admitting that they have COVID-19 symptoms and seeking treatment. Humanitarian organizations should take initiative to implement outbreak response teams within refugee camps, ensure that there are sufficient medical resources in these camps, and provide economic relief to refugees. Their ability to do so has been significantly hindered/constrained by the financial impacts of the pandemic; however, many organizations such as the WHO and UN-associated humanitarian relief agencies have adopted the $2.01 billion 2019 Humanitarian COVID-19 response plan. This program seeks to fight COVID-19 in the world’s most vulnerable nations while maintaining funding for the treatment of other diseases that continue to persist in third world nations such as malaria, cholera, and tuberculosis. Through this plan, many countries in need of humanitarian aid from international organizations have managed to control their rates of COVID-19 infections and their incidence of other diseases, according to the CDC. This is a hopeful statistic in the face of the global pandemic, but more can and should be done to aid the millions of refugees who continue to suffer due to COVID-19 and are almost entirely dependent on humanitarian organizations for aid. References: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6146746/ https://apps.who.int/gb/ebwha/pdf_files/WHA72/A72_25-en.pdf?ua=1 https://www.who.int/bulletin/volumes/98/8/20-271080/en/ https://www.who.int/emergencies/diseases/novel-coronavirus-2019/donate  HER STORY:“My perspective on global health and social justice takes me back to my experiences in northern Uganda. During a very tense and violent period of war by rebel groups, I had been working with the World Food Program of the United Nations, where I was in charge of general food distributions to camps of Internally Displaced Persons (IDPs). People were fighting and shooting among civilian streets, but I continued my work. I also often carried injured or dead bodies to our nearest hospital.
Every time I distributed food, I cried. I saw suffering women with their children waiting in the queue. One woman waited for over 6hrs with her child on her back, witnessing many others raiding the food. After I served her that day, she realized that her baby had died. This was a turning point in my life: whatever food I could give her in that moment could not bring her child back to life. I counseled her and talked to her family and began to realize that the problems she told me about were shared amongst most women in Northern Uganda. Women were bearing more of the burden and the suffering in our community. From talking with women one by one, many women found solidarity in me; they came to me with their problems. I quickly set up a regular venue where women could sit with me for counseling. There was one Mango Tree near my place— that was where we could meet. Many women shared their stories of rape, abuse, torture, and lack of health support. I left my personal work and started figuring out ways we can support women, girls, and communities. I called for friends to help, too. Together, we started Gulu Women’s Economic Development & Globalization (GWED-G). And today, we serve over 150,000 individuals in programs for health, human rights, access to justice, peace- building, psychosocial support, advocacy, and economic empowerment. Due to the COVID-19 pandemic, we are now on lockdown, but that does not mean that our work stops. We are now playing an active role on our District’s COVID-19 Task Force and have been distributing food to over 300 food-insecure families. Our Village Health Teams are travelling miles by bike, door-to-door, to continue providing antiretroviral treatment for those with HIV/AIDS and we are actively responding to cases of Gender-Based Violence (GBV) in domestic households, which have been on the rise because of the lockdown. After this pandemic, I hope to reunite with my communities from where it all began— under the Mango Tree.” To support GWED-G during the COVID-19 Pandemic, please share her story and consider donating via eventbrite or venmo @covid19uganda. Follow her on Facebook at GWED-G and on Instagram @gwed.g Post By: Gabriella Wolf
A new start up in Israel promises to change the future of regenerative medicine -- they claim they can 3D print new organs and tissues. Across America, there is a huge shortage of organ donations. More than 113,000 are on waiting lists for an organ, and about 20 people die each day from not receiving a life-saving transplant in time. This new technology can be a solution that can save countless lives globally, while also helping the environment. The new technology focuses on printing human tissue, which can be used for a variety of different medical needs. They are focusing on 3D printing full organs, but they also are going to utilize their technology to “developing and commercializing tissue repair products for orthobiologics, and advanced wound care markets.” The tissue is created mainly using rhCollagen, which is recombinant human collagen. The collagen is grown using plant based technology, which is economically good because of its low production cost. They use human collagen, which is genetically engineered to grow inside tobacco plants. This technology connects the company with local farmers and together they can mass produce the substance needed to create this regenerative material. Using plant based materials is effective because it is good for the environment, and the producers do not have to pay heavy costs for fancy chemical machinery to genetically produce a fake material. The material they have created does not only have to be used by their company, they have created a "building block" to a whole new world of medical regenerative technology. This new product will hopefully change the future of regenerative medicine. The ability to save lives using natural, non-allergenic material will speed up the process of bioengineering the specific needs of patients. Especially because of the low cost to produce, and the expansive possible uses of their product, this new tissue could be the new lifesaving medical breakthrough. Although the technology has not been put into public use yet, it is a promising insight into the future of regenerative medicine. Sources: https://en.globes.co.il/en/article-collplant-reports-commercialization-underway-1001183534 https://www.organdonor.gov/statistics-stories/statistics.html https://www.collplant.com By: Mizia Claire Wessel
Earlier this month, the pharmaceutical giant Johnson & Johnson entered into a $20.4 million settlement with counties in Ohio state in an opioid case. The settlement marks one of the first federal opioid related cases to be brought against a pharmaceutical company. While a large sum of the payment will be funneled toward opioid addiction treatment, settling litigation leaves us a long way from solving the deep rooted and deadly consequences of the opioid crisis across our country. One of the most serious and dire effects of the opioid epidemic is its link to deaths by suicide. In a study in Flint, Michigan, researchers found that 39% of patients at a local hospital described one of the main reasons for the opioid or sedative overdose was because they either wanted to die or did not care about the risks. Moreover, most patients prescribed opioids are suffering from chronic pain. As a result, they are often more likely to suffer from mental illnesses such as depression and therefore also at a higher risk of suicide. Opioid users are a higher-risk population when it comes to death by suicide; a truth that pharmaceutical companies like Johnson & Johnson have been slow to address. While companies like Johnson & Johnson may fail to adequately address the consequences of the opioid epidemic, politicians on both sides of the aisle are paving the way for a shift in this mindset. U.S. Senator Kirsten Gillibrand (D-NY) and U.S. Senator Cory Gardner (R-CO) announced legislation in March 2019 to limit opioid prescriptions for acute pain to less than a week. While this bill may not help those using opioid prescriptions for chronic pain, it is a step in the right direction in terms of how to critically think and enact change for those suffering as a result of the epidemic. A change in the views about mental health and opioid usage is also happening at the level. In Washington, D.C., for example, the newly created Community Response Team is actively working to connect opioid users to crisis response as well as longer term mental health support. Hopefully, grass-roots movements like the one in D.C. will spread to the federal level to help those most at risk and help destigmatize the opioid crisis around the United States. Sources https://www.nimh.nih.gov/about/director/messages/2019/suicide-deaths-are-a-major-component-of-the-opioid-crisis-that-must-be-addressed.shtml https://www.sciencedirect.com/science/article/pii/S0306460317304380?via%3Dihub https://www.npr.org/2019/10/02/766332253/in-opioid-settlement-johnson-johnson-agrees-to-pay-ohio-counties-20-million https://www.gillibrand.senate.gov/news/press/release/senators-gillibrand-and-gardner-announce-bipartisan-legislation-to-combat-opioid-crisis-by-limiting-prescriptions-to-seven-days https://wtop.com/dc/2019/10/d-c-s-fight-against-the-opioid-epidemic-includes-an-expansion-of-community-based-mental-health-support/ |
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