How Not To Die – by Dr. Michael Greger
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We previously reviewed this book some years ago, but we’re revisiting it now because:
- It really is a book that should be in every healthspan-enjoyer’s collection
- Our book reviews back then were not as comprehensive as now (though we still generally try to fit into the “it takes about one minute to read this review” idea, sometimes we’ll spend a little extra time).
Dr. Greger (of “Dr. Greger’s Daily Dozen” fame) outlines for us in cold hard facts and stats what’s most likely to be our cause of death. While this is not a cheery premise for a book, he then sets out to work back from there—what could have prevented those specific things?
Thus, while the book doesn’t confer immortality (the title is not “how to not die”, after all), it does teach us how not to die—i.e, from heart disease, lung diseases, brain diseases, digestive cancers, infections, diabetes, high blood pressure, liver disease, blood cancers, kidney disease, breast cancer, suicidal depression, prostate cancer, Parkinson’s disease, and even iatrogenic causes.
This it does with a lot of solid science, explained for the layperson, and/but without holding back when it comes to big words, and a lot of them, at that. If you want to add in daily exercises, just lifting the book could be a start; weighing in at 678 pages, it’s an information-dense tome that’s more likely to be sifted through than read cover-to-cover.
The style is thus dense science somewhat editorialized for lay readability, and well-evidenced with around 3,000 citations. That’s not a typo; there are 178 pages of bibliography at the back with about 15–20 scientific references per page.
In terms of practical use, he does also devote chapters to that, it’s not just all textbook. Indeed, he discusses the reasonings behind the items, portion sizes, and quantities of his “daily dozen” foods, so that the reader will understand how much bang-for-buck they deliver, and then it’ll seem a lot less like an arbitrary list, and more likely to be adopted and maintained.
Bottom line: if you care about not getting life-threatening illnesses (which at the end of the day, come to most people at some point), then this book is a must-read.
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It’s A Wrap
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We hope all our readers have had a great and healthy week! Here are some selections from health news from around the world:
A lack of transparency
Thousands of chemicals blanket-approved for food contact in packaging, under the FDA’s “Generally Recognized As Safe” umbrella, have been found in humans.
This highlights a gap in the safeguarding system, because the GRAS classification is given when there’s no known significant association with disease—but in this case, a problem can occur when the build-up in the blood and brain cause problems much later.
Read in full: Thousands of toxins from food packaging found in humans – research
Learn more: We Are Such Stuff As Bottles Are Made Of (It’s Not Fantastic To Be Plastic)
Cafestol for weight loss?
Most coffee intervention studies use instant coffee. Which is understandable; they are scientists on a budget, not coffee shop baristas. But, instant coffee is low in some of coffee’s important compounds, such as cafestol—which as it turns out, can lower not only overall body fat, but also (importantly!) visceral fat.
Read in full: 12-week coffee compound study shows promising results for weight and fat reduction in at-risk individuals
Learn more: The Bitter Truth About Coffee (or is it?)
Doing something is better than doing nothing
While a lot of the bad news both locally and around the world can be infuriating and/or depressing, turning a blind eye may not be the best approach for dealing with it. This study was in teens, but it’s likely that the benefits are similar for other ages too:
Read in full: Racial justice activism, advocacy found to reduce depression, anxiety in some teens
Learn more: Make Social Media Work For Your Mental Health
A ray of hope!
Sometimes, the topic of sun and sunscreens can seem like “damned if you do; damned if you don’t”, with regard to the harmful effects of the sun, and in some cases, potentially harmful effects of some sunscreen chemicals. We’ve argued ultimately in favor of sunscreens in this tug-of-war, but it’s nice to see improvements being made, in this case, with lignin-based sunscreen (a plant-based by-product of the pulp industry).
Read in full: Researchers create high-performing, eco-friendly sunscreen
Learn more: Who Screens The Sunscreens?
All about the pores
Researchers have identified a protein, and from that, a stack of protein fragments, that are involved in the formation of large pores. This is important, as it’s pointing to a means of relief for a lot of inflammatory diseases.
Read in full: Scientists unravel the process of pore formation in cells
Learn more: Why Do We Have Pores, And Could We Not?
Getting to the bottom of Crohn’s
If you have Crohn’s, or perhaps someone close to you has it, then you’ll be familiar with the common medical refrain of “we don’t know”. While this honesty is laudable, it’s not reassuring. So, it’s good that researchers are making progress in understanding why many people with Crohn’s may respond differently not only to lifestyle interventions, but also to various relevant drugs—allowing doctors to prescribe the right treatment for the right person.
Read in full: Patient-derived gut organoids reveal new insights into Crohn’s disease subtypes
Learn more: Diet Tips for Crohn’s Disease
Another carotenoid that holds back Alzheimer’s
Phytoene is a carotenoid that is found in many red, orange, or yellow foods, including tomatoes, carrots, apricots, red peppers, oranges, mandarins and passion fruit, among others. Researchers have found that it slows the onset of symptoms associated with the formation of amyloid plaques, by 30–40%, and increases longevity by 10–19%:
Read in full: Carotenoid phytoene shows potential in slowing Alzheimer’s plaque formation and increasing lifespan
Learn more: Brain Food? The Eyes Have It! ← this is about a different carotenoid, lutein, found mostly in dark green leafy vegetables, but it’s best to enjoy both 😎
Take care!
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Skin Care Down There (Incl. Butt Acne, Hyperpigmentation, & More)
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Dr. Sam Ellis, dermatologist, gives us the low-down:
Where the sun don’t shine
Common complaints and remedies that Dr. Ellis covers in this video include:
- Butt acne/folliculitis: most butt breakouts are actually folliculitis, not traditional acne. Folliculitis is caused by friction, sitting for long periods, or wearing tight clothes. Solutions include antimicrobial washes like benzoyl peroxide and changing sitting habits (i.e. to sit less)
- Keratosis pilaris: rough bumps around hair follicles can appear on the butt, often confused with acne.
- Boils and abscesses: painful, large lumps; these need medical attention for drainage.
- Hidradenitis suppurativa: recurrent painful cysts and boils in skin creases, often in the groin and buttocks. These require medical intervention and treatment.
- Ingrown hairs: are common in people who shave or wax. Treat with warm compresses and gentle exfoliants.
- Hyperpigmentation: is often caused by hormonal changes, friction, or other irritation. Laser hair removal and gentle chemical exfoliants can help.
In the event that the sun does, in fact, shine on your genitals (for example you sunbathe nude and have little or no pubic hair), then sun protection is essential to prevent further darkening (and also, incidentally, reduce the risk of cancer).
For more on all of this, plus a general introduction to skincare in the bikini zone (i.e. if everything’s fine there right now and you’d like to keep it that way), enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
The Evidence-Based Skincare That Beats Product-Specific Hype
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What’s Keeping the US From Allowing Better Sunscreens?
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When dermatologist Adewole “Ade” Adamson sees people spritzing sunscreen as if it’s cologne at the pool where he lives in Austin, Texas, he wants to intervene. “My wife says I shouldn’t,” he said, “even though most people rarely use enough sunscreen.”
At issue is not just whether people are using enough sunscreen, but what ingredients are in it.
The Food and Drug Administration’s ability to approve the chemical filters in sunscreens that are sold in countries such as Japan, South Korea, and France is hamstrung by a 1938 U.S. law that has required sunscreens to be tested on animals and classified as drugs, rather than as cosmetics as they are in much of the world. So Americans are not likely to get those better sunscreens — which block the ultraviolet rays that can cause skin cancer and lead to wrinkles — in time for this summer, or even the next.
Sunscreen makers say that requirement is unfair because companies including BASF Corp. and L’Oréal, which make the newer sunscreen chemicals, submitted safety data on sunscreen chemicals to the European Union authorities some 20 years ago.
Steven Goldberg, a retired vice president of BASF, said companies are wary of the FDA process because of the cost and their fear that additional animal testing could ignite a consumer backlash in the European Union, which bans animal testing of cosmetics, including sunscreen. The companies are asking Congress to change the testing requirements before they take steps to enter the U.S. marketplace.
In a rare example of bipartisanship last summer, Sen. Mike Lee (R-Utah) thanked Rep. Alexandria Ocasio-Cortez (D-N.Y.) for urging the FDA to speed up approvals of new, more effective sunscreen ingredients. Now a bipartisan bill is pending in the House that would require the FDA to allow non-animal testing.
“It goes back to sunscreens being classified as over-the-counter drugs,” said Carl D’Ruiz, a senior manager at DSM-Firmenich, a Switzerland-based maker of sunscreen chemicals. “It’s really about giving the U.S. consumer something that the rest of the world has. People aren’t dying from using sunscreen. They’re dying from melanoma.”
Every hour, at least two people die of skin cancer in the United States. Skin cancer is the most common cancer in America, and 6.1 million adults are treated each year for basal cell and squamous cell carcinomas, according to the Centers for Disease Control and Prevention. The nation’s second-most-common cancer, breast cancer, is diagnosed about 300,000 times annually, though it is far more deadly.
Dermatologists Offer Tips on Keeping Skin Safe and Healthy
– Stay in the shade during peak sunlight hours, 10 a.m. to 4 p.m. daylight time.– Wear hats and sunglasses.– Use UV-blocking sun umbrellas and clothing.– Reapply sunscreen every two hours.You can order overseas versions of sunscreens from online pharmacies such as Cocooncenter in France. Keep in mind that the same brands may have different ingredients if sold in U.S. stores. But importing your sunscreen may not be affordable or practical. “The best sunscreen is the one that you will use over and over again,” said Jane Yoo, a New York City dermatologist.
Though skin cancer treatment success rates are excellent, 1 in 5 Americans will develop skin cancer by age 70. The disease costs the health care system $8.9 billion a year, according to CDC researchers. One study found that the annual cost of treating skin cancer in the United States more than doubled from 2002 to 2011, while the average annual cost for all other cancers increased by just 25%. And unlike many other cancers, most forms of skin cancer can largely be prevented — by using sunscreens and taking other precautions.
But a heavy dose of misinformation has permeated the sunscreen debate, and some people question the safety of sunscreens sold in the United States, which they deride as “chemical” sunscreens. These sunscreen opponents prefer “physical” or “mineral” sunscreens, such as zinc oxide, even though all sunscreen ingredients are chemicals.
“It’s an artificial categorization,” said E. Dennis Bashaw, a retired FDA official who ran the agency’s clinical pharmacology division that studies sunscreens.
Still, such concerns were partly fed by the FDA itself after it published a study that said some sunscreen ingredients had been found in trace amounts in human bloodstreams. When the FDA said in 2019, and then again two years later, that older sunscreen ingredients needed to be studied more to see if they were safe, sunscreen opponents saw an opening, said Nadim Shaath, president of Alpha Research & Development, which imports chemicals used in cosmetics.
“That’s why we have extreme groups and people who aren’t well informed thinking that something penetrating the skin is the end of the world,” Shaath said. “Anything you put on your skin or eat is absorbed.”
Adamson, the Austin dermatologist, said some sunscreen ingredients have been used for 30 years without any population-level evidence that they have harmed anyone. “The issue for me isn’t the safety of the sunscreens we have,” he said. “It’s that some of the chemical sunscreens aren’t as broad spectrum as they could be, meaning they do not block UVA as well. This could be alleviated by the FDA allowing new ingredients.”
Ultraviolet radiation falls between X-rays and visible light on the electromagnetic spectrum. Most of the UV rays that people come in contact with are UVA rays that can penetrate the middle layer of the skin and that cause up to 90% of skin aging, along with a smaller amount of UVB rays that are responsible for sunburns.
The sun protection factor, or SPF, rating on American sunscreen bottles denotes only a sunscreen’s ability to block UVB rays. Although American sunscreens labeled “broad spectrum” should, in theory, block UVA light, some studies have shown they fail to meet the European Union’s higher UVA-blocking standards.
“It looks like a number of these newer chemicals have a better safety profile in addition to better UVA protection,” said David Andrews, deputy director of Environmental Working Group, a nonprofit that researches the ingredients in consumer products. “We have asked the FDA to consider allowing market access.”
The FDA defends its review process and its call for tests of the sunscreens sold in American stores as a way to ensure the safety of products that many people use daily, rather than just a few times a year at the beach.
“Many Americans today rely on sunscreens as a key part of their skin cancer prevention strategy, which makes satisfactory evidence of both safety and effectiveness of these products critical for public health,” Cherie Duvall-Jones, an FDA spokesperson, wrote in an email.
D’Ruiz’s company, DSM-Firmenich, is the only one currently seeking to have a new over-the-counter sunscreen ingredient approved in the United States. The company has spent the past 20 years trying to gain approval for bemotrizinol, a process D’Ruiz said has cost $18 million and has advanced fitfully, despite attempts by Congress in 2014 and 2020 to speed along applications for new UV filters.
Bemotrizinol is the bedrock ingredient in nearly all European and Asian sunscreens, including those by the South Korean brand Beauty of Joseon and Bioré, a Japanese brand.
D’Ruiz said bemotrizinol could secure FDA approval by the end of 2025. If it does, he said, bemotrizinol would be the most vetted and safest sunscreen ingredient on the market, outperforming even the safety profiles of zinc oxide and titanium dioxide.
As Congress and the FDA debate, many Americans have taken to importing their own sunscreens from Asia or Europe, despite the risk of fake products.
“The sunscreen issue has gotten people to see that you can be unsafe if you’re too slow,” said Alex Tabarrok, a professor of economics at George Mason University. “The FDA is just incredibly slow. They’ve been looking at this now literally for 40 years. Congress has ordered them to do it, and they still haven’t done it.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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From Painkillers To Hunger-Killers
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Here’s this week’s selection of health news discoveries, the science behind them, what they mean for you, and where you can go from there:
Killing more than pain
It’s well-known that overuse of opioids can lead to many problems, and here’s another one: messing with the endocrine system. This time, mostly well-evidenced in men—however, the researchers are keen to point out that absence of evidence is very much not evidence of absence, hence “the hidden effects” in the headline below. It’s not that the effects are hard to see—it’s that a lot of the research has yet to be done. For now, though, we know at the very least that there’s an association between opioid use and hyperprolactinemia in men. The same research also begins to shine a light on the effects of opioid use on the hypothalamic-pituitary system and bone health, too:
Read in full: The hidden effects of opioid use on the endocrine system
Related: The 7 Approaches To Pain Management
Gut microbiome dysbiosis may lead to slipping disks
These things sound quite unconnected, but the association is strong. The likely mechanism of action is that the gut dysbiosis influences systemic inflammation, and thus spinal health—because the gut-spine axis cannot really be disconnected (while you’re alive, at least). It’s especially likely if you’re over 50 and female:
Read in full: Are back problems influenced by your gut?
Related: Is Your Gut Leading You Into Osteoporosis?
The Internet is really really great (for brains)
It’s common to see many articles on the Internet telling us, paradoxically, that we should spend less time on the Internet. However… Remember when in the 90s, it was all about “the information superhighway”? It turns out, the fact that it’s more like “the information spaghetti junction” these days doesn’t change the fact that stimulation is good for our brains, and daily Internet use improves memory, because of the different way that we index and store information that came from a virtual source. While there are parts of your brain for “things at home” and “things at the local supermarket”, there are also parts for “things at 10almonds” and “things at Facebook” and so forth. You are, in effect, building a vast mental library as you surf:
Read in full: Daily internet use supercharges your memory!
Related: Make Social Media Work For Your Mental Health
Fall back
Around this time of year in many places in the Northern Hemisphere, the clocks go back an hour (it’s next weekend in the US and Canada, by the way, and this weekend in most of Europe). Many enjoy this as the potential for an extra hour’s sleep, but for night owls, it can be more of a nuisance than a benefit—throwing out what’s often an already difficult relationship with the clock, and presenting challenges both practical and physiological (different processing of melatonin, for instance). Here be science:
Read in full: Why night owls struggle more when the clocks go back
Related: Early Bird Or Night Owl? Genes vs Environment
Can you outrun your hunger?
It seems so, though benefits are strongest in women. We say “outrun”, though this study did use stationary cycling. To put it in few words, intense exercise (but not moderate exercise) significantly reduced acylated ghrelin (hunger hormone) levels, and subjective reports of hunger, especially in women:
Read in full: Study finds intense exercise may suppress appetite in healthy humans
Related: 3 Appetite Suppressants Better Than Ozempic
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Testosterone, Tourette’s, and Tickly Throats
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝Could you do a series on mens health? Testosterone boosters. Libido? What works what doesnt? Also could you discuss prostate health and what supplements, meds, foods or protocols work to relieve symptoms of bph❞
We could indeed! We’ll be sure to write more, but while you’re waiting, you might like to read our main feature from a while back:
Too Much Or Too Little Testosterone?
…as it does include a lot about the use of a supplement that helps against Benign Prostatic Hyperplasia, with performance comparable to the most common drug prescribed for such.
And since (like that drug) it’s a 5α-reductase inhibitor (meaning it works by blocking the conversion of testosterone to DHT), this means it helps against prostate problems (and also, incidentally, male pattern hair loss) without reducing overall testosterone levels. In fact, because less testosterone will be converted to DHT, you’ll actually (all other things being equal) end up with slightly higher free testosterone levels.
❝My BMI is fine, but my waist is too big. What do I do about that? I am 5′ 5″ tall and 128 pounds and 72 years old.❞
It’s hard to say without knowing about your lifestyle (and hormones, for that matter)! But, extra weight around the middle in particular is often correlated with high levels of cortisol, so you might find this of benefit:
Lower Your Cortisol! (Here’s Why & How)
❝Is there anything special that might help someone with Tourette’s syndrome?❞
There are of course a lot of different manifestations of Tourette’s syndrome, and some people’s tics may be far more problematic to themselves and/or others, while some may be quite mild and just something to work around.
It’s an interesting topic for sure, so we’ll perhaps do a main feature (probably also covering the related-and-sometimes-overlapping OCD umbrella rather than making it hyperspecific to Tourette’s), but meanwhile, you might consider some of these options:
- Deep Brain Stimulation (DBS)
- Medications/ Pharmacology
- Comprehensive Behavioral Intervention for Tics (CBIT)
- Speech Therapies
❝Natural solutions for osteoarthritis. Eg. Rosehip tea, dandelion root tea. Any others??? What foods should I absolutely leave alone?❞
We’ll do a main feature on arthritis (in both its main forms) someday soon, but meanwhile, we recommend eating for good bone/joint health and against inflammation. To that end, you might like these main features we did on those topics:
- We Are Such Stuff As Fish Are Made Of (collagen for bone and joint health)
- The Bare-Bones Truth About Osteoporosis (eating for bone health generally)
- Keep Inflammation At Bay (dietary tips for minimizing inflammation—also, our all-time most popular article to date!)
Of these, probably the last one is the most critical, and also will have the speediest effects if implemented.
We turn the tables and ask you a question!
We’ll then talk about this tomorrow:
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Early Detection May Help Kentucky Tamp Down Its Lung Cancer Crisis
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Anthony Stumbo’s heart sank after the doctor shared his mother’s chest X-ray.
“I remember that drive home, bringing her back home, and we basically cried,” said the internal medicine physician, who had started practicing in eastern Kentucky near his childhood home shortly before his mother began feeling ill. “Nobody wants to get told they’ve got inoperable lung cancer. I cried because I knew what this meant for her.”
Now Stumbo, whose mother died the following year, in 1997, is among a group of Kentucky clinicians and researchers determined to rewrite the script for other families by promoting training and boosting awareness about early detection in the state with the highest lung cancer death rate. For the past decade, Kentucky researchers have promoted lung cancer screening, first recommended by the U.S. Preventive Services Task Force in 2013. These days the Bluegrass State screens more residents who are at high risk of developing lung cancer than any state except Massachusetts — 10.6% of eligible residents in 2022, more than double the national rate of 4.5% — according to the most recent American Lung Association analysis.
The effort has been driven by a research initiative called the Kentucky LEADS (Lung Cancer Education, Awareness, Detection, and Survivorship) Collaborative, which in 2014 launched to improve screening and prevention, to identify more tumors earlier, when survival odds are far better. The group has worked with clinicians and hospital administrators statewide to boost screening rates both in urban areas and regions far removed from academic medical centers, such as rural Appalachia. But, a decade into the program, the researchers face an ongoing challenge as they encourage more people to get tested, namely the fear and stigma that swirl around smoking and lung cancer.
Lung cancer kills more Americans than any other malignancy, and the death rates are worst in a swath of states including Kentucky and its neighbors Tennessee and West Virginia, and stretching south to Mississippi and Louisiana, according to data from the Centers for Disease Control and Prevention.
It’s a bit early to see the impact on lung cancer deaths because people may still live for years with a malignancy, LEADS researchers said. Plus, treatment improvements and other factors may also help reduce death rates along with increased screening. Still, data already shows that more cancers in Kentucky are being detected before they become advanced, and thus more difficult to treat, they said. Of total lung cancer cases statewide, the percentage of advanced cases — defined as cancers that had spread to the lymph nodes or beyond — hovered near 81% between 2000 and 2014, according to Kentucky Cancer Registry data. By 2020, that number had declined to 72%, according to the most recent data available.
“We are changing the story of families. And there is hope where there has not been hope before,” said Jennifer Knight, a LEADS principal investigator.
Older adults in their 60s and 70s can hold a particularly bleak view of their mortality odds, given what their loved ones experienced before screening became available, said Ashley Shemwell, a nurse navigator for the lung cancer screening program at Owensboro Health, a nonprofit health system that serves Kentucky and Indiana.
“A lot of them will say, ‘It doesn’t matter if I get lung cancer or not because it’s going to kill me. So I don’t want to know,’” said Shemwell. “With that generation, they saw a lot of lung cancers and a lot of deaths. And it was terrible deaths because they were stage 4 lung cancers.” But she reminds them that lung cancer is much more treatable if caught before it spreads.
The collaborative works with several partners, including the University of Kentucky, the University of Louisville, and GO2 for Lung Cancer, and has received grant funding from the Bristol Myers Squibb Foundation. Leaders have provided training and other support to 10 hospital-based screening programs, including a stipend to pay for resources such as educational materials or a nurse navigator, Knight said. In 2022, state lawmakers established a statewide lung cancer screening program based in part on the group’s work.
Jacob Sands, a lung cancer physician at Boston’s Dana-Farber Cancer Institute, credits the LEADS collaborative with encouraging patients to return for annual screening and follow-up testing for any suspicious nodules. “What the Kentucky LEADS program is doing is fantastic, and that is how you really move the needle in implementing lung screening on a larger scale,” said Sands, who isn’t affiliated with the Kentucky program and serves as a volunteer spokesperson for the American Lung Association.
In 2014, Kentucky expanded Medicaid, increasing the number of lower-income people who qualified for lung cancer screening and any related treatment. Adults 50 to 80 years old are advised to get a CT scan every year if they have accumulated at least 20 pack years and still smoke or have quit within the past 15 years, according to the latest task force recommendation, which widened the pool of eligible adults. (To calculate pack years, multiply the packs of cigarettes smoked daily by years of smoking.) The lung association offers an online quiz, called “Saved By The Scan,” to figure out likely eligibility for insurance coverage.
Half of U.S. patients aren’t diagnosed until their cancer has spread beyond the lungs and lymph nodes to elsewhere in the body. By then, the five-year survival rate is 8.2%.
But regular screening boosts those odds. When a CT scan detects lung cancer early, patients have an 81% chance of living at least 20 years, according to data published in November in the journal Radiology.
Some adults, like Lisa Ayers, didn’t realize lung cancer screening was an option. Her family doctor recommended a CT scan last year after she reported breathing difficulties. Ayers, who lives in Ohio near the Kentucky border, got screened at UK King’s Daughters, a hospital in far eastern Kentucky. The scan didn’t take much time, and she didn’t have to undress, the 57-year-old said. “It took me longer to park,” she quipped.
She was diagnosed with a lung carcinoid tumor, a type of neuroendocrine cancer that can grow in various parts of the body. Her cancer was considered too risky for surgery, Ayers said. A biopsy showed the cancer was slow-growing, and her doctors said they would monitor it closely.
Ayers, a lifelong smoker, recalled her doctor said that her type of cancer isn’t typically linked to smoking. But she quit anyway, feeling like she’d been given a second chance to avoid developing a smoking-related cancer. “It was a big wake-up call for me.”
Adults with a smoking history often report being treated poorly by medical professionals, said Jamie Studts, a health psychologist and a LEADS principal investigator, who has been involved with the research from the start. The goal is to avoid stigmatizing people and instead to build rapport, meeting them where they are that day, he said.
“If someone tells us that they’re not ready to quit smoking but they want to have lung cancer screening, awesome; we’d love to help,” Studts said. “You know what? You actually develop a relationship with an individual by accepting, ‘No.’”
Nationally, screening rates vary widely. Massachusetts reaches 11.9% of eligible residents, while California ranks last, screening just 0.7%, according to the lung association analysis.
That data likely doesn’t capture all California screenings, as it may not include CT scans done through large managed care organizations, said Raquel Arias, a Los Angeles-based associate director of state partnerships at the American Cancer Society. She cited other 2022 data for California, looking at lung cancer screening for eligible Medicare fee-for-service patients, which found a screening rate of 1%-2% in that population.
But, Arias said, the state’s effort is “nowhere near what it needs to be.”
The low smoking rate in California, along with its image as a healthy state, “seems to have come with the unintended consequence of further stigmatizing people who smoke,” said Arias, citing one of the findings from a 2022 report looking at lung cancer screening barriers. For instance, eligible patients may be reluctant to share prior smoking habits with their health provider, she said.
Meanwhile, Kentucky screening efforts progress, scan by scan.
At Appalachian Regional Healthcare, 3,071 patients were screened in 2023, compared with 372 in 2017. “We’re just scratching the surface of the potential lives that we can have an effect on,” said Stumbo, a lung cancer screening champion at the health system, which includes 14 hospitals, most located in eastern Kentucky.
The doctor hasn’t shed his own grief about what his family missed after his mother died at age 51, long before annual screening was recommended. “Knowing that my children were born, and never knowing their grandmother,” he said, “just how sad is that?”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
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