We don’t all need regular skin cancer screening – but you can know your risk and check yourself

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Australia has one of the highest skin cancer rates globally, with nearly 19,000 Australians diagnosed with invasive melanoma – the most lethal type of skin cancer – each year.

While advanced melanoma can be fatal, it is highly treatable when detected early.

But Australian clinical practice guidelines and health authorities do not recommend screening for melanoma in the general population.

Given our reputation as the skin cancer capital of the world, why isn’t there a national screening program? Australia currently screens for breast, cervical and bowel cancer and will begin lung cancer screening in 2025.

It turns out the question of whether to screen everyone for melanoma and other skin cancers is complex. Here’s why.

Pixel-Shot/Shutterstock

The current approach

On top of the 19,000 invasive melanoma diagnoses each year, around 28,000 people are diagnosed with in-situ melanoma.

In-situ melanoma refers to a very early stage melanoma where the cancerous cells are confined to the outer layer of the skin (the epidermis).

Instead of a blanket screening program, Australia promotes skin protection, skin awareness and regular skin checks (at least annually) for those at high risk.

About one in three Australian adults have had a clinical skin check within the past year.

clinician checks the back of a young man with red hair and freckles in health office
Those with fairer skin or a family history may be at greater risk of skin cancer. Halfpoint/Shutterstock

Why not just do skin checks for everyone?

The goal of screening is to find disease early, before symptoms appear, which helps save lives and reduce morbidity.

But there are a couple of reasons a national screening program is not yet in place.

We need to ask:

1. Does it save lives?

Many researchers would argue this is the goal of universal screening. But while universal skin cancer screening would likely lead to more melanoma diagnoses, this might not necessarily save lives. It could result in indolent (slow-growing) cancers being diagnosed that might have never caused harm. This is known as “overdiagnosis”.

Screening will pick up some cancers people could have safely lived with, if they didn’t know about them. The difficulty is in recognising which cancers are slow-growing and can be safely left alone.

Receiving a diagnosis causes stress and is more likely to lead to additional medical procedures (such as surgeries), which carry their own risks.

2. Is it value for money?

Implementing a nationwide screening program involves significant investment and resources. Its value to the health system would need to be calculated, to ensure this is the best use of resources.

Narrower targets for better results

Instead of screening everyone, targeting high-risk groups has shown better results. This focuses efforts where they’re needed most. Risk factors for skin cancer include fair skin, red hair, a history of sunburns, many moles and/or a family history.

Research has shown the public would be mostly accepting of a risk-tailored approach to screening for melanoma.

There are moves underway to establish a national targeted skin cancer screening program in Australia, with the government recently pledging $10.3 million to help tackle “the most common cancer in our sunburnt country, skin cancer” by focusing on those at greater risk.

Currently, Australian clinical practice guidelines recommend doctors properly evaluate all patients for their future risk of melanoma.

Looking with new technological eyes

Technological advances are improving the accuracy of skin cancer diagnosis and risk assessment.

For example, researchers are investigating 3D total body skin imaging to monitor changes to spots and moles over time.

Artificial intelligence (AI) algorithms can analyse images of skin lesions, and support doctors’ decision making.

Genetic testing can now identify risk markers for more personalised screening.

And telehealth has made remote consultations possible, increasing access to specialists, particularly in rural areas.

Check yourself – 4 things to look for

Skin cancer can affect all skin types, so it’s a good idea to become familiar with your own skin. The Skin Cancer College Australasia has introduced a guide called SCAN your skin, which tells people to look for skin spots or areas that are:

1. sore (scaly, itchy, bleeding, tender) and don’t heal within six weeks

2. changing in size, shape, colour or texture

3. abnormal for you and look different or feel different, or stand out when compared to your other spots and moles

4. new and have appeared on your skin recently. Any new moles or spots should be checked, especially if you are over 40.

If something seems different, make an appointment with your doctor.

You can self-assess your melanoma risk online via the Melanoma Institute Australia or QIMR Berghofer Medical Research Institute.

H. Peter Soyer, Professor of Dermatology, The University of Queensland; Anne Cust, Professor of Cancer Epidemiology, The Daffodil Centre and Melanoma Institute Australia, University of Sydney; Caitlin Horsham, Research Manager, The University of Queensland, and Monika Janda, Professor in Behavioural Science, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Kimchi Fried Rice

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    Fried rice is not something that leaps to many people’s minds when one says “health food”. But it can be! Today’s recipe is great for many aspects of health, but especially the gut, because of its star ingredient, the kimchi—as well as the fiber in the rest of the dish, which is mostly a variety of vegetables, as well as the rice, which we are assuming you got wholegrain. An optional egg per person adds more healthy fats too!

    You will need

    • Avocado oil, for frying. We picked avocado oil for its healthy fats profile, neutral taste, and high smoke point (we’ll be working at very high temperatures today that might make olive oil or coconut oil smoke). We also recommend against seed oils (e.g. sunflower or canola) for health reasons.
    • 1lb cooked and cooled rice—here’s our recipe for Tasty Versatile Rice if you don’t have leftovers you want to use
    • 7oz kimchi, roughly chopped
    • 4 spring onions, finely chopped
    • 4oz white cabbage, finely shredded
    • 3oz frozen peas, defrosted
    • 1 bulb garlic, thinly sliced
    • 1 carrot, grated
    • ½ red pepper, finely diced
    • 2 tbsp chili oil (or 2 tbsp extra virgin olive oil and 1 red chili, very finely chopped) ← don’t worry about the smoke point of this; it’s going to be for drizzling
    • 1 tbsp dark soy sauce
    • 2 tsp black pepper, coarse ground
    • Optional: 1 egg per person
    • Note: we didn’t forget to include salt; there’s simply enough already in the dish because of the kimchi and soy sauce.

    Method

    (we suggest you read everything at least once before doing anything)

    1) Lightly oil a wok (or similar) and crank up the heat as high as your stove can muster. Add the garlic and spring onions; keep them moving. When they’re turning golden, add the cabbage, carrot, and red pepper. Add them one by one, giving the wok a chance to get back to temperature each time before adding the next ingredient.

    2) When the vegetables are beginning to caramelize (if the temperature is good, this should only be a couple of minutes at most), add the rice, as well as the kimchi, peas, soy sauce, and black pepper. Toss everything ensure it’s all well-combined and evenly cooked. When it’s done (probably only another minute or two), take it off the heat.

    3) Optional: if you’re adding eggs, fry them now. Serve a bowl of kimchi-fried rice per person, adding 1 fried egg on top of each.

    4) Drizzle the chili oil as a colorful, tasty garnish that’s full of healthful polyphenols too.

    Enjoy!

    Want to learn more?

    For those interested in some of the science of what we have going on today:

    Take care!

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  • Measles, Memory, & Mouths

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Three important items from this week’s health news:

    It’s not about obesity

    This news is based on a rodent study, so we don’t know for sure if it’s applicable to humans yet, but there’s no reason to expect that it won’t be.

    The crux of the matter is that while it’s long been assumed that when it comes to diet and cognitive decline, obesity is the main driver of problems, it turns out that rats fed a high fat diet—for three days or three months—did much worse in memory tests.

    This was observed in older rats, but not in younger ones—the researchers hypothesized that the younger rats benefited from their ability to activate compensatory anti-inflammatory responses, which the older rats could not.

    Notably, the three-day window of high-fat diet wasn’t sufficient to cause any metabolic problems or obesity yet, but markers of neuroinflammation skyrocketed immediately, and memory test scores declined at the same rate:

    Read in full: High-fat diet could cause memory problems in older adults after just a few days

    Related: Can Saturated Fats Be Healthy?

    Vax, Lies, & Mortality Rates

    Measles is making a comeback in the US.

    100 cases were reported in Gaines county, TX, recently, with 1 death there so far (an unvaccinated child). And of course, it’s spreading; in the neighboring Lea county, NM, they now have an outbreak of 30 confirmed cases, and 1 death there so far (an unvaccinated adult).

    This comes with the rise of the anti-vax movement which comes with a lot of misleading rhetoric (and some things that are simply factually incorrect), and an increase in “measles parties” whereby children are deliberately exposed to measles in order to “get it out of the way” and confer later immunity. That technically does work if everyone survives, but the downside is your child may die:

    Read in full: New Mexico reports 30 measles cases a day after second US death in decade

    Related: 4 Ways Vaccine Skeptics Mislead You on Measles and More

    What your gums say about your hormones

    Times of hormonal change (so, including menopause) can show in one’s gums,

    ❝Recent research shows that 84% of women over 50 did not know that menopause could affect their oral health; 70% of menopausal women reported at least one new oral health symptom (like dry mouth or sensitive gums), yet only 2% had discussed these issues with their dentist.❞

    Because gum disease can progress painlessly for a long while, it’s very important to stay on top of any changes, and look for the cause (enlisting the help of your doctor and/or dentist), lest you find yourself very far into periodontal disease when it could have been stopped and reversed much more easily before getting that bad.

    Different life stages’ hormonal changes have different effects; the article we’ll link below also list puberty, menstrual variations, and pregnancy, but for brevity we’ll just quote what they say about menopause:

    ❝Menopause: the hormonal changes of menopause—primarily the drop in estrogen—can lead to oral health issues. Many menopausal women experience dry mouth, which increases the risk of cavities and gum disease, since saliva helps protect teeth. Gums may also recede or become more sensitive, and some women feel burning sensations in the mouth or changes in taste.❞

    As for the rest…

    Read in full: Gum health: A key indicator of women’s overall well-being

    Related: How To Regrow Receding Gums

    Take care!

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  • Toxic Gas That Sterilizes Medical Devices Prompts Safety Rule Update

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    Over the past two years, Madeline Beal has heard frustration and even bewilderment during public meetings about ethylene oxide, a cancer-causing gas that is used to sterilize half of the medical devices in the U.S.

    Beal, senior risk communication adviser for the Environmental Protection Agency, has fielded questions about why the agency took so long to alert people who live near facilities that emit the chemical about unusually high amounts of the carcinogenic gas in their neighborhoods. Residents asked why the EPA couldn’t close those facilities, and they wanted to know how many people had developed cancer from their exposure.

    “If you’re upset by the information you’re hearing tonight, if you’re angry, if it scares you to think about risk to your family, those are totally reasonable responses,” Beal told an audience in Laredo, Texas, in September 2022. “We think the risk levels near this facility are too high.”

    There are about 90 sterilizing plants in the U.S. that use ethylene oxide, and for decades companies used the chemical to sterilize medical products without drawing much attention. Many medical device-makers send their products to the plants to be sterilized before they are shipped, typically to medical distribution companies.

    But people living around these facilities have been jolted in recent years by a succession of warnings about cancer risk from the federal government and media reports, an awareness that has also spawned protests and lawsuits alleging medical harm.

    The EPA is expected to meet a March 1 court-ordered deadline to finalize tighter safety rules around how the toxic gas is used. The proposed changes come in the wake of a 2016 agency report that found that long-term exposure to ethylene oxide is more dangerous than was previously thought.

    But the anticipated final rules — the agency’s first regulatory update on ethylene oxide emissions in more than a decade — are expected to face pushback. Medical device-makers worry stricter regulation will increase costs and may put patients at higher risk of infection from devices, ranging from surgical kits to catheters, due to deficient sterilization. The new rules are also not likely to satisfy the concerns of environmentalists or members of the public, who already have expressed frustration about how long it took the federal government to sound the alarm.

    “We have been breathing this air for 40 years,” said Connie Waller, 70, who lives with her husband, David, 75, within two miles of such a sterilizing plant in Covington, Georgia, east of Atlanta. “The only way to stop these chemicals is to hit them in their pocketbook, to get their attention.”

    The EPA says data shows that long-term exposure to ethylene oxide can increase the risk of breast cancer and cancers of the white blood cells, such as non-Hodgkin lymphoma, myeloma, and lymphocytic leukemia. It can irritate the eyes, nose, throat, and lungs, and has been linked to damage to the brain and nervous and reproductive systems. Children are potentially more vulnerable, as are workers routinely exposed to the chemical, EPA officials say. The agency calculates the risk based on how much of the gas is in the air or near the sterilizing facility, the distance a person is from the plant, and how long the person is exposed.

    Waller said she was diagnosed with breast cancer in 2004 and that her husband was found to have non-Hodgkin lymphoma eight years later.

    A 2022 study of communities living near a sterilization facility in Laredo found the rates of acute lymphocytic leukemia and breast cancer were greater than expected based on statewide rates, a difference that was statistically significant.

    Beal, the EPA risk adviser, who regularly meets with community members, acknowledges the public’s concerns. “We don’t think it’s OK for you to be at increased risk from something that you have no control over, that’s near your house,” she said. “We are working as fast as we can to get that risk reduced with the powers that we have available to us.”

    In the meantime, local and state governments and industry groups have scrambled to defuse public outcry.

    Hundreds of personal injury cases have been filed in communities near sterilizing plants. In 2020, New Mexico’s then-attorney general filed a lawsuit against a plant in Santa Teresa, and that case is ongoing. In a case that settled last year in suburban Atlanta, a company agreed to pay $35 million to 79 people who alleged ethylene oxide used at the plant caused cancer and other injuries.

    In Cook County, Illinois, a jury in 2022 awarded $363 million to a woman who alleged exposure to ethylene oxide gas led to her breast cancer diagnosis. But, in another Illinois case, a jury ruled that the sterilizing company was not liable for a woman’s blood cancer claim.

    Greg Crist, chief advocacy officer for the Advanced Medical Technology Association, a medical device trade group that says ethylene oxide is an effective and reliable sterilant, attributes the spate of lawsuits to the litigious nature of trial attorneys.

    “If they smell blood in the water, they’ll go after it,” Crist said.

    Most states have at least one sterilizing plant. According to the EPA, a handful, like California and North Carolina, have gone further than the agency and the federal Clean Air Act to regulate ethylene oxide emissions. After a media and political firestorm raised awareness about the metro Atlanta facilities, Georgia started requiring sterilizing plants that use the gas to report all leaks.

    The proposed rules the EPA is set to finalize would set lower emissions limits for chemical plants and commercial sterilizers and increase some safety requirements for workers within these facilities. The agency is expected to set an 18-month deadline for commercial sterilizers to come into compliance with the emissions rules.

    That would help at facilities that “cut corners,” with lax pollution controls that allow emissions of the gas into nearby communities, said Richard Peltier, a professor of environmental health sciences at the University of Massachusetts-Amherst. Stronger regulation also prevents the plants from remaining under the radar. “One of the dirty secrets is that a lot of it is self-regulated or self-policed,” Peltier added.

    But the proposed rules did not include protections for workers at off-site warehouses that store sterilized products, which can continue to emit ethylene oxide. They also did not require air testing around the facilities, prompting debate about how effective they would be in protecting the health of nearby residents.

    Industry officials also don’t expect an alternative that is as broadly effective as ethylene oxide to be developed anytime soon, though they support researching other methods. Current alternatives include steam, radiation, and hydrogen peroxide vapor.

    Increasing the use of alternatives can reduce industry dependence on “the crutch of ethylene oxide,” said Darya Minovi, senior analyst with the Union of Concerned Scientists, an advocacy group.

    But meeting the new guidelines will be disruptive to the industry, Crist said. He estimates companies will spend upward of $500 million to comply with the new EPA rules and could struggle to meet the agency’s 18-month timetable. Sterilization companies will also have difficulty adjusting to new rules on how workers handle the gas without a dip in efficiency, Crist said.

    The Food and Drug Administration, which regulates drugs and medical devices, is also watching the regulatory moves closely and worries the updated emissions rule could “present some unique challenges” if implemented as proposed, said Audra Harrison, an FDA spokesperson. “The FDA is concerned about the rule’s effects on the availability of medical devices,” she added.

    Other groups, like the American Chemistry Council and the Texas Commission on Environmental Quality, the state’s environmental agency, assert that ethylene oxide use isn’t as dangerous as the EPA says. The EPA’s toxicity assessment has “severe flaws” and is “overly conservative,” the council said in an emailed statement. Texas, which has several sterilizing plants, has said ethylene oxide isn’t as high a cancer risk as the agency claims, an assessment that the EPA has rejected.

    Tracey Woodruff, a researcher at the University of California-San Francisco who previously worked at the EPA, said it can be hard for the agency to keep up with regulating chemicals like ethylene oxide because of constrained resources, the technical complications of rulemaking, and industry lobbying.

    But she’s hopeful the EPA can strike a balance between its desire to reduce exposure and the desire of the FDA not to disrupt medical device sterilization. And scrutiny can also help the device sterilization industry think outside the box.

    “We continue to discover these chemicals that we’ve already been exposed to were toxic, and we have high exposures,” she said. “Regulation is an innovation forcer.”

    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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  • What Matters Most For Your Heart?
  • Tooth Remineralization: How To Heal Your Teeth Naturally

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Dr. Michelle Jorgensen, dentist, explains:

    The bare-bones details:

    Teeth cannot be regrown (yet!) but can be remineralized, which simply involves restoring lost minerals. When we’re talking about health, “minerals” is usually used to mean elemental minerals, like calcium, magnesium, phosphorus, etc, but the specific mineral that’s needed here is hydroxyapatite (a calcium phosphate mineral, the same as is found in bones).

    Not only can acids from food and bacteria dissolve the minerals from the teeth, but also, the body itself may extract minerals from the teeth if it needs them for other functions it considers more critical and/or more urgent.

    Cavities occur when acids create porous holes in teeth by dissolving minerals, which allows bacteria to invade, which means more acid, and cavities.

    Remineralization can be achieved by doing the following things:

    • Use hydroxyapatite-based products (tooth powder, mouthwash).
    • Improve gut health to ensure proper mineral absorption.
    • Reduce acidic food and drink intake.
    • Maintain good oral hygiene to prevent bacteria build-up.
    • Eat foods rich in vitamins A, D, E, and K, which help direct minerals to teeth and bones.

    For more on all of the above, enjoy:

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    Want to learn more?

    You might also like to read:

    Take care!

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  • Let’s Get Letting Go (Of These Three Things)

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    Let It Go…

    This is Dr. Mitika Kanabar. She’s triple board-certified in addiction medicine, lifestyle medicine, and family medicine.

    What does she want us to know?

    Let go of what’s not good for you

    Take a moment to release any tension you were holding, perhaps in your shoulders or jaw.

    Now release the breath you might have been holding while doing that.

    Dr. Kanabar is a keen yoga practitioner, and recommends it for alleviating stress, as well as its more general somatic benefits. And yes, stress is in large part somatic too!

    One method she recommends for de-stressing quickly is to imagine holding a pin-wheel (the kind that whirls around when blown), and imagine slowly blowing it. The slowness of the exhalation here not only means we exhale more (shallow breathing starts with the out-breath!), but also gives us time to focus on the present moment.

    Having done that, she recommends to ask yourself:

    1. What can you change right now?
    2. What about next time?
    3. How can you do better?

    And then the much more relaxing questions:

    1. What can you not change?
    2. What can you let go?
    3. Whom can you ask for help?

    Why did we ask the first questions first? It’s a lot like a psychological version of the physical process of progressive relaxation, involving first a deliberate tensing up, and then a greater relaxation:

    How To Deal With The Body’s “Wrong” Stress Response

    The diet that’s not good for you

    Dr. Kanabar also recommends letting go of the diet that’s not good for you, too. In particular, she recommends dropping alcohol, sugar, and animal products.

    Note: from a purely health perspective, general scientific consensus is that fermented dairy products are healthy in small amounts, as are well-sourced fish and poultry in moderation, assuming they’re not ultraprocessed or fried. However, we’re reporting Dr. Kanabar’s advice as it is.

    Dr. Kanabar recommends either doing a 21-day challenge of abstention (and likely finding after 21 days that, in fact, you’re fine without), or taking a slow-and-gentle approach.

    Some things will be easier one way or the other, and in particular if you drink heavily or use some other substance that gives withdrawal symptoms if withdrawn, the slow-and-gentle approach will be best:

    Which Addiction-Quitting Methods Work Best?

    If it’s sugar you’re quitting, you might like to check out:

    Food Addictions: When It’s More Than “Just” Cravings

    If it’s meat, though (in particular, quitting red meat is a big win for your health), the following can help:

    The Whys and Hows of Cutting Meats Out Of Your Diet

    Want more from Dr. Kanabar?

    There’s one more thing she advises to let go of, and that’s excessive use of technology (the kind with screens) in the evening, and not just because of the blue light thing.

    With full appreciation of the irony of a one-hour video about too much screentime:

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    Enjoy!

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  • Stolen Focus – by Johann Hari

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    Having trouble concentrating for long periods? It’s not just a matter of getting older…

    Johann Hari outlines twelve key ways in which our attention has not merely “wandered”, so much as it has been outright stolen.

    By whom? For what purpose? Obvious culprits include social media and outrage-stoking news outlets, but the problem, as Hari illustrates, goes much deeper than that.

    He talks about how we cannot truly multi-task, and can only switch beween tasks, at a cost. And yet, the modern world is not at all friendly to single-tasking!

    Writer’s note: as I write this, I have active two screens, containing four windows, one of which has three tabs open. I am not multitasking; all those things pertain to the work I am doing right now. If I closed them between use, it’d only cost me more time and attention opening and closing them all the time. And yet, my working conditions are considered practically “hyperfocused” in this century!

    • We learn about how the working world has changed, and the rise of physical and mental exhaustion that has come with it.
    • We learn about the collapse of sustained reading, that started well before the modern Internet.
    • We learn about factors such as dietary shifts that sap our energy too.

    …and more. Twelve key things, remember.

    But, it’s not all doom and gloom. There are things we can do to fight back. Some are personal changes; others are societal changes to push for.

    The last part of the book is given over to, essentially, a manifesto (and how-to guide) for reclaiming our attention and thinking deeply again.

    Bottom line: if you struggle with maintaining attention; this is a book for you. You might want to put your phone in a drawer while you read it, though

    Click here to check out Stolen Focus, and reclaim yours!

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    Learn to Age Gracefully

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