Delivery of Care

The cancer connection

Did you know that there were 921 chemicals that increase the risk of breast cancer, and that they are ubiquitous in consumer products, food and drinks, pesticides, medications and workplaces?

Photo by Richard Asinof

The Lifespan Cancer Institute may soon be the home of a new research hub designated by the National Cancer Institute, led by Dr. Wafik El-Deiry, the director of the Cancer Center at Brown University, and Dr.. Sephanie Graff, the director of breast oncology.

By Richard Asinof
Posted 2/26/24
The timing of the decision by the McKee administration to announce a $1.5 million investment in the creation of a new “Planning Cabinet” to address the future of Rhode Island’s health care delivery system seemed curious at best, given the work underway by the Attorney General, the Rhode Island Foundation, and the Care Transformation Collaborative to come up with solutions.
When will the research and writings of Sandra Steingraber on fracking and Rebecca Altman on plastics receive more attention to help Rhode Island regulators better understand the health problems created by the fossil fuel industry? What will be the repercussions of a state takeover of the Steward Health Care hospitals? What will the evolution of EpVax 2.0 mean for the life sciences innovation ecosystem in Rhode Island? Will the General Assembly ever commission an audit of the Managed Care Organizations under Medicaid to determine how the money is being spent?
The latest investigative reporting by Moe Tkacik, “Attack of the Straw Doctors,” details how the Oregon House passed a new law, HB4130, to limit the loopholes to the corporate practice of medicine, despite the lobbying from Amazon, UnitedHealth, and telemedicine firms. The legal framework provides other states, including Rhode Island, the opportunity to better regulate the practice of what is known as “straw doctors.”

PROVIDENCE – A funny thing happened on Friday afternoon, Feb. 23, as I was finishing up my six-month infusion treatment to address my auto-immune encephalitis, my seventh infusion in the last four years, a treatment that keeps me persevering.

Gov. Dan McKee put out a Friday afternoon news dump, a news release at 2:50 p.m., announcing he had signed an executive order establishing a “state health care system planning cabinet.”

The mission of the new “planning cabinet” was allegedly to serve as the coordinating body for all health care system planning efforts within the executive branch, according to the words scripted in the press release.

I must have guffawed out loud, because one of the nurse technicians managing the infusion suite asked if I was all right. I said yes, and went back to reading the press release on my phone, careful to chuckle quietly to myself.

The State Health Care System Planning Cabinet, the Governor promised, “will take a unified, interdepartmental approach to evaluating and proposing recommendations for Rhode Island’s health care system.” Whatever that means.

My response was to say, quietly to myself: “Really?” to quote WPRO’s Steve Klamkin, the indefatigable news reporter who that afternoon was serving as news anchor at the desk at the radio station.

What had prompted Gov. McKee to issue the press release at 10 minutes before 3 p.m. on a Friday afternoon at the end of school vacation week?

Who exactly were the members of the new “statewide planning cabinet” on the health care delivery system? And, who had been conveniently left out of the planning scrum? 

The news release, apparently put together in a big hurry, only listed the titles of the members of the statewide Planning Cabinet, save for Richard Charest, the executive director of the R.I. Executive Office of Health and Human Services who is chairing the group.

The others were shown in a staged photo, looking on as the Governor signed the executive order. They included: the assistant secretary at EOHHS [Ana Novais], the director of DCYF [Ashley Deckert], the acting interim director of the Office of the Health Insurance Commissioner [Cory King], the director of the state Medicaid office, Kristen Pono Sousa], the director of the Department of Human Services [Kimberly Merolla-Brito], the interim director of BHDDH [Dr. Louis Cerbo], the director of the Department of Labor and Training [Matthew Weldon]; and the director of the Department of Health [Dr. Utpala Bandy, who is scheduled to retire at the end of March].

Translated, the Planning Cabinet is composed of insiders within the McKee administration.

Who was missing? Housing is now considered to be health care these days, according to health insurer Blue Cross and Blue Shield of RI, but Stefan Pryor, the director of the Department of Housing, was not included. The disruptive impacts of climate change may have strong implications for future population health outcomes for Rhode Islanders, but Terence Gray, the director of the Department of Environmental Management, was not included. Neither was Peter Alviti, the head of the Department of Transportation, which has been swamped with bridge repairs and inundated roadways – and finds himself fighting off hungry alligators and crocodiles in the news media. And, Lt. Gov. Sabina Matos was also missing in action.

Translated, the statewide “Planning Cabinet” seems destined to preserve the status quo in health care delivery, apparently allowing for little or no input from experts, legislators, consultants, hospitals, and lobbyists – at least input that is publicly shared. Those influencers may no doubt have access through the backdoors provided by the McKee administration.

The budget for the “Planning Cabinet” was said to be $500,000 from the current budget year, with another $1 million in funding in the proposed McKee budget for FY 2025, according to the news release. The first report by the “Planning Cabinet” will be produced on or about Dec. 1, 2025, according to the news release.

Translated, the McKee administration plans to spend $1.5 million to produce a report. One question not yet answered: Who is actually going to do the work?

Why now?  
The curious timing of the decision to announce the creation of a new “Planning Cabinet” to tackle the future of the state’s health care delivery system seemed a bit odd, in ConvergenceRI’s opinion. Why now?

  •    The McKee administration is currently facing many threats to its credibility. The Governor is scrambling to respond to and to contain the continuing fallout of the broken down Route 195 highway bridge scandal.
  •    The growing lack of affordable housing and the dramatic increases in the homeless population has further challenged the state’s ability to promote a prosperous future for its residents.
  •    Budget season is now upon the General Assembly, and big questions remain about whether the legislators will rise up and challenge the Governor’s assumptions about fiscal investments needed – in particular, the proposed $45 million increase in Medicaid fee-for-service provider reimbursements.
  •    Meanwhile, the state takeover of the Providence Public Schools is collapsing under the weight of teachers resigning at an unprecedented rate. The Governor and his Commissioner are busy producing fancy videos to promote the “Attendance Matters” initiative, but the irony is that administrators are unwilling to attend meetings when angry parents demand answers about school closings.
  •    Next door in Massachusetts, that state’s health care delivery system in on the verge of collapse, a result of the financial insolvency of the for-profit Steward Health Care, owned by Medical Properties Trust, with Gov. Maura Healy threatening to seize the hospitals in order to keep them functioning.
  •    A similar scenario in Rhode Island was averted with Roger Williams Medical Center and Our Lady of Fatima hospitals, thanks to the intervention of R.I. Attorney General Peter Neronha and his legal team. In turn, the Attorney General’s office has been aggressively pursuing developing solutions to the failures of the health care delivery system in Rhode Island, focusing in part of the dire lack of access to primary care providers. [See link below to ConvergenceRI story, “AG Neronha weighs in on future of health care.”]

Up until the Friday, Feb. 23, news dump, there has been a veritable vacuum of leadership when it came to the McKee administration and Rhode Island’s health care delivery system. Nature – and politics – tends to abhor a vacuum. As a result, other players have stepped into the fray:

  •    The Rhode Island Foundation has embarked on an effort to create a dataset about the actual costs of the health care delivery system. [See link below to ConvergenceRI story, “Tracking the heartbeat of community.”]
  •    The Care Transformation Collaborative of Rhode Island has created a strategic roadmap to address the lack of access to primary care providers. [See link below to ConvergenceRI story, “A strategic roadmap for primary care in Rhode Island.”
  •    United Way of Rhode Island has put its weight behind an effort to support the nonprofit sector, roughly one-fifth of the state’s private workforce, to end the practice of agencies being treated as “disposal vendors” – many of whom are responsible for providing the glue for services that support patients – in mental and behavioral health, in childcare services, in outreach to an aging population, and in caring or residents coping with recovery from a plague of illicit drugs.

In many ways, the announcement by Gov. McKee to establish the new “Planning Cabinet” could be seen as a political riposte to the Attorney General’s aggressive legal advocacy as the state’s public health advocate.

Burying the lede  
I admit that I am guilty of burying the lede to this story, which was originally conceived as a story to address the failure of Rhode Island’s health care delivery system and, in particular, the excellent Lifespan Cancer Institute, to respond to the recent research by the Silent Spring Institute connecting endocrine disruptors as the catalyst to the dramatic increase in the incidence of breast cancer.

If all goes well, the Lifespan Cancer Institute will be designated a cancer research hub by the National Cancer Institute in 2025, enabling Rhode Island’s medical establishment and Brown University to attract a significant increased share of research dollars to fuel the enterprise. The designation is the highest federal rating a cancer center can achieve, and having it would boost collaborative research, increase the portfolio of clinical trials, and bring cancer-related funding to Brown University and local hospitals, according to a Boston Globe story written by reporter Alexa Gagosz.

“No one will solve Rhode Island’s problems with cancer other than a home-grown cancer center at NCI standards,” said Dr. Wafik El-Diery, the director of Brown’s cancer research center, Gagosz reported. El-Diery called the investment critical in “the fight to cure cancer in Rhode Island.”

The root causes of breast cancer  
The question is: How would you describe the failure to include the root causes of the current breast cancer epidemic as part of the equation?   

Convincing research by the Silent Spring Institute on endocrine disruptors has linked more than 921 chemicals that increase the risk of breast cancer – chemicals that are ubiquitous in consumer products, food and drinks, pesticides, medications and workplaces.

Here is a summary of the research findings, as reported by Environmental Health News:

More than 900 chemicals commonly found in consumer products and the environment have been linked to breast cancer risk in a new study.

The study, published in Environmental Health Perspectives, identified 921 chemicals that increase the risk of breast cancer and found that 90% are ubiquitous in consumer products, food and drinks, pesticides, medications and workplaces.

The list includes chemicals like parabens and phthalates, which are commonly found in makeup, skin and hair care products; and numerous pesticide ingredients, including malathion, atrazine and triclopyr, which are used on food and in household pest control products in the U.S. 

Breast cancer among young women has increased in recent years. Between 2010 and 2019, diagnoses among people 30 to 39 years old increased 19.4 percent, and among those ages 20 to 29, rates increased 5.3 percent. This change is too fast to be explained by genetics, so researchers have begun looking more closely at potential environmental causes for the disease.

A 2020 study found that women who used chemical hair straighteners more than six times a year had about a 30 percent higher risk of breast cancer than those who didn’t use chemical straighteners. Those products typically contain one or more of the chemicals identified in the new study as increasing the chances of getting breast cancer.

Women of color face greater risk. Studies have shown that products marketed to women of color tend to be more toxic and are more likely to contain chemicals associated with increased cancer risk compared to products marketed to white women. 

To conduct the new study, researchers at Silent Spring Institute, a nonprofit breast cancer prevention research group, developed a new method to quickly identify compounds that can increase the likelihood of the disease.

“We know there are lots of environmental chemicals that can increase breast cancer risk, but we need more efficient and more effective ways to identify them so they can be regulated and reduced,” Jennifer Kay, a research scientist at Silent Spring Institute and lead author of the study, told Environmental Health News (EHN).

Historically, regulators have used animal studies to determine whether chemicals cause mammary tumors in mice to assess whether they could increase breast cancer risk in humans, but these studies are slow and expensive. In 2016, the International Agency for Research on Cancer (IARC) published a landmark study outlining 10 ways that carcinogens cause cancer to develop. Since then, scientists and regulators have begun working to identify chemicals that have those characteristics as a quicker, less expensive way to determine whether exposure to them is likely to increase cancer risk. 

“What’s unique about our approach is that we recognized that breast carcinogens tend to increase hormonal activity,” Kay explained. “So for this study, we looked at whether chemicals increase certain hormonal activities that are known to increase breast cancer risk.”

Stay tuned.

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