Editorials

Public health issues in cancer

Thomas C. Meyer, MD, Medical Editor, WMJ

What better way to open an issue primarily devoted to cancer than the positive report of the activities of the Breast Cancer Recovery Foundation Inc., founded by Ann Haney after the time she spent as Wisconsin’s Health Officer (p 9). Always upbeat, it was typical of her to envision and implement the Infinite Boundaries retreats—and this report is a reflection of Ann Haney’s vision. We are grateful to the authors for sharing the information.


Author Affiliations: Medical Editor

Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St. Madison, WI 53715

Healthy Babies in Wisconsin: A Call to Action Summary of the Wisconsin Perinatal Summit General Plenary Sessions, July 15, 2003, Wisconsin Rapids, Wis

Murray L. Katcher, MD, PhD; Jodi J. Pritzl, BS; Margaret Talley Bartholomew, MD; Katherine M. Kvale, PhD; Anne Harvieux, LCSW, BCD; Terry Kruse, RN, BS

Healthy Babies in Wisconsin: A Call to Action was held July 15, 2003 in Wisconsin Rapids, Wis. This summit began as a discussion among Wis-consin state and local Maternal and Child Health professionals, academicians, and leaders of community-based organizations regarding the continuing disparity in infant mortality rates, prematurity, low birth weight, and use of prenatal care among racial and ethnic groups in Wisconsin. The purpose of this summary of Healthy Babies in Wisconsin: A Call to Action is to provide content and a framework for change in reducing disparities. As a result of the summit, 5 state regional teams formed, as well as an African American and a Native American team that will use a new data model, Perinatal Periods of Risk, to create innovative action plans and recommendations to improve perinatal outcomes for women and their families in Wisconsin.



Author Affiliations: Doctor Katcher is Chief Medical Officer and State Maternal and Child Health Director, Division of Public Health (DPH), Wisconsin Department of Health and Family Services (DHFS); and Professor of Pediatrics, University of Wisconsin Medical School (UWMS), M

Corresponding Author: Address reprint requests to Murray L. Katcher, MD, PhD, Wisconsin Division of Public Health, 1 W Wilson St, PO Box 2659, Madison, WI 53701-2659; 608.266.5818; Fax: 608.266.3135; e-mail: katchml@dhfs.state.wi.us

Citizen Congress takes shape

By Richard A. Dart, MD, and Norman M. Jensen, MD, MS, Chair and Vice-Chair, Wisconsin Medical Society Task Force on Professionalism

In response to rapidly growing concerns on many fronts with health care among Wisconsin citizens and physicians, the Wisconsin Medical Society commissioned a Task Force on Professionalism in July 2001. The task forces report was accepted by the Societys Board of Directors in July 2002 and the House of Delegates in April 2003 with a direction to proceed with several proposed actions, and specifically, the proposed Citizen Congress.

Author Affiliations: Wisconsin Medical Society Task Force on Professionalism

Corresponding Author: Wisconsin Medical Society

Commentaries

Recovering from loss

Trudy A. Karlson, PhD, and David L. Weber, MD

The Breast Cancer Recovery Foundation, Inc. (BCRF) is a Wisconsin organization founded in 1997 by Ann Haney to share her vision that life can be rich even with a breast cancer diagnosis. Haney believed that women could come together at retreats and be relieved of the day-to-day responsibilities of their lives. She thought that breast cancer patients and survivors could help each other, that at retreats they could experience the healing of nature, learn new ways of coping with the disease, and share their stories. During her time as Health Officer for the state of Wisconsin, Haney had come to know the problems of women with breast cancer. After her own diagnosis, and while still working full time as an executive for Dean Health Systems in Madison, she set about bringing her vision to life by developing the BCRF’s Infinite Boundaries retreats.



Author Affiliations: Dr Karlson is a Senior Scientist at the University of Wisconsin-Madison and has served as a volunteer at the Breast Cancer Recovery Foundation’s Infinite Boundaries retreats. Doctor Weber is a family physician with Dean Medical Center in Sun Prairie

Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, WI 53715

The myths and realities of pain control with opioids

June L. Dahl, PhD

Numerous studies have shown that dying patients and those with advanced disease experience significant pain that is often inadequately treated. This occurs in spite of the existence of drugs and other therapies that can relieve almost all pain. Opioid analgesics are particularly important for pain control at the end of life. Unfortunately, they are often underutilized. Decisions about the use of opioids continue to be influenced by a lack of knowledge of their basic pharmacology and a variety of myths about these drugs. As a result, there is often apprehension surrounding their routine use—a fear that has been referred to as "opiophobia." Disabusing yourself, your patients, and their families of these myths is critical to providing optimal care.

Author Affiliations: Dr Dahl is a Professor of Pharmacology at the University of Wisconsin Medical School and the Director of the American Alliance of Cancer Pain Initiatives. This article has been reprinted with permission from HospiceCare Inc.


Corresponding Author: Hospice Care Inc.

A radiologist’s duty to directly communicate with the treating physician

Dean P. Laing, JD

Typically, radiologists review films and dictate their reports without any direct communication with the treating physician or patient. Direct communication is, however, required where the radiologist feels that immediate patient treatment is indicated; where a significant change exists between a preliminary report and a final report; or where the findings, while not warranting immediate treatment, constitute significant unexpected findings. Failure to directly communicate with the treating physician or patient in these situations may expose the radiologist to legal liability.



Author Affiliations: Mr Laing is an attorney with the Milwaukee law firm of O’Neil, Cannon & Hollman, S.C. He is a frequent author and speaker on litigation issues.


Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St. Madison, WI 53711

Original Research

Differences in Preventive Screening Rates in Wisconsin Farm and Non-Farm Resident Women

Catherine A. McCarty, PhD, MPH; Po-Huang Chyou, PhD; Robert Greenlee, PhD; Daniel J. McCarty, PhD; Paul Gunderson, PhD; Douglas Reding, MD, MPH

Purpose: To determine the proportion of rural women who met screening recommendations for Pap smears, mammograms, blood cholesterol, and blood pressure measurements. Methods: Women aged 25-75 were recruited for a population-based study of chronic diseases in rural residents. In addition to a self-administered health questionnaire and a brief examination, the most recent Pap smear, mammogram, blood pressure, and blood cholesterol measurements were documented from electronic medical records. Results: The study population was comprised of 675 farm and 825 non-farm residents. Fifty-five women (3.7%) had no documentation in their medical records of having ever had a Pap smear, and 19.3% (95% CL 16.9, 21.7) of women aged 40 and older had no documentation of a mammogram. Ninety-two percent of the women (95% CL=90.2, 93.7) had a blood pressure measurement in the previous 2 years and 74.9% (95% CL=72.2, 77.6) had a blood cholesterol measurement in the previous 5 years. Age was inversely related to Pap smears and positively correlated with mammograms, blood pressure, and blood cholesterol measurements. Farm residents were significantly less likely to have Pap smears or blood pressure measurements at recommended time intervals. Discussion: To increase the proportion of rural women in compliance with preventive screening recommendations, public health education efforts should target farm residents and younger women.



Author Affiliations: All authors are with the Marshfield Clinic Research Foundation.

Corresponding Author: Direct correspondence to Dr Catherine McCarty, Marshfield Clinic Research Foundation, 1000 North Oak Avenue (ML1) Marshfield, WI 54449, 715.389.3120, fax 715.389.4950, e-mail mccarty. catherine@mcrf.mfldclin.edu. The Rural Women’s Health Study was funded

Racial Disparities in Cancer Incidence and Mortality:Wisconsin and United States, 1996-2000

Mary Foote, MS

These findings focus on African American-white disparities in cancer incidence and mortality between 1996 and 2000 in Wisconsin and the United States. Cancer incidence data were obtained from the Wisconsin Cancer Reporting System (WCRS), the National Cancer Institute’s (NCI) Surveillance, Epidemiology and End Results (SEER) Program, and mortality data from the National Center for Health Statistics. Results of this study highlight site-specific differences in cancer incidence and mortality rates age adjusted to the 2000 US standard population. Incidence and mortality rate ratios (RR) were calculated comparing African American and white populations. Supplemental variables of cancer-related risk behaviors from the Wisconsin Behavioral Risk Factor Surveillance System (BRFSS) and stage of disease at diagnosis information from WCRS were also examined for differences between African American and white populations. Results showed Wisconsin had an overall greater disparity than the United States for all cancers combined and for cancers of the lung, cervix, and gastrointestinal sites. During the 5-year period, Wisconsin’s overall cancer mortality rate was 196 per 100,000, but among African Americans in Wisconsin, the overall mortality rate was 272 per 100,000.



Author Affiliations: Ms Foote is the Epidemiologist at Wisconsin Cancer Reporting System, Bureau of Health Information, Wisconsin Department of Health and Family Services.


Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, WI 53719

Wisconsin Physicians Advising Smokers to Quit: Results from the Current Population Survey, 1998-1999 and Behavioral Risk Factor Surveillance System, 2000

Anne M. Marbella, MS; Amanda Riemer; Patrick Remington, MD, MPH; Clare E. Guse, MS; Peter M. Layde, MD, MSc

Introduction: Physicians advising their patients to quit smoking has been recognized as an effective component of smoking cessation treatment, yet evidence suggests that physicians are not consistently providing this type of counseling. Methods: Data from both the Current Population Sur-vey’s (CPS) Tobacco Use Supplements administered September 1998, January 1999, and May 1999 and from the 2000 Behavioral Risk Factor Survey System (BRFSS) were analyzed and compared. The weighted proportions and 95% confidence intervals of Wisconsin and US smokers who had seen a physician in the past year and reported receiving advice from them to quit smoking were calculated. Proportions were analyzed for the total population as well as for subgroups of gender, age, race, educational level, and income level. Results: CPS data showed that Wisconsin smokers who had seen a physician in the past year were significantly more likely to receive smoking cessation advice from their physician (64%) compared to US smokers (59%). Though not significant, a similar trend was seen in the BRFSS data. There were no consistent significant differences in rates analyzed by gender, age, race, educational level, or income level. Conclusions: Data from the CPS and BRFSS show that less than two thirds of Wisconsin smokers are receiving smoking cessation advice from their physicians. Increasing physician counseling of patients who smoke continues to be a priority public health goal for decreasing morbidity and mortality from tobacco-related illnesses.



Author Affiliations: Ms Marbella and Ms Guse are at the Department of Family and Community Medicine, Medical College of Wisconsin and Dr Layde is a professor at the Department of Family and Community Medicine, Medical College of Wisconsin. Ms Riemer is a graduate student in t

Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, WI 53715

Follow-up of Abnormal Results in an Urban Community-Based Breast Cancer Screening Program

Capri-Mara Fillmore, MD, MPH, MSc; Sher-ree Beekman, BA; Barbara Johnson Farmer, RN, MSN; Mildred Leigh Gold, MS

Abstract Objective: Determine the rates of follow-up for abnormal mammograms and see how they compare with rates of similar programs elsewhere. Data: Records from 1990-2000 of the Breast Cancer Awareness Program were analyzed and reviewed to determine follow-up rates.

Results: The follow-up rate for all 11 years was 85%; during the last 7 years the rate has been 90%.

Conclusion: Follow-up rates were as good and generally better than those reported in the literature for similar programs. The rates, though good to begin with, improved with the more rigorous training and requirements of the Wisconsin Well Women’s Program.



Author Affiliations: Doctor Fillmore is an Assistant Professor of Epidemiology at the Health Policy Institute and the Department of Family and Community Medicine, Medical College of Wisconsin. She also serves as Associate Medical Director, City of Milwaukee Health Department.

Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, WI 53715

Review Articles

Cancer Prevention in Underserved African American Communities: Barriers and Effective Strategies— A Review of the Literature

Marie Wolff, PhD; Tovah Bates, PhD; Barbra Beck, PhD; Staci Young, MS; Syed M. Ahmed, MD, MPH, DrPH; Cheryl Maurana, PhD

African Americans suffer significantly more cancer morbidity and mortality than the white population. In order to decrease this differential, it is critical to understand the particular barriers to health and health care that underserved African Americans face. It is also important to identify the critical components of effective cancer prevention programs for this population. The barriers that impede care for underserved African Americans have been identified as: 1) inadequate access to and availability of health care services; 2) competing priorities; 3) lack of knowledge of cancer prevention and screening recommendations; 4) culturally inappropriate or insensitive cancer control materials; 5) low literacy; 6) mistrust of the health care system; and 7) fear and fatalism. Effective programs must incorporate community participation, innovative outreach, use of social networks and trusted social institutions, cultural competence, and a sustained approach. Programs that include these strategies are much more likely to be effective in reducing cancer incidence. Cancer ranks second only to cardiovascular disease as the leading cause of death in the United States. For the majority population, cancer incidence and prevalence have declined in recent years and cure rates for certain cancer diagnoses have improved. This can be attributed to progress in the development and implementation of prevention, early detection, and treatment strategies. However, despite these gains, medically underserved African American populations have not fared as well. When African American-white mortality rates are compared, African Americans are 1.3 times more likely to die of cancer than the general population.1 Data from the Bureau of Health Information, Wisconsin Department of Health and Family Services indicate that from 1996 to 2000, cancer accounted for 33% of deaths in African Americans aged 45-64 and 34% of deaths for those aged 65-74. To decrease the disparities in cancer morbidity and mortality between the African American and white population, it is critical to understand the particular barriers to health and health care that African Americans face. This paper is a literature review of the barriers that low-income African American populations confront in obtaining needed cancer prevention and detection and the characteristics of programs that have been effective in reaching these populations.



Author Affiliations: Authors are with the Medical College of Wisconsin. Dr Wolff is an Assistant Professor in the Center for Healthy Communities in the Department of Family and Community Medicine. Dr Bates is an Assistant Professor in the Center for Healthy Communities in the

Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, WI 53715

Your Practice

Prepare your children for their financial future

Kurt G. Krumholz, CFP, Principal-in-Charge of SVA Planners, Inc., Registered Investment Advisor

You teach your children how to tie their shoes, cross the street, and make their beds. But do you teach them how to manage their money? If not, how else will they learn its value and the importance of saving?

Author Affiliations: Based in Madison, WI, Kurt G. Krumholz is a fee-only financial consultant with SVA Planners Inc., Registered Investment Advisor. Well-respected in the wealth management industry, Kurt has been named to Mutual Funds list of “100 Great Financial Plann

Corresponding Author: For more information, call Wisconsin Medical Society Insurance and Financial Services, Inc. toll free at 866.442.3810.

Mediation will be option for resolving Medicare beneficiary complaints

Jay A. Gold, MD, JD, MPH; Eric Streicher, MD; and Shanin Pepple

Quality of care complaints most often arise from a patient’s perception of error or negligence rather than certifiable acts or omissions. When complaints occur, one of the least confrontational ways to address them is through mediation.



Author Affiliations: Authors are with MetaStar, Inc. Doctor Gold is Senior Vice President and Principal Clinical Coordinator; Doctor Streicher is Medical Director and Pepple is a Communications Specialist. This material was prepared by MetaStar, Inc., the Quality Improvement

Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St. Madison, WI 53715

Don’t leave your survivors unprepared

Michael J. McKersie, CFP, Financial Consultant SVA Planners, Inc., Registered Investment Advisor

Death is never an easy subject. Few like to think about it, and even fewer want to sit down and discuss it. Unfortunately, this leaves many people unprepared for the inevitable, leaving details, arrangements, and bills for loved ones to manage when emotions are at their highest. As a result, planning for death is—unfortunately—a necessary and important step in the estate planning process.



Author Affiliations: Based in Madison, Wis, Mike McKersie, CFP, is a fee-only financial consultant with SVA Planners Inc., Registered Investment Advisor. McKersie works with individual investors and business clients, helping them manage their retirement plans, monitor their i

Corresponding Author: For more information, call Wisconsin Medical Society Insurance and Finan-cial Services, Inc. toll free at 866.442.3810.

Your Profession

Using the power of genetics, genomics and molecular biology to fight cancer

Philip M. Farrell, MD, PhD

Before his untimely death from a heart attack on Feb-ruary 22, 2002, my friend and colleague Paul Carbone, MD, who served so effectively as long-term director of the University of Wisconsin Comprehensive Cancer Center, convinced me that we are at the beginning of a veritable cancer epidemic among the elderly. Scien-tists who are aware of this serious problem aren’t yet sure how to explain it. It could be that aging immune systems deteriorate, or that, with extended years, multiple carcinogenic factors have the time they need to trigger malignant processes. Paul used to say that since heart disease is no longer killing as many people as before, cancer is now taking over, especially in our growing older population.



Author Affiliations: Doctor Farrell is Dean, University of Wisconsin Medical School, and Vice Chancellor for Medical Affairs at UW-Madison.


Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St. Madison, Wi 53715