Environment, News, public health

Scientists recommend expanding investigation of suspected thyroid cancer clusters in NC

Source: National Cancer Institute

North Carolina health officials should expand their investigations of suspected thyroid cancer clusters, including potential environmental causes such as coal ash, according to recommendations by a panel of doctors, scientists and medical investigators. 

The panel, many members of which are from North Carolina, convened in May and issued its report last week.

The state’s Central Cancer Registry statistics show that for the past 23 years Iredell County has reported statistically higher incidences of papillary thyroid cancer than the state average, as much as double or three times greater. In May 2018, state and county health officials designated two zip codes near Lake Norman — 28115 and 28117 — as suspected cancer clusters.

There were 260 cases of thyroid cancer diagnosed in those two zip codes from 1995 to 2016; statistically, the expected number was 124.  From 2012 to 2016, 110 cases were reported, compared to 46, the number expected.

Many of the thyroid cancer cases in Iredell County were reported among teenage girls. Although thyroid cancer rates are rising nationwide, it is still largely a disease of middle age, afflicting primarily women over 50. It is unusual for young women to develop it.

Sen. Vickie Sawyer, a Republican from Iredell County, co-sponsored Senate Bill 297, which directs the NC Policy Collaboratory to assemble a research team to help determine whether cancer clusters exist in the state, and where. The bill had bipartisan support, including several Democratic secondary sponsors, and passed both chambers. The measure was sent to the governor on July 11.

Source: National Cancer Institute

Although North Carolina as a whole ranks low among states for thyroid cancer incidences among women under 50, several counties are outliers. Elevated rates of thyroid cancer have also been reported in Rowan County, directly east of Iredell, and in five counties in southeastern North Carolina: Brunswick, New Hanover, Pender, Onslow and Duplin.

Cancer clusters are hard to pinpoint, especially in areas where people move frequently. Other environmental, lifestyle and genetic factors can also play a role in the development of cancer. The only known environmental risk factor for thyroid cancer is radiation.

Nonetheless, the panel identified ways to at least partially overcome some of those obstacles, including more detailed population studies to compare areas with elevated cancer rates and those without. These studies should also involve neighboring states to account for possible patterns in border counties.

Calculating cancer rates is dependent on accurate data. The panel said doctors should be encouraged to provide timely, consistent reporting of cancer cases to the state registry. And access to health care can also skew the results. The panel advised that future investigations should examine the role of health care access plays in cancer diagnoses.

“Areas with strong access to health care and cancer screening sometimes report higher rates of cancer than areas without such services,” the recommendations read. “Identifying areas where there are many medical practices can provide insight into how medical surveillance may contribute to thyroid cancer diagnosis.”

University scientists have already begun studying possible environmental links to the high rate of thyroid cancer in Iredell County. Heather Stapleton and Kate Hoffman, scientists at Duke University, found three homes where people had been recently diagnosed with thyroid cancer also had significantly elevated levels of compounds used in flame retardants.

Susan Wind’s teenage daughter was among the 110 people diagnosed with thyroid cancer in the affected zip codes within the last five years. Wind raised $110,000 for Stapleton’s study and has been an outspoken proponent for a detailed study of the clusters. “I believe the state should fund this research, too,” said Wind, whose family recently moved out of North Carolina because of concerns about the number of cancer cases — of several types — in their neighborhood. “It should not have to be from a private citizen whose kids got cancer. So once this study runs out of money, what is the state going to do next?”

The budget bill, still hung up over Medicaid expansion and other matters, contains no funding for studying suspected thyroid cancer clusters, though it does include $100,000 for a study of a suspected cancer cluster involving ocular melanoma in the Mecklenburg County town of Huntersville.

The panel advised the state to also investigate “potential associations” between exposure to coal ash, coal burning emissions, and papillary thyroid cancer. The two affected zip codes in Iredell County are close to Lake Norman, the site of Duke Energy’s Marshall Steam Plant. Coal ash was also widely used as structural fill throughout Iredell County.

“Given the concerns in North Carolina communities about the potential health effects of exposure to coal ash,” whose compounds can emit radiation when they decay, the recommendations read, more study is warranted. “Such studies should consider the most likely ways that people are exposed to harmful chemicals associated with coal ash: breathing them in or drinking contaminated water.”

Wind said the amount of coal ash used as fill in Iredell County was not fully documented. “It was a common practice to use coal ash like dirt, dumped in fields and sold as top soil for flower beds,” she said. “This sounds like a good hypothesis to test.”

UNC and Virginia Tech researchers recently found that more than three-quarters of 786 drinking water wells tested in Iredell County had levels of Chromium 6 above the state health advisory level of 0.07 parts per billion. Chromium 6 both occurs naturally and is present in coal ash.

Eighty-five percent of Iredell County wells had levels of vanadium, also naturally occurring and found in coal ash, above 0.3 ppb, the state’s interim maximum concentration for groundwater.

A spokeswoman for the Department of Health and Human Services said the agency “is reviewing the input from the panel and identifying the role we can play in helping to move these recommendations forward.”

[Note: This story has been updated to make clear that the proposed budget bill includes funding to study a suspected cancer cluster involving ocular melanoma in the town of Huntersville.]

News, public health

Remembering a voice who spoke for those in dire need of healthcare

Dr. Charles van der Horst

On Tuesday, friends and family gathered at Beth El Synagogue in Durham to honor the life and legacy of Dr. Charles van der Horst.

Van der Horst, who died unexpectedly over the weekend in a swimming accident in New York, was a prominent voice for the uninsured and for Medicaid expansion in North Carolina.

The Raleigh News & Observer noted his career spanned decades and made a lasting impact:

Van der Horst was a preeminent UNC researcher and clinician who helped develop groundbreaking treatment protocols for HIV/AIDS and, after that once-terrifying virus had been tamed to a manageable disease, inspired a new generation of scientists to tackle Ebola. He was a compassionate doctor who turned a community service stint into a campaign to eradicate Hepatitis C in Wake County. He was a social justice advocate willing to go to jail to draw attention to the needs of the state’s uninsured.

NC Policy Watch got to know van der Horst in that last role, as a social justice advocate.

In 2017, he appeared on Policy Watch’s News & Views to discuss the wrongheaded approach by Republicans in Washington to gut the Affordable Care Act. Here’s an excerpt of that interview:

Governor Roy Cooper also remembered the doctor this week on Facebook: “Dr. Charlie Van Der Horst’s life and work were defined by compassion. From his time volunteering in North Carolina’s free clinics to his efforts on the front lines of the HIV/AIDS epidemic, he made our state and our world better.”

Van der Horst was 67.

Governor Roy Cooper, News, public health

At Opioid Summit, experts call for Medicaid expansion

A new “Opioid Action Plan 2.0” unveiled Wednesday by North Carolina officials aims to combat the lingering narcotic crisis with new, youth-targeted programs, tougher laws and greater access to the drug naloxone, used to treat or reverse opioid overdoses.

“I’m going to work with all of you to make sure that we reduce opioid deaths in North Carolina and that we meet this problem head on,” said Governor Roy Cooper at the opening of the 2019 Opioid Misuse and Overdose Prevention Summit, a conference supported by the North Carolina Department of Health and Human Services (DHHS).

The updated plan uses “feedback from partners and stakeholders,” according to a press release by the Governor’s Office.

The original N.C. Opioid Action Plan, released in 2017, identified the steps that the DHHS aimed to take in order to reduce the number of deaths from the opioid epidemic.

Officials introduced the new plan during the second and final day of the Opioid Summit.

At the opening of the summit Tuesday, Cooper highlighted the progress made since the plan was launched. According to Cooper, since 2017, the number of prescriptions for opioids has decreased by 24 percent and the number of emergency department visits for opioid overdoses decreased by nearly 10 percent from 2017 to 2018.

But the most important step, according to the DHHS? Medicaid expansion.

“We need to close the coverage gap if we are to make serious headway against this epidemic, as they have done in other states,” said Dr. Mandy Cohen, Secretary of the NC DHHS.

Numerous studies have shown that expanding Medicaid and closing the coverage gap has led to a decline in opioid overdoses by increasing substance use disorder treatment. According to the Opioid Action Plan 2.0, an estimated 89 percent of people who are in need of substance use disorder treatment do not receive it.

“The progress we’ve made shows what we can achieve when we partner across agencies and organizations and with those on the ground in communities,” said Cohen in a press release. “But there is much more to do. Moving forward we need to work even harder to focus on prevention, reduce harm and connect people to care.”

News, public health

UNC/Vidant Health conflict headed to Senate committee

Update: Meeting in an emergency session late Monday, the Pitt County Board of Commissioners approved a proposal to end the dispute between Vidant Health, the county and the UNC System.

Under the proposal the UNC Board of Governors would appoint four members to the hospital’s board rather than the nine it appointed under the original agreement. Pitt County would retain its 11 appointments (at least one a physician from Pitt County) and the Vidant board would itself appoint two members (both physicians from ECU nominated by a committee at the university). The dean of ECU’s medical school would also hold a seat on the board.

UNC rejected the proposal in a statement, insisting that the system in place since the 1970s agreement between the parties be restored.

“We continue to believe that the best path forward for Vidant, Pitt County and East Carolina University would be to honor the long-standing partnership that has served eastern North Carolina well for more than 40 years and to fully restore the governance structure all parties had agreed to in the affiliation agreement,” the UNC System statement read. “We welcome future dialogue with Vidant leadership and look forward to hearing their concerns, as well as resolving problems that have arisen in the relationship with Vidant and its support of the Brody School of Medicine.”

Members of the committee said they weren’t sure whether that discussion would go forward as the parties are now in mediation.

Tensions between UNC and the eight hospital system based in Greenville exploded last month after Vidant announced it was no longer acknowledging the UNC Board of Governors’s right to appointment members to the the board of Vidant Medical Center.

Under an agreement in place since the 1970s the UNC Board of Governors appoints nine members to the board, part of its serving as a teaching hospital for ECU’s Brody School of Medicine. The Pitt County Board of Commissioners, whose county once owned the hospital, appoints 11.

ECU and the UNC system sued to prevent losing those appointments, the court issued a temporary restraining order freezing the current relationship in place and the parties have now entered into mediation.

Last week the UNC system issued a statement on the struggle through UNC Spokesman Josh Ellis.

“We continue to believe that the best path forward for Vidant, Pitt County and East Carolina University would be to honor the long-standing partnership that has served eastern North Carolina well for more than 40 years and to fully restore the governance structure all parties had agreed to in the affiliation agreement,” the statement read. “We look forward to hearing Vidant’s concerns, as well as resolving problems that have arisen in the relationship between with Vidantand its support of the Brody School of Medicine.”

But Vidant leaders in Greenville say the conflict goes deeper. Last week Greenville TV news station WITN released confidential documents from a consulting firm hired by the UNC system that showed their research into taking over the system.

In response Vidant released a statement accusing the UNC system of a “behind the scenes” plan to take over Vidant.

“It is part of a coordinated effort by outside interests and Raleigh politicians to take dominant position in governance, deal terms, etc. in eastern North Carolina,” the statement said.

“Despite this and many false narratives, the affiliation agreement with the Brody School of Medicine has always been and continues to be in effect,” Vidant said in its statement. “In fact, Vidant continues to support the education of medical students, residents and other health care providers, including Pirate nurses. The significant financial support from Vidant to Brody continues.”

UNC responded with a statement denying they had any plan — secret or otherwise — to take over the system.

“Even if there were plans, secrecy would be impossible,” the system said in a statement. “A combination of UNC Health Care and Vidant Health would require the approval of multiple public entities and boards. It would also require a public bidding process under State law.”

“Like all hospital systems, the UNC Health Care System is keenly aware of the rapid consolidation occurring across the country,” the statement read. “All systems look frequently to consider potential partners. The leaked document was prepared by a consulting firm hired by the UNC Board of Governors to illustrate and educate them on what the consolidating health care market might look like in the future. It was not prepared to evaluate partners or to pursue new partners.”

UNC Health Care has had a number of conversations with Vidant CEO Mike Waldrum about working together better, the system said in the statement, but none about takeovers. The statement alleges that Waldrum has talked with the UNC system and members of the Board of Governors in the past about the possibility of merging with UNC Health Care, which until recently was headed by Bill Roper, now interim president of the UNC System. UNC Health Care did not pursue the idea, the statement said.

The Senate budget, passed last week, would cut $35 million in Medicaid funds from Vidant Medical Center, an outcome both Republican and Democratic Senators said they would like to prevent.

Waldrum told Greenville’s Daily Reflector newspaper he didn’t understand why the budget cuts were put in place as the two parties were trying to resolve their disagreement.

““We think they have some valid concerns but we want to make sure our concerns are heard and we are committed to working with them through the process,” Waldrum said. “That’s why the thing we don’t understand is these cuts were put in the budget at the same time the two legal teams were working to resolve the issues.”

“We had hoped that we made appropriate and best-governance changes (and) they would work with us,” he said said. “We did not anticipate people would take actions that would damage eastern North Carolina. We were surprised by that.”

Senate leader Phil Berger said Monday that “all potential options” are being considered to resolve the dispute.

News, public health

As measles cases reach a new high, NC medical providers urge vaccine-skeptics to immunize their children

For those keeping a tally, 60 new measles cases cropped up in the U.S. last week. That brings the total number of cases to 940 this year.

Health officials say confirmed cases have been reported in more than half the states and we are now experiencing the worst outbreak in 25 years.

The continuing spread has health officials worried ahead of a busy summer travel season.

If you missed it over the holiday weekend, be sure to listen to our interview (click below) with NC Health News reporter Reporter Sarah Ovaska-Few, who talks with Policy Watch about the increase in measles outbreaks and what North Carolina pediatricians are doing about the drop in vaccination rates.

And for more from Ovaska-Few, check out her latest story at NC Health News on the ongoing court challenges to the DHHS’ choices for Medicaid managed care providers, which threatens to derail more than than $30 billion in contracts.