Category Archives: News roundups

Mar 21 2014
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Public Health News Roundup: March 21

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Study Finds Dramatic Increase in Opioid Prescriptions by Emergency Rooms
The past decade has seen a dramatic increase in opioid analgesic prescriptions by emergency rooms, despite only a modest increase in pain-related complaints, according to a new study in the journal Academic Emergency Medicine. Using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2001 and 2010, researchers found that there was a 49 percent increase in prescriptions for potentially addictive narcotic painkillers such as OxyContin, Percocet and Vicodin. Approximately 12 million Americans abused prescription painkillers in 2010 and approximately 15,000 die annually due to overdoses, according to the U.S. Centers for Disease Control and Prevention. Read more on prescription drugs.

Study: Many Chronically Ill Adults Forced to Decide Between Medicine, Food
Chronically ill adults who due to financial instability lack consistent access to food are far more likely to underuse or even skip their medications completely, according to a new study in The American Journal of Medicine. Researchers analyzed data of 9,696 adults with chronic illness who participated in the National Health Interview Survey (NHIS), finding that 23.4 percent reported cost-related medication underuse, while 18.8% percent reported food insecurity and 11 percent reported both. Hispanic and non-Hispanic blacks were at the highest risk. "The high overall prevalence of food insecurity and cost-related medication underuse highlights how difficult successful chronic disease management in the current social environment is," said lead investigator Seth A. Berkowitz, MD, Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, in a release. "These findings suggest residual unmet needs for food-insecure participants and thus have clear implications for health policy." Read more on health disparities.

FDA Approves Implantable Device for Adults with a Certain Type of Hearing Loss
The U.S. Food and Drug Administration (FDA) has approved the first implantable hearing device for adults with severe or profound sensorineural hearing loss of high-frequency sounds in both ears, but who can still hear low-frequency sounds with or without a hearing aid. Sensorineural hearing loss is the most common form of hearing loss and can be caused by aging, heredity, exposure to loud noise, drugs that are toxic to the inner ear and certain other illnesses. “Hearing loss greatly impacts the education, employment, and well-being of many Americans,” said Christy Foreman, director of the Office of Device Evaluation at the FDA’s Center for Devices and Radiological Health, in a release. “This device may provide improved speech recognition for people with this kind of hearing loss, who have limited treatment options.” Read more on technology.

Mar 20 2014
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Public Health News Roundup: March 20

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Study: School Hearing Tests Cannot Detect Adolescent High-Frequency Hearing Loss
School-administered hearing tests cannot detect the sort of adolescent high-frequency hearing loss associated with exposure to loud noises, according to a new study in the Journal of Medical Screening. Researchers at Penn State College of Medicine compared the results for 282 11th graders of a special hearing screening designed to detect noise-related high-frequency hearing loss with the results of the standard Pennsylvania school hearing test. Each tests for the ability to hear a tone at a specific loudness. "More participants failed the initial screening than we predicted," said study author Deepa Sekhar, assistant professor of pediatrics, in a release, "Even with the effort and care put in by school nurses across the state, the current Pennsylvania school screen just isn't designed to detect high-frequency hearing loss in adolescents," adding "The results of this study have the potential to reach schools across the nation, as many use screens similar to those used in Pennsylvania schools." Read more on pediatrics.

HUD Gives $1.8B to Support 3,100 Public Housing Authorities
The U.S. Department of Housing and Urban Development (HUD) has awarded almost $1.8 billion to approximately 3,100 public housing authorities across all 50 states, as well as the District of Columbia, Guam, Puerto Rico and the U.S. Virgin Islands. The grants, which come through HUD’s Capital Fund Program, will go toward building, repairing, renovating and modernizing public housing, from large scale improvements such as replacing roofs or smaller tasks such as energy-efficient upgrades. “This funding is critically important to public housing agencies as they work to provide the best housing possible for their residents,” said HUD Secretary Shaun Donovan. There are 1.1 million public housing units in the United States. Read more on housing.

New Heart Health Guidelines Would Increase Adults Eligible for Statins to 12.8M
New guidelines from the American College of Cardiology and the American Heart Association (ACC–AHA) for the treatment of cholesterol would increase the number of adults who would be eligible for statin therapy by 12.8 million, according to a new study in the New England Journal of Medicine. Roughly half of the U.S. population between 40 and 75 years of age—or 56 million people—would be eligible. Most of the increase would be among older adults without cardiovascular disease. Read more on heart health.

Mar 19 2014
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Public Health News Roundup: March 19

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HHS: Common Sports Injuries Mean High Costs for People Without Insurance
The ASPE Office of Health Policy, part of the U.S. Department of Health and Human Services (HHS), has released a new issue brief analyzing the incidence and average health care charges associated with common sports injuries. The injuries range from minor sprains and strains to more serious injuries such as broken bones and concussions, where direct medical bills can be significant, placing an especially heavy burden on people without health insurance. Such individuals could be made to pay not just out-of-pocket costs, but also providers’ full stated charges. Breaking down health care costs by age and sometimes gender, the brief found, for example, that the average cost to fix a leg fracture for a person 10-19 years old was $4,689 and for those ages 25-40 was $3,403. Read more on injury prevention.

CDC: Drexel Meningitis Death Linked to Princeton Outbreak
Researchers at the U.S. Centers for Disease Control and Prevention have confirmed through “genetic fingerprinting” that a Drexel University student who died March 10 from meningitis died from the same serogroup B meningococcal strain that previously caused an outbreak at Princeton University. Health department officials confirmed that the Drexel student had been in close contact with Princeton students a week before becoming ill, indicating that the strain may still be present in the Princeton University community. Health officials have already administered antibiotic prophylaxis to prevent additional cases of meningococcal disease in people who had been close to the Drexel student. No new cases have since been reported. Read more on infectious diseases.

Study: ICU Survivors Face Heightened Risk for Mental Health Problems
Critically ill people who survive a stay in a hospital intensive care unit (ICU) are at heightened risk for mental health problems such as depression and anxiety in the following months, according to a new study in the Journal of the American Medical Association. Examining the records of more than 24,000 Danish ICU patients, researchers found that in the three months post-discharge that about 0.5 percent had a new diagnosis—which was 22 times higher than the rate in the general population. Approximately 13 percent received a new prescription for a psychiatric medication, including antidepressants and drugs for anxiety and insomnia, during that period. Researchers said the findings indicate that as doctors become better at saving the lives of critically ill patients, more people will also be at risk for problems beyond their physical health. Read more on mental health.

Mar 18 2014
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Public Health News Roundup: March 18

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Study: Prescriptions for Opioids Steadying After Nearly Tripling over Two Decades
After nearly tripling from 1991 to 2010—from 76 million annually to 210 million annually—prescriptions for opioid analgesics in the United States are stabilizing, according to a new reporting in the journal Public Health Reports. Researchers at Columbia University’s Mailman School of Public Health attributed much of the success to stopping the soaring number of prescriptions to state-implemented prescription drug monitoring programs (PDMPs). “We found that PDMPs administered by state health departments appeared to be more effective than those administered by other government agencies, such as the bureau of narcotics and the board of pharmacy, ” said senior author Guohua Li, MD, professor of epidemiology and director of the Center for Injury Epidemiology and Prevention. Read more on prescription drugs.

Study: Mother’s Monitoring of Kids’ Media Consumption Tied to Changes in Weight
Children whose mothers pay more attention to their kids’ media habits—how much time they spend watching television or playing video games—are more likely to weigh less than children who do not receive the same sort of supervision, according to a new study in JAMA Pediatrics. Researchers found that kids with mothers who monitored their media consumption were thinner at age seven and gained less weight over the following few years. While the authors said they cannot point to the exact reason for the relationship, possibilities include vigilant mothers who encourage more physical activity and the fact that the kids are exposed to fewer food advertisements. The study used a questionnaire to asses 112 mothers, 103 fathers and their 213 children; media monitoring by fathers was not linked to weight gain or loss. Stacey Tiberio, the study's lead author from the Oregon Social Learning Center in Eugene, told Reuters Health that the results emphasize the important role that early adolescence plays with weight.  "It's basically a one-way door," she said. "If you are obese by middle childhood, you have an increased likelihood of staying in that group." Read more on obesity.

Finding Unlisted Milk Protein, FDA Announces Recall of Certain Simply Lite Chocolate Products
The U.S. Food and Drug Administration (FDA) has announced a recall of certain lots of Simply Lite brand dark chocolate bars after finding significant amounts of milk protein, which the product does not list as an ingredient. FDA testing found more than 3,500 parts per million of milk protein in single 3-ounce bars of the chocolate—or the equivalent found in about 4 teaspoons of whole milk. People with milk allergies or sensitivity to milk could have serious or even life-threatening reactions to the product. Consumers with questions about food safety can contact the FDA at 1-888-SAFEFOOD Monday through Friday between 10 a.m. and 4 p.m. Eastern Daylight Time. Go here for complete information on the recall. Read more on food safety.

Mar 17 2014
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Public Health News Roundup: March 17

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Poison Prevention Week 2014
March 16-24 is Poison Prevention Week this year, and an important opportunity to remind health officials and consumers about the resources provided by the National Poison Prevention Program and Hotline (1-800-222-1222). The National Poison Control Program is a program of the Health Resource Services Administration (HRSA). Programs include:

  • Poison centers serving all states, Puerto Rico, the District of Columbia, Guam, the Federated States of Micronesia and American Samoa.
  • A single, national toll-free number (1-800-222-1222) that connects callers with the poison center serving their area.
  • A nationwide media campaign to educate the public and health care providers about poison prevention, poison center services and the 1-800 number.
  • Programs to support the enhancement and improvement of poison education, prevention and treatment.
  • Partnership development with other federal agencies and national organizations to advance poison prevention awareness.
  • Development of uniform patient management guidelines so that poison centers can provide uniform treatment recommendations.
  • Improvement of data collection systems and toxic exposure surveillance for enhanced capability to capture national poisoning data.
  • Multilingual interpreter service in 161 languages to anyone who calls the 1-800 number. 

Read an FAQ on assistance available from the Poison Prevention Program for consumers and health providers. Read more on prevention.

Colon Cancer Incidence Rates Decreasing Steeply in Older Americans
Colon cancer incidence rates have dropped 30 percent in the United States in the last 10 years among adults 50 and older because of the widespread use of colonoscopies, according to a new study in CA: A Cancer Journal for Clinicians. The largest decrease has been in people over age 65. Colonoscopy use has almost tripled among adults ages 50-75, from 19 percent in 2000 to 55 percent in 2010. The study relied on data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program and the U.S. Centers for Disease Control and Prevention's National Program of Cancer Registries.

The "larger declines among Medicare-eligible seniors likely reflect higher rates of screening because of universal insurance coverage," according to the study authors. Mortality rates from colon cancer have also declined most rapidly within the past decade. From 2001 to 2010, death rates from colon cancer decreased by approximately 3 percent per year in both men and women, compared with declines of approximately 2 percent per year during the 1990s. The data is being released as the U.S. Department of Health and Human Services launches a nationwide effort to increase colorectal cancer screening rates to 80 percent by 2018. Read more on cancer.

DOT Proposed Rules on Electronic Log Books for Large and Bus Drivers to Help Reduce Fatalities and Injuries
The U.S. Department of Transportation (DOT) has announced a proposal to require interstate commercial truck and bus companies to use Electronic Logging Devices (ELDs) in their vehicles to improve compliance with the safety rules that govern the number of hours a driver can work. According to DOT, the proposed rule will ultimately reduce hours-of-service violations by making it more difficult for drivers to misrepresent their time on logbooks and—significantly—help reduce crashes by fatigued drivers and prevent approximately 20 fatalities and 434 injuries each year, for an annual safety benefit of $394.8 million. Impaired driving, including fatigue, was a factor in more than 12 percent of the 129,120 total crashes that involved large trucks or buses in 2012. Read more on injury prevention.

Mar 13 2014
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Public Health News Roundup: March 13

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Hypertension Often Untreated in U.S. Hispanic Community
A new study in the American Journal of Hypertension finds that there is too little recognition and control of hypertension among the Hispanic population of the United States.

The new data comes from the Hispanic Community Health Study/Study of Latino, a longitudinal study of 16,415 Hispanics/Latinos, ages 18 to 74 years from four communities in the U.S. (Bronx, Chicago, Miami, and San Diego). Measures including hypertension levels and whether patients were on hypertension medications were collected between 2008 and 2011 and then followed up last year.

The study also found that the prevalence of hypertension in the Hispanic community increased with age, and was highest among those with Cuban, Puerto Rican, and Dominican backgrounds.

Read more on heart health.

USDA Funds News Childhood Obesity Prevention Programs at Three Universities
The National Institute of Food and Agriculture of the U.S. Department of Agriculture has given grants to childhood obesity prevention projects at three U.S. universities:

  • University of Tennessee, Knoxville, Tenn. for "Get Fruved:" A peer-led, train-the-trainer social marketing intervention to increase fruit and vegetable intake and prevent childhood obesity
  • Tufts University, Boston, Mass., for a “kids-only" retail coupon study to promote healthy snack options among adolescents in convenience stores.
  • Winston-Salem State University, Winston-Salem, N.C., for a program works with 10-12 year-old children from low income families.

Read more on obesity.

Almost Half of U.S. Population Lives in Jurisdictions that Strengthened Gun Laws in 2013
Fifteen states and the District of Columbia strengthened their gun laws in the year following the Newtown school shooting, according to a new review from the Johns Hopkins University press, Updated Evidence and Policy Developments on Reducing Gun Violence in America.

Among the changes in the last year was legislation at the state level to reduce intimate partner violence offenders’ access to firearms.

Read more on injury prevention.

Mar 12 2014
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Public Health News Roundup: March 12

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Robert Wood Johnson and CDC Foundations Launch New Project on Using Law and Policies to Help People Make Healthier Choices
The Robert Wood Johnson and CDC Foundations have announced the launch of a new project to advance discussion about how laws and policies can assist people in making healthier choices. Subject matter experts will work with federal partners to develop 10 to 15 evidence-based reports during the next three years to highlight laws and policies related to specific topic areas within the U.S. Department of Health and Human Services (HHS) Healthy People 2020 initiative. Healthy People 2020 is a set of goals and objectives with 10-year targets designed to guide national health promotion and disease prevention efforts aimed at improving the health of all people in the United States.

The new project, which will be led by the Office of Disease Prevention and Health Promotion (ODPHP) at HHS, will provide practical information to public health officials and associations; health-related industries; legal practitioners; non-profit organizations; policymakers; and individuals about the use of law and policy to address health factors:

  • ODPHP will provide leadership and support for the development of the reports.
  • CDC will provide technical guidance on the development of specific reports and collaborate with public health partners and communities to promote knowledge and understanding of the reports.
  • RWJF will provide public health law and policy expertise.
  • The CDC Foundation will manage administration and implementation of the project and amplify the results to stakeholders through communications efforts.

“The Robert Wood Johnson Foundation believes that law and policy are important levers for building a culture of health in our nation,” said Risa Lavizzo-Mourey, MD, president and CEO of the Robert Wood Johnson Foundation. “We’re pleased to collaborate with leaders in public health and government to focus attention on policies based on the best science to help achieve the national health goals set out in Healthy People 2020—strategies that all states and communities can use to help people live healthier lives.” Read more on prevention.

FDA Approves Marketing of First Migraine Prevention Device
The U.S. Food and Drug Administration (FDA) has authorized the marketing of the first device designed to stop migraine headaches before they happen. The preventative treatment is a small, portable prescription device that uses an electrical current to stimulate branches of the trigeminal nerve, which has been associated with migraine headaches. An estimated 10 percent of people suffer from migraines, which if untreated can last from four to 72 hours and lead to nausea, vomiting and sensitivity to light and sound. In a release, Christy Foreman, director of the Office of Device Evaluation at the FDA’s Center for Devices and Radiological Health, said Cefaly “may help patients who cannot tolerate current migraine medications for preventing migraines or treating attacks.” Read more on technology.

HHS: 4.2 Million Have Signed Up for Coverage Under the Affordable Care Act
Just a few weeks before the final deadline of March 31, the U.S. Department of Health and Human Services (HHS) has announced that more than 4.2 million people have enrolled in the Health Insurance Marketplace under the Affordable Care Act. Approximately 943,000 enrolled in February. Of the 4,242,300 who have enrolled:

  • 55 percent are female and 45 percent are male;
  • 31 percent are age 34 and under;
  • 25 percent are between the ages of 18 and 34;
  • 63 percent selected a Silver plan (up one percentage point over the prior reporting period), while 18 percent selected a Bronze plan (down one point)
  • 83 percent selected a plan and are eligible to receive Financial Assistance (up one point)

Read more on the Affordable Care Act.

Mar 11 2014
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Public Health News Roundup: March 11

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New Report on US Cancer Care Finds Significant Cost and Quality Challenges
A new report from the American Association of Clinical Oncology (ASCO) finds that several factors including an aging population and poor lifestyle habits in the United States have resulted in an increase in annual cancer cases at the same time many smaller oncology practices are closing because of financial pressures. "We're facing a collection of challenges, each one of which could keep cancer treatment advances out of reach for some individuals," said ASCO President Clifford A. Hudis, MD.

ASCO’s recommendations include:

  • Support for novel cancer care delivery efforts.
  • Development of new healthcare delivery and payment models to help ensure the viability of small community practices while encouraging high-quality care.
  • Support for quality initiatives that will speed up dissemination of cancer treatment breakthroughs and changes.

Read more on cancer.

Spring Break Highlights Dangers of Binge Drinking
The average male Spring Breaker reports drinking 18 alcoholic drinks per day during the week-long festivity, while the average female reports up to 10 drinks, according to the American College of Health. Five or more drinks within two hours qualify as “binge drinking” for men and four or more qualifies for women. Each year 1,825 college students ages 18-24 die from alcohol-related unintentional injuries, with alcohol poisoning among the biggest causes. Signs of alcohol poisoning include irregular breathing, vomiting, confusion and unconsciousness, and should be met with an immediate trip to the emergency room.

Among the other unintentional injuries:

  • Assault — More than 690,000 students between the ages of 18 and 24 are assaulted by another student who has been drinking.
  • Sexual Abuse — More than 97,000 students between the ages of 18 and 24 are victims of alcohol-related sexual assault or date rape.
  • Injury — 599,000 students between the ages of 18 and 24 receive unintentional injuries while under the influence of alcohol.

Read more on alcohol.

Mass Analysis Confirms Link Between Bullying, Suicidal Thoughts
A new review of 43 previous studies seems to confirm the link between bullying and an increase in suicidal thoughts, with cyber bullying linked the most strongly. The study appears in JAMA Pediatrics and included data on approximately 350,000 youths. Approximately half of students in grades 4-12 report being bullied within the previous month, with one-third saying they were bullies themselves. While the new analysis does not demonstrate causation, it does indicate a more complex connection, perhaps even showing that kids with suicidal thoughts in the first place are more likely to be bullied. Read more on violence.

Mar 10 2014
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Public Health News Roundup: March 10

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Majority of Youth C. Difficile Infections Linked to Doctor Visits
Antibiotics prescribed in a doctor’s office for other conditions are associated with the majority of Clostridium difficile infections, according to a new study in the journal Pediatrics. Researchers from the U.S. Centers for Disease Control and Prevention (CDC) determined that 71 percent of the cases for youth ages 1-17 were linked to the visits, rather than to overnight stays in health care facilities; two-thirds of adult cases are linked to hospital stays. The findings raise the profile of ongoing efforts to reduce unnecessary prescriptions. “Improved antibiotic prescribing is critical to protect the health of our nation’s children,” said CDC Director Tom Frieden, MD, MPH. “When antibiotics are prescribed incorrectly, our children are needlessly put at risk for health problems including C. difficile infection and dangerous antibiotic resistant infections.” Read more on prescription drugs.

Study: Even Slightly Elevated Blood Pressure Can Do Cardiovascular Damage Over Time
Even slightly elevated blood pressure that does not rise to the clinical definition of hypertension can do cardiovascular damage over time, according to a new study in the Journal of the American Medical Association. Researchers at the University of Oklahoma Health Sciences Center analyzed blood pressure data on more than 4,600 participants, all of whom had their readings tracked over 25 years from young adulthood to middle age. They placed the participants in five blood pressure trajectory categories:

  • Low-stable: blood pressure that starts low and stays low
  • Moderate-stable: blood pressure that begins only slightly elevated and stays that way
  • Moderate-increasing: blood pressure begins only slightly elevated and increases over time
  • Elevated-stable: blood pressure that starts at elevated levels, but does not increase
  • Elevated-increasing: blood pressure that begins elevated and increases over time

The study determined that participants in the moderate-stable group were 44 percent more likely to have coronary artery calcification than those in the low-stable group. Read more on heart health.

Study: Men Die Earlier in More Patriarchal Societies
Gender differences when it comes to mortality rates are higher in more patriarchal societies, meaning women’s rights are good for men’s health, according to a new study in the American Psychological Association’s Evolutionary Behavioral Sciences. Utilized sociodemographic and mortality data from the World Health Organization, researchers from the University of Michigan (UM) School of Public Health found that men living in the top 25 percent most-patriarchal societies were 31 percent more likely to die than men in the least patriarchal quartile, compared to mortality rates for women. Researchers noted that the study only included societies with infrastructures capable of providing reliable data, so the difference could be even more pronounced. Possible explanations include:

  • Males in societies where they are more socially dominant tend to engage in riskier behaviors that can lead to death.
  • These societies tend to have more resources and social status concentrated in a smaller group of elite men, and men with greater control of resources and social status historically have had more reproductive success.
  • In their quest for social dominance, men will go up against other men to gain power and engage in forms of competitive, and sometimes dangerous, behavior.

"Gender inequality is inherently related to inequality in general, and this is bad for both men and women's health, though especially harmful to men in increasing the risk of death," said UM researcher Daniel Kruger. Read more on health disparities.

Mar 7 2014
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Public Health News Roundup: March 7

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CDC: Reducing High-risk Antibiotic Prescriptions Could Also Reduce Deadly Infections
The most recent Vital Signs report from the U.S. Centers for Disease Control and Prevention (CDC) finds that if prescriptions of high-risk antibiotics in hospitals were reduced by just 30 percent, then there could be as many as 26 fewer cases of deadly diarrhea infections with Clostridium difficile. “Improving antibiotic prescribing can save today’s patients from deadly infections and protect lifesaving antibiotics for tomorrow’s patients,” said CDC Director Tom Frieden, MD, MPH. “Health care facilities are an important part of the solution to drug resistance and every hospital in the country should have a strong antibiotic stewardship program.” As part of its ongoing efforts to improve antibiotic prescribing, the CDC has release a checklist of seven core elements for hospitals:

  1. Leadership commitment: Dedicate the necessary human, financial, and IT resources.
  2. Accountability: Appoint a single leader responsible for program outcomes. Physicians have proven successful in this role.
  3. Drug expertise: Appoint a single pharmacist leader to support improved prescribing.
  4. Act: Take at least one prescribing improvement action, such as requiring reassessment of prescriptions within 48 hours to check drug choice, dose, and duration.
  5. Track: Monitor prescribing and antibiotic resistance patterns.
  6. Report: Regularly report prescribing and resistance information to clinicians.
  7. Educate: Offer education about antibiotic resistance and improving prescribing practices.

Read more on infectious diseases.

Poorer Women Most Likely to Be Caught in ‘Vicious’ Caregiving, Financial Well-being Cycle
Low-income women are at increased risk of finding themselves caught in a “vicious cycle” of parental caregiving and financial well-being, according to a new study in The Journals of Gerontology. While women of better financial means can afford additional caregiver assistance and better health care for aging parents, poorer women lack those options. "People who had less household income and less financial resources were more likely to take care of their parents so there is this cycle that they cannot get out of—they are poor, then taking care of parents, then being poor and taking care of their parents—there's this kind of cycle," said lead author Yeonjung Lee, a researcher and professor at the Faculty of Social Work at the University of Calgary in Alberta, Canada, according to Reuters. Read more on aging.

Young Skin Cancer Survivors at Heightened Risk for Other Cancers
Younger skin cancer survivors are at increased risk for additional cancer types later in life, according to a new study in the journal Cancer Epidemiology, Biomarkers & Prevention. A review of data of more than 500,000 people with a history of nonmelanoma skin cancer found that while all age groups were at heightened risk for melanoma and other types of cancers, the increase was especially significant for people under the age of 25, who were 23 times more likely to develop cancer than people who had never had nonmelanoma cancer. The risk was 3.5 times higher for nonmelanoma survivors ages 25-44, 1.74 times higher for those ages 45-59 and 1.32 times higher for those older than 60. The types of cancer they are at risk for include melanoma skin cancer, and cancers of the breast, colon, bladder, liver, lung, brain, prostate, stomach and pancreas. Read more on cancer.