TIME Cancer

Many Breast Cancer Patients Don’t Understand Their Condition, Study Says

The disparity is particularly pronounced for minority women

Many breast cancer patients don’t understand the details of their disease, according to a new study. While many believed they understood the grade, stage and type of tumor, only 20% to 58% identified those characteristics correctly.

The study, published Monday in the journal Cancer, found that minority women fared particularly poorly in identifying their tumor characteristics, a finding that remained true even as researchers controlled for factors like education. The lack of understanding about their own disease makes it difficult for patients to make informed medical decisions and to follow prescribed treatments, said study author and Harvard Medical School professor Rachel Freedman.

“Our results illustrate the lack of understanding many patients have about their cancers and have identified a critical need for improved patient education and provider awareness of this issue,” Freedman said.

TIME Addiction

Typical American Smokers Burn Up at Least $1 Million During Their Lifetimes

Alaska smokers will spend over $2 million

American smokers spend at least $1 million dollars on cigarette-related expenditures over their lifetimes, according to a state-by-state analysis done by the financial consultancy company WalletHub.

The most expensive state for smokers is Alaska, where the habit costs over $2 million dollars on average. For a bargain, move to South Carolina, but that still comes in at nearly $1.1 million.

“I and most people really just think of the cost of cigarettes and taxes on the packs, but if you think about the healthcare costs, which can totally be avoided, healthcare insurance premiums, and in the workplace, bias against smokers, that can … add up,” said WalletHub spokeswoman Jill Gonzalez.

The study’s “average smoker” is someone who smokes one pack a day starting from the age of 18 (legal age to buy) and ending at 69 (the average age of death for a smoker).

So, if you’re looking for another excuse to quit, perhaps take a quick peak down millionaire’s row.

TIME Reproductive Health

Birth Control Pill Risks May Now Include Brain Cancer

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Raymond Forbes—Getty Images/age fotostock RM

Certain forms of birth control may promote growth of a rare brain tumor

Taking any drug is a matter of weighing the benefits and risks, and when it comes to birth control, women may now have one more factor to consider.

Dr. David Gaist, a neurologist at Odense University Hospital and the University of Southern Denmark, and his colleagues found that women taking hormonal contraceptives — those containing estrogen, progestin or a combination of both — showed higher rates of a rare brain tumor known as glioma. Their results, published Thursday in the British Journal of Clinical Pharmacology, raise questions about the connection between oral contraceptives and brain cancer, but shouldn’t yet be interpreted as a reason to stop taking birth control, says Gaist.

MORE: This Contraceptive Is Linked to a Higher Risk of HIV

Using data from Denmark’s national registries of health records, cancer cases and prescriptions, Gaist zeroed in on the women aged 15 years to 49 years diagnosed with glioma, and then analyzed whether they were prescribed contraceptives and for how long. Overall, women who had used hormonal contraceptives at any point in their lives showed a 50% higher risk of developing the brain tumors compared to those who had not used them. And women who used the birth control for more than five years nearly doubled their risk of the cancer. Still, Gaist says, since gliomas are rare, even a doubling of a rare event is still a small risk.

MORE: Which Birth Control Works Best? (Hint: It’s Not the Pill)

“If you look at women in Denmark aged 15 to 49, about five in 100,000 experience that terrible diagnosis in a year, and that figure includes women on hormonal contraceptives, so it’s a very rare event.”

But he admits he was “a bit surprised” by the results, since previous studies suggested that the sex hormones estrogen and progestin might be protective against the gliomas. But those studies primarily included women past menopause, who self-reported their use of contraceptives. In his study, the women were at the age where they would be taking contraceptives, and the data came directly from medical records and registries and therefore more likely to be accurate.

MORE: Take a Look at History’s Worst Contraceptives for Women

Interestingly, Gaist found that women using progestin-only birth control showed slightly higher risk of developing gliomas. While it’s not clear why, he suspects that obesity may be playing a role. In Denmark, regulations require that doctors avoid prescribing estrogen-based contraceptives to obese women, since estrogen can increase risk of blood clots.

Dr. Santosh Kesari, director of neuro-oncology at University of California San Diego and a member of the American Academy of Neurology, notes that rates of gliomas have not spiked since the introduction of hormonal contraceptives, but agrees that the correlation deserves discussion and more study. “It’s something women should be aware about, but I don’t think there is enough evidence to say don’t use it. But the discussion about this potential risk needs to happen,” he says.

Until more research is done to tease apart how the hormones in contraceptives are influencing cells in the brain, Gaist agrees that there isn’t any reason for women to stop using such birth control methods. “With the present knowledge we have, I would still favor using contraception in eligible women,” he says. “But we need to do more research to get a better handle on the issues.”

TIME Cancer

This Drink Could Protect You From Skin Cancer

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Cindy Prins—Getty Images/Flickr RF

The sun is the biggest culprit in causing skin cancer, but there’s a beverage that may thwart some of the tumor-causing effects of ultraviolet rays

You may grab a cup (or two) of coffee every morning to help you wake up and face the day, but you may also be doing your skin a favor. Researchers in a new paper released Tuesday say that coffee can protect against melanoma, the deadliest form of skin cancer.

Melanoma is triggered by damage to skin cells’ DNA caused by UV rays from the sun or tanning beds; these mutations prompt the cells to grow abnormally and spread to other tissues in the body, where it can be fatal. But in a report published in the Journal of the National Cancer Institute, Erikka Loftfield from the National Cancer Institute and her colleagues found that people who drank more than four cups of coffee a day on average had a 20% lower risk of developing melanoma over 10 years.

Loftfield’s group looked at food and cancer information from more than 447,000 people enrolled in a National Institutes of Health-AARP study who answered a 124-item food questionnaire and allowed the scientists access to their medical records. Even after the team adjusted for the potential effects of age, smoking, alcohol use and family history of cancer, the connection between high coffee consumption and lower risk of melanoma remained significant. The researchers even factored in the potential effect of casual sun exposure by looking at the average July ultraviolet readings where the participants lived.

The association only held for caffeinated coffee—not for decaf—and Loftfield’s group says there’s sound biological reason for that. Coffee contains numerous compounds, including polyphenols and caffeine, that keep cancer-fighting processes that are triggered by UV light under control. The roasting process of coffee beans also releases vitamin derivatives that protect against UV damage in mice. There’s also intriguing evidence that caffeine may act as a molecular sunscreen, absorbing UV rays and therefore protecting DNA from damage.

The group says that their results need to be repeated and confirmed, and that it’s too early yet to change your coffee habits to protect yourself from skin cancer. But the findings support the idea that there might be more you can do to protect yourself from the sun’s harmful rays than only slathering your body in sunscreen. It’s okay to enjoy a few cups of joe (as long as it’s in the shade).

TIME medicine

It Doesn’t Matter How Much You Exercise If You Also Do This

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Sitting too much can negate the benefits of exercise Simon Watson—Getty Images

Your workouts may not mean a lot if you sit too much

Most of us know that we need to be more physically active. Only 20% of American adults get the recommend amount of physical activity—150 minutes of the moderately intense aerobic kind—each week.

But simply moving more isn’t enough, according to a new report published in the Annals of Internal Medicine. The benefits of exercise can be blunted if you also spend most of the rest of your day sitting.

MORE Sitting Is Killing You

Dr. David Alter, a heart expert from the University of Toronto and senior scientist at the Toronto Rehabilitation Institute, and his colleagues found that sitting too much—even among people who exercise regularly—led to higher rates of hospitalization, heart disease and cancer, as well as early death.

The researchers looked at 47 studies that asked people how much time they spent sitting and exercising, as well as rates of heart disease, diabetes, cancer and death from any cause. The more hours people in the studies spent sedentary—like watching TV or reclining on a couch—the higher their risk of all of these negative outcomes. Heavy sitters showed a 90% higher risk of developing diabetes than those who sat less, an 18% higher chance of dying of heart disease or cancer, and 24% greater odds of dying from any cause. These rates were the average among people who both exercised regularly and those who did not.

MORE Now There’s Another Reason Sitting Will Kill You

“What struck me, and I was quite surprised by this, was that the deleterious effects of sitting time were almost uniform across the board of total mortality, heart disease mortality, the occurrence of heart disease, the occurrence of cancer and the mortality from cancer,” says Alter. “When we see a consistent effect, that reaffirms that something real is going on.”

What’s happening, he suspects, is that the metabolic effects of sitting are overwhelming any benefits that exercise might have. Even if people exercise regularly for half an hour or an hour a day, how they spend the remainder of that day is also important to their health. Alter says that the unhealthy effects of sitting are somewhat reduced among those who are physically active—by about 15%—but they aren’t completely erased. “You can make a little bit of headway on the bad effects of sedentary time by at least doing some exercise,” he says. “But you can’t completely nullify it.”

MORE Sitting Can Increase Your Risk of Cancer By Up to 66%

The only way to do that is to sit less, and not just exercise more. For so long, the public health message has been to move more and squeeze in as much active time as possible into the day. That message is still important, he says, but it needs to change as new research on the dangers of sitting starts to emerge. “It’s time to modify the public health message,” he says. “We still need more research, but there is a signal there that it’s time to do that. We need two different strategies—one that targets exercise for 30 minutes to 60 minutes a day, and the other is to reduce sedentary behavior.”

For his patients, Alter starts by helping them realize how much of their day they spend in a chair. There’s no prescription for sitting, and no research yet to support the optimal levels for avoiding cancer or heart disease or early death. But studies have shown that standing burns twice as many calories per hour, about 140, as sitting. And burning extra calories is a good way to maintain a healthy weight, one of the key factors in preventing heart disease and some cancers.

“Little things add up to a lot,” says Alter, who says he checks emails while on a elliptical. He also recommends standing up or moving around for several minutes every half hour when you’re at your desk, and aiming to sit two to three hours less in a 12 hour day. If you can’t give up your favorite TV shows, he adds, stand during the commercials.

Read next: Why You Should Start Forcing Your Coworkers to Take a Walk With You

Listen to the most important stories of the day.

TIME Healthcare

When Can a Person Be Forced to Receive Medical Care?

'We subscribe to the principle that people should get to make decisions for themselves almost all the time'

Last week, the case of a Connecticut teenager, identified as Cassandra C., 17, made headlines. Diagnosed with Hodgkin’s lymphoma, Cassandra wanted to forgo chemotherapy altogether—a decision her mother reportedly supported. But in early January, child services took the 17-year-old into custody and on Jan. 8 the state Supreme Court denied the teenager’s request to not receive the drugs.

The state’s interference in a personal decision about health care provides a rare lens into when and how health officials can mandate health care. Forced treatment is rare, but it happens when people, most often minors and the mentally ill, find themselves in extenuating circumstances.

“We subscribe to the principle that people should get to make decisions for themselves almost all the time,” says Paul S. Appelbaum, a psychiatry, medicine and law professor at Columbia University. “The exceptions to that rule are rare. What we’re seeing play out in Connecticut is really the exception, not the rule.”

Competent adults in the United States are almost always permitted to make their own health care decisions, even if that means forgoing a potentially life-saving treatment. Even in cases of highly infectious disease, state laws don’t typically allow forced medical treatment. Instead, sick individuals may be quarantined until they agree to comply with treatment procedures.

The most obvious exception to the principle applies to mentally ill patients deemed incompetent to make their own health decisions. Though laws vary for long-term involuntary treatment between states, most jurisdictions allow short-term hospitalization for individuals thought to be a risk to themselves or others.

Read more: Dangerous Cases: Crime and Treatment

Minors have no official say when it comes to decisions about their health care; parents or guardians are typically charged with making treatment decisions on their behalf. (Minors do have the right to petition the courts to show that they are “mature”—something Cassandra from Connecticut did—and therefore capable of making their own decisions. Cassandra’s petition was denied.)

If parents refuse a recommended treatment, the state typically works with parents to reach a mutually agreeable solution, says Appelbaum. If the parties still can’t agree, the case may go to the courts. “The legal principles here are fairly consistent, but their application is not necessarily straightforward,” said Appelbaum of the difficulty of resolving health care issues in court. “There is no algorithm.”

When brought to court, judges weigh a range of concerns, including the consequences of leaving an ailment untreated. Life-threatening conditions are much more likely to result in forced treatment than, say, a recommended cosmetic surgery, said Appelbaum.

“How long is a person actually supposed to live, and why? Who determines that?” Cassandra wrote in a op-ed in the Hartford Courant. “I care about the quality of my life, not just the quantity.”

The court, which had previously ruled Cassandra’s mother unfit to make decisions on her daughter’s behalf, rejected Cassandra’s explanation and ordered her to undergo chemotherapy.

“This is a curable illness, and we will continue to ensure that Cassandra receives the treatment she needs to become a healthy and happy adult,” said a statement from the Connecticut Department of Children and Families.

TIME

Eminem Makes Wish Come True for Terminally-Ill Fan

The day before the teen passed away

Gage Garmo had one wish before he died: Meet Eminem.

The teenager was battling a rare and aggressive form of bone cancer, and his friends wanted to help make his life-long dream come true. They set out on a social media campaign to bring the rapper to the Detroit suburb of Rochester, MI., to meet Garmo. Their efforts got a boost when the Michigan-based charity The Rainbow Connection, which grants wishes to children facing terminal illnesses, head about Garmo’s case, and managed to set up a meeting with the 8 Mile rapper within just 48 hours.

After hearing that Garmo only had a week to live, Eminem flew to Michigan on Sunday to spend time with his young fan. The Detroit Free Press reported that the two talked about hip-hop and football in Garmo’s living room. According to the Free Press, Garmo “sat up with a grin on his face” upon seeing the rapper and a Rainbow Connection staffer noted that Garmo’s “family hadn’t seen their son do that in such a long time.”

Garmo died Monday night. He would have turned 18 on Friday.

TIME Media

Thank You, Stuart Scott, for Your Unapologetic Blackness

Stuart Scott accepts the 2014 Jimmy V Perseverance Award at the 2014 ESPYS in Los Angeles on July 16, 2014.
Stuart Scott accepts the 2014 Jimmy V Perseverance Award at the 2014 ESPYS in Los Angeles on July 16, 2014. Kevin Winter—Getty Images

xoJane.com is where women go to be their unabashed selves, and where their unabashed selves are applauded

You changed the game forever

xojane

There were times when a trip to the ESPN website’s comment section made me want to (a) take a shower and (b) call the Southern Poverty Law Center to file a hate crime complaint whenever legendary anchor Stuart Scott was being discussed.

But Scott, who passed away at the age of 49, didn’t ever let the prejudices he was working against slow him down. On the contrary, he changed the game entirely.

By remaining true to himself despite calls for him to be less “urban,” Scott managed to connect African American sports fans — fans that most sports networks couldn’t be bothered to reach out to — to the games they love and educated all of us in the process.

When I got the news that the ESPN SportCenter host had finally succumbed to the cancer that he had been fighting like a boss for much of the last eight years, I thought about a trip I took in 1996.

A friend of mine was credentialed to cover the National Basketball Association Draft, and because he needed a ride to the Continental Airlines (now the Izod) Arena in the New Jersey Meadowlands, I got a credential too.

Everyone in Philly was paying close attention to this particular Draft for two reasons: one, the Philadelphia 76ers, a team whose ineptitude over the years is the stuff of NBA records, had a Lottery pick, which meant that they were going to get a player that would make an immediate impact.

And two, the buzz was that the Sixers were actually going to do something useful with their lottery pick and use it to grab a flashy, undersized point guard from Georgetown named Allen Iverson.

A.I. was the talk of the City of Brotherly Love. He won the Rookie of the Year award with a game more at home on a guy twice his size. He led the Sixers to the playoffs more often than not.

But Iverson — like sportscaster Scott and his urban language — also caused his share of “problems.”

For example, he refused to wear a suit on the team plane, opting instead for sweat suits and sneakers. He was covered in tattoos and wore his rather large Afro in cornrows on the court.

By the time he retired a few years ago, Iverson had inspired NBA Commissioner David Stern to create a dress code and put a few other rules in place to take some of this influence out of a game played by guys who grew up in urban areas.

But despite Stern’s best efforts to make the NBA a lot more palatable to a crowd that’s waiting for Larry Bird to come through the doors of the Boston Garden, the league’s parquet floors are still filled with men covered in tattoos, wearing cornrows and bringing the urban swagger that they picked up on the courts where they learned the game.

Kind of like the swagger that Scott brought to telling the stories of their exploits on “SportsCenter.” Like Iverson changed the game on the court, Scott managed to change the game for sports television.

For a lot of people, Scott’s phrases like “Can I get a witness from the congregation?!” or “Cool as the other side of the pillow,” or a whole host of other phrases heard commonly in the Black community were landmark and unapologetic.

And if I had a nickel for every time I’ve heard someone shout “Booyah!” to one another just the same way Scott did on TV, I would be writing this piece from my villa in Barcelona, Spain.

My relationship was like many Americans with the sportscaster. Scott was often the last voice that I heard as I fell asleep at night.

I say this because I live with a sportswriter.

ESPN and I became acquainted whether I wanted to or not. Before seeing Scott for the first time at a National Association of Black Journalists convention, I already felt like I knew the man because of that late-night version of “SportsCenter” that played me to sleep every night.

For me, Scott made the hours and hours spent watching “SportsCenter” (sometimes three times in a row, the 90-minute program played again and again) an unforgettable and entertaining and very real slice of television — because Scott brought the games to life in a way that you didn’t see elsewhere on television.

Just like any Black church in South Philly on Sunday, he spoke the words of the preacher: “Can I get a witness from the congregation?!”

He could and he did.

Scott also made it a point to reach out to another group that sports networks don’t often bother to reach out to: young, African American reporters. Every year, the NABJ Sports Task Force holds a Mentor Breakfast that’s sponsored by ESPN. He was a constant presence there and mentored in a way that’s become legendary.

We don’t even notice how much our language has changed in the years since Scott first presided over the network like a formidable, unflinching presence breaking the rules and ignoring the common parlance.

And that is his legacy.

Denise Clay is a journalist and educator in Philadelphia. This article originally appeared on xoJane.com.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Cancer

Court Denies Teen’s Wish to Refuse Cancer Treatment

Intravenous Saline Drip on IV Pole.
Getty Images

"Cassandra C" reportedly believes chemotherapy will do her harm rather than save her life

A 17-year-old cancer patient does not have the right to refuse treatment for her disease, the state of Connecticut’s highest court has ruled.

In a significant decision Thursday, the State Supreme Court upheld a lower court’s ruling allowing the girl, identified as Cassandra C. in court papers, to be forced to undergo treatment for Hodgkin lymphoma, according to the Hartford Courant. Her doctors say that she will die unless she undergoes chemotherapy.

Cassandra’s mother, Jackie Fortin, says her daughter believes the chemical treatment will do more damage to her than the cancer. Fortin said she respect’s Cassandra’s decision.

Cassandra was removed from Fortin’s care after the mother and daughter missed follow-up appointments and placed into the custody of child welfare officials, who forced her to undergo the cancer treatment. The teenager ran away from hospital after just two days of chemotherapy.

The court made its expedited decision Thursday following a 45-minute hearing, during which lawyers for Cassandra and her mother argued that even though Cassandra is a minor, she can make her own health decisions. Cassandra is months away from turning 18.

“The general rule for adults is that you can say no to treatment no matter how life-saving it may be,” said one of Cassandra’s attorneys, Joshua Michtom. “You can say no even to helpful treatment. If she were 18, no matter what anyone said, it would be her choice to make.”

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