By Katie Kerwin McCrimmon

Summer is officially over, but with temperatures approaching 90 degrees and bright sunny September days, you still might be able to dose up on some vitamin D.

That raises a health conundrum, however.

Sharon McKenna spent her childhood getting blistering burns before she’d get tan. She survived melanoma and now advises people to protect themselves from potentially dangerous sun exposure. Source: U.S. Centers for Disease Control and Prevention.

On the one hand, skin cancer is the most common cancer in the U.S. and dermatologists would much prefer if we stayed out of the sun altogether or remain well covered with sunscreen, hats and long sleeves during peak sun hours. New research has found that melanoma, the deadly form of skin cancer, is striking younger people — especially teen girls — in much higher numbers.

At the same time, researchers say Americans are chronically deficient in vitamin D. The name is misleading. Vitamin D is a hormone, not a vitamin, and we get it by converting UV rays into the hormone. Vitamin D is crucial to bone health and may have all sorts of other benefits from preventing some types of cancer to thwarting infections.

With seemingly incongruent advice to stay out of the sun because it causes skin cancer while finding ways to get adequate vitamin D, what do doctors advise?

Skin cancer experts are adamant. They say UV radiation is a known carcinogen, and potential harm from sun exposure is too great to risk spending time outdoors without sunscreen. People who need vitamin D should get it through fortified foods or supplements.

But vitamin D experts say that some individuals may decide to load up on vitamin D by spending very short periods of time outside on sunny days without sunscreen since sunlight gives much bigger boosts of vitamin D than people can get through food or supplements.

“I’m not personally making this recommendation, but the amount of vitamin D that a light-skinned individual in the summer in Colorado would get wearing short sleeves for about 10 to 15 minutes would be as much vitamin D as you’d get in 30 glasses of (fortified) milk,” said Dr. Adit Ginde, an emergency room physician at University of Colorado Hospital and an associate professor of emergency medicine at the University of Colorado School of Medicine.

“The darker your skin tone, the more likely you are to need vitamin D,” Ginde said.

“It’s a personal decision. If you want to raise your vitamin D levels and you want 0 risk, taking a supplement is probably the safest way to do that,” he said.

For those who want some vitamin D through minimal sun exposure, Ginde said you’d never want to stay out to the point of getting a sunburn. Rather, you’d absorb some rays for less than half the time it would take to get any kind of burn.

The complication is that individuals are so different. Some people have a greater risk of getting skin cancer, so they should be very cautious. Skin tones vary, as do exposure levels depending on the latitude. In Colorado, it’s very difficult to get any exposure to vitamin D in the winter and you don’t absorb much during off-peak hours.

Ginde was the lead researcher of a 2009 study that found that three out of four people are deficient in vitamin D and that deficiency levels are growing.

Deficiencies among African-Americans and Hispanics are particularly high, according to the study, which was published in the Archives of Internal Medicine.

Ginde is completing a study now on the role that vitamin D might play in preventing infection. He can’t share those results yet, but said researchers may find that lower vitamin D levels in the winter may make people more vulnerable to colds, the flu and respiratory infections.

The optimal level of vitamin D in the blood ranges from about 30 to 40 nanograms per milliliter, he said.

Ginde and his fellow researchers found a marked increase in people who were deficient. The population of people who were severely deficient with levels of less than 10 nanograms per milliliter had gone up from 2 to 6 percent when the researchers compared vitamin D levels in people in the late ’80s and early ’90s compared to those tested between 2001 and 2004.

Since Ginde’s study, the Institute of Medicine issued new guidelines ecommending 600 IUs per day for adults ages 70 and younger and 800 IUs per day for those 71 and older. Those recommendations were controversial as soon as they came out in 2010 and some researchers have said people should be getting much more vitamin D.

“It’s clear that the rates of deficiency are high and increasing,” Ginde said. “Increased sunscreen (use) has some part of it, but also becoming a more indoor population has played a big role.”

Ginde said that 80 to 90 percent of vitamin D intake is related to UV exposure and that outdoor exposure is the “primary determinant of vitamin D levels in people.”

If most of the exposure to vitamin D happens outdoors, that brings back the concerns about skin cancer.

Melanoma surged into the news recently when former President Jimmy Carter revealed that he had been diagnosed with melanoma that had spread to his brain.

While Carter is 90, researchers at a New York cancer center have found staggering increases in melanoma rates among young patients.

Researchers at the Roswell Park Cancer Institute in Buffalo, N.Y., earlier this summer unveiled a study that found that the number of cases of melanoma in children, adolescents and young adults increased by 253 percent from 1973 to 2011. Survival rates linked to much better treatments for melanoma have also increased.

But the disease still can be deadly or require extensive, costly treatments. Young people who get it are shocked to have cancer at such an early age. In particular, melanoma cases have shot up among young women. Risky behavior including the use of tanning beds is a likely culprit for the increase in cases among younger women.

Dr. Demytra Mitsis, a fellow at Roswell Park and lead author of the study, said she often meets young patients who wish they could turn the clock back.

“They say, ‘I thought I was invincible. If I could go back and talk to my 16-year-old self, I would do things differently.’ It’s hard for them to understand that something like this can happen,” said Mitsis.

For her study, she analyzed data from 35,726 people who had gotten melanoma between 1973 and 2011. Before 1980, females represented 57 percent of cases. That percentage rose to 65 percent from 2001 to 2011.

While survival rates have improved, about 7 to 10 percent of people diagnosed with melanoma will die, Mitsis said.

Dr. Ilene Rothman, chair of the dermatology department and Mitsis’ colleague at Roswell Park, said she used to see one or two patients a month with melanoma.

“Now we’re seeing them all the time. One American dies from melanoma every hour. It’s still quite common and quite serious,” Rothman said.

“Skin cancer is the most common (cancer) in the U.S. One in five Americans gets some kind of skin cancer. One in 58 gets melanoma,” Rothman said.

Rothman said vitamin D is very important to bone health. Other potential benefits haven’t been proven yet, so she sees no conflict between the need to get vitamin D and the importance of preventing skin cancer.

“There are excellent sources of vitamin D that don’t cause skin cancer. Any UV exposure — whether it’s from the sun or tanning beds — can cause cancer. We already know that. We can get vitamin D from our diet, from fatty fishes like salmon and tuna. And supplements are readily available.

“I do not recommend that people get their vitamin D from the sun,” Rothman said.

She said the jury is out on exactly how much extra vitamin D people should take. Rothman recommends getting your levels checked, then mapping out a plan with your doctor.

And she says skin cancer can be prevented.

About 24 states have some kind of ban for tanning beds for teens. (Colorado does not.)

Adults and young people need to use sunscreen properly and more often. The U.S. Centers for Disease Control and Prevention found that only about 30 percent of women and 15 percent of men regularly use sunscreen.

“It’s abysmally low,” Rothman said.

Even when people use sunscreen, they often don’t put it on properly or forget to reapply it.

“You need water-resistant sunscreen if you’re active, and try to avoid the middle of the day. Seek shade. Wear hats. Think of enjoying yourself outside, but not trying to get a tan,” Rothman said.

The non-melanoma skin cancers are directly linked to sun exposure. Causes for melanoma are more complex.

“We can’t say for sure, but many patients recall those blistering burns as children,” Mitsis said. “They could have actually prevented this. It can be very frustrating for patients.”(Click here to see the video Dear 16-year-old me.)

“There are a lot of factors we can’t do anything about. We can’t change our genetics. One thing we can change is our behavior,” Rothman said.

Telling young people that they might someday have cancer doesn’t always resonate. But teens who want to be beautiful sometimes heed warnings if they hear that sun exposure could make their skin look bad.

Colorado has a higher rate of melanoma than the U.S. average, but surprisingly some northern states have higher rates. Colorado’s rate is 21.6 per 100,000 people compared to the U.S. average of 19.7. By comparison, Vermont has a rate of 28.1 while in Minnesota the rate is 27.5 per 100,000 people.

For Ginde, the vitamin D expert, health choices are always about tradeoffs.

“Certainly by using sunscreen all the time, you increase your risk of vitamin D deficiency and you have some protection from skin cancer,” he said. “Perhaps for an individual, there’s some middle ground.”

By Katie Kerwin McCrimmon

Rosa Snyder has searing memories of the pain and shame of tooth decay.

By age 7, her teeth started falling out. At around 11, she remembers a late-night trip to the Emergency Room at Denver Health.

Rosa Snyder, with her husband, and two children, had terrible problems with tooth decay as a child. She’s working hard to make sure her children, Thomas, 3 and Eliana, nearly 2, don’t suffer the same fate.

“I had a fever and excruciating pain,” Snyder, now 30, recalls.

Soon after that, she was enduring dental surgeries and a root canal.

It’s unclear exactly what caused Snyder’s dental problems all those years ago. It wasn’t common in her family to go to the dentist for preventive visits. Snyder remembers going only when she was in pain.

Dental health experts now are honing in on another surprising factor that may put Latino families at greater risk for costly and debilitating tooth decay: fear of tap water.

As a child, Snyder never drank Denver’s fluoridated tap water. Her parents had grown up in Mexico and moved here later. Although they were well educated, like many immigrants from Mexico, they feared tap water.

“Absolutely,” said Snyder. “We were taught not to drink tap water — ever. My dad’s been in the U.S. almost 50 years and he still has a water dispenser. You don’t wash your vegetables with tap water. I never formula-fed my kids, but my sister did and you don’t make formula from tap,” Snyder said.

Doctors who work with Hispanics and new immigrants say fear of water is common.

“In Denver, our water is great, but families don’t know that,” said Dr. Patricia Braun, a pediatrician with Denver Health, who has focused extensively on the harms of tooth decay. “In other countries, especially Mexico, families don’t drink the water and it’s not safe. Some of those perceptions are carried over to the U.S.

“Some still fear that the water’s not safe. And it’s a bit of a status issue. If you have a guest, it’s perceived as unsophisticated to serve them tap water,” said Braun, who practices at Denver Health’s Eastside Family Health Center and is also a professor at the University of Colorado School of Medicine.

“We want families to drink tap water in Denver. We need to educate them,” Braun said.

The Synders make sure their kids brush their teeth and also give them mostly water to drink. Rosa Synder grew up not drinking tap water, but now gives it to her children.

A widespread reluctance among Hispanics to drink Colorado water could contribute to a triple whammy that allows cavities to form and multiply.

First, if Hispanics avoid tap water, they are missing out on fluoride in the water. (Approximately 75 percent of Colorado water is fluoridated.) Second, some parents who avoid water are giving their babies, toddlers and older children juice or other sugar-sweetened beverages throughout the day instead of water. Sipped on regularly, sugary drinks can cause cavities, obesity and diabetes. And third, beverage companies are targeting Hispanic families who may be more receptive to ads for sugar-sweetened beverages if they avoid water.

Experts at the Yale Rudd Center for Food Policy and Obesity found in a 2014 study that beverage giants including Coca-Cola Co., PepsiCo, Dr. Pepper Snapple Group and four others spent $83 million to advertise sugary drinks and energy shots on Spanish-language TV in 2013, an increase of 44 percent compared to 2010.

Hispanic preschoolers and children saw between 23 and 32 percent more Spanish-language TV ads for sugary drinks and energy shots in 2013 than in 2010, the study found.

African-American kids, who are also at greater risk for tooth decay and obesity, are also seeing more ads. The Rudd study found that black children and teens see twice as many ads for sugary beverages and energy drinks compared with white children and teens.

Wyatt Hornsby, director of the Cavities Get Around Campaign for the Delta Dental of Colorado Foundation, said the beverage industry appears to be borrowing from the tobacco industry playbook by marketing to kids and harming their health.

“If history is repeating itself, these children who are being targeted by the sugary drink industry are being singled out for higher rates of tooth decay, diabetes and obesity,” Hornsby said.

Cavities may not sound like an earth-shattering health problem. But, in fact, tooth decay is the No. 1 chronic disease among children in Colorado.

The statistics are startling and the problem is most pronounced among Latinos and children from low-income families. If experts can hone in on unexpected causes, like fear of water, they may be able to slow the tooth decay epidemic.

According to state health statistics for 2011 — the most recent year available — 32 percent of Caucasian kids already had at least one cavity by kindergarten, while 38 percent of black kids did. Among Hispanics that number was 55 percent.

By third grade, the numbers had spiked significantly.

At that age, 48 percent of white kids had a cavity, compared to 56 percent of African Americans and 70 percent of Hispanics.

In attempting to combat cavities, Hornsby’s group first focused on getting kids to brush more often. But then they realized they were reaching parents and children too late. They started honing in on baby teeth and the little-understood fact that cavities in baby teeth spread to adult teeth. Tooth decay in babies can start as early as six months.

If problems escalate, kids can have a mouth full of cavities before they ever enter school. Those with severe problems can end up in an operating room with costs that swell to $10,000 or more to have the teeth pulled.

To try to reverse the problem, researchers working with Hornsby began interviewing families around Colorado and started hearing comments that surprised them.

“There was something going on here with sugary drinks and water,” Hornsby said.

As researcher Karl Weiss started talking to more and more immigrants from Mexico, he kept hearing about the tap water.

“Their mindset was: if it’s coming out of the tap, it’s going to make you sick. You want to avoid it,” Weiss said.

So Hornsby said the campaign began emphasizing the benefits of tap water.

“If we can move them to water, the fluoridated water will strengthen the enamel,” he said.

The trick is steering parents away from drinks they’ve long enjoyed and underscoring the fact that too much juice can be unhealthy — especially when many families say they are receiving it from government programs like the federal Women, Infants and Children program.

A Delta Foundation survey of 600 homes last year found that 87 percent of parents reported giving their children juice several times a week, 72 percent thought juice was healthy and 55 percent said juice was the most common beverage that their children drank.

“A lot of parents think juice is good for their children, but it’s pretty much sugar water,” said Weiss. “If they’re drinking it from a sippy cup, the sugar is just landing on the teeth all day. It’s the biggest cause of early childhood caries (cavities).”

Dr. Braun of Denver Health, says once the disease process has started in babies and toddlers, it’s very difficult to reverse.

“Eighty percent of the problem is in 20 percent of the kids. It’s low-income families and exposure to sugary drinks,” she said.

Poverty worsens dental problems because there’s little money to afford a dentist. Shortages of providers only compound the problems.

“It’s hard for families to get to a dentist, period. We want to provide the service early and often,” Braun said.

More health clinics are integrating dental health providers so patients can get basic dental care at the same time they’re getting medical check-ups.

Sometimes not seeing a dentist is cultural too. Parents never went to the dentist and aren’t great at brushing themselves.

“If there are other stresses in your life and the child isn’t used to having their teeth brushed, sometimes it’s easier not to fight your kid on it. It just takes a minute or two to help them establish these routines,” Braun said.

Few people also understand that cavities are essentially an infection that can spread from adult to child.

“There are cavity germs that live in our mouth that we don’t want to pass along to kids,” Braun said. “Once a baby has acquired the germ, that increases the chance of a lifetime of cavities.”

To cut cavities, doctors suggest:

• Getting babies to the dentist by age 1 or as soon as the first tooth appears.
• Brushing baby teeth early and often.
• Being cautious about sharing germs from adults who have cavities with babies and older children. For instance, sharing drinks or licking a pacifier can spread cavities.
• If allowing juice, give one serving of 100 percent real fruit juice in an open glass. Have the child drink it all at once (preferably with meals), then brush and move on.
• Avoid sippy cups of juice that babies and toddlers drink from all day.
• Avoid “bottle propping,” giving babies juice, milk or formula that sits on their teeth as they fall asleep.
• Drink tap water throughout the day.
• If avoiding tap water, turn to bottled water rather than sugar-sweetened beverages.

Tooth decay that starts at a young age has long-term implications.

“When kids have cavities in their teeth and that turns into tooth pain, they miss more days of school and fall behind. GPAs are lower. There’s an ongoing cumulative effect that starts as a simple cavity,” Weiss said. “If you don’t take care of it early, it can impact a child’s entire life.”

Snyder remembers her dental problems escalating throughout her childhood.

“Things got really bad with my teeth when I was 18 or 19. It was such a rough time in my life. I was in such pain. I would take two Tylenol PM to get to sleep every night,” Snyder said.

Remarkably, she excelled in school and graduated magna cum laude from college. But even when she got her first job and dental insurance for the first time, she realized that the dental woes of her childhood would continue to haunt her as an adult.

“I remember feeling helpless. I didn’t have enough (insurance) to take care of my whole mouth,” she said.

Now a mother of two young children and a Spanish-language translator, Snyder’s mouth no longer aches and she and her husband dutifully help their son and daughter brush their teeth and see a dentist regularly for preventive care.

Snyder’s husband has never had a cavity in his life and his mom worked for a dentist, so he had regular dental care.

Snyderhopes that when it comes to dental health, her children will be just like their dad.

“I hope they don’t have any cavities and that they don’t go through any pain. I remember it affecting so much of my academic life and how I felt about things. I felt really cruddy,” she said.

Snyder gives her children water throughout the day. When she participated in a recent focus group for the Cavities Get Around campaign, she was surprised to learn that tap water is safer and more regulated than bottled water.

“That was really eye-opening for me. Denver is super fortunate to have great tap water. It’s safe and it’s regulated. And there’s an added bonus. It’s got fluoride.”

By Katie Kerwin McCrimmon

Opting out of vaccines for potentially deadly diseases like the measles will become much harder in Colorado after the Board of Health on Wednesday voted for a set of tougher rules for parents seeking exemptions.

The new rules mark a striking change in Colorado after a bill that aimed to increase immunizations got watered down during the 2014 legislative session. Then the widely publicized measles outbreak tied to Disneyland in California heightened concerns about highly contagious diseases like the measles.

The Board of Health also voted to require the Colorado Department of Public Health and Environment to collect and report annually on vaccination rates at Colorado schools and day care centers.

The changes will go into effect in July of 2016 and are a radical departure from Colorado’s “one-and-done” system where parents could opt out of vaccines once and never consider the issue again.

Under the new rules, parents who want to opt out will have to do so each time their infant or toddler would need immunizations — so up to five times between birth and kindergarten — then annually once children are in school.

“These new rules are a positive step forward in strengthening our immunization rates and protecting our kids and the communities in Colorado,” Gov. John Hickenlooper said in a written statement.

Hickenlooper said Colorado health officials have more work to do to ensure that parents have the facts about immunizations. Colorado is home to many parents who don’t vaccinate their children or who seek to delay immunizations.

Making it harder to opt out of vaccines could dramatically boost Colorado’s immunizations rates, which are among the worst in the country.

Currently parents of about 4.6 percent of Colorado kindergartners opt out of vaccines while the national average is 1.8 percent.

Dr. Rachel Herlihy, director of disease control for the Colorado Department of Public Health and Environment, was among those who spoke in favor of the new rules and better reporting.

She said states like Colorado that have made it easy to opt out of vaccines have the highest rates of parents who exempt their children. In turn, research shows that children whose parents claim exemptions are more likely to get and transmit vaccine-preventable diseases.

Herlihy said parents who have simply skipped vaccines out of convenience will be more likely to get them now.

“We certainly believe there will be an impact. To what degree, we don’t know yet,” Herlihy said.

Stephanie Wasserman, executive director of the Colorado Children’s Immunization Coalition, said the new rules, along with beefed up funding in Colorado’s budget for vaccine reporting, mark a “really significant change.”

Among the most striking changes will be the new data about school vaccination rates.

The media outlet, Chalkbeat Colorado, was the first to request data from multiple school districts. Now the Board of Health will require that all day care facilities and school districts report their vaccination rates each year.

“Parents will be able to use the information to make informed decisions about where to send their children for child chare and for school, especially parents who have children who are immune-compromised. You want them to be part of routine childhood experiences. But you want to provide them with the safest classroom experiences,” Wassermann said.

“This (will be) timely and accurate information,” she said.

Colorado will remain one of 20 states that will allow what are known as “philosophical exemptions” to vaccines, Wasserman said.

She said it’s critical for parents to get accurate advice from their doctors since scare tactics are so common online.

The measles outbreak spurred some parents who had previously skipped vaccines to seek them, but Wasserman said past focus groups cast doubt over whether Coloradans are ready to bar exemptions altogether.

“Colorado has one big gap in our system: our exemptions,” Wasserman said. “There was some discussion that perhaps we could go even (further). Coloradans don’t seem ready yet to get rid of the personal belief exemption, but people feel strongly that this a step forward. It’s a common-sense, practical approach that will improve our ability to ensure that our children and families are protected from preventable diseases.”

By Kristin Jones

Rocky Mountain PBS I-News

Access to quality treatment can mean the difference between life and death for the more than 24,000 people in Colorado expected to be diagnosed with cancer this year.

New and experimental drugs are extending the lives of people with the deadliest forms of cancer. At the University of Colorado Cancer Center in Aurora, Dr. Ross Camidge leads clinical trials for lung cancer, which kills more people each year than breast cancer, colon cancer and pancreatic cancer combined.

Erin Moore and her husband, Michael Moore, enrolled in a clinical trial at the University of Colorado Cancer Center to treat Michael’s advanced lung cancer. The couple, who have been together for seven years, were married in November.(Marcy MacCarthy/Special to Rocky Mountain PBS)

Camidge calls them “niche-busters” – targeted therapies that dig deep into the profiles of each individual cancer. Researchers have discovered that just as individual patients have different genetic make-ups, so do their tumors.

The revolution in the last decade has been in diagnosing and treating cancer at the molecular level, says Camidge.

“It’s not one miracle drug,” says Camidge. “It’s lots of different miracles for lots of different cancers.”

His patient Polly Rogers is a former soap opera star – she was “naughty girl” Kate Lodge on “The Secret Storm” – and a retired professor of public speaking at Arapahoe Community College who lives in Highlands Ranch. She is enrolled in a clinical trial using a combination of dabrafenib and trametinib. British pharmaceutical company GlaxoSmithKline won licenses for the two drugs in 2013 to treat melanoma for patients who exhibited a mutation in a gene called BRAF.

The mutation is common in melanoma but rare among patients with lung cancer. Rogers is one of only around 4,000 people nationwide who have the mutation. Fewer than three dozen people around the country are enrolled in a trial to see if the drugs can also slow tumor growth in lung cancer as they do for melanoma.

The regimen has worked for Rogers.

Polly Rogers, a lung cancer patient enrolled in a clinical trial, is checked by Dr. Ross Camidge, who leads the lung cancer trials at the University of Colorado Cancer Center.(Marcy MacCarthy/Special to Rocky Mountain PBS)

“The cancer has melted away,” Camidge told Rogers, during a recent visit. He showed her a line chart that plummeted toward zero. He asked her about side effects. She had missed a dose because of an intolerably high fever, and she had a rash.

Rogers said she felt “somewhat of a shock” when she first received her diagnosis in January 2013. She and her husband had been avid travelers, saving their money for trips to Australia, New Zealand, Jordan, Iceland, France. Scotland was her favorite; she turns actress when she slips into a Scottish accent. Since the diagnosis, they’ve traveled closer to home, opting for jaunts to the Columbia River, New Mexico, and Florida to visit the grandkids.

“I was told when I met with a doctor first that I had less than a year to live,” says Rogers, in a voice that is raspy but clear. “Here I am more than two years later, being frisky. So not bad.”

The University of Colorado Hospital is among the top-ranked cancer treatment centers in the nation, according to U.S. News and World Report. Outcomes for its cancer patients routinely top state and national rates. The Cancer Center is one of 68 institutions given a special designation by the National Cancer Institute to conduct cancer research, the only such facility in the state.

Clinical trials provide a chance to try a potentially life-saving treatment with little or no financial cost. They also give patients access to drugs that are not yet available on the market. But being the first to try a drug can be costly in its own way.

Michael Moore was a high school basketball coach in Pueblo when he was diagnosed with stage four lung cancer on his 40^th birthday. It blindsided him; he worked out with his students, and was never a smoker. Moore jumped on the chance to try a drug targeted to the EGFR gene mutation that he exhibits.

“It feels like walking into a dark room,” Moore says of the clinical trial. “But anything that’s going to prolong my life, I’m going to try.”

It controlled his cancer. But it also caused brutal side effects, unknown before he exhibited them. Moore went blind.

As Camidge explains it, a drug-induced diabetes brought on cataracts. They developed over just two days, says Moore. He lived in darkness for three weeks until surgery restored his eyesight.

For others, the ride has been easier. Joe Schneider hasn’t stopped working for Hewlett-Packard in Fort Collins since getting diagnosed with stage four lung cancer in 2012. The impact of the disease on his day-to-day life has been negligible, he says.

Schneider does his research. He knows what clinical trials are available, and where. Xalkori, a drug designed for his ALK gene mutation, stopped working on his cancer. So he signed up for an early-phase clinical trial for a second-generation ALK inhibitor. On March 11, he took his first dose. For him, the treatments have been remarkably effective.

“It has changed cancer from being a death sentence to a chronic illness,” says Schneider. “It’s manageable the same way a person might manage diabetes or arthritis. Your life continues and you manage the illness.”

Other promising treatments, says Camidge, spark the immune system to attack cancer. In about one in five people, cancer stimulates the immune system. But cancer expresses a molecule that allows it to hide from immune attack. New drugs block that communication, leaving the cancer exposed.

“My job is to pick the winners (among the clinical trials) in advance,” says Camidge. “We’ve been pretty good at that.”

The odds of surviving stage four lung cancer are disheartening. Nationwide, fewer than 3 percent of those diagnosed will live five years. At the University of Colorado Hospital, the odds are twice as good, but still just more than 5 percent.

There is still no cure. Cancers eventually adapt to the drugs. Some adapt quickly, and some adapt slowly.

But the numbers don’t tell the full story. They don’t tell the story of what people decide to do with their time when, as Camidge puts it, “they’re staring down the barrel of a gun.”

Rogers calls herself a “half-day lady” – that’s the portion of the day when she feels good. She’s been using it to read serious nonfiction – the kind she never had time to read. Right now, she’s reading The Sixth Extinction, Elizabeth Kolbert’s look at the mass die-off of plant and animal species resulting from human interference.

“I should have studied geology,” Rogers exclaims.

Moore got married to the woman he’d loved for years. They said their vows on a beach in Destin, Fla., in November, with 40 of their closest friends and family as witnesses.

“I was going to marry her anyway,” he says, looking a little sheepish as his wife Erin laughed. “I keep telling her that.”

Schneider has been basically carrying on as before. He and his wife don’t put off things they want to do, which means plenty of trips to New York for walks in Central Park, jazz at the Blue Note and brunch at Sarabeth’s.

He thinks a lot about luck.

“If I would have had the same cancer present itself 10 years ago, I would not have had such a good outcome, to put it mildly,” he says. “I couldn’t ask for a better time to have cancer.”

Health News Colorado brings you this report in partnership with Rocky Mountain PBS I-News. Learn more at rmpbs.org/news. Contact Kristin Jones at kristinjones@rmpbs.org.

The new Ken Burns documentary, Cancer – The Emperor of All Maladies, will be presented on Rocky Mountain PBS at 8 p.m. March 30-31 and April 1.

By Katie Kerwin McCrimmon

A UK researcher who trained at National Jewish Health in Denver has shaken up the allergy world with a study released Monday in the New England Journal of Medicine that shows that early exposure to peanuts prevents rather than causes allergies.

Dr. Gideon Lack visited Denver in March to share his theories about peanut allergies and now the results of his long-term study are likely to cause tectonic shifts for allergists, pediatricians and primary care providers. (Click here to read Reversing the allergy epidemic: ‘Let them eat dirt’ and maybe peanuts too.)

A new landmark study has found that early exposure to peanuts decreases allergies later.

Dr. Erwin Gelfand, the chief of pediatrics at National Jewish, who many years ago trained Lack when he served for five years as a fellow in Denver, summed up the implications of Lack’s findings in four simple words.

“We clearly were wrong.”

Gelfand said allergists for many years told parents to delay giving infants potentially allergenic foods like peanuts, eggs, milk and shellfish. In the meantime, the allergy epidemic exploded.

Gelfand said it’s now obvious that that advice was not rooted in science.

“We’ve been talking for five decades about holding off (on potentially allergenic foods) until the child is 12 or 14 months (old) or later. We never had a database to suggest this was true. It was almost one of these old wives tales,” Gelfand said. “Yet every pediatrician, every mother would go online and read this.”

He called Lack’s new study “overwhelming” and said the findings will trigger dozens of new studies on what’s best for preventing allergies in infants.

For now, if Gelfand were giving advice to his own daughter about how to feed his grandchildren, he’d advise a radical departure from the go-slow approach.

“There’s no allergy in our family, so give it early,” he said of teething biscuits that contain peanut. “Of course we’re not going to give them (whole) peanuts. But we worry more about aspiration (choking) not allergies.”

Gelfand warned that it’s not time yet for parents who have older children with peanut allergies or their own history of food allergies to start feeding babies peanut products early. It will be important for parents with high-risk infants to get skin testing first to see if their infants are showing proclivities toward allergies.

Dr. David Fleischer, a food allergy expert at Children’s Hospital Colorado, said it’s time for all the leading medical associations that represent allergists, pediatricians and family physicians to prepare guidelines together so parents get consistent advice.

Fleischer said he was not surprised by Lack’s findings because he’s been keeping close track of other less comprehensive studies with similar findings: that early introduction of foods can prevent allergies later.

Nonetheless, Fleischer said he’s very excited about the new study because it marks the first randomized, controlled study of its kind.

Fleischer is an associate professor of pediatrics at the University of Colorado School of Medicine and medical director of the Food Challenge Unit at Children’s Hospital Colorado.

He said the advice about infant feeding began to change in 2008 when doctors realized that delaying allergenic foods wasn’t preventing the onset of peanut allergies, which have skyrocketed in recent years.

Fleischer helped write guidelines two years ago regarding infant feeding and allergies for the American Academy of Allergy, Asthma and Immunology. Now, he’ll be working on new guidelines that he hopes to complete by year’s end. He’d like to work closely with colleagues at the American Academy of Pediatrics and the National Institutes of Health.

“We all need to get the same message out,” Fleischer said.

And what would Fleischer advise?

“When babies have had a few solid foods, there’s no reason why you can’t start giving dairy or eggs in baked goods,” he said.

“The first food is not going to be peanut butter because they’re not going to be able to swallow it. For fish, it’s good to do it later too when they can swallow.”

Fleischer said parents will probably want to start with traditional first foods like rice, applesauce and bananas.

“But there’s no reason to delay potentially allergenic foods longer. They just need to be ready to eat them in a safe form,” Fleischer said.

He gave similar advice to Gelfand’s that any high-risk patients — those with siblings who have allergies or babies with moderate to severe, uncontrolled eczema — should be skin-tested before eating high-risk foods to ensure that they don’t already have a food allergy.

But he said it’s not reasonable to think that routine skin-testing of 4-month-old babies will be recommended.

“This is going to create a bit of controversy. I think there are going to be parents that are very nervous to do this. They’ll want to come see us to get skin-tested. But talking to their (babies’) primary care providers is going to be an important thing,” Fleischer said. “If a skin test is negative, there will be an extremely low chance that they will react (to allergenic foods).

“This is groundbreaking. It’s exciting,” Fleischer said. “We need to really come together as multiple organizations to see what we want to do about this.”

While parents have been cautious about what they’ve been feeding their babies, many pregnant and breastfeeding women also have restricted their diets to reduce allergies for their babies.

Fleischer said there’s no evidence that mothers should do that.

“Moms shouldn’t avoid milk or eggs,” Fleischer said. “Right now there’s no recommendation to take anything out of the diet in order to prevent allergy — including peanuts.”

Gelfand said early introduction of foods could end up having major implications for children throughout their lives. He said preventing food allergies or getting our bodies used to foods that might cause some sensitivity is much easier than trying to treat or fix an allergy later.

“It’s much easier to create tolerance in the very young than after sensitization has occurred. The immune system is hard to turn around,” he said.

Lack, who is a professor of pediatric allergy at King’s College London and heads children’s allergy treatment at Guy’s and St. Thomas’ NHS Foundation Trust in London, first came up with his theory about early exposure almost by chance.

Like most physicians, Lack said during his Denver visit last year that he used to warn parents about early introduction and in fact avoided giving his own children peanuts.

“I bought into this. I was part of the establishment,” he said.

Then in about 2003, Lack spoke at a medical conference in Israel and happened to see a friend feeding her baby a teething snack full of peanuts.

“I was horrified. If she were living in the UK, she would probably go to jail for this,” Lack joked during a talk at National Jewish.

It turned out that parents in Israel commonly feed their babies peanuts as early as four months and peanut allergies are rare.

In contrast, rates of both eczema and peanut allergies in the United Kingdom have been soaring as they have been in the U.S.

“There’s an EpiPen in just about every classroom. This really has become an epidemic,” Lack said.

His trip to Israel triggered an idea for Lack. Could babies who have eczema be getting exposed to peanut proteins through creams that commonly contain peanut oils? If these babies are not at the same time ingesting peanuts, could their bodies wrongly see peanut proteins as attackers?

As an allergy fellow, Lack had spent five years in Denver at National Jewish. He used to work in a mouse lab here and as part of research for Gelfand, Lack painted egg proteins on mice to help make them allergic. After the Israel trip, a light went off for Lack. In mice, he remembered that topical exposure to allergens could cause allergies while mice that were fed the same proteins did not become allergic. Perhaps, when it comes to peanuts, mice and babies were similar. Maybe ingesting potentially harmful proteins can be protective.

Gelfand said he heard from Lack this week and his former student is elated about the results. Since the study was blind, researchers had no idea what the study would find.

Gelfand said it was important that the study was done in the UK because some experts in the U.S. might have sought to bar testing on infants.

But, said Gelfand, Lack has proven that if we want to understand and prevent allergies, researchers must focus on the very young.

Said Gelfand: “That’s where the action is.”