reminded of the effectiveness of vaccinations at mitigating our risk for infections.

But we also learned that they may protect us from some cancers.

Stay with us as we review this and other topics from the past year with our guests.

Louisville Public media health reporter Morgan Watkins next on Kentucky Health.

>> Kentucky health is funded in part by a grant from the Foundation for a Healthy Kentucky.

>> During this past year, we have had many wonderful discussions on a diverse number of healthcare topics.

The aim of these discussions has been to keep us all informed and aware of those conditions and things that affect our health and that of our family, friends and neighbors living in the Commonwealth of Kentucky.

Thanks to our willing and excellent guests, I believe that we have succeeded.

To wrap up this season, we're going to look back at some of the past shows and get a broader perspective as to how this year's topics fit into the overall healthcare narrative.

Joining me in this retrospective view, we have Miss Morgan Watkins.

Miss Watkins is a native of Florida and started her career covering city and county government at the Gainesville Sun.

She moved to Louisville and worked at The Courier Journal, where she covered national, regional and local news.

Miss Watkins is now part of the Kentucky Center for Investigative Reporting, where she covers health and environment for Louisville Public Media.

Our review will be in two parts.

In the first part, we will look at ways to decrease the mortality rates from lung and breast cancer, how to minimize complications from infectious disease, vaccinations and infections, how to physically age more gracefully and protect our faculties.

And finally, mental health and emerging problem in pediatric populations.

But first, let's talk about breast cancer.

Breast cancer is the second most common type of cancer in women, behind skin cancer.

1 in 8 or 13% of women in the United States will be diagnosed with breast cancer in her lifetime.

And even more worrisome trend is that the number of women diagnosed under the age of 50 is increasing.

Our guest doctor, Layla Agarwal, a medical oncologist specializing in breast cancer at Norton Healthcare in Louisville, discuss the importance of knowing one's family history in determining the risk of acquiring breast cancer.

>> So there's many risk factors that we know about, and people might have some of these risk factors that place them at a higher risk than the general population of women.

And a big one is family history, really.

>> So how much does family history increase one's risk for developing breast cancer?

>> Yeah.

So, you know, there's different ways that family history can contribute to somebody's risk of breast cancer.

Sometimes having family members, that does increase the risk.

But I always encourage people to know their family history, meaning who in the family might have been diagnosed with breast cancer, but also what age were they?

Because that can influence the risk.

>> Doctor Agarwal noted that there are specific genetic mutations associated with breast cancer, and she explained their significance.

>> The most common genetic mutation that I'm talking about is called BRCA.

And there's BRCA one and two.

>> And that's what BRCA.

>> Exactly BRCA.

And so this is a gene.

And when there's particular mutations or changes in those genes which can be passed on through families, individuals who carry that genetic mutation have a higher risk of developing breast cancer.

And one thing that we know is that there may be people out there who carry this mutation or whose family carries this mutation, and they may not even know.

And that's why I think it's so important that we talk about family history and bring that information to our medical teams to figure out if this is something that could be associated with a genetic mutation.

>> Many cancers are being diagnosed in younger patients.

Many factors may be at play, including environmental toxins.

Doctor Agarwal discussed this also.

>> Well, air pollution is one.

So there have been research studies that have come out recently that have linked higher rates of breast cancer to areas where there might be more air pollution, but more research is needed to really understand, is there a particular factor that's at play here?

What period of a person's life, you know, would this exposure cause the greatest risk?

But I think it's important to understand, you know, we talk about modifiable risk factors and non-modifiable risk factors, but some of these may be modifiable as a collective, maybe not as an individual.

>> All right.

>> Screening and identifying cancers early in their course have been found to decrease cancer death.

However, in the case of breast cancer, there is still some question as to who should be screened and when.

>> So another another question that can have multiple different answers.

But as a medical oncologist who frequently treats breast cancer in young women, for.

In my opinion, women who are at average risk will start their screening mammograms at age 40 and have annual exams.

Their recommendations from a variety of different medical groups that may have a different starting age or a different frequency of testing.

So it's always important to talk to your own doctors and medical teams to have kind of a risk based discussion for each person, but that's for women who have average risk.

But how do you know if you are at average risk or not?

And so to partner with that, every woman starting at age 25 or even earlier, should do something called a risk assessment.

And that's trying to figure out that's trying to figure out, am I somebody who has an average risk, or am I somebody who has an increased risk because the screening recommendations can look very different.

>> Just as we discussed the benefits of screening for breast cancer, there is also benefit in screening for lung cancer.

Doctor Mansi M Shaw and assistant professor of thoracic surgery at University of Kentucky Health Care and Markey Cancer Center, told us that lung cancer screening using a CT scan can save lives.

>> I think that's one of the biggest things that I would like patients to be aware of, and people in this region to be aware of.

Lung cancer screening helps save lives.

If we can catch lung cancer early while it's small and it hasn't spread, that's our best chance at curing lung cancer.

And so I highly encourage anyone out there that has a smoking history or has been exposed to, to smoke in the past, to, to talk to your doctor about getting screened for lung cancer.

It's just like any other preventive health care maintenance, like women getting mammograms, men getting their prostate levels checked, getting your colonoscopies, as you know.

So lung cancer screening should really be part of that routine.

Health care maintenance.

Anyone that has smoked what we call 20 pack years or more pack year is considered.

If you smoke one pack a day for 20 years, that's 20 pack years.

If you smoke half a pack a day for 40 years, that's 20 pack years.

So if you have a 20 pack year smoking history or more, if you're an active smoker or if you've quit smoking, but for less than 15 years, and if you're between the ages of 50 and 80, you qualify for lung cancer screening.

>> Doctor Shaw also reminded us that though smoking is the number one risk factor for causing lung cancer, there are also other significant factors to be considered.

>> I mean, smoking is definitely the biggest thing.

I think if you can stop smoking or stop being exposed to smoking, that's one of the biggest things that that people can do to to protect their health.

Secondhand smoke is another big risk factor for for lung cancer.

So even if you're not smoking yourself, but you're around it, that can be a problem.

Radon exposure is another big risk factor for lung cancer.

So testing your house to make sure that the house is, is safe and there's not, you know, radon levels that are, that are high where, where you're living and then other, you know, work related risk factors.

So people that work in the coal mines, which is a big part of the Appalachian region, chemical plants working around pesticides, working with asbestos and other things that can be breathed in and can cause damage to the lungs.

Those are all risk factors.

And some things are in our control, right?

Some things aren't.

You got to work to be able to live and, and survive.

But whatever we can do that's in our control, I think is, is, is the best thing.

>> So Morgan Watkins, you're a reporter.

Are we getting the message out about screening?

Because just as we heard screening is beneficial, are we doing a good job or are we just ringing bells and nobody's paying attention?

>> I don't know, I guess you'd have to find out, survey doctors and see how many of their patients are saying yes to the screening.

But I do think that's always like, the question is, how do you get useful information out there that people can rely on and use without scaring them?

I know I worry about that a lot just in my line of work in general, you know, how do I like give people useful information without overwhelming them?

And then they tune out and they miss something important.

They should know like, oh, I might be at high risk, you know, for this type of cancer because I've got 20 pack years that she was just talking about or, you know, maybe I should get tested for the gene that, you know, can put me at an elevated risk for breast cancer.

I know that it seems like doctors are doing the best, and health care providers in general are doing the best they can to try to, like, talk to their patients about this.

I hear that a lot when I interview different healthcare workers is that they'll always try to, you know, talk to patients about doing these screenings and kind of pair that with outreach, whether it's through shows like yours or on social media or articles that I might write, it's kind of an everybody sort of pulling together, I think thing with the same goal of just making sure people know, hey, cancer's just a fact of life.

I think it's always like I always try to emphasize, like, risk isn't destiny.

>> Yeah.

>> I think you can get that white coat like syndrome.

I get it at the doctor, right?

We're all of a sudden, like, my heart's beating faster.

I feel like I'm about to fail a test, you know?

And it's like, hey, this is just a routine thing that you can do to protect yourself.

Just, you know, find out if you are at high risk or not higher risk or not.

These aren't don't have to be scary.

>> I think that's very important though.

You said risk is not destiny.

How do you tell somebody that?

>> I mean, honestly, maybe just say it exactly like that.

You said.

>> That's a good point.

>> But but no, but like, I think it is about being like, hey, it if you do have, if you are a former smoker or current smoker.

Hey, this does increase your risk of lung cancer, but it doesn't mean you're going to get lung cancer.

It just means that it's worth it if you also hit other eligibility requirements like age, it's worth it to get the screening like it doesn't.

I think it's like trying to do our best not to scare.

It shouldn't be scary.

It's just, hey, these are things, these are routine ways to protect yourself and then you can worry about it.

I try to think of it like even in my own personal life.

It's okay.

I'll just like if I'm eligible for the screening for whatever, I'll just get it.

Yeah.

And then I can worry about it less, you know?

But I do think that there is that very human instinct when you hear about a risk, like, oh, younger people are getting cancer, certain kinds of cancer more often there's that like very human reaction of like, just to shy away from thinking about it at all or talking about it like, oh, I don't want to like, it feels like engaging with the possibility of risk puts you at higher risk.

And it doesn't, I think, you know, but it's hard to fight that.

>> All right.

Well, we're going to come back to that in a moment because it seems that we have forgotten about measles.

But measles clearly has not forgotten about us.

We're now seeing a resurgence of measles infections.

Doctor Mark Burns, an infectious disease specialist and associate professor in the department of medicine at University of Louisville School of Medicine, told us how easy it is to get measles.

>> Yeah, measles.

Can it?

It actually that's usually how it's obtained through through respiratory droplets.

It is highly, highly contagious.

Really?

Yes, yes.

And statistics will tell you, I'm sure you probably heard stories.

If you have a person in a room with measles.

Okay, that person leaves the room.

Yeah.

Okay.

You get people that come in the room within a two hour period.

You have ten people come in, nine out of those ten will get infected.

Really?

With with the measles virus.

>> Wow.

Yeah.

>> It just hangs around and can be passed on.

>> And that and it takes such a such a small inoculum for a person to get infected.

And that's why it's so highly, highly contagious.

>> Doctor Burns pointed out that there is a measles vaccine available and that it is effective.

>> The measles, the well, the measles, mumps, rubella, MMR vaccine is very, very effective.

One dose.

It is 93% effective, two doses is about 97% effective.

And it does provide lifelong immunity.

>> We know that viruses like the measles virus can cause infections.

Interestingly, the human papillomavirus, which causes genital warts, is also a cause of some cancers.

Doctor Wendy Jackson, a pediatric and adolescent gynecologist, discuss how the HPV vaccine can mitigate the risk of human papillomavirus infection and cancers.

>> My job to mention it, right?

It's so important.

Normally by the time I've seen them and they're Menocal, yeah, they will have already had discussions with their pediatrician.

So most are familiar that this HPV vaccine exists because the age of vaccination is nine through 26.

And there are some newer guidelines that suggest up to age 45 in certain demographics.

That's shared decision making.

The average age and best age to vaccinate would be ages between ages 11 and 12, and I have a discussion with them if they've not been vaccinated.

Understanding based on their age how many injections they would need because that varies.

If they're less than 15, they need to give the first one and then 6 to 12 months later get the second.

If you're 15 or older, it's a series of three.

So you get the first injection two months later, the second four months after that, the third one and complete the series.

If they initiated the vaccine with, say, their pediatrician but never followed up, you can pick up where you left off.

And so I highlight that I also, if there are fears about a vaccine, right?

If I see someone who has not been vaccinated and the parents in the room, like we're not interested in that.

>> Yes.

>> I feel comfortable saying, can you share with me why?

I'm just curious, you know?

And that opens the door for further conversation, at least to get the wheels turning again.

And maybe this is something valuable I like to also share.

And I'm not trying to coerce anyone, but I'm a mom of sons and I vaccinated them.

Right?

So for me, I know the literature that exists.

I know the safety profile, and I know how protective it can be against one cervical cancer, two genital warts, three or pharyngeal cancers.

And for some potentially and vaginal cancers.

If we can do anything to minimize the risk of someone developing a cancer through a vaccination when they're naive to the virus, we should be thinking about that.

We should be promoting it.

>> We are seeing an increase in vaccine hesitancy.

The decision to opt out of vaccination has generated considerable attention in recent years.

While some arguments for this may seem specious to one group, there are legitimate concerns to another.

Doctor Bethany Hodge, professor of pediatrics and vice chair for clinical services and population health in the Department of Pediatrics, University of Kentucky School of Medicine, commented on the discussion that she has with her patients and their families over vaccinations.

>> It can really look very different depending on the family, and I think that's part of how we can have better conversations about vaccines, is understanding what it is about the whole situation that's giving them pause, because it's a much different discussion.

If it's, well, I'm really scared of needles.

That's why I don't want to get a flu shot.

That's a different discussion than I have fundamental concerns about the components.

I want to see more science.

I want to, you know, the people that are maybe driven by sitting down with actual studies and numbers and telling them or people that say, well, I just don't think it's a problem.

That's when I bring in the public health data and say, well, it's more of a problem than it used to be.

So to, to bring whatever information that they feel like they're lacking or that they want to be able to make a decision into that discussion doesn't always work, but that's how I approach it.

>> So, Morgan, you know, Doctor Hodge made an interesting point.

She likes to discuss data, but it seems to me we're becoming a society that more is following our gut feelings or instincts.

The two don't always get across.

How are we to interpret what is good information?

What is bad information?

As you are a person who provides us with information.

>> It's hard.

I mean, I, I get tripped up like when I'll someone notable in Kentucky or in nationally will make a claim that X vaccine is dangerous or something like that.

And so then I'll go and I'll try to fact check.

Is that true?

Where are they pulling?

What information are they citing?

What information is out there?

And even I can get tripped up sometimes where I'm trying to figure out, okay, I found a scientific article, but is this was it was it does it read in a way that makes sense?

Like, is there anything does it make sense when I read it, also, was it published in a legitimate academic journal with a strong track record of of accurate information?

Because there's also, you know, sometimes it'll say it's published by a journal and then you look it up and the journal is questionable, you know, so, so trying to sort through that information is hard.

And also, I think interestingly, you can have almost like a flood of information.

I know we've seen this with like there's federal data on adverse events reported on vaccines.

So like if I were to get a vaccine and I had some what, any kind of medical experience after that, I could report it and say, hey, I, you know, this gave me a bad stomachache or something like that or whatever, a fever.

But so people you can see that like you'll see a post online that's like, you know, a bunch of adverse reactions were reported to this vaccine.

And when I, if I'm scrolling and I see that you don't necessarily know, oh, but those are just reported, those aren't verified.

So I think that you can see a lot of bad information out there about vaccines, you know, questioning their safety.

That's based on bad information, misinterpreted data, you know, not giving you all the facts.

I think it is tough.

There are a lot of good resources out there that you can find that will help you learn how to read a scientific study and kind of understand what you're dealing with, or how to look for signals that the claim that you are being given is a good one.

What I always try to think about is we have decades of evidence built up that show vaccines as a class are based on a solid scientific foundation, are safe and effective, and have saved millions of lives from different diseases like the measles.

So when I see a claim, whether it's online or something I hear in person, if I see a claim saying, you know, this vaccine is dangerous, I. Those claims need to be subjected to a high standard of scrutiny because they fly in the face of decades of scientific research that has been backed up.

>> But when you're talking to people, >> Yeah.

>> What is the general feeling that they may have about why they don't want to trust this thing?

>> I think and as one of your guests mentioned, like, people can come at this from a lot of different perspectives, like vaccine hesitancy isn't new.

Like it's a long it's a common fear for people to be afraid of needles and not not want to get a vaccine for that reason.

There's people with religious reasons for opposing vaccines.

But I do think we're seeing a big increase that's been documented in hesitancy, that's fueled by people seeing scary posts about it online or hearing things through the grapevine, you know, from talking with friends and not knowing what to believe.

And again, I think it's just that fear factor, like fear is a very strong emotion and it can be hard to overcome.

And, you know, you think, well, I'm getting injected with something that might seem scary.

So it is.

I mean, it's a challenge, but I think that, you know, historically we've found great success with vaccines, right?

Like people have, we've saved many lives.

We've even essentially eliminated some diseases.

So I think that like there is a track record where people have said like, as you know, large portions of our society have been willing to do this.

Like, and I, I talk, you know, one thing I've heard from a lot of like different healthcare workers I've talked to about this is that the most success they have is in these one on one conversations with people like, talk to me, take people's concerns seriously because they are they should be taken seriously, but then talk to them one on one about like, what are you afraid of?

What?

Where is that coming from?

Here's what I can tell you based on my expertise or my research, here's what I have to offer and have just real human conversations about this because, you know, the fear is real.

>> Well, I think we're going to come back to that.

Let's go to our last segment here.

There is a growing mental health crisis affecting our children.

Doctor Bethany Hodge explained that this can have a long term impact not only on the child, but also on the family.

>> It definitely feels very real to all of us that are working in pediatrics, that it's something that we're looking for, something that we're finding a lot and something that we're seeing is tied into overall health outcomes that children who start struggling with anxiety or depression earlier in life have more issues.

Their whole the whole rest of their life.

And the families that are struggling with those things in their household are also affected.

As far as the opportunities that that child has for normal growth and development, socialization and all those things that are going to help them future in their life as well.

>> You know, we seem to give a lot of lip service to a mental health crisis.

From what you're seeing, are you seeing people concerned about mental illness in the Commonwealth, either in kids or even adults?

>> Oh, yeah.

Definitely.

I think you've seen it feels like, especially over the last decade though, I know it's like started before that, but you see people talking about mental health a lot more.

Like people both like one on one with their friends and family or their coworkers or and then also like online.

So I do think there's more awareness of, you know, the significance of these issues, even just like anxiety, something that maybe might have been written off as like, oh, he's just, he's just a nervous kid, you know?

But now people are maybe more like, oh, well, maybe he is nervous, kid, but maybe is there something deeper here?

Like something that maybe is, is treatable, you know?

So I think and I, you see, I mean, I've seen people talking about this, like this mental health stuff is coming up in the legislature, Republicans and Democrats talking about being concerned about it.

Like, I think this is an issue that you do see genuine interest in and and concern about here in Kentucky.

>> What what are you hearing from politicians when you talk to them?

Are they as appreciative of this concern as the rest of us?

I mean, I don't see us putting in any money into it.

>> That's why.

>> The budget is always a battle.

I mean, I've seen like, I think it depends on the issue because obviously mental health encompasses a lot of different topics.

And I think depending on what type of mental health challenge you're talking about, you'll have a different discussion.

But I mean, overall, I have seen like people on both sides of the political aisle having real conversations, talking with doctors or therapists that will come and speak with them and at least expressing interest in having the discussion.

And even if it doesn't always lead to we're going to dump a bunch of money into this mental health thing.

But but they have sometimes said, you know, let's do this program or, you know, let's look at this more closely.

>> Just give me the short answer here.

We oftentimes talk about mental illness and violence.

Are you seeing people trying to make this connection?

>> Oh, like, yeah, I think that's been a long time thing that's come up.

But I mean, every time that comes up, I mean, I always, there's so much data out there that shows that people with mental health challenges are more likely to be victims of violence than perpetrators of it.

>> I'm going to leave you with that one.

Thank you.

Thank you for being with us.

And if you wish to watch this show again or watch an archived version of past shows, please go to ket.org.

Health.

If you have a question or comment, we can be reached at KY at ket.org.

Please feel free to go back and look at past shows.

And also we look forward to seeing you on the next Kentucky Health.

Thank you very much.

>> Kentucky Health is funded in part by a grant from the Foundation for a Healthy Kentucky.