Perspectives from those who live it everyday.

This blog is the final in our four-part  “Cancer-Free Mondays” series about how the Maryland Cigarette Restitution Fund is helping Maryland Citizens.

CRF programs have improved the health of Marylanders, and CRF research has greatly advanced the understanding of cancer.  This work has earned scientific recognition and awards, been published in science journals and been the subject of media reports. Careers, products, and businesses have been launched. Revenue has been made for our state. There are countless success stories to tell.  Here are a few that had far-reaching impact.

Reducing Maryland’s Cancer Burden:

Working together, researchers and elected officials reclaimed and reformed Maryland’s legacy.  Maryland went from having the highest cancer death rates in the nation to 30^th since the implementation of the Maryland Cancer Control Plan and the Maryland Cigarette Restitution Fund. Cancer death rates in our state are below the national average and rates for certain types of cancer are declining faster than the national rate, and this drop coincides directly with the timing of these two initiatives. All of the major cancer killers—lung, prostate, breast, and colorectal cancers—and all of cancers targeted through the CRF are on a downward trend in Maryland. Maryland’s efforts did not go unnoticed. In 2002, Maryland received recognition from the U.S. Congress for establishing the Maryland CRF and became the first state—at the time, the only state—to use its tobacco settlement funds to fight cancer.

Pioneering the First True Tests for Cancer:

Victor Velculescu, M.D., Ph.D., and Luis Diaz, M.D., launched their careers with seed funding from the CRF. Velculescu relocated to Maryland from California, and Diaz from Michigan to become part of the research team that led the world in deciphering the genetic blueprints for cancer.  Their work has led to pioneering new cancer tests that can detect the earliest genetic changes that precede cancer development in blood, urine, cervical fluids, sputum and other bodily fluids.  The ability to detect these initial changes would permit early interventions and could potentially make many cancers curable.  Their success led Velculescu and Diaz to form, and in 2013 expand, the Maryland company Personal Genome Diagnostics.  In 2014, their research team leveraged these and other discoveries and received a  gift from Ludwig Cancer Research for cancer genetics research and translation to new cancer treatments.

Taking on the Leading Cancer Killer:

In the inaugural year of the CRF at Johns Hopkins, Shyam Biswal, Ph.D., received support to construct a cigarette exposure facility.  He used mouse models to study smoke-induced lung cancer and uncovered genetic biomarkers that may be useful in the early detection of lung cancer, the leading cancer killer.  With this discovery, Biswal began collaborating with University of Maryland investigator Geoffrey Gurnin to identify drugs that target the genes affected by cigarette smoke and could potentially be used to prevent lung cancer. The demand for his cigarette smoke facility and lung cancer expertise led Biswal to expand his laboratory and create Cureveda, a Maryland biotechnology start up company that employs 20 people.  His work resulted in one patent already, and two patents are pending. In addition, Biswal leveraged the findings from his initial CRF support to earn grants from the Maryland Technology Development Corporation (TEDCO), the Flight Attendant Medical Research Institute (FAMRI) and the National Institutes of Health to continue his work.

 Cancer Prevention:

When the CRF was established, Maryland, and particularly Baltimore City, had some of the highest prostate cancer death rates in the nation.  As a result, prostate cancer was named a CRF priority.  In pioneering research in an emerging new field known as translational epidemiology that combines population research with interventions, Johns Hopkins CRF investigator Elizabeth Platz, Sc.D., uncovered a connection between cholesterol-lowering drugs called statins and a decreased risk of developing aggressive and deadly prostate cancer.  She later collaborated with CRF investigators William Nelson, M.D., Ph.D., and Vasan Yegnasubramanian, M.D., Ph.D., to reveal that the commonly used heart drug digoxin halted prostate cancer cell growth in laboratory studies and that men taking the drug to treat their heart disease had a lower risk of developing prostate cancer. The CRF team is now working to better understand the cellular mechanisms to identify drugs that could safely prevent prostate cancer.  Other cancer prevention successes include CRF investigator Kala Visvanathan, M.B.B.S., who harnessed the power of broccoli sprouts to stave off cancer.  She is heading cancer prevention clinical trials of broccoli-sprouts tea and other preparations, rich in the carcinogen detoxifier sulforaphane.  CRF researcher Michael Carducci, M.D., is studying pomegranate extract, muscadine grapes, and other natural compounds that may have the ability to prevent prostate cancer.  The work of these investigators is revealing inexpensive and non-toxic ways, many of them from the grocery store shelves, which show promise in preventing cancer.

Growing Research Dollars for Maryland:

Though he had no connections to Maryland or Johns Hopkins, in 2002, Sidney Kimmel chose Johns Hopkins as the recipient of his historic $150 million gift to cancer research and care. At the time of his gift, Mr. Kimmel stated that Johns Hopkins captured his attention with its unique combination of scientific leadership with economic leadership. He specifically cited the partnership between the Cancer Center at Johns Hopkins and the state of Maryland to use the Cigarette Restitution Fund to finance cancer research.  This is one of many incidences where CRF investigators and CRF-supported research played an important role in bringing additional funding to Maryland. Multi-million grants from Ludwig Cancer Research, Stand Up To Cancer, the American Recovery and Reinvestment Act, the Avon Foundation, The Flight Attendant Medical Research Institute, the Department of Defense, and Centers for Medicare and Medicaid Services are among the groups investing in Maryland science and medicine at Johns Hopkins.  For every CRF research dollar spent, $10 has been brought back to our state through business contracts and other economic development.

Part 1:  Maryland and Johns Hopkins – A Partnership that Works for Maryland Citizens

Part 2: Maryland and Johns Hopkins - Teaming Up to End Smoking

Part 3: The Maryland CRF and Johns Hopkins in the Community

This blog is part 3 of 4 of our “Cancer-Free Mondays” series about how the Maryland Cigarette Restitution Fund is helping Maryland Citizens.

The best way to reduce deaths from cancer is through prevention and early detection. Cancer deaths could be cut in half simply through changes in behaviors associated with cancer development and increased early detection of cancers through cancer screening, experts say.  It sounds straightforward enough, but the key to success is in ensuring that our citizens, particularly the poor and underserved, have the information they need and the resources they need to act on the information. This is another area where Johns Hopkins and the Cigarette Restitution Fund (CRF) have joined forces to improve the health of Maryland citizens.

From 2001 through 2010, when Johns Hopkins received a CRF Public Health grant, our physicians, nurses, and health educators provided education on cancer prevention and screening to hundreds of thousands of Marylanders and provided free cancer screenings to thousands more. Building upon CRF community partnerships, our healthcare team earned a federal grant to improve colon cancer screening rates among Medicare recipients.  Our physicians also provided colonoscopies to uninsured Baltimore residents through a collaborative initiative under the Baltimore City Public Health Department’s CRF Public Health Grant.

It is not coincidental that the U.S. Centers for Disease Control and Prevention (CDC) reported that Maryland leads the nation in decreased colon cancer incidence rates.  It is further proof that action against cancer—in this case colorectal cancer screening—brings results.  That same CDC report found that Maryland was among the best in cancer screening overall.

Though Johns Hopkins no longer receives CRF Public Health Grant support, its leadership has maintained and strengthened their commitment to the community. Even before the Affordable Care Act, Johns Hopkins voluntarily joined Priority Partners and became one of seven managed care organizations authorized by the state of Maryland to provide healthcare to our state’s uninsured. Our community outreach and public health experts have expanded the community partnerships established through the CRF and started new programs dedicated to eliminating racial disparities in Maryland’s cancer death rates.

More recently, a small CRF grant has allowed Johns Hopkins to broaden its participation in the Day at the Market program. The program is a bimonthly event that brings nurses and other clinicians, safety experts, and various caregivers to the Northeast Market on Monument Street in East

CRF-supported Day at the Market

Baltimore to meet face to face with citizens of Baltimore. A Day at the Market, which has received recognition from the Maryland Department of Health and Mental Hygiene, fosters dialog about prevention and detection of cancer and other diseases and ways to achieve a healthier lifestyle.

The Day at the Market program is about more than health education. It is about addressing the needs of a community and providing citizens with the resources they need to make choices and changes that prevent cancer and other diseases.  Johns Hopkins experts say obtaining and maintaining a healthy weight is one of the most important things we can do for our health. A nutritious diet is essential to achieving that goal, and the Northeast Market provides convenient access to fresh and affordable produce and other healthy foods.  Johns Hopkins leadership felt so strongly about this health commitment, that the Johns Hopkins University partnered with Baltimore Public Markets Corporation, the City of Baltimore, the State of Maryland, and other groups to help finance a recent $2 million renovation to the market.  The renovations include dedicated space for community health outreach and education and broader use of nutrition-friendly menus that provide a green leaf graphic to make healthy menu choices easily recognizable to customers.

We can talk about the value of cancer prevention, but as the old adage says, “Talk is cheap.”  Without the tools to understand and adopt healthy behaviors, Johns Hopkins experts and Maryland’s elected officials understand that the dialog is meaningless to many of our citizens. That is why we continue to work together to get the information, the access, and the support to the people of our state.

Cancer Prevention Tips and Resources

Cancer experts say if we do just a few things—applying what we understand today to strengthen cancer prevention—we could cut cancer incidence by more than half.  Here’s how:

• Quit smoking
• Maintain a healthy weight and diet
• Limit alcohol consumption
• Exercise regularly Find an activity you enjoy (walking, jogging, dancing) and incorporate 30 minutes of this activity into your daily routine.)
• Protect skin from the sun
• Talk to your doctor about reducing, when possible, medical exposures to radiation (X-rays, etc.)
• Find out about your medical history.  Talk to your doctor about a cancer screening and prevention plan.
• Avoid on the job exposures to carcinogens such as asbestos
• Women, talk to your doctor about hormone replacement therapy at menopause and increased breast cancer risk
• Get vaccinated against known cancer-causing viruses.

The hepatitis B vaccine can prevent certain types of liver cancer.  The Gardasil vaccine prevents HPV (human papillomavirus) infection, a common sexually transmitted virus that causes the majority of cervical cancers and more than half of oral cancers.

Do you have questions or need help with any of these tips?  Visit the Johns Hopkins booth at the Northeast Market on the 2^nd Wednesday of each month.

Do you need health insurance?  Get help at the Maryland Health Connection.

Part 1:  Maryland and Johns Hopkins – A Partnership that Works for Maryland Citizens

Part 2: Maryland and Johns Hopkins - Teaming Up to End Smoking

This blog is part 2 of 4 of our “Cancer-Free Mondays” series about how the Maryland Cigarette Restitution Fund is helping Maryland Citizens.

This year marks the 50^th anniversary of the landmark report by the U.S. Surgeon General that linked smoking with cancer and other diseases.  Prior to the Surgeon General’s report, it is estimated that 42 percent of Americans smoked.  In the years that followed the report—which for the first time made public the dangers of smoking—U.S. smoking rates declined and are now 18 percent.  Experts calculate that this decline in smoking translates to some 8 million lives saved.

The same smoking-related health dangers that prompted the 1964 Surgeon General’s report were at issue in the 1990s class action law suit that resulted in the creation of the Maryland Cigarette Restitution Fund (CRF).  It seems fitting then, on this historic anniversary, to take a look at how Maryland’s public officials have tackled smoking and how the CRF has made a difference.

In fact, Maryland is doing better than the U.S. as a whole.  At 14.9 percent, Maryland smoking rates among adults are below the national average and are one of the lowest in the nation. Elected officials and researchers have worked particularly hard to protect Maryland’s youngest citizens, and that has been one of our state’s greatest success stories.   The youth (age 12-17) smoking rate in Maryland is 8 percent, well below the national average of 14 percent.

These positive smoking trends did not occur by chance.  They are the result of a dedicated and informed effort by Maryland’s elected officials in conjunction with CRF investigators. Backed by the results of CRF research, Maryland lawmakers made significant policy changes. They increased taxes on cigarettes and instituted tough regulations on smoking, such as the Clean Air Act.  Our state has enacted some of the nation’s strictest smoking policies, and theses changes have led to declines in Maryland smoking rates, and most importantly, saved lives.

CRF supported research at Johns Hopkins is helping guide policy and improve smoking cessation strategies. Since 2001, 15 CRF grants have been awarded to Johns Hopkins scientists to develop strategies to help people quit smoking, to study the best ways to communicate the dangers of smoking to teens and young adults, and for in-depth research of the science of smoking and cancer.

CRF investigators at Johns Hopkins have:

• uncovered the genetic mutation that provided the definitive scientific proof that smoking causes cancer.

•  studied the combined effect of firsthand and secondhand smoke on cancer incidence.

• constructed a cigarette smoke facility and deciphered the specific genetic mechanisms corrupted by cigarette smoke and at play in the development of smoking-related cancers.

• assessed Maryland’s smoking prevention strategies to determine what works and what does not.

• completed a comprehensive analysis of smoking-related gene mutations in GI cancer.

• conducted research to establish evidence-based antismoking strategies for youth.

• engaged in a partnership with Howard University for community-based research to better understand the factors that influence tobacco use among 18-24 year old African Americans.

Although our state’s leaders and scientists have again positioned Maryland as a trailblazer in addressing the dangers of cigarette smoke, they also recognize that there is still work to be done.  About one half million Marylanders continue to smoke. Smoking remains the leading risk factor for cancer. The National Cancer Institute reports that smoking is a cause of cancers of the lung, esophagus, voice box (larynx), mouth, throat, kidney, bladder, pancreas, stomach, and cervix, and acute myeloid leukemia. Even for those who have developed cancer, smoking only makes it worse. Research shows that people with cancer who continue to smoke increase their risks of developing second cancers, do not respond as well to cancer treatments, and are at higher risk than nonsmokers of dying of other chronic diseases, such as heart disease.

The message is simple.  If you don’t smoke, don’t start.  If you smoke, quit.

WHERE TO GET HELP TO QUIT SMOKING:

 MDQuit.org

Call the Maryland Quit Line 1-800-QUITNOW

Talk to your doctor.  Under the Affordable Care Act, tobacco users may be eligible for free tobacco cessation interventions.

 SmokeFree.gov provides information about methods and medications that make it easier to quit.

 Part 1:  Maryland and Johns Hopkins – A Partnership that Works for Maryland Citizens

This blog is part 1 of 4 of our “Cancer-Free Mondays” series about how the Maryland Cigarette Restitution Fund is helping Maryland Citizens.

In 1990, Maryland had the highest cancer death rates in the nation.  Today, cancer deaths rates in our state are below the national average, and Maryland ranks 30^th among all states.  How did Maryland go from first to 30^th?  The lion’s share of this progress is attributable to the Maryland Cancer Control Plan and the Maryland Cigarette Restitution Fund (CRF).

It was about the same time as these alarming cancer rates were made public that Maryland joined 46 other states in a class action lawsuit against America’s cigarette manufacturers.  States were seeking reimbursement for the huge costs they faced because of smoking related diseases, like cancer. The states won and split the $53 billion in penalties they received.  The governors and legislators from other states that benefitted from the tobacco company settlement chose to use the money to patch holes in their state budgets or engaged in lengthy legal battles over it. Maryland stood alone and earned national distinction when its elected officials decided to use the money to fight cancer.  Wow, has that decision paid off.

Cancer death rates in our state are plummeting, and this decline coincides directly with the establishment of the Maryland Cancer Control Plan and the Maryland Cigarette Restitution Fund.  All of the major cancer killers:  lung, prostate, breast, colorectal, and cervical cancers, are on a downward trend in Maryland.  While cancer death rates throughout the nation are trending downward, Maryland’s death rates are falling more rapidly than the national average. In fact, for colorectal cancer specifically, Maryland has the highest rate of decrease in the U.S.

Our experts at Johns Hopkins are proud to call Maryland home, and they are honored to have had the opportunity to work with Maryland officials and citizens to help achieve this remarkable success.  We look forward to further progress.  We understand there is more work to be done, but the formula for success has been put in place.  There may be ups and downs in funding, but state officials have demonstrated their commitment to staying the course, and that is why Maryland is making unprecedented strides against cancer.

Look for future blogs on Mondays throughout January about how Maryland CRF-supported research at Johns Hopkins is helping Marylanders. Read more about Maryland CRF-supported research at Johns Hopkins Kimmel Cancer Center.