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Early detection may help Kentucky tamp down its lung cancer crisis
Anthony Stumbo’s heart sank after the doctor shared his mother’s chest X-ray.
“I remember that drive home, bringing her back home, and we basically cried,” said the internal medicine physician, who had started practicing in eastern Kentucky near his childhood home shortly before his mother began feeling ill. “Nobody wants to get told they’ve got inoperable lung cancer. I cried because I knew what this meant for her.”
Now Stumbo, whose mother died the following year, in 1997, is among a group of Kentucky clinicians and researchers determined to rewrite the script for other families by promoting training and boosting awareness about early detection in the state with the highest lung cancer death rate. For the past decade, Kentucky researchers have promoted lung cancer screening, first recommended by the U.S. Preventive Services Task Force in 2013. These days the Bluegrass State screens more residents who are at high risk of developing lung cancer than any state except Massachusetts — 10.6% of eligible residents in 2022, more than double the national rate of 4.5% — according to the most recent American Lung Association analysis.
Veronica Turner for KFF Health News
The effort has been driven by a research initiative called the Kentucky LEADS (Lung Cancer Education, Awareness, Detection, and Survivorship) Collaborative, which in 2014 launched to improve screening and prevention, to identify more tumors earlier, when survival odds are far better. The group has worked with clinicians and hospital administrators statewide to boost screening rates both in urban areas and regions far removed from academic medical centers, such as rural Appalachia. But, a decade into the program, the researchers face an ongoing challenge as they encourage more people to get tested, namely the fear and stigma that swirl around smoking and lung cancer.
Lung cancer kills more Americans than any other malignancy, and the death rates are worst in a swath of states including Kentucky and its neighbors Tennessee and West Virginia, and stretching south to Mississippi and Louisiana, according to data from the Centers for Disease Control and Prevention.
It’s a bit early to see the impact on lung cancer deaths because people may still live for years with a malignancy, LEADS researchers said. Plus, treatment improvements and other factors may also help reduce death rates along with increased screening. Still, data already shows that more cancers in Kentucky are being detected before they become advanced, and thus more difficult to treat, they said. Of total lung cancer cases statewide, the percentage of advanced cases — defined as cancers that had spread to the lymph nodes or beyond — hovered near 81% between 2000 and 2014, according to Kentucky Cancer Registry data. By 2020, that number had declined to 72%, according to the most recent data available.
“We are changing the story of families. And there is hope where there has not been hope before,” said Jennifer Knight, a LEADS principal investigator.
Older adults in their 60s and 70s can hold a particularly bleak view of their mortality odds, given what their loved ones experienced before screening became available, said Ashley Shemwell, a nurse navigator for the lung cancer screening program at Owensboro Health, a nonprofit health system that serves Kentucky and Indiana.
“A lot of them will say, ‘It doesn’t matter if I get lung cancer or not because it’s going to kill me. So I don’t want to know,'” said Shemwell. “With that generation, they saw a lot of lung cancers and a lot of deaths. And it was terrible deaths because they were stage 4 lung cancers.” But she reminds them that lung cancer is much more treatable if caught before it spreads.
The collaborative works with several partners, including the University of Kentucky, the University of Louisville, and GO2 for Lung Cancer, and has received grant funding from the Bristol Myers Squibb Foundation. Leaders have provided training and other support to 10 hospital-based screening programs, including a stipend to pay for resources such as educational materials or a nurse navigator, Knight said. In 2022, state lawmakers established a statewide lung cancer screening program based in part on the group’s work.
Jacob Sands, a lung cancer physician at Boston’s Dana-Farber Cancer Institute, credits the LEADS collaborative with encouraging patients to return for annual screening and follow-up testing for any suspicious nodules. “What the Kentucky LEADS program is doing is fantastic, and that is how you really move the needle in implementing lung screening on a larger scale,” said Sands, who isn’t affiliated with the Kentucky program and serves as a volunteer spokesperson for the American Lung Association.
In 2014, Kentucky expanded Medicaid, increasing the number of lower-income people who qualified for lung cancer screening and any related treatment. Adults 50 to 80 years old are advised to get a CT scan every year if they have accumulated at least 20 pack years and still smoke or have quit within the past 15 years, according to the latest task force recommendation, which widened the pool of eligible adults. (To calculate pack years, multiply the packs of cigarettes smoked daily by years of smoking.) The lung association offers an online quiz, called “Saved By The Scan,” to figure out likely eligibility for insurance coverage.
Half of U.S. patients aren’t diagnosed until their cancer has spread beyond the lungs and lymph nodes to elsewhere in the body. By then, the five-year survival rate is 8.2%.
But regular screening boosts those odds. When a CT scan detects lung cancer early, patients have an 81% chance of living at least 20 years, according to data published in November in the journal Radiology.
Some adults, like Lisa Ayers, didn’t realize lung cancer screening was an option. Her family doctor recommended a CT scan last year after she reported breathing difficulties. Ayers, who lives in Ohio near the Kentucky border, got screened at UK King’s Daughters, a hospital in far eastern Kentucky. The scan didn’t take much time, and she didn’t have to undress, the 57-year-old said. “It took me longer to park,” she quipped.
She was diagnosed with a lung carcinoid tumor, a type of neuroendocrine cancer that can grow in various parts of the body. Her cancer was considered too risky for surgery, Ayers said. A biopsy showed the cancer was slow-growing, and her doctors said they would monitor it closely.
Ayers, a lifelong smoker, recalled her doctor said that her type of cancer isn’t typically linked to smoking. But she quit anyway, feeling like she’d been given a second chance to avoid developing a smoking-related cancer. “It was a big wake-up call for me.”
Adults with a smoking history often report being treated poorly by medical professionals, said Jamie Studts, a health psychologist and a LEADS principal investigator, who has been involved with the research from the start. The goal is to avoid stigmatizing people and instead to build rapport, meeting them where they are that day, he said.
“If someone tells us that they’re not ready to quit smoking but they want to have lung cancer screening, awesome; we’d love to help,” Studts said. “You know what? You actually develop a relationship with an individual by accepting, ‘No.'”
Nationally, screening rates vary widely. Massachusetts reaches 11.9% of eligible residents, while California ranks last, screening just 0.7%, according to the lung association analysis.
That data likely doesn’t capture all California screenings, as it may not include CT scans done through large managed care organizations, said Raquel Arias, a Los Angeles-based associate director of state partnerships at the American Cancer Society. She cited other 2022 data for California, looking at lung cancer screening for eligible Medicare fee-for-service patients, which found a screening rate of 1%-2% in that population.
But, Arias said, the state’s effort is “nowhere near what it needs to be.”
The low smoking rate in California, along with its image as a healthy state, “seems to have come with the unintended consequence of further stigmatizing people who smoke,” said Arias, citing one of the findings from a 2022 report looking at lung cancer screening barriers. For instance, eligible patients may be reluctant to share prior smoking habits with their health provider, she said.
Meanwhile, Kentucky screening efforts progress, scan by scan.
At Appalachian Regional Healthcare, 3,071 patients were screened in 2023, compared with 372 in 2017. “We’re just scratching the surface of the potential lives that we can have an effect on,” said Stumbo, a lung cancer screening champion at the health system, which includes 14 hospitals, most located in eastern Kentucky.
The doctor hasn’t shed his own grief about what his family missed after his mother died at age 51, long before annual screening was recommended. “Knowing that my children were born, and never knowing their grandmother,” he said, “just how sad is that?”
KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
CBS News
CIA officer who drugged, photographed and sexually assaulted dozens of women gets 30 years in prison as victims stare him down
A longtime CIA officer who drugged, photographed and sexually assaulted more than two dozen women in postings around the world was sentenced to 30 years in federal prison Wednesday after an emotional hearing in which victims described being deceived by a man who appeared kind, educated and part of an agency “that is supposed to protect the world from evil.”
Brian Jeffrey Raymond, with a graying beard and orange prison jumpsuit, sat dejectedly as he heard his punishment for one of the most egregious misconduct cases in the CIA’s history. It was chronicled in his own library of more than 500 images that showed him in some cases straddling and groping his nude, unconscious victims.
“It’s safe to say he’s a sexual predator,” U.S. Senior Judge Colleen Kollar-Kotelly said in imposing the full sentence prosecutors had requested. “You are going to have a period of time to think about this.”
Prosecutors say the 48-year-old Raymond’s assaults date to 2006 and tracked his career in Mexico, Peru and other countries, all following a similar pattern.
He would lure women he met on Tinder and other dating apps to his government-leased apartment and drug them while serving wine and snacks. Once they were unconscious, he spent hours posing their naked bodies before photographing and assaulting them. He opened their eyelids at times and stuck his fingers in their mouths.
U.S. Embassy and Consulates in Mexico
One by one, about a dozen of Raymond’s victims who were identified only by numbers in court recounted how the longtime spy upended their lives. Some said they only learned what happened after the FBI showed them the photos of being assaulted while unconscious.
“My body looks like a corpse on his bed,” one victim said of the photos. “Now I have these nightmares of seeing myself dead.”
One described suffering a nervous breakdown. Another spoke of a recurring trance that caused her to run red lights while driving. Many told how their confidence and trust in others had been shattered forever.
“I hope he is haunted by the consequences of his actions for the rest of his life,” said one of the women, who like others stared Raymond down as they walked away from the podium.
Reading from a statement, Raymond told the judge that he has spent countless hours contemplating his “downward spiral.”
“It betrayed everything I stand for and I know no apology will ever be enough,” he said. “There are no words to describe how sorry I am. That’s not who I am and yet it’s who I became.”
In October 2021, the FBI issued a notice to the public, seeking other potential victims of and additional information about Raymond, saying that some women depicted in the incriminating photos and videos remain unidentified.
In a statement Wednesday, authorities praised all the victims who came forward.
“The FBI thanks the brave women who shared information that furthered this investigation,” said
FBI Assistant Director in Charge David Sundberg of the Washington Field Office. “We recognize our domestic and foreign law enforcement partners who helped bring Raymond to justice for his reprehensible crimes.”
Raymond’s sentencing comes amid a reckoning on sexual misconduct at the CIA. The Associated Press reported last week that another veteran CIA officer faces state charges in Virginia for allegedly reaching up a co-worker’s skirt and forcibly kissing her during a drunken party in the office.
Still another former CIA employee – an officer trainee – is scheduled to face a jury trial next month on charges he assaulted a woman with a scarf in a stairwell at the agency’s Langley, Virginia, headquarters. That case emboldened some two dozen women to come forward to authorities and Congress with accounts of their own of sexual assaults, unwanted touching and what they contend are the CIA’s efforts to silence them.
And yet the full extent of sexual misconduct at the CIA remains a classified secret in the name of national security, including a recent 648-page internal watchdog report that found systemic shortcomings in the agency’s handling of such complaints.
“The classified nature of the activities allowed the agency to hide a lot of things,” said Liza Mundy, author of “Sisterhood: The Secret History of Women at the CIA.” The male-dominated agency, she said, has long been a refuge for egregious sexual misconduct. “For decades, men at the top had free rein.”
CIA has publicly condemned Raymond’s crimes and implemented sweeping reforms intended to keep women safe, streamline claims and more quickly discipline offenders.
Last year, the CIA announced the appointment of Dr. Taleeta Jackson, a seasoned psychologist who previously led the Sexual Assault Prevention Program at the U.S. Navy, as the new head of a dedicated sexual assault and prevention office at CIA.
“There is absolutely no excuse for Mr. Raymond’s reprehensible, appalling behavior,” the agency said Wednesday. “As this case shows, we are committed to engaging with law enforcement.”
But a veil of secrecy still surrounds the Raymond case nearly four years after his arrest. Even after Raymond pleaded guilty late last year, prosecutors have tiptoed around the exact nature of his work and declined to disclose a complete list of the countries where he assaulted women.
Still, they offered an unbridled account of Raymond’s conduct, describing him as a “serial offender” whose assaults increased over time and become “almost frenetic” during his final CIA posting in Mexico City, where he was discovered in 2020 after a naked woman screamed for help from his apartment balcony.
U.S. officials scoured Raymond’s electronic devices and began identifying the victims he had listed by name and physical characteristics, all of whom described experiencing some form of memory loss during their time with him.
One victim said Raymond seemed like a “perfect gentleman” when they met in Mexico in 2020, recalling only that they kissed. Unbeknownst to the woman, after she blacked out, he took 35 videos and close-up photos of her breasts and genitals.
“The defendant’s manipulation often resulted in women blaming themselves for losing consciousness, feeling ashamed, and apologizing to the defendant,” prosecutors wrote in a court filing. “He was more than willing to gaslight the women, often suggesting that the women drank too much and that, despite their instincts to the contrary, nothing had happened.”
Raymond, a San Diego native and former White House intern who is fluent in Spanish and Mandarin, ultimately pleaded guilty to four of 25 federal counts including sexual abuse, coercion and transportation of obscene material. As part of his sentence, the judge ordered him to pay $10,000 to each of his 28 victims.
Raymond’s attorneys had sought leniency, contending his “quasi-military” work at the CIA in the years following 9/11 became a breeding ground for the emotional callousness and “objectification of other people” that enabled his years of preying upon women.
“While he was working tirelessly at his government job, he ignored his own need for help, and over time he began to isolate himself, detach himself from human feelings and become emotionally numb,” defense attorney Howard Katzoff wrote in a court filing.
“He was an invaluable government worker, but it took its toll on him and sent him down a dark path.”
Bangkok — A 64-year-old woman was preparing to do her evening dishes at her home outside Bangkok when she felt a sharp pain in her thigh and looked down to see a huge python taking hold of her.
“I was about to scoop some water and when I sat down it bit me immediately,” Arom Arunroj told Thailand’s Thairath newspaper. “When I looked I saw the snake wrapping around me.”
The 13-to-16-foot-long python coiled itself around her torso, squeezing her down to the floor of her kitchen.
“I grabbed it by the head, but it wouldn’t release me,” she said. “It only tightened.”
Kunyakit Thanawtchaikun/AP
Pythons are non-venomous constrictors, which kill their prey by gradually squeezing the breath out of it.
Propped up against her kitchen door, she cried for help but it wasn’t until a neighbor happened to be walking by about an hour and a half later and heard her screams that authorities were called.
Responding police officer Anusorn Wongmalee told The Associated Press on Thursday that when he arrived the woman was still leaning against her door, looking exhausted and pale, with the snake coiled around her.
Police and animal control officers used a crowbar to hit the snake on the head until it released its grip and slithered away before it could be captured.
In all, Arom spent about two hours on Tuesday night in the clutches of the python before being freed.
She was treated for several bites but appeared to be otherwise unharmed in videos of her talking to Thai media shortly after the incident.
Encounters with snakes are not uncommon in Thailand, and last year 26 people were killed by venomous snake bites, according to government statistics. A total of 12,000 people were treated for venomous bites by snakes and other animals 2023.
The reticulated python is the largest snake found in Thailand and usually ranges in size from 5 to 21 feet, weighing up to about 165 pounds. They have been found as big as 33 feet long and 287 pounds.
Smaller pythons feed on small mammals such as rats, but larger snakes switch to prey such as pigs, deer and even domestic dogs and cats. Attacks on humans are not common, though do happen occasionally.
There have also been fatal attacks in Indonesia, where a woman was found inside the belly of a reticulated python that swallowed her whole in June — the fifth person to be devoured by one of the snakes in the country since 2017.
CBS News
After Tyre Nichols’ fatal beating, Memphis officer texted photo of bloodied man to ex-girlfriend, she testifies
A former Memphis police officer charged in the fatal beating of Tyre Nichols sent his ex-girlfriend a photo of the badly injured man on the night he was punched, kicked and hit with a police baton following a traffic stop, according to trial testimony Wednesday.
Brittany Leake, a Memphis officer and Demetrius Haley’s former girlfriend, testified during the criminal trial that she was on the phone with Haley when officers pulled Nichols over for a traffic stop. She said she heard a “commotion,” including verbal orders for someone to give officers his hands.
The call ended, but Haley later texted the photo in a group chat comprising Haley, Leake and her godsister, she testified. Prosecutors displayed the photo for the jury. It showed Nichols with his eyes closed, on the ground with what appeared to be blood near his mouth and his hands behind his back.
Leake said that when she saw the photo, her reaction was: “Oh my God, he definitely needs to go to the Med.”
The Med is shorthand for Memphis’ trauma hospital.
The fatal beating, caught on police bodycams and street surveillance cameras, has sparked protests and calls for police reform. Officers said they pulled over Nichols for reckless driving, but Memphis’ police chief said there was no evidence to substantiate that claim.
Haley, Tadarrius Bean and Justin Smith are on trial after pleading not guilty to charges that they deprived Nichols of his civil rights through excessive force and failure to intervene, and obstructed justice through witness tampering. Their trial began Sept. 9 and is expected to run three to four weeks.
George Walker IV / AP
The Memphis Police Department fired the three men, along with Emmitt Martin III and Desmond Mills Jr., after Nichols’ death. The beating was caught on police video, which was released publicly. The officers were later indicted on the federal charges. Martin and Mills have taken plea deals.
During her testimony Wednesday, Leake said she deleted the photo after she saw it and that sending such a photo is against police policy.
“I wasn’t offended, but it was difficult to look at,” she said.
Leake said Haley had sent her photos before of drugs, and of a person who had been injured in a car accident.
Earlier Wednesday, Martin was on the witness stand for a third day. Defense attorneys tried to show inconsistencies between Martin’s statements to investigators and his court testimony. Martin acknowledged lying about what happened to Memphis Police Department internal investigators, to try to cover up and “justify what I did.”
But Martin said he told the truth to FBI investigators after he pleaded guilty in August, including statements about feeling pressure on his duty belt where his gun was located during the traffic stop, but not being able to see if Nichols was trying to get his gun. Martin has testified that he said “let go of my gun” during the traffic stop.
Martin Zummach, the attorney for Justin Smith, asked Martin if he knew of any reasons why Nichols did not simply say, “I give up.”
“He’s out of it,” Martin said. “Disoriented.”
Martin testified that the situation escalated quickly when Haley pulled his gun and violently yanked Nichols from his car, using expletives and failing to tell Nichols why he had been pulled over and removed from the vehicle.
“He never got a chance to comply,” Martin said.
Nichols, who was Black, was pepper sprayed and hit with a stun gun during the traffic stop, but ran away, police video shows. The five officers, who also are Black, then beat him about a block from his home, as he called out for his mother.
Video shows the officers milling about and talking as Nichols struggled with his injuries. Nichols died Jan. 10, 2023, three days after the beating.
An autopsy report shows Nichols – the father of a boy who is now 7 – died from blows to the head. The report describes brain injuries, and cuts and bruises on his head and elsewhere on his body.
Jesse Guy testified that he was working as a paramedic for the Memphis Fire Department the night of the beating. He arrived at the location after two emergency medical technicians, Robert Long and JaMichael Sandridge.
Guy said he was not told about the medical problems Nichols had experienced before he arrived, and that Nichols was injured, seated on the ground and unresponsive.
Nichols had no pulse and was not breathing, and it “felt like he was lifeless,” Guy said.
In the ambulance, Guy performed CPR and provided mechanical ventilation, and Nichols had a pulse by the time he arrived at the hospital, the paramedic said.
Guy said Long and Sandridge did not say if they had checked Nichols’ pulse and heart rate, and they did not report if they had given him oxygen. When asked by one of Bean’s lawyers whether that information would have been helpful in treating Nichols, Guy said yes.
Long and Sandridge were fired for violating fire department policies after Nichols died. They have not been criminally charged.
The five officers also have been charged with second-degree murder in state court, where they pleaded not guilty. Mills and Martin are expected to change their pleas.
Federal prosecutors have previously recommended a 40-year sentence for Martin. A date has not been set in state court yet.
Nichols worked for FedEx, and he enjoyed skateboarding and photography. The city of Sacramento, where Nichols grew up, named a skatepark in his honor. “Tyre fell in love with skateboarding at a young age and it wasn’t long before it became a part of his lifestyle,” states the resolution approved by the city council. He had a tattoo of his mother’s name.
“Tyre Nichols’ family have been praying for justice and accountability from the very beginning of this tragedy,” Ben Crump and Antonio Romanucci, the civil rights attorneys representing Nichols’ family, said in a statement when the trial began.
More Minnesota nonprofits are facing financial distress
CIA officer who drugged, photographed and sexually assaulted dozens of women gets 30 years in prison as victims stare him down
Python squeezes Thai woman in her kitchen for 2 hours before she’s rescued by police
More Minnesota nonprofits are facing financial distress
CIA officer who drugged, photographed and sexually assaulted dozens of women gets 30 years in prison as victims stare him down