At a certain age, you might start to wonder if you should be stepping up your screening for cancer. And then you might start to wonder: what exactly is that age? And what kinds of cancer screening should I consider?

While there are some guidelines to these questions, there has to be a lot of individualized assessment when counseling patients about screening for certain cancers. Every woman’s personal health risks may vary, says Kimberly Peairs, M.D., an assistant professor of medicine at Johns Hopkins and clinical director of internal medicine at Green Spring Station. For a woman with a clear genetic disposition to certain cancers—such as a family history of the BRCA mutations linked to certain breast and ovarian cancers—“screening may also be recommended to start earlier than would be done with an average risk patient,” Peairs says.

The benefit of cancer screening varies on the cancer type. Most cancers become more prevalent as women get older but there are some exceptions.

Younger than 40?: You’ve got a few more years for most screenings at this age, but “cervical cancer screening is important to have done in the earlier years to establish if a patient is high risk from HPV infection,” Peairs says. “That would help determine how frequently she would need to be screened thereafter.”

In Your 40s: The most common screening question that comes up for women in their 40s is when and how often to get a mammogram, Peairs notes. The recommendations for a mammogram use vary in this decade.  Patients should be made aware of this and providers should help them decide what the right screening timeline is for each individual. “This decision will depend on a woman’s risk for breast cancer as well as their individual preferences,” Peairs says. Risks can include a family history of breast cancer as well as genetic factors. “A patient-centered conversation regarding the risks and benefits of screening in this age group is very important,” she adds. Cervical cancer screening, especially for women at high-risk for HPV infection, can continue in the 40s.

In Your 50s: Peairs recommends breast cancer screening, cervical cancer screening, and the start of colon cancer screening during this decade of life. “There are several options to discuss for colon cancer screening but presently, the gold standard is still a screening colonoscopy, with appropriate follow-up testing depending on a patient’s individual risks,” she says. Women with a long history of continued smoking may consider lung cancer screening at age 55.

In Your 60s: Breast cancer and colon cancer screening should continue, and cervical cancer screening could continue into your mid- 60s, says Peairs. Lung cancer screenings can continue in women with a risky history of smoking.

60s and Beyond?: Patients can ask their doctors about guidelines for when it might be appropriate to stop doing a colonoscopy or a mammogram, taking into account a patient’s individual risk for specific cancers. In general, Peairs says, if a patient is not likely going to be living more than five years because of age or other medical conditions, the benefits of most cancer screening is limited.

In all cases, patients should talk with their doctors about their personal risks for each type of cancer. You could be reluctant to get a mammogram or a colonoscopy, but you may change your mind after you have a thorough discussion of “the potential benefits or harms of the screening test,” Peairs says. “Ideally, the physician and the patient can identify an approach they are both comfortable with.”

VN:F [1.9.17_1161]
Rating: 0.0/5 (0 votes cast)
No Comments

News of an FDA advisory committee that has reviewed one pharmaceutical company's approach to Cancer Immunotherapyengineering a cancer patient's own T-cells, the so-called soldiers of the immune system, and injecting them back into patients with astounding success has prompted questions on the therapy's safety and the company's ability to reliably custom-engineer each patient's T-cells.

“The success of CAR-T in pediatric leukemia is the ability to dramatically eliminate disease in patients who had previously failed most standard treatments, and, in general, have a very poor prognosis. This high response rate is associated with significant toxicity, especially in the patients that ultimately show a benefit from the treatment. Major questions still unanswered are how durable these responses will be, whether the toxicity can be reduced while still maintaining the activity and thus whether the treatment can be given to a broader patient population in nonacademic hospital settings,” says Ivan Borrello, M.D., an associate professor at the Johns Hopkins Bloomberg~Kimmel Institute for Cancer Immunotherapy.

Borrello has long studied how to collect T-cells from their hiding spots within the blood and bone marrow, and coax them into becoming better cancer cell killers. Several approaches to this type of therapy, including two currently under review by the FDA, use T-cells found circulating throughout the blood. Therapies made from these cells are called CAR-T, which stands for chimeric antigen receptor T-cells.

However, Borrello wasn't satisfied with how well the blood-derived T-cells were able to specifically home in on tumor cells. He found similar T-cells located in the bone marrow, where cancers of the blood are born. These cells, called marrow-infiltrating lymphocytes or MILs, are better equipped to recognize certain proteins on the surface of tumor cells, he says.

For the past decade, Borrello and his team at Johns Hopkins have led clinical trials to engineer MILs fished out of the bone marrow of patients with multiple myeloma, a cancer of white blood cells. Results, published in 2015, of the first trial of 22 patients who received MILs therapy along with a standard stem cell transplant showed that 13 of the 22 had a partial response to the therapy. Two more trials are ongoing.

He believes the MILs approach to T-cell therapies may be safer than CAR-T. "There have been no trends of major toxicities," he says. But therein lies a problem. Some toxicities, such as the so-called cytokine release storm, may actually rev up the immune system, improving its ability to find and destroy cancer cells. Borrello says it's a delicate balance to find the right amount of toxicity that will not overwhelm patients. He's working to find that balance in the current clinical trials, and potentially, he says, provide a new frontier for T-cell therapies.

VN:F [1.9.17_1161]
Rating: 0.0/5 (0 votes cast)
2 Comments

Mammogram machineA frequent question women ask Susan Harvey, M.D. about mammograms: “Can’t you make it so they don’t squeeze so hard?”

Unfortunately, some discomfort is part of the screening, as breast imagers “compress the breast to get the best quality image,” says Harvey, director of the Johns Hopkins Breast Imaging Division in the Department of Radiology.  With that question out of the way, there are several other things women may want to know and perhaps should know about this important cancer screening tool.

For instance, the advice on when to get your first screening mammogram varies between organizations like the U.S. Preventive Services Task Force, the American Cancer Society, and others, and women may feel confused by the conflicting recommendations. These differences “come from variations in perspective” by the organizations, Harvey explains. The UPSTF, for instance, weighs national health care system costs of mammograms heavily in its recommendations, while the ACS comes at the question from the perspective of how many more lives can be saved by this screening.

In breast imaging at Johns Hopkins, Harvey says, we recommend that women get their first screening at age 40, and come annually after that, “because our focus is to save as many lives as possible through early detection, so we recommend the screening methods that have the biggest impact on survival.”

Women may need to get a screening earlier than age 40, she says. She recommends speaking with their doctors or breast cancer specialists about factors that could increase their personal risk of breast cancer, including a family history of breast cancer, a patient’s own history of previous breast cancer, previous breast biopsies that have turned up abnormal tissue, Ashkenazi Jewish descent and genetic mutations in the BRCA genes that have been linked to a higher risk of developing breast and ovarian cancers.

“Speaking with your primary care physician is important because they know your whole health history,” Harvey advises. “Yet they may not know all the complex details of screening, so reaching out to a breast imaging center where you can speak with a specialist will also be of benefit.”

You may also be curious about the difference between screening mammography and diagnostic mammography. Screening mammography is used “to detect breast cancer in women who have no symptoms,” Harvey says. Diagnostic mammography, on the other hand, analyzes the breasts for abnormalities in women with breast lumps, who have had a history of breast cancer, or women who had some potential problem show up on their screening mammogram that should be examined further.

Women also need to know that there are differences in the mammography technology used for screening and diagnostic imaging. Very few places in the United States now use film screen mammography, where the breast is imaged as an x ray on film. Instead, most breast imaging centers use either 2D (full field) or 3D (digital breast tomosynthesis, DBT) digital mammography. The 3D technology, or DBT, was approved by the FDA in 2011, and is the most sensitive and specific screening imaging available.

“3D or DBT has been a fabulous innovation for mammography,” Harvey says. “We detect approximately 40 percent more cancers, and we have approximately 40 percent fewer false alarms or recalls for further imaging that do not demonstrate cancer.” While private insurance has been slow to cover this examination, the state of Maryland passed legislation in March of 2017 requiring insurance companies cover the cost of the exam. Medicare and Medicaid were early to cover it.

The Affordable Care Act mandates insurance coverage for screening mammograms for women under most private health care plans, Medicaid and Medicare. “But a lot of women don’t know this, and a lot of insurance companies may not comply with it, so it becomes complicated,” says Harvey. “For instance, it varies from state to state whether you will need a referral from a primary care doctor to get a mammogram, and there are insurance plans that won’t cover your screening mammography unless there is a referral.”

Harvey says that breast imaging experts are improving their techniques to lower the rates of “false positive” mammograms—when an image looks abnormal but there is no cancer found. She says women are “less likely to have a false alarm and more likely to have a cancer identified early” at imaging centers with radiologists who specialize in breast cancer imaging.

Harvey is proud that the Johns Hopkins center is among those that have lowered their rates of recalling women from screening for additional evaluation —limiting it to 6 percent of mammograms, well below the recommended rate of 10 percent.

“My job is to save lives by identifying breast cancer early, and we hope all women are accessing this important screening tool annually,” she says.

 

VN:F [1.9.17_1161]
Rating: 0.0/5 (0 votes cast)
No Comments

William Nelson, M.D., Ph.D.

William Nelson, M.D., Ph.D.

“Prostate cancer mortality has been declining since prostate cancer screening started in 1995,” says William G. Nelson, M.D., Ph.D., director of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins. “There’s no question that it works. The problem is diagnosing these cancers in men who aren’t threatened by the disease and then pursuing treatment."

"When we find a cancer that has a low risk of progressing to threaten life, a low Gleason score, the best move may be not to treat this upfront but instead to pursue an active surveillance regimen involving repeated PSA testing, rectal exams, or imaging studies. Through this process, many men (up to 40%) may never go on to get their prostate cancer treated. Currently, we think that’s the best way to benefit from screening but also not to be overdiagnosed or overtreated.”

Listen to the Cancer News Review podcast with Dr. Nelson.

VN:F [1.9.17_1161]
Rating: 0.0/5 (0 votes cast)
No Comments

“Cancer is a terrible turn in a person’s life, but it may bring out the best in their family and friends,” says Johns Hopkins Kimmel Cancer Center Chaplain Rhonda Cooper. “The best gift of all is a strong shoulder to lean on, along with an understanding heart.”

She notes that you may be able to reach out for spiritual support from your family or friends; your priest, rabbi or imam; or from one of your caregivers. “Connection to a true caregiver may be your best link to God or to a transcendant spirit,” Cooper notes. Chaplains at the center can provide support not only for patients, but their families as well.

Chaplain Cooper explains more in this video about spiritual care for cancer patients at the center:

VN:F [1.9.17_1161]
Rating: 0.0/5 (0 votes cast)
No Comments

William Nelson, M.D., Ph.D.

William Nelson, M.D., Ph.D.

Prostate cancer is extremely common in the U.S. “It’s the most common life-threatening cancer in men, responsible for 26,000 deaths per year,” says William G. Nelson, M.D., Ph.D., director of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins. But there are a lot of prostate cancers that are not life-threatening, he says. “In autopsies done for causes not related to cancer, we find small cancers in an unimaginably large fraction of men. By the time men reach 60-70 years old, two-thirds of them are harboring small cancers in their prostate; the lifetime risk of a prostate cancer diagnosis is about 1 in 8. Yet the lifetime risk of dying from prostate cancer is only about 1 in 37. What this means is many, many more men are going to die with prostate cancer than from it.”

Listen to the Cancer News Review podcast with Dr. Nelson.

VN:F [1.9.17_1161]
Rating: 0.0/5 (0 votes cast)
No Comments

Southern magnolia

Southern magnolia

In your Facebook feed, in conversations with friends, in a magazine article—the talk about natural remedies for preventing and treating breast cancer seems to pop up everywhere. But which natural products are actually being tested in the lab and in clinical trials, and what’s the evidence for their effectiveness?

Saraswati Sukumar, Ph.D., Johns Hopkins oncology professor and founding director of the Kimmel Cancer Center’s Breast Cancer Program, has been studying natural compounds and their effects on cancer, and she says it’s too early to tell yet whether certain natural remedies can reduce the number of women who develop breast cancer, or whether any of them can help women with breast cancer live longer. But there are a few of these remedies that are being tested at Johns Hopkins and elsewhere, with promising results.

Curcumin: Curcumin is the active ingredient in turmeric, the yellow spice in curry powder, that has been used in the Indian Ayurvedic medicine tradition for centuries, according to Sukumar. “We have studied it extensively for many years in cells and in animals, and eventually it is ready to make the big jump into human clinical trials,” she says.

One of curcumin’s “most important effects is that it reduces inflammatory reactions,” says Sukumar. For breast cancer patients, this means that curcumin pills taken during and after radiation treatment could help heal burns and deep wounds, as studies conducted at the University of Rochester have shown. Sukumar and her colleagues are also testing curcumin in mice, to see if small doses of the compound can prevent cancers from growing, or possibly shrink the size of breast tumors that are already present. So far, these studies haven’t turned up any harmful side effects of curcumin; in fact in several mouse models of breast cancer, curcumin has helped reduce the number of tumors, and aided chemotherapy and hormone therapy to shrink the tumors. Sukumar cautions that it does act as a blood thinner, so it wouldn’t be a safe choice for patients who are already taking blood-thinning medications like heparin or Coumadin.

Honokiol: Another natural compound being studied by Johns Hopkins researchers is honokiol, a compound extracted from the seed cones and bark of the magnolia tree. Dipali Sharma, MS, Ph.D., an associate professor of oncology, is testing honokiol in mice to see whether it can slow the growth of breast cancers fueled by leptin, a hormone closely connected with obesity and cancer in humans.

Broccoli sprouts: Johns Hopkins cancer prevention expert Kala Visvanathan, M.D., is conducting clinical trials of a broccoli sprout compound called sulforaphane in women who have been treated for breast cancer and in women and men at high risk for the cancer. In animal studies, sulforaphane has been shown to “turn on” proteins that protect cells against breast cancer. Others scientists are studying similar compounds called isothiocyanates, found in things like horseradish and cruciferous vegetables like broccoli, cabbage and Brussels sprouts, to see if they can protect against breast cancer as well.

Red wine and soy: Natural compounds found in red wine and soybeans have been studied by breast cancer researchers for decades, with some positive results, Sukumar says. In particular, the red wine chemical resveratrol has been shown to suppress tumor growth in studies of breast cancer cells and cancers in animals. In soybeans and soy products, compounds called isoflavones also have been successful in animals to prevent breast cancer and slow tumor growth. Isoflavones are plant estrogens, so researchers are positive about its cancer preventive properties, but cautious about its use in women with cancer, since the breast cancers use estrogen to grow, Sukumar says.

One more thing to remember about natural remedies is that scientists are often testing the pure form of these compounds, rather than how they appear in our foods. However, adding a handful of broccoli sprouts to your salad regularly or mixing a teaspoonful of turmeric into your meal can help to reduce your risks of cancer, Sukumar says.

VN:F [1.9.17_1161]
Rating: 5.0/5 (1 vote cast)
No Comments

William Nelson, M.D., Ph.D.

William Nelson, M.D., Ph.D.

“PSA, or prostate specific antigen, is an enzyme that normally appears in the ejaculate or central reproduction but when there’s a cancer present, it leaks into the circulation system so you can detect it in the bloodstream, where it becomes a marker of prostate cancer and other prostate diseases,” explains William G. Nelson, M.D., Ph.D., director of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins. “Studies show that PSA starts to rise many years before prostate cancers are diagnosed, so finding an abnormal PSA that increases year after year might be a hint that prostate cancer is afoot.”

Listen to the Cancer News Review podcast with Dr. Nelson.

VN:F [1.9.17_1161]
Rating: 0.0/5 (0 votes cast)
No Comments

Food PyramidIf the phrase “Meatless Monday” has you staring blankly into your fridge, take heart. There may already be a few “power foods” lurking in there that can help you get your week off to a healthy start, says nutritionist Lynda McIntytre.

Avocado, beans, berries, broccoli, eggs, leeks, nuts, oats, spinach and yogurt make the top ten power list for McIntyre, R.D., L.D., a clinical dietician specialist at the Johns Hopkins Kimmel Cancer Center, along with spices such as cinnamon, ginger and turmeric.

“Power foods are foods that naturally contain vitamins, minerals and other nutritional benefits,” McIntyre explains. “They can energize you, boost your immune system and help you ward off disease. And incorporating these foods into your diet is a simple way to maintain a healthy lifestyle.”

McIntyre works with cancer patients before and after their diagnoses, and she recommends these power foods to them to help prevent cancer recurrence. But a diet full of these power foods contains the kinds of antioxidant and anti-inflammatory components that nutritionists also recommend to prevent other illnesses including diabetes, stroke, and heart disease, she says. Antioxidants in foods like blueberries, for instance, help to subdue damaging molecules in the body called free radicals that can make cells more vulnerable to cancer or heart disease.

And if you’re thinking a multivitamin might provide all these benefits without a trip to the produce section, think again, says McIntyre. “Eating the whole food insures that you are getting all the vitamins, minerals, fiber and nutrients important to health. It’s the synergy of all the nutrients in whole foods that work together to improve health.”

McIntyre’s power list has a few items that might surprise you, like eggs. “In the not-so-recent past, eggs were thought to increase cholesterol, but recent studies have proven this wrong,” she says. “Eggs are a power food that is versatile, inexpensive and a perfect source of protein for a Meatless Monday.”

“More people should include avocado in their diets regularly,” she adds. “Many people don’t include this food because they believe they are high in fat and therefore not healthy. But the fat in avocado is a very healthy form of fat, and eating this food with other power foods--like carrots dipped in guacamole, for example—helps increase the absorption of nutrients in those power foods.”

The Meatless Monday idea has been around for a little more than a decade, exploding in popularity and how observed by many in over 36 countries, McIntyre says.

“Meatless Monday is brilliant in its simplicity. It doesn’t ask a lot from you and the benefits to your health, the environment, and your wallet are significant,” McIntyre says. “The idea is simple: don’t eat meat on Mondays. That’s it. It is a small change in the way you eat, just one day a week, that brings about big benefits.”

VN:F [1.9.17_1161]
Rating: 0.0/5 (0 votes cast)
No Comments

William Nelson, M.D., Ph.D.

William Nelson, M.D., Ph.D.

“If you look at the overall incidence of cancer in the U.S., 80% of all cancers are diagnosed in people older than 60, and 30% of cancers are diagnosed in people older than 80, so in general, more cancers appear in people as they get older,” explains William G. Nelson, M.D., Ph.D., director of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins. “Screening men in their 50s for colorectal and prostate cancers makes sense because that’s when these diseases generally start to appear. There are certain populations of men who are more prone to develop these cancers. Many believe African-American men might be better starting screening at age 45 because their risk of dying of prostate cancer is about 1.7 times the risk of Caucasians. Men with a strong family history of prostate cancer also should consider PSA screening before age 50.”

Listen to the Cancer News Review podcast with Dr. Nelson.

VN:F [1.9.17_1161]
Rating: 0.0/5 (0 votes cast)
No Comments