--This post was written by lung cancer expert Dr. Phillip Dennis.

Lung cancer is the most deadly cancer in the United States and will kill over 200,000 Americans this year. Deaths from lung cancer exceed the number of deaths from breast cancer, prostate cancer, and colon cancer combined. The high mortality of lung cancer is related to the fact that lung cancer is often diagnosed at a late stage when it is incurable. Today’s draft recommendation of annual low dose chest CT scans for lung cancer screening in high-risk individuals by the USPSTF is a milestone in health care, because screening for lung cancer is more likely to discover cancer when it is at a curable stage.  This will prevent thousands of deaths in the United States every year.  The benefits of lives saved by screening far exceed concerns over radiation exposure and costs of medical procedures needed to diagnose an abnormality seen on CT scan. We expect that the demand for screening will increase once the Center for Medicare and Medicaid and insurance companies offer coverage, which should follow the USPSTF recommendation. 

At Johns Hopkins, we specialize in understanding an individual’s risk for lung cancer that is based on family history, occupational exposures, as well as smoking history. We have an established lung cancer screening clinic that is staffed by professionals from several disciplines, including radiologists that specialize in chest and lung imaging, pulmonary medicine, medical oncology, and thoracic surgery.  If we discover an abnormality on chest CT, we arrange for individualized follow up to make sure you receive the best care possible, so that if you have lung cancer you have the best chance of being cured. To discuss your own risks for lung cancer and make an appointment with our team, please call 410-955-LUNG (955-5864).

Phillip A. Dennis, M.D., Ph.D.
Director, Center of Excellence for Thoracic Oncology at Johns Hopkins
Director, Department of Oncology at Johns Hopkins Bayview

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This blog is part 3 of 4 of our "Gene" Fridays series on cancer genetics.

To help people understand the complexity of cancer and the series of genetic events that lead to its formation, Dr. Bert Vogelstein built upon the encyclopedia analogy. “Each of us has an encyclopedia in our cells, and each page of that encyclopedia represents one gene,” explains Dr. Vogelstein.  A set of genetic encyclopedias is comprised of 46 books, and each of these books represents chromosomes—23 books are inherited from our mother and 23 are inherited from our father.  Each “chromosome” book has about 1,000 pages—one for each gene on that chromosome. Every page is filled with about 1500 letters. However, the letters on the “gene” pages are not the 26 A through Z alphabet characters.  Rather, just four characters represent the “gene” alphabet:  A, C, G, and T, an abbreviation for the chemicals that make up genes.

Mistakes that occur in this genetic encyclopedia are like transposed letters.  For example, if a book contains letters to form the word “feet,” it means one thing to the reader.  If two letters are transposed, and the word appears as “fete,” it means something altogether different.  The same is true of the characters that make up the genetic alphabet. The cancer cell genome may have an “A” instead of a “C” or a “G” instead of a “T.”  This, he says is a mutation, and when they occur, it changes the way a cell interprets its instructions, and as a result, how it behaves.

A few other errors can occur.  Sometimes a page is repeated, in a process known as gene amplification.  In other cases, the page is missing.  This is a genetic deletion.  Dr. Vogelstein says of these possible errors, by far the most common is the typographical character transpositions known as mutations.

Save for these approximate 50 errors among the millions of characters that make up the genes, cancer cells are nearly identical to normal cells, and that is what makes cancer such a complex disease.  Teasing out these errors from a sea of normal cells confounds both scientists and the human body’s own checks and balances.

Consider bacteria, says Dr. Vogelstein.  Bacterial infections are easily recognized by the body’s immune system and treatable with drugs known as antibiotics.  The reason, he says, is that bacterial genomes are vastly different than the human genome.  Bacteria have 1,000 to 2,000 genes as opposed to the 20,000 or so genes in the human genome.  These differences make it possible to develop drugs that target genes made by bacteria and impact infections without affecting the genes of human cells.

“In cancer, 19,950 genes are the same in most cases, and the other 50 have just slight changes to distinguish them from normal cells,” says Dr. Vogelstein.  To further complicate matters, “Two cancers can be from the same organ, look similar under the microscope, but genetically they are distinct.” That is why therapies that work in one patient may not work in another.

Part One: Understanding Cancer Genetics

Part Two: No Two Cancers are the Same

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This blog is part 2 of 4 of our "Gene" Fridays series on cancer genetics.

Pancreas cancer was one of the first cancer genomes Dr. Bert Vogelstein and team deciphered.  For this study, the scientists examined 24 pancreas cancers and determined the sequence of all of the genes in these cancers.  On average, they found just 50 mutations (genetic mistakes that are present only in cancer cells) among the 20,000 genes in each cell. Other than these 50 differences, the genes in the cancer cell were identical to those in normal cells. It is no wonder then that progress has come slower than the public would like and that general curative treatments have been elusive.  These studies also revealed a complexity that no one had anticipated. The 50 or so changes that lead to cancer are not consistent.  While every cancer has a similar number of alterations, not every cancer has the same 50 alterations. They vary from patient to patient. “No two cancers are exactly the same,” says Dr. Vogelstein.   The difficulty of the work the Vogelstein team accomplished to find these rare changes has been likened to finding a few critical typographical errors within 20 volumes of Encyclopedia Britannica and then figuring out how they got there.

Part One: Understanding Cancer Genetics

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This blog is part 1 of 4 of our "Gene" Fridays series on cancer genetics.

There is no one better suited to explain the intricacies of cancer genetics than Dr. Bert Vogelstein.  He and his team completed the lion’s share of the work that proved that cancer is a genetic disease caused by an accumulation of genetic defects—some inherited at birth and some acquired throughout life.

His more than three decades of research is universally regarded as the most relevant in the field. In the 1980s, without the benefit of today’s automated gene sequencing technology, Dr. Vogelstein, Dr. Kenneth Kinzler, and their team of bright young researchers began uncovering the collection of genetic errors that make cancers originate, grow, and finally spread.

Then in the last six years, they went a step beyond, accomplishing something that would have been impossible just a decade ago. They identified the precise sequence of all the genes in a cancer cell, encompassing more than 30 million base pairs of DNA.  This accomplishment caught the scientific world by storm and has opened new vistas of research.

Since Hopkins investigators completed the first genetic blueprints of cancers in 2006 and 2008, many other research teams have built upon their pioneering discoveries, which are considered the classic model for all of cancer medicine, and applied their methods to other cancers.  “As a result, all of the major tumor types and also some rare cancers have now been analyzed,” says Dr. Vogelstein.  Answers that remained elusive for decades have now been revealed.

We'll explain,  in easy to understand terms, the importance of these cancer genetics discoveries in managing cancer and preventing cancer deaths in this four-part series Understanding Cancer Genetics.

Look for these future blogs on the next four Fridays this month:
No Two Cancers are the Same:  Learn why two patients with seemingly identical cancers have very different responses to treatment.

The Encyclopedia Analogy:  Inside the DNA of each cell is an encyclopedia of information that instructs the cell how to behave. Learn how errors in the encyclopedia cause cancer and what scientists are doingto correct them.

Personalized, Genome-Based Medicine:  Now that scientists have unraveled the genetic mistakes driving cancer, we'll tell you how they're using what they've learned to create better treatments and new tests that have the potential to prevent cancer deaths.

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This is Part Two of a series on nutrition for breast cancer patients.

Nutrition is a vital component of your breast cancer treatment, says Hopkins Kimmel Cancer Center nutritionist Mary Eve Brown. “Nutrition helps you maintain your weight and your strength during treatment,” she says.

Brown recommends partnering with a registered dietitian to manage your symptoms. The Academy of Nutrition and Dietetics website, eatright.org, lets you enter your zip code to find all the registered dietitians in your area, along with their specialty. A registered dietitian can help you come up with a food plan that lets you manage side effects while maintaining good nutrition, and you can find oncology dietitians.

You can find out more about nutrition and your breast cancer journey in Brown’s recent free webinar, What’s Food Got to Do With It? Eating Well Before, During and After Treatment.

Part One:
When do breast cancer survivors use nutrition in their cancer journey?

More from Mary Eve Brown:
Colon Cancer and Nutrition
Pancreatic Cancer and Nutrition

This blog post was prepared by Denise Graveline, a communications and social media consultant based in Washington, DC.

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Combination therapy quote from Bert VogelsteinIt is a fait accompli. Advanced cancers are destined to recur, and drug resistance to single agents is determined simply by how long it takes cancer cells with mutant genes to multiply. That's what a Johns Hopkins team of scientists announced last year when they published findings of experiments with targeted cancer therapies.

To overcome drug resistance and the eventual recurrence of cancer, Johns Hopkins' Bert Vogelstein and colleagues found that the best combination is to give two or more drugs together, not sequentially, as is often the tactic, but all at once. Vogelstein and colleagues from Harvard published recent findings in the journal eLife.

The idea, itself, is not new. I've listened to many scientist and clinicians debate the potential merits of multi-drug combination therapies. The new research is, in my opinion, an elegant demonstration of why we need to test it further. But, as Carl Zimmer points out in his article in the New York Times, the road to incorporating this strategy into more clinical trials and, hopefully, standard care, may be long and difficult. Let's hope we can defy the norm and give cancer the one-two punch it needs. Share this post if you agree.

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This is Part One of a series on nutrition for breast cancer patients.

It’s never too early to start thinking about nutrition when you have breast cancer. Whether your treatment is yet to happen, just beginning, or already underway, nutrition is an important support system for your body.

Hopkins Kimmel Cancer Center nutritionist Mary Eve Brown suggests you start with hydration, warning that it’s “not one size fits all." Your weight determines how much water you will need to become hydrated, so Brown offers this easy formula: Divide your weight by 2.2 to get your hydration level in ounces to consume per day. That’s the minimal amount to drink per day, so you may need to think about how to add hydration to your day. Other steps Brown recommends for cancer patients beginning their treatment include:

• Gather your friends and family and let them know how they can help: Tell them “I’m beginning treatment and I can use your help to stay nourished.” Ask for help with preparing food, stocking up on water, and stocking your pantry with nutritious foods.
• Think about equipment: Brown suggests you consider an immersion blender—a handheld device that can blend soups or smoothies right in the cup, pot or bowl in which you’re preparing them. It’s easy to use and can help motivate you to prepare these useful dishes, or to prepare individual portions of these dishes.
• Think about how you will become active: In addition to nutrition, physical activity can be an important part of your treatment. Work with a professional to design a program that will be safe for you, based on your specific diagnosis and treatment. Brown notes that the cancer center’s physical medicine department specializes in physical recovery, and can help you develop a safe program.

You can find out more about nutrition and your breast cancer journey in Brown’s recent free webinar, What’s Food Got to Do With It? Eating Well Before, During and After Treatment.

Part Two: What nutrition can contribute to breast cancer patients
Part Three: How to manage breast cancer treatment side effects with nutrition: Sore mouth, taste changes and nausea
Part Four: Breast cancer patients may need a management game plan for diarrhea
Part Five: The breast cancer patient’s management game plan for constipation
Part Six: The breast cancer patient’s management game plan for weight loss
Part Seven: Nutrition after therapy: How breast cancer patients can create a prevention diet
Part Eight: What about supplements? Nutrition advice for breast cancer patients
Part Nine: Do organic foods help breast cancer patients?

More from Mary Eve Brown:
Colon Cancer and Nutrition
Pancreatic Cancer and Nutrition

This blog post was prepared by Denise Graveline, a communications and social media consultant based in Washington, DC.

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Kimmel in the Community
Kimmel Cancer Center employees at the Living Classrooms Foundation

A “Kimmel in the Community” team spent the afternoon on May 29, 2013, at the Living Classrooms Foundation on Caroline Street in East Baltimore and helped clean up its East Harbor campus.  As part of the Kimmel Cancer Center’s 40th anniversary celebration, the volunteers, led by Center Director Dr. Bill Nelson, walked the campus and traveled its waterways in paddleboats, nets in hand, and removed more than a dozen bags of garbage from the campus’ wetlands.

Read more about the Kimmel Cancer Center's 40th Anniversary.

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Last week's U.S. Supreme Court decision on Myriad's breast cancer gene patents sparked many comments from patients, the public and scientists. Here's what several Johns Hopkins experts had to say about the topic:

"I am thrilled with the Supreme Court's unanimous decision to overturn gene patents.  This was the only choice and will open up opportunities for patients, health care providers and the research community." 

Ada Hamosh, MD, MPH
Dr. Frank V. Sutland Professor
McKusick-Nathans Institute of Genetic Medicine
Johns Hopkins University

"After all this time, it is gratifying that the US Supreme Court has ruled 9-0 that gene patents are invalid because they are products of nature. At the same time, the Court has taken a middle ground by ruling that patents on complementary DNA or cDNA are still valid. I would respectfully disagree with the latter ruling because complementary DNAs makes up about 1% of our genome as processed pseudogenes, and are also natural products. However, the decision is a real victory for the public because it opens up competition in gene testing for inherited disease. This should lower the price of testing for BRCA1 and BRCA 2 and allow for second opinions on test results. Since the ruling does not affect the patenting of process or use of genes, the biotech industry will still be able to patent their innovations arising from the knowledge of gene sequences and their functions."

Haig H. Kazazian, Jr.
Professor
Johns Hopkins University School of Medicine

"Like every controversial topic, there are pros and cons that have to be considered with the Supreme Court's decision regarding patenting of genes and specifically for the BRCA1 and 2 genes isolated and patented by Myriad Genetics. At its heart, this is a good thing for patients as it will allow for more options in the future, and indeed competition and laws preventing monopolies generally have been met with enthusiasm from consumers, businesses and politicians as it can lead to decreased costs and increased quality.  Arguments have also been made that this will "free up" the scientific process leading to more productive research for the betterment of public health. This may or may not be true, as the potential downside of the patent ruling is whether this will stifle scientific creativity and development due to fears of not being able to recoup initial investments into research as others have argued.  For now, the decision has been made, and it is likely that this will lead to increased competition for Myriad Genetics but the true impact remains to be seen. It should also be noted that while the Supreme Court's decision clearly stated that naturally occurring genes cannot be patented, synthetic DNA often created in the lab from mRNA (and a surrogate measure of the protein coding sequences of a gene) can in fact still be patented because they are not naturally occurring.  This leaves some intellectual freedom and space on how entities could still lay claims to gene products that are produced in the lab."

Ben Ho Park, M.D., Ph.D.
Associate Professor of Oncology, Breast Cancer Program
Associate Director, Hematology/Oncology Fellowship Training Program
The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins

 What do you think? Tell us by adding your comments.

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Joining forces to beat childhood cancer and raise awareness, Johns Hopkins Pediatric Oncology, along with other cancer-related organizations, have been selected by World Wide Motion Pictures Corporation to receive a portion of the box-office proceeds from the North American release of the upcoming film, Ways to Live Forever.

According to the film's trailer, "12-year old Sam has leukemia, and although the adults in his life don’t want him to dwell on it, Sam wants to know everything about his disease and death, a possibility he might face. Together with his best friend, Felix, he embarks on a "scientific investigation" with questions, observations, evidence, reflections, and lists of all the things he wants to do someday -- like breaking a world record, flying in a blimp, kissing a girl for the first time, and experiencing what it’s like to be a teenager. They discuss ways they could live forever."

When you first think about it, living forever might seem like a blessing. You would never worry about death and could continue living life each day without worry of injury or illnesses that could possibly harm you. However, living forever, of course, has its downfalls. For one, you would out-live all of your loved ones and celebrations such as anniversaries and birthdays wouldn’t seem so special. Carpe Diem would have a different meaning and, in a sense, life would be taken for granted.

Besides the obvious meaning of "living forever," there are other symbolic ways to achieve the same thing. What kind of legacy do you want to leave for future generations?  It’s not often a question you think of, but how would you live forever?

Hear Sam’s thoughts on living forever in the film, Ways to Live Forever, which opens in theatres July 19-21.

More information the film, Ways to Live Forever.

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