Cancer Diagnosis from a Blood Draw? Liquid Biopsies Are Still a Dream

Nick Papadopoulos tracks down tumors for a living. Not with X-rays or CT scans, but with DNA. The oncologist and director of translational genetics at the Johns Hopkins Kimmel Cancer Center has spent decades uncovering the unique sets of mutations that define cancers—the kind of genetic signals that not only drive tumor formation and metastasis, but distinguish one cancer from another. And now, he’s working to develop a test that could sniff out those signals before a patient starts to get sick.

It’s the kind of test that Papadopoulos thinks could have saved his uncle’s life, had it been around a few years ago. “He had no symptoms until a cough showed up,” he says. But when it didn’t go away he went in for an X-ray, and there on the radiograph were the lesions. Dozens of them, filling his entire chest cavity. The doctors sequenced the tumors, and got him signed up for a clinical trial for a new, targeted drug. It worked for a few of them, shrinking them back to almost nothing. But the rest developed resistance.

“He was supposed to only live two months, and the drugs prolonged his life by a year. But that year wasn’t good.” says Papadopoulos. “I think it’s time to start thinking more about detecting cancers early and less about treating them when they are late.”

On Thursday, Papadopoulos’ research group at Hopkins revealed a novel blood test based on the combined analysis of DNA and proteins that correctly detected eight kinds of the most common cancers with a range of accuracies—from 98 percent for ovarian cancers to less than 40 percent for breast cancers. Published in Science, the test is just one among many so-called “liquid biopsies” in development; noninvasive tests that classify cancers by identifying the tiny bits of DNA that tumors shed into the bloodstream.

Most published studies, including this one, focus on measuring and monitoring advanced tumor stages. A few liquid biopsies have even been approved to help match tumors to targeted drugs. But the dream is to develop a simple blood test to actually diagnose solid tumors in healthy-looking people. The scarcity of circulating cancer biomarkers (both in quality and quantity; tumor DNA makes up less than 0.1 percent of blood) has held those aspirations back for decades. But now, sensitive assays and computational platforms are driving the discovery of biomarkers and better ways to measure them, luring a pack of well-financed startups into the field.

In 2016, for example, the world’s largest sequencing company, San Diego-based Illumina, spun out a new company called Grail. Its mission is described as “detecting cancer early, when it can be cured.” This ambitious aim is supported by $1.2 billion of venture capital Grail raised last year, which it intends to put toward financing massive, population-based clinical studies and optimizing its sensitive sequencing technologies.

Grail has yet to publish any actual data (its website does advertise a commentary published in Cell last year). And neither has its chief rival in the Valley, a machine learning startup called Freenome. That three-year old company snagged a $65 million Series A last March, led by Andreessen Horowitz. Freenome isn’t limiting itself to the genetic breadcrumbs left by tumor cells—it looks to capture other disease signatures in the blood, like how the immune system changes in response to tumor microenvironments.

Of course, Freenome has offered scant details on how exactly that kind of test would work. “You show your cards at the end, not while you’re playing poker,” says Andreessen partner Vijay Pande, who heads the investment firm’s biofunds. “Publications indicate that you’re not interested in building a company.” That said, he does expect Freenome to publish in a peer-reviewed journal ahead of its first foray into the market.

When that could be, though, is anyone’s guess. To evaluate any of these blood screens, thousands of patients will have to get tested—and then researchers will have to wait for some of them to actually get cancer. That’s the only way to determine not only their predictive power, but also whether they lead to improved patient outcomes. The noninvasive screening tests available today—mammography for breast cancer, a protein-measuring test for prostate cancer—are rife with their own issues. Incorrect diagnoses waste time and money on treatments and burden patients with unnecessary anxiety.

Liquid biopsy is likely to be beset by the same kinds of controversy, says Geoff Oxnard, a thoracic oncologist at the Dana-Farber Cancer Institute and a professor at Harvard Medical School. He routinely uses a single-gene liquid biopsy developed at Dana Farber to figure out which drugs represent the best options for his lung cancer patients. But will early detection versions one day be part of routine doctor’s visits? “No. I think these tests will help us better understand the risks for patients who already have a history of cancer in their family or who’ve already had something show up on a scan,” he says. “But I don’t think we have the kind of data we need to support liquid biopsy as a panacea for diagnosing cancer. At the end of the day, it’s still just a shortcut.”

Still, Oxnard pointed out that Papadopoulos’s test represents an important step forward. One, it starts to identify where a tumor might be located. That’s been a big limitation of liquid biopsies; OK, you’ve found cancer, but what do you do next? Where do you look for the tumor? Most mutations don’t tell you anything about location. But by layering in measurements for 31 additional proteins to their machine learning model, the Hopkins team was able, on the first try, to correctly identify the tissue of origin around 80 percent of the time colorectal cancers, pancreatic, and ovarian cancers.

The other advance is cost. Papadopoulos estimates the test could be commercialized for around $500, and cancer-spotting approaches that rely on ultra-deep sequencing could stretch costs for existing screening tests, which only look for a single gene. “This is great for the field and provides promise that these analyses will become a reality in the clinic,” says Victor Velculescu, an oncologist and colleague of Papadopoulos’ at Johns Hopkins, who has also developed liquid biopsy technologies, though he was not involved in the Science study.

The two have developed a sort of friendly turf war as they’ve turned Baltimore into its own little liquid biopsy hub. Both researchers have recently spun off diagnostics companies to further develop their own early detection technology platforms. Earlier this month, Velculescu’s venture, Personal Genome Diagnostics, hauled in a $75 million Series B led by pharma giant Bristol-Myers Squibb. That brings its total financing to $99 million, putting it on par with some of its better-known counterparts in the Valley, adding some bicoastal intrigue to the race to the market. Whatever the outcome, it’s patients who will ultimately be the winners.

“If it can even catch 50 percent of cancers that right now we have no way of screening for, that’s still 50 percent of patients who can now be treated in Stage 1, when they still have a chance,” says Papadopoulos. “It doesn’t have to be perfect to still save a lot of lives.”

Read more: https://www.wired.com/story/cancer-diagnosis-from-a-blood-draw-liquid-biopsies-are-still-a-dream/

I have cancer. Don’t tell me you’re sorry | Elizabeth Wurtzel

Everyone else can hate cancer. I dont. Everyone else can be afraid of cancer. I am not, writes Elizabeth Wurtzel

I have cancer. Don’t tell me you’re sorry

Everyone else can hate cancer. I dont. Everyone else can be afraid of cancer. I am not, writes Elizabeth Wurtzel

Read more: https://www.theguardian.com/commentisfree/2018/jan/20/cancer-elizabeth-wurtzel

Is marijuana a medical miracle? The truth is, we still don’t know

Whats the evidence behind medical cannabis? While many attest to its healing powers, research into the full potential has long been legally restricted

Is marijuana a medical miracle? The truth is, we still don’t know

Is marijuana a medical miracle? The truth is, we still don’t know

Whats the evidence behind medical cannabis? While many attest to its healing powers, research into the full potential has long been legally restricted

Read more: https://www.theguardian.com/society/2018/jan/15/medical-marijuana-does-it-work-miracle-drug-evidence

‘Best diets’ ranking puts keto last, DASH first

(CNN)If you’re a fan of the “fat-burning” keto diet, you’ll be fired up about its ranking in the 2018 list of best diets from US News and World Report: It’s tied for last, along with the relatively unknown Dukan diet.

Both stress eating a ton of protein and minimal carbs, putting the dieter into “ketosis,” when the body breaks down both ingested and stored body fat into ketones, which it uses as energy. People on such diets often deal with fatigue and light-headedness as they adjust to a lack of carbohydrates.
Though the experts on the US News and World Report panel that created the list said eating that way isn’t harmful short-term, they ranked the diets poorly on long-term weight loss success, ease of use and overall impact on health.
    For the relatively new keto diet, the experts were especially concerned about extremely high fat content — about 70% of daily calorie intake — as well as unusually low carbohydrate levels: only 15 to 20 net carbs a day. The 2015-20 dietary guidelines for Americans suggest that 45% to 65% of daily calories come from carbs but less than 10% from saturated fat.
    “When you are on the keto diet, you drastically cut your carbs to only 20 per day. That’s less than one apple!” said nutritionist Lisa Drayer, a CNN contributor. “The keto diet is just not sustainable over the long term. It doesn’t teach you how to acquire healthy eating habits. It’s good for a quick fix, but most people I know can hardly give up pasta and bread, let alone beans and fruit.”
    The expert panel was particularly concerned for people with liver or kidney conditions, “who should avoid it altogether,” the report said, adding that there was not enough evidence to know whether the diet would help those with heart issues or diabetes. Because of the recommended “cycling” nature of the diet, taking breaks and then starting it again, experts also warn that hormones could fluctuate.
    Another popular low-carb diet, Whole30, was also at the bottom of the list, just before keto and Dukan. Whole30 is a 30-day diet designed to end “unhealthy cravings and habits, restore a healthy metabolism, heal your digestive tract and balance your immune system,” according to its website.
    The panel slammed the diet as having “No independent research. Nonsensical claims. Extreme. Restrictive.” and tied it with the raw food diet as “the worst of the worst for healthy eating.”

    First place is a tie

    For the first time, the well-researched Mediterranean diet moved into first place, tied with the DASH diet. DASH, which stands for Dietary Approaches to Stop Hypertension, has held the top spot for eight consecutive years. Both diets also tied for healthiest in the rankings.
    “What I love about both the DASH and Mediterranean diets is that they offer guiding principles for eating, like eating more fruits and vegetables, as well as whole grains, fish, legumes, nuts and low-fat dairy foods,” Drayer said. “I personally love the fact that a daily glass of red wine is encouraged as part of the Mediterranean diet.”
    The DASH diet is often recommended to lower blood pressure. Its premise is simple: Eat more veggies, fruits and low-fat dairy foods while cutting way back on any food high in saturated fat and limit your intake of salt.
    The meal plan includes three whole-grain products each day, four to six servings of vegetables, four to six servings of fruit, two to four servings of dairy products and several servings each of lean meats and nuts/seeds/legumes.
    Studies have shown that following this diet can reduce blood pressure in a matter of weeks.
    The Mediterranean diet also ranked first on the US News and World Report list for easiest diet to follow, best plant-based diet and best diet for diabetes. It came in second for best heart-healthy diet, just behind DASH.
    Meals from the sunny Mediterranean have been linked to stronger bones, a healthier heart, a lower risk of dementia and breast cancer, and longer life, along with a reduced risk for diabetes and high blood pressure.
    The diet emphasizes simple, plant-based cooking, with the majority of each meal focused on fruits and vegetables, whole grains, beans and seeds, with a few nuts and a heavy emphasis on extra virgin olive oil. Say goodbye to refined sugar or flour. Fats other than olive oil, such as butter, are consumed rarely, if at all.
    Meat can make a rare appearance, but usually only to flavor a dish. Meals may include eggs, dairy and poultry, but in much smaller portions than in the traditional Western diet. However, fish are a staple, and an optional glass of wine with dinner is on the menu.
    The flexitarian diet came in third on the list of best overall diets for its emphasis on whole grains, fruits, veggies and plant-based proteins. It’s basically a vegetarian diet that allows the occasional piece of meat or fish, thus making it “flexible.”
    The ever-popular Weight Watchers diet was ranked fourth, followed by the MIND diet, a combination of the Mediterranean and DASH diets that some may find a bit easier to follow, as it requires less fish and fruit.
    Both the MIND diet and the Mediterranean diet have been shown in studies to lower the risk of Alzheimer’s disease.

    Best weight-loss diets

    Weight Watchers topped the list of best weight-loss and best commercial diet plans, and it tied with HMR for best fast weight-loss diet. HMR, the Health Management Resources program, involves purchasing meal replacements, such as shakes, nutrition bars and multigrain cereals, and adding vegetables and fruits to round out the meals.
    Since 2015, Weight Watchers has been focused on its Beyond the Scale program. It is designed to help people move more and focus on overall well-being, including more “me” time, which includes mindfulness and self-compassion.

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    The US News and World Report expert panel — made up of 25 experts from major medical centers across the country — gave Weight Watchers top points for being healthy, also stressing the importance of support for dieters.
    Pointing to a 2006 British Medical Journal study, the panel said that “programs like Weight Watchers that offer emotional support and group meetings lead to higher compliance than a do-it-yourself dieting.”
    Drayer agreed: “I’ve always been a fan of Weight Watchers because it teaches you how to incorporate all types of foods into your diet, and it also offers a support component, which can be extremely beneficial.”
    But whatever diet you choose, she recommends choosing the one that fits your lifestyle and that you can stick to over the long term.
    “I always recommend meeting with a registered dietitian, who can take into account your health history, lifestyle habits, likes and dislikes, and develop an eating plan that is specific to your needs,” she added. “I also recommend checking with your doctor first before starting any new diet plan.”

    Read more: http://www.cnn.com/2018/01/04/health/keto-worst-diet-2018/index.html

    How the hardest year of my life ended my catastrophic thinking

    Worst-case scenario has always been my default setting but complications during pregnancy and an ill mother and partner meant I had to get my anxiety under control

    It is March and I am Googling meningitis again. My partner has caught our sons chicken pox and her symptoms are frightening me. Vice-like headache. Aversion to light. Brain fog. Also, I am pregnant and my habit of catastrophising has sprouted horns, and, pumped up on hormones, my heart is working twice as hard as usual. Nausea is now approaching something more cataclysmic. My phone starts autocorrecting morning to meningitis. I become convinced that my partner has developed brain swelling, a rare complication of chicken pox. From here, it is a short step to picturing her dying and me giving birth alone, letting the worst case scenario in like an old friend.

    The thing is, this time I am right. Sort of. She does have meningitis. The GP takes one look at her and sends her up to the infectious diseases ward in a taxi. I feel a tiny bit triumphant in the way only catastrophisers can. See? I told you. The worst has happened! But Im also wrong: a tiny wad of catastrophe may have been fired at us, but my partner does not die and I do not give birth alone. She recovers. The baby is born. We are lucky again.

    Time and again during the hardest year of my life (to date, the catastrophiser in me would like to qualify), my habit of fearing that the worst will happen got, well, worse. I dont know when it began, so peculiarly subtle is the feeling that the most likely outcome is the really bad one. But last year some of my most calamitous predictionscame true, at least in part. The realisation that I needed to do something about it came when my partner, who is a psychotherapist, arrived home with a book. I saw this and thought of you, she said. It was called Why Does Everything Always Go Wrong?. I laughed a bit too hard. The truth is, there was a lot to catastrophise about last year, on a global, national and personal level.

    Just before the meningitis episode I discovered that the baby I was carrying was high risk for Downs syndrome. While we awaited more results, my pregnancy was reduced to a series of statistics one-in-58 chance of Downs, one-in-100 risk of miscarriage with amniocentesis and I grappled with the fact that someone has to be the one. In fact, I already knew what it was to be the one, because my son is autistic and, actually, we are all coping brilliantly; being the one is not a catastrophe once you are living it.

    But catastrophising does not give a damn about hard evidence and I remained terrified. A fortnight later, the results came in: the chance of the baby having Downs was vastly reduced, to one in 10,000. It occurred to me that catastrophising is more than just a destructive habit: sometimes it is a reasonable response to what is happening, a kind of mental preparation.

    In April, my mother, who is incurably ill with breast cancer, got pneumonia and ended up in A&E. She asked to see my sister and I, so I rushed to London from Edinburgh, five months pregnant, with a daughter (and dread) somersaulting in my belly. I feared the distress would make me lose the baby and I thought my mother was going to die. Catastrophisers have a habit of thinking a person is dead if they are half an hour late, so a situation like this suits our sense of drama perfectly. My mother recovered. We continued to live with the deep uncertainty that comes with scans every three months and the neverending wait for results. Each time, I prepared myself for the worst. Maybe this is not a habit to be broken, but a coping mechanism.

    By June, I had to make a major decision that provided an opportunity to see whether I could nix the catastrophising: how to have my baby. My son, who is four, was born by emergency C-section and so I was offered an elective caesarean. I saw a consultant who ran through the risks I faced if I attempted a natural birth without constant foetal monitoring and a cannula in my hand. I decided to laugh or, at least, get off my head on laughing gas in the face of potential catastrophe and attempted a natural birth on my own terms. I hired a doula to support me in hospital and here is a first hoped for the best.

    In August, my daughter was born 45 minutes after I arrived in hospital. It was a short, fierce and mind-blowing natural labour. It was not perfect I had an episiotomy and there was a minor Strep B scare that meant we ended up in A&E twice in the first week after her birth but it was one of the best days of my life (to date, the optimist in me would like to qualify).

    How am I trying to break my habit of catastrophising? Not by deep breathing, yoga, therapy, drugs or imagining all the catastrophes I fear floating away down a river. Talking and thinking have helped in the daily maintenance of perspective, which is catastrophisings greatest enemy. Has this year been about the worst happening (and I write this a week after my beloved dog has had four tumours removed from her powerful, young body) or about a series of narrow escapes? Is it about bad luck or survival? After all, my partner recovered. The baby is perfect. My mother is still here. The dog is walking off the lead again. We are lucky.

    Catastrophising is dependent on you never being in the moment: it constantly shoves you up against an unknowable, uncontrollable future. Once you go there, you are lost. Parenting, so often a source of anxiety, has been the best antidote to this. The hard graft and small, pure joys of looking after a baby and a little boy with autism anchor me to the present. The baby keeps me healthy, makes me feel lucky and gives me a constant dose of perspective. She is also exhausting: I am too tired and busy to catastrophise with as much fervour as the habit demands.

    Then there is my brilliantly singular, loving and brave son. Before he was diagnosed with autism (that happened this year, too) I feared this moment: how will we manage? What will we do about school? How will he develop? Is everything going to be OK? The mystery and idiosyncrasy of autism can be frustrating, but it is also a visceral reminder that none of us knows what lies ahead and that compassion is the most powerful weapon against anxiety. So, here I am, living and thriving in the future over which I once catastrophised. And you know what? It is not so scary after all.

    Read more: https://www.theguardian.com/lifeandstyle/2017/dec/29/hardest-year-my-life-ended-catastrophic-thinking-anxiety

    Opioids now kill more people than breast cancer

    (CNN)More than 63,600 lives were lost to drug overdose in 2016, the most lethal year yet of the drug overdose epidemic, according to a new report from the National Center for Health Statistics, part of the US Centers for Disease Control and Prevention.

    Most of those deaths involved opioids, a family of painkillers including illicit heroin and fentanyl as well as legally prescribed medications such as oxycodone and hydrocodone. In 2016 alone, 42,249 US drug fatalities — 66% of the total — involved opioids, the report says. That’s over a thousand more than the 41,070 Americans who die from breast cancer every year.

    Much of the increase was driven by the rise in illicit synthetic opioids like fentanyl and tramadol. The rate of deadly overdoses from synthetic opioids other than methadone has skyrocketed an average of 88% each year since 2013; it more than doubled in 2016 to 19,413, from 9,580 in 2015.
      Heroin also continues to be a problem, the report says. Since 2014, the rate of heroin overdose deaths has jumped an average of 19% each year.
      The opioid crisis has raised significant awareness of prescription painkillers. Between 1999 and 2009, the rate of overdoses from such drugs rose 13% annually, but the increase has since slowed to 3% per year.
      In 2009, prescription narcotics were involved in 26% of all fatal drug overdoses, while heroin was involved in 9% and synthetics were involved in just 8%. By comparison, in 2016, prescription drugs were involved in 23% of all deadly overdoses. But heroin is now implicated in about a quarter of all drug fatalities, and synthetic opioids play a role in nearly a third.
      These increases have contributed to a shortening of the US life expectancy for a second year in a row.

      A state-by-state look

      The states with the highest rates of overdosein 2016were West Virginia, Ohio and New Hampshire, the report said. The rate of overdose in West Virginia was over 2.5 times the national average of 19.8 overdose deaths for every 100,000 people.
      While the outlook nationwide is fairly bleak, it’s particularly bad in some states. Twenty-two states and the District of Columbia had overdose rates significantly higher than the national average.
      While overdose rates increased in all age groups, rises were most significant in those between the ages of 25 and 54.
      Provisional data for 2017 from the CDC show no signs of the epidemic abating, with an estimate of more than 66,000 overdose deaths for the year. “Based on what we’re seeing, it doesn’t look like it’s getting any better,” said Bob Anderson, chief of the mortality statistics branch at the National Center for Health Statistics.
      He said the data for this year were still incomplete because of the time it takes to conduct death and toxicology investigations. However, Anderson says, the 2017 estimates are alarming. “The fact that the data is incomplete and they represent an increase is concerning,” he said.
      But addiction specialist Dr. Andrew Kolodny said that despite the devastating overdose numbers, there appeared to be some indicators of good news.
      “Even though deaths are going up among people who are addicted heroin users, who use black-market opioids … it’s possible that we are preventing less people from becoming addicted through better prescribing,” said Kolodny, executive director of Physicians for Responsible Opioid Prescribing.
      Studies have shown that while rates of opioid prescribing remain high in the US, they have decreased from a peak of 81 prescriptions for every 100 people in 2010 to about 70 per 100. Kolodny also pointed to recent surveys indicating that opioids were being less-frequently abused by teens.

      A public health emergency

      In October, President Trump declared the opioid crisis a public health emergency. “As Americans, we cannot allow this to continue. It is time to liberate our communities from this scourge of drug addiction,” he said. “We can be the generation that ends the opioid epidemic.”
      The week following, the President’s Commission on Combating Drug Addiction issued its final report with more than 50 recommendations to help solve the opioid crisis, including expanding medicated assisted treatment, increasing the number of drug courts, coordinating electronic health records and increasing prescriber education.
      However, Kolodny and other public health experts were disappointed that the actions by the president and the commission were not accompanied by funds.
      “You don’t call it an emergency and sit around do nothing about it — and that’s where we are,” Kolodny said. “The doing something should be a plan from the agencies … and it should be seeking money from Congress.”
      Commission member and former Rep. Patrick Kennedy agreed. “It means nothing if it has no funding to push it forward. You can’t just have a speech like the President gave.”

      But fellow commission member Bertha Madras said that funding requests can’t be immediately answered and pointed out that the White House is working with agencies now to determine costs and processes to implement the group’s recommendations. “The commitment has to be accompanied by wise decisions and wise planning and a very judicious use of funding,” she said.
      The White House’s Council of Economic Advisers recently estimated that the cost of the opioid crisis in 2015 alone was $504 billion, nearly 3% of gross domestic product.

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      Kennedy worries that the tax bill passed this week will only worsen the crisis. “It’s going to be the vote that sets this country back further than anything else in our ability to tackle this crisis. Period. There’s going to be no more significant vote on opioids.”
      The bill, which is now headed to the President’s desk to be signed into law, eliminates provisions of the individual mandate or penalties for being uninsured that were required under Obamacare. Once it is enacted, the nonpartisan Congressional Budge Office estimates, 13 million individuals will be uninsured by 2027, and health insurance premiums will go up. According to the 2016 Surgeon General’s Report on Alcohol, Drugs, and Health, 30% of Americans do not seek any sort of addiction treatment because they do not have insurance and cannot afford treatment.
      “We’ve got a human addiction tsunami. We need all hands on deck,” Kennedy said.

      Read more: http://www.cnn.com/2017/12/21/health/drug-overdoses-2016-final-numbers/index.html

      Birth control still linked to increased risk of breast cancer

      (CNN)Birth control can increase a woman’s risk of breast cancer by up to 38%, depending on how long she has taken it, a new study finds.

      The risk was associated with all forms of hormonal contraception — such as the pill, injections or IUDs — when compared with women who have never used them.
      Researchers from the University of Copenhagen analyzed data from 1.8 million women under the age of 50 in Denmark. They followed the women for nearly 11 years, on average.
        The level of breast cancer risk increased the longer a woman had been taking hormonal contraceptives, with the average risk increase being 20% among all current and recent users of these forms of contraceptives.
        The researchers saw a 9% increased breast cancer risk among women taking hormonal contraceptives for under a year, rising to 38% if more than 10 years.
        Among women who had been using hormonal contraceptives for more than five years, a slight risk persisted for at least five years after they stopped, according to the study published Wednesday in the New England Journal of Medicine.
        The results suggested a “rapid disappearance of excess risk of breast cancer after discontinuation of use among women who have used hormonal contraceptives for short periods,” the authors write in the paper. The authors noted that other studies have found no evidence of a persistent risk.
        In an accompanying editorial, David Hunter, professor of epidemiology and medicine at the Nuffield Department of Population Health in the UK, said that the link between oral contraceptives and breast cancer is already well-established. However, this new study is important because it looked at newer preparations of contraceptives, he told CNN.
        “These results do not suggest that any particular preparation is free of risk,” he wrote in the editorial.
        However, Hunter also stresses that “breast cancer remains a relatively rare disease in younger women.” In women under 35 included in the study, taking hormonal contraceptives for less than one year resulted in 1 extra case per 50,000 women, he said.
        “The number of cases increases with age because the risk of breast cancer increased with age,” said Hunter.
        Hunter also adds that the persistent risk found in the study “should be regarded as preliminary,” with the increase unlikely to be significant when other factors, such as different durations of use and time since last use, are accounted for.
        “The risk does decline over time since ceasing their use,” said Hunter, highlighting that once women reach the age when breast cancer rates peak — ages 50 to 70 — they are not very influenced by whether they took the hormonal contraceptives.
        Low breast cancer rates were seen among younger woman — with rates almost five times higher in women in their 40s than women in their 30s, he writes in the editorial, and adds that women in their late 30s and 40s should perhaps discuss non-hormonal contraceptive options with their physician.

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        Hunter also points out that hormonal contraceptives, namely oral contraceptives, are linked to a lower risk of ovarian, endometrial and colorectal cancers later in life.
        “The benefits (against these other cancers) persists for one to two decades,” he said, while breast cancer risk declines more rapidly. “Overall, it may be more beneficial.”
        But the search must continue for risk-free options, he concluded. “A lot of momentum has gone,” he said. “But this study reminds us this is an important objective.”

        Read more: http://www.cnn.com/2017/12/07/health/hormonal-contraceptive-breast-cancer-intl/index.html

        NFL concussion: researchers hope blood tests can better detect head trauma

        Several firms trying to develop new methods to assess extent of damage to head and brain

        In the second quarter of an NFL game on Thursday night, the Baltimore Ravens quarterback Joe Flacco slid to gain a first down. The 233lb Miami Dolphins linebacker Kiko Alonso flew into him, ploughing shoulder-first into his head.

        Such was the force of the hit, Flaccos helmet flew off. He walked from the field but he was dazed and bleeding from one ear. There was little doubt he had suffered a concussion.

        It was an extreme example of the brutal reality of football. Many head injuries caused by the game, however, are harder to detect, the product of collisions repeated over time. Some researchers think a blood test may soon be one way of detecting such problems.

        At this point there are probably as many as 20 to 25 incredibly insightful biomarkers for brain health, said Kevin Hrusovsky, chief executive of Quanterix, a startup that is one of a handful of companies seeking to develop standardized blood tests to detect concussions.

        We are hopeful we will be able to transform brain health in the way weve transformed cardiac health and even cancer health.

        Researchers at Quanterix and other companies hope blood tests will soon look for evidence of Alzheimers or dementia, much as standard cholesterol tests now help to assess heart problems.

        I think about [such tests] every minute of every day, said Robert Stern, a researcher at Boston University who co-authored a landmark study that found the degenerative disease chronic traumatic encephalopathy (CTE) in the brains of 110 of 111 dead NFL players.

        Since the 1920s, researchers have known that repeated blows to the head can result in cognitive degeneration. Recent research has shown how severe such damage can be. However, because CTE in particular can only be diagnosed after death, it is almost impossible to know how many people have it.

        Theres been tremendous advances over the last two years with regard to fluid biomarkers and Alzheimers disease, said Stern. We can then exploit whats being done in that area for CTE.

        Kiko Alonso hits Joe Flacco.

        Blood tests for concussive injury could help manage neurodegenerative diseases, for example, answering with more certainty questions about how long an athlete should stay out of play; whether a person is predisposed for neurodegenerative disease; or whether disease is advancing. Stern and others hope the technology will eventually help ordinary people too, such as car accident victims.

        There is still disagreement on how tests for concussion, and then neurodegeneration, might be applied. Stern sees a blood test as the first in a series of more specific panels, the way a breast cancer patient might first receive a mammogram, then a biopsy. Hrusovsky hopes degenerative diseases will be found in one blood test hopefully, of course, one developed by his company.

        Neurologists currently rely on a series of cognitive tests to see whether symptoms of traumatic brain injury are present. Perhaps that is why Quanterixs work has caught the imagination of the public and the attention of the NFL. Through a partnership with General Electric, the league has given Quanterix $800,000 to continue the research, Bloomberg BusinessWeek reported.

        I did the math today, said Pete Cronan, a former linebacker with Washington and the Seattle Seahawks, when asked about his concussions. Ive got six I can remember through my life. The first was when he fell out of a bunk bed as a kid.

        But those are the ones that I can remember, he said.

        Researchers now consider blows that do not concuss but produce altered states to represent a cumulative danger.

        There were thousands of those in my life, Cronan said.

        According to the Baltimore Sun, Flaccos injury was the first reported concussion of his 10-year, Super Bowl-winning career.

        Were 30-plus years into studying these fluid-based biomarkers, and the data definitely supports that they can be used to correlate quite nicely with injury severity, said Joshua Gaston, a researcher at the University of Texas Southwestern medical center who is also a football fan.

        The work was now focused, he said, on making tests reproducible, sensitive, specific.

        Read more: https://www.theguardian.com/sport/2017/oct/30/nfl-concussion-head-trauma-researchers-blood-tests

        Loss of the night: Light pollution rising rapidly on a global scale

        (CNN)Artificial lighting at night is contributing to an alarming increase in light pollution, both in amount and in brightness, affecting places all over the world, a new study has found.

        Some regions have showed a steady increase in light pollution aligned with economic development, but more developed nations that were thought to be “going dark” by switching to energy-saving LEDs showed no apparent decline in their rates of light pollution.
        Globally, there has been a push toward more energy- and cost-efficient light sources, such as LEDs, but this has directly contributed to an alarming increase in light pollution, the researchers believe.
          Using the first calibrated satellite radiometer for night lights, which can detect radiance, a team of scientists found a 2.2% increase in the Earth’s outdoor artificial lighting each year between 2012 and 2016.
          “I was very surprised by the result of the study, particularly in wealthy well-lit countries like the US,” said Christopher Kyba of the GFZ German Research Centre for Geosciences, lead author of the study.
          “When we switch from a sodium lamp to a white LED, what we observe is a decrease in the total amount of light that the satellite can see. But what we saw instead for the US was basically a constant amount of light; new lights were added in other places,” he said.
          In many other developed countries that are already very bright, the team saw an increase in the total amount of light, despite the fact that many cities appear to be “going dark” by switching to LEDs, Kyba added.
          As with the US, some of the world’s brightest countries like Spain, Italy and the Netherlands showed stability in levels of outdoor light over this time frame.
          The study also noted a consistent growth in lighting in South America, Africa and Asia, with a few exceptions in regions like Yemen and Syria, which showed a decrease due to escalating conflict and warfare.

          The risks from light pollution

          The study concluded that a steady increase in the use of energy-efficient lights that are cheap and readily available will result in even more light pollution and a reduction of natural day-night light cycles in areas that still experience them.
          Light pollution poses a threat to 30% of vertebrates and more than 60% of invertebrates that are nocturnal, including plants, microorganisms and, most alarmingly, human health, the researchers add.
          White LED light has been linked to disruptions in sleep patterns, and the glare is found to affect eyesight.
          Last year, the American Medical Association issued an official policy statement about LED street lighting, recommending a radiance and color temperature level less harmful to health.
          In August, a Harvard study found an increased risk of breast cancer in women living in neighborhoods with higher outdoor lighting. This was linked to increased brightness at nighttime, as the body expects light during daytime and darkness at night.
          The health of birds is also at risk. A study published last month found that high-intensity light in urban areas can alter their behavior in terms of migration, foraging and vocal communication. The impact was especially adverse in nocturnal migrating birds that were used to orienting in darkness and were failing to do so due to light pollution.
          Another landmark study published last year found that 83% of the world’s population and more than 99% of the US and European populations were affected by light pollution and could not see the stars at night.
          Gareth Jones, professor of biological sciences at the University of Bristol, who was not part of the new study, said it is “an important paper because it uses new and carefully calibrated methods for quantifying light pollution over a wide range of wavelengths at high spatial resolution. The study confirms that light pollution continues to increase and is of global relevance.”
          “Although there are benefits in terms of greater energy efficiency associated with changes to new lighting technologies such as LEDs, nevertheless light pollution and its associated risks to human health and biodiversity continue to increase,” Jones added.

          The Rebound Effect: How much is too much light?

          The arguments for the transition to LEDs include cost-saving and reductions in energy consumption, but this has led to increased demand and greater use of outdoor lighting.
          Large cities like Milan appeared to have a decrease in radiance around the city center but an increase in rural areas, which the scientists attributed to the replacement of older lamps with LEDs.
          “From energy economics, there’s a phenomenon called The Rebound Effect,” Kyba said: If we have an energy-efficient car, for example, we allow ourselves to live farther from work and thus end up driving more. Though there’s a limit to the amount of time one spends driving, with LED lights, there seems to be no saturation point.
          The improved energy efficiency has therefore led to more LED lighting being installed in households and outdoors, Kyba said.
          He also highlighted an issue with the way people are using LEDs, which offer features like dimmers that are going unused.
          “What is currently happening is that we take take the old lamps out, keep the masts standing and get the new lamp on,” he said. “So we’re not using these amazing ways of using LEDs.”

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          He also offered a practical solution to reduce the light being emitted in cities.
          “In city centers, we need to completely rethink the way we light by putting people at the center and not cars, which have their own lights,” Kyba said. “We shouldn’t have streetlights anymore. We should have lighting for pedestrians and for the people riding bikes.”

          Read more: http://www.cnn.com/2017/11/23/health/light-pollution-increase-study/index.html

          Data, cancer treatment and patient personalisation

          Image: pixabay

          In recent years, the scientific community has come to think about cancer — and cancer treatment — differently.

          Whereas in past decades, cancer was diagnosed, classified and treated according to the specific types of tissues it affected — breast cancer, for example, has traditionally been treated with drugs developed specifically for tumours in the breast — modern medicine takes a decidedly more personalised approach.

          Today, explains Dr Warren Kaplan, the Chief of Informatics at the Garvan Institute of Medical Research, cancer is thought of as a disease of DNA, rather than something that easily fits into “buckets” based on where in the tissue it originates.

          Different treatments for different genetic profiles

          “The three billion base pairs that make up our DNA — our genome — make each and every person in the world unique,” says Kaplan. “But this is also what makes each person’s cancer unique.”

          By understanding a patient’s genome, doctors can determine the specific combination of drugs that will best suit their patient.

          Researchers and scientists at Garvan and all over the globe are working to decode and sequence genomes in order to investigate the genetic makeup of cancers. The end goal, Kaplan explains, is to deviate from a “one size fits all” approach to treatment options. Once genomes are sequenced, it becomes easier for doctors and scientists to construct tailored treatment programs based on patients’ individual genetic profiles.

          The benefit of this approach to treatment is twofold, says Kaplan.

          “First, tumours with certain genetic profiles may respond to certain anti-cancer drugs better than others,” he says, citing an example of a pancreatic tumour that responds better to a drug traditionally prescribed for breast cancer. “Secondly, this information can also help tailor a patient’s treatment plan. By understanding a patient’s genome, doctors can determine the specific combination of drugs that will best suit their patient and avoid any harmful side effects.”

          The role of data 

          One of the obstacles to this approach, however, is the sheer amount of data it takes to sequence a single person’s genome: about 500 gigabytes. That’s equivalent to streaming about 100 HD movies.   

          In order to lend a hand – and a byte – Vodafone Foundation has released a mobile app, DreamLab, that crowd-sources data from willing donors. All users have to do is download the app (which is now available on iOS and Android), select a project they want to contribute to, and then charge their phone as they do normally. The app then goes to work downloading small bits of information from the cloud, which helps fuel cancer research such as the work being done by Garvan.

          To date, users around the world have taken up the night shift as a ‘cancer researcher,’ and “crunched” about 70% of the first research project, which focuses on comparing genetic profiles of patients with four types of cancer (breast, ovarian, prostate and pancreatic). DreamLab now has 165,000 active users – the more people that use the app, the faster researchers can complete projects which lead to discoveries.

          Kaplan has high hopes that this data holds at least a few of the answers for solving cancer.

          “We hope that in the future, those diagnosed with cancer will have their genomes sequenced and compared to this library, so that they can benefit from much more effective and accurate assessments of their illness,” he explains. “This way, doctors will be able to develop customised treatment plans that are known to be effective for a patient’s specific genetic profile.”

          Download the DreamLab app now on iOS from the App Store or on Android from Google Play to help fight cancer.

          Disclaimer: Downloading DreamLab uses data. DreamLab can be used when your device is charging and has mobile network or WiFi connectivity. Mobile data to use DreamLab is free for Vodafone Australia customers on the Vodafone Australia network. Roaming incurs international rates. 

          Read more: http://mashable.com/2017/11/16/data-patient-personalisation/