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child Hand holding breast cancer ribbon pink

This week’s topics include extending therapy in breast cancer, a high fat Mediterranean diet, risks of IVF, and hormone therapy and cognition.

Program notes:

0:57 Continuing aromatase inhibitors
1:58 Extending for five more years
2:54 Most women extend
3:10 Does IVF increase breast cancer risk?
4:12 25,000 women total
5:11 Hormone replacement and cognition
6:11 Some received within six years of menopause
7:12 Slow decline won’t delay
7:24 Unrestricted fats in Mediterranean diet
8:24 Randomized and observational trials
9:57 End

Related blog: https://podblog.blogs.hopkinsmedicine.org/2016/07/22/extending-breast-cancer-therapy/

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Anchor lead:  What do you need to know about genes and diabetes? Elizabeth Tracey reports

Common genes really do account for much of the observed type 2 diabetes in families, a recent study concludes.  Rita Kalyani, a diabetes expert at Johns Hopkins, says such a survey of what’s involved in predicting risk for the condition is helpful for both patients and their families, as well as clinicians.

Kalyani:  We know that type 2 diabetes tends to run in families, but whether genetic changes or variants that are common account for this heritability versus variants that are less common wasn’t known until this study. And what this study demonstrated was in fact it was the common variants that tended to account for some of what we saw in the risk for type 2 diabetes. As we talk about precision medicine it can really help inform the best direction for future research.   :27

Kalyani says Johns Hopkins has just launched a new, advertisement free website for patients who want to know more about all aspects of diabetes, including management strategies and research, at hopkinsdiabetesinfo.org.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: You can ask for a palliative care consultation yourself, Elizabeth Tracey reports

Many people with troubling and sometimes disabling symptoms of chronic health conditions aren’t offered palliative care, a medical specialty devoted to helping people live best with such problems, a recent study concluded.  Rab Razzak, a palliative care expert at Johns Hopkins, says patients can help themselves here.

Razzak:  It’s important to prepare for the worst, especially for people who have a life limiting illness. Get educated.  There are many resources out there in the community, like getpalliativecare.org.  Number two is talk to your doctors about this, and say, hey, I’ve read that palliative care can be beneficial for me or for my family member, can we get palliative care involved?  One thing we’re doing is we’re educating doctors and nurses about what palliative care is, what it isn’t, and also many of the benefits of palliative care, and the impact of quality of life, of survival, of hope.   :30

Razzak says if you or a loved one is living with chronic disease, it’s been shown that palliative care really helps throughout the course of illness.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  How often are palliative care services used for people with different conditions? Elizabeth Tracey reports

People who have cancer are offered palliative care, a type of medical care designed to help manage symptoms as well as possible, the majority of the time, a recent study shows, but not so for those who are simply frail, or have heart or lung conditions.  Rab Razzak, a palliative care expert at Johns Hopkins, saws what’s needed is greater awareness.

Razzak: There’s great data indicating the use of palliative care in cancer patients that shows great benefit both in symptom management, quality of life as well as length of life. We really need to show the impact of palliative care on symptom management versus not having palliative care. Are patients less short of breath when palliative care is involved? Do people have more dignity when palliative care is involved, what’s the quality of life, the amount of spiritual distress people have?  I think more of that needs to be studied in different diseases beyond cancer.   :30

Razzak says palliative care physicians can help people live better with a host of troubling symptoms across a range of health conditions.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: How much euthanasia and physician assisted suicide takes place around the world? Elizabeth Tracey reports

How often do people choose euthanasia and physician assisted suicide in places where it is legal?  That was the subject of a recent worldwide study, with results indicating that it isn’t elected very often, but when it is, it’s most often white, educated males who do so.  Rab Razzak, a palliative care expert at Johns Hopkins, says the finding on why people made such a choice surprised him.

Razzak:  It wasn’t pain that was the main concern. It was actually their dignity.  It brings out many ethical questions both for our country and the world.  What’s our role as health care providers? As doctors to care for our patients? I think of the impact palliative care can be is quite profound. And making sure people have high quality palliative care provided for these patients first, so we can address things like their dignity, so we can address things like pain and suffering, so that they may not need this option.  :31

At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Even as rates of many cancer types are falling, one keeps rising, Elizabeth Tracey reports

Human papilloma viruses cause cancer, and that’s why a vaccine has been developed against the most common cancer causing types.  Yet new data from the Centers for Disease Control and Prevention finds that rates of HPV associated cancers continue to climb nationally.  Connie Trimble, an HPV expert at Johns Hopkins, comments.

Trimble:  In the United States that’s in part because of exposure behaviors, and it’s also because hardly anyone gets the prophylactic vaccines. We know that at least 20% of human cancers are caused by specific infectious pathogens.  Of all the virally caused cancer, HPV causes more cancers than any other virus. We know how to prevent it.  We know how to screen for it in the cervix, and yet if you look at the CDC report that’s the biggest number of cases.   :28

Trimble recommends that everyone who’s eligible receive all recommended doses of the vaccine, and notes that she and her colleagues have also developed a therapeutic vaccine, with impressive results.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  Could a new technique help deliver therapies to the brain? Elizabeth Tracey reports

Our brains are protected from the rest of our circulation by something called the blood brain barrier, but this elegant system keeps therapies from crossing into the brain also.  Now a new technique uses both ultrasound and tiny bubbles to disrupt the barrier in very small areas to allow drug passage.  Jon Weingart, a neurosurgeon at Johns Hopkins, describes the technique.

Weingart: They used microbubbles in the circulation.  Those microbubbles when the sound waves hit them start to vibrate, which then adds to the disruption of the blood brain barrier. And so this particular study looked at an approach in people where they placed the little ultrasound transducer into the skull, and then they were able to deliver the ultrasound waves without opening the skin. The skull in a human is too thick to deliver the ultrasound just through the skin.  :30

Weingart says he’s hopeful that when the study is expanded the technique will prove helpful in treating brain tumors.  At Johns Hopkins, I’m Elizabeth Tracey.

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