Johns Hopkins Kimmel Cancer Director William Nelson discusses top cancer news during July 2015.

Program Notes:

0:11 Treatment of advanced prostate cancer
1:12 Improved overall survival
2:11 Real flurry of new agents
2:27 Active surveillance
3:27 More threatened by other health maladies
4:11 Treatment of DCIS
5:11 99% had no additional problems
6:11 A moving target?
6:35 Ongoing debate on aspirin or NSAIDs and colorectal cancer
7:35 Reduced risk by 27%
8:20 Who is best to take it?
9:20 End

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This week’s topics include calcium supplements, chemotherapy during pregnancy, cardiometabolic impact of obesity in children, and a low nicotine cigarette.
Program notes:
0:31 Low nicotine cigarette
1:32 Attempted to prove that nicotine addicts
2:30 FDA should regulate nicotine level
3:26 No significant withdrawal
4:00 Childhood obesity and risk
5:00 Three stratifications based on weight
6:00 Need to intervene early
6:27 Pregnancy and cancer treatment
7:27 Looked at outcomes in 129 children
8:25 Calcium supplements?
9:26 Meta-analysis
10:35 End
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Anchor lead:  Could variations in a common test identify early dementia? Elizabeth Tracey reports

Oral glucose tolerance tests are commonly used during pregnancy and to test for diabetes.  Now research led by Esther Oh, a dementia expert at Johns Hopkins, shows the same test may distinguish people who have the very earliest stages of dementia, a condition known as mild cognitive impairment, because of how the test affects a protein in the blood known as amyloid.

Oh: What we don’t have right now is a very simple blood-based biomarker.  :05

Oh: Basically the difference is that when we give the oral glucose tolerance test and we measure blood amyloid levels, patients who are normal have what we call clearance patterns, so the amount of amyloid detected in the blood actually goes down after baseline in about 10 minutes, and then goes back up.  We don’t see that pattern in patients with mild cognitive impairment.   :22

Oh says such a test may help determine who might benefit from drugs to slow down or halt the development of dementia.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  People who are considering obesity surgery might want a nutritional assessment beforehand, Elizabeth Tracey reports

One in five very obese patients who were about to have obesity or bariatric surgery at Johns Hopkins were found to have nutritional deficiencies prior to the procedure, a study led by Kimberley Steele, a bariatric surgeon, has found.  Steele says specific micronutrients were seen to be at low levels.

Steele: We looked at vitamin A, D, and E, we looked at B1 which is thiamine, we also looked at B12, folate and we also looked at iron.  And why those? Well those are kind of the big vitamins that we also address following surgery because those are the ones that are most prominently found to be malnourished after surgery in our bariatric surgery population.  We found significant deficiencies in vitamin D and also in iron.   :25

Steele says while iron deficiency wasn’t that surprising, vitamin D was, and because the vitamin is involved in healing it’s concerning that it’s low before the operation.  She says further studies will look at whether supplements to normalize levels prior to surgery help.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  What’s the nutritional status of people who are obese? Elizabeth Tracey reports

In spite of consuming large amounts of food, a surprising number of people who are very overweight, so-called morbidly obese, are nutritionally compromised.  That’s according to a Johns Hopkins study led by Kimberley Steele, a bariatric surgeon

Steele: We looked at baseline nutrition, and we found one in five had more than three micronutrient deficiencies.  This is alarming for us, we need to then consider what this means in the perioperative period for our bariatric patients.  More studies need to be done now to look to see whether patients who are undergoing bariatric surgery, they might have these deficiencies , should we be addressing them prior to surgery?    :29

Steele says assessments of a number of so-called micronutrients, including vitamins, revealed deficiencies.  She says at this point it’s not known whether supplements or other strategies should be employed to improve nutrition prior to surgery, although generally improving health does have positive impacts on outcomes.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: What are the options for men with low risk prostate cancer? Elizabeth Tracey reports

Men with low risk prostate cancer can be safely monitored carefully over time, with intervention undertaken only if their cancer begins to look threatening, a long term Johns Hopkins study has shown. William Nelson, director of the Kimmel Cancer Center and a prostate cancer expert, describes the study.

Nelson: They took almost 1300 men who they followed very carefully, this was to monitor these men with blood tests for serum prostate specific antigen and another biopsy perhaps if needed, and what they found was among men with very low risk disease only two men in the whole study died of prostate cancer so the chance of dying of prostate cancer was almost zero, if you look at the whole cohort, 69% if the men lived 15 years, that’s because they were more threatened by other health maladies, like cardiovascular disease.   :30

Nelson says men are carefully selected for so-called active surveillance, previously known as watchful waiting.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: A new strategy may improve the outlook for men with advanced prostate cancer, Elizabeth Tracey reports

Depriving the body of the male hormone testosterone is one way of treating prostate cancer.  Now a new study shows that when combined with the chemotherapy drug docetaxel, such a strategy may be even more effective.  William Nelson, director of the Kimmel Cancer Center at Johns Hopkins and a prostate cancer expert, describes the findings.

Nelson: What they did is take a chemotherapy that’s often used after the hormonal therapy is no longer effective, docetaxel, and they took men, almost 1800 of them, randomly assigned them to get hormonal therapy or hormonal therapy and the docetaxel chemotherapy right from the start.  The chemotherapy basically tremendously improved overall survival, length of time that that treatment was effective, in a very convincing way, enough that it should become the standard of care.   :29

Nelson predicts that the combination of hormone therapy and docetaxel will be the treatment of choice immediately for men who are eligible.  At Johns Hopkins, I’m Elizabeth Tracey.

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