In this month's podcast, Johns Hopkins Kimmel Cancer Director William Nelson discusses breast cancer awareness,  breast cancer guidelines and screening controversy, and an overview look at new approaches to breast cancer treatments.

Program Notes:

0:35 Breast cancer awareness
1:32 Controversy regarding screening
2:34 Look as if the woman lived longer
3:32 Can we figure out which ones will get worse?
4:28 Guidelines reevaluated often
5:35 19 out of 100 Medicare recipients
6:35 Look at broad approach to breast cancer
7:33 Women have every right to expect
8:25 Our understanding of inherited risk factors
9:17 Aid in improving cardiovascular risk
10:00 End

 

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Anchor lead: How many deaths would a wholesale conversion to e-cigarettes avert? Elizabeth Tracey reports

The discussion over e-cigarettes is complicated, with a new study in the BMJ showing a huge benefit if those who smoke combustible cigarettes switch to the devices. But Enid Neptune, a lung expert and antismoking advocate at Johns Hopkins, says it all comes down to what you compare it to.

Neptune: What it tells us is basically what we know. In that if you replace regular cigarettes with e-cigarette use you will probably have better outcomes in the long run but the arm that it didn’t have is if patients had used conventional smoking cessation tools to stop and had not continued on any nicotine product over the long term. What would that number of avoided premature deaths have been? And that’s really the number that we want.  :28

Neptune is concerned that those studies comparing e-cigarettes to traditional smokes will always demonstrate their superiority, but the real comparator is no nicotine delivery vehicle at all. She notes that there are plenty of toxic substances in e-cigarette vapors we don’t yet know the full impact of. At Johns Hopkins, I’m Elizabeth Tracey.

 

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Anchor lead: Is it reasonable to expect a wholesale switch to e-cigarettes? Elizabeth Tracey reports

Lower the nicotine in combustible cigarettes and people will quit the habit. That’s the clear underpinning of a new strategy unveiled by Scott Gottleib, FDA commissioiner, but Enid Neptune, a lung expert and antismoking advocate at Johns Hopkins, has some concerns.

Neptune: What it looks like is they see e-cigarettes as being the transitional devices that people will use as they come off the low nicotine combustible cigarettes. And the endpoint for e-cigarette use is just unexplained.  :16

Neptune says the problem is complex.

Neptune: Getting people off nicotine is not just simply reducing the nicotine in cigarettes. You have to address the habit. You have to address the long term exposure to nicotine so you have to have some larger model in mind as opposed to we’ll reduce it to a certain level and then they will invariably stop smoking at some point.   :21

At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: What is the rationale for low nicotine cigarettes? Elizabeth Tracey reports

Can reducing nicotine levels in combustible cigarettes induce people to quit? That’s the hope of Scott Gottleib, FDA commissioner, in a recent announcement of this strategy as part of the agency’s regulatory authority. Enid Neptune, a lung expert and antismoking advocate at Johns Hopkins, says she sees some issues.

Neptune: If you’re going to have a low nicotine policy that’s saying first, that you can reduce nicotine to a level that’s nonaddictive. From a physiological standpoint it’s not clear that that’s even achievable on a population scale. Your level of addiction may be very different from mine. And then there’s the whole issue of do you do this over five years, one year? How long will people have to be exposed to combustible cigarettes for this to even be achievable?  :29

Nepture says she would be more comfortable with a comprehensive plan that also includes cessation of e-cigarette use over time. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Women who are considering breast reconstruction need support, Elizabeth Tracey reports

More and  more women are choosing breast reconstruction following mastectomy, data from the Agency for Healthcare Research and Quality find. Gedge Rosson, a breast reconstruction expert at Johns Hopkins, says women need to take a comprehensive approach to deciding which option is best for them.

Rosson: Reach out to support groups, find other women who have gone through it, see what was important to them, really immerse yourself in trying to figure out what is best for you. We tell all of our patients you have three options: you can have no reconstruction, you can do reconstruction with implants or you can do reconstruction with your own tissue. We encourage people to reach out as much as they can, definitely there are patient support groups that are wonderful. Here at the breast center there are so many patient volunteers and nurse navigators to help patients with that.  :30

Rosson says each option comes with a full set of considerations so women should proceed deliberately, and choose centers that offer the full range of support and experience to assist. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Can a lower thyroid hormone level actually be beneficial? Elizabeth Tracey reports

Many people are diagnosed with inadequate thyroid hormone levels as they age, but now research by Jenna Mammen, an endocrinologist at Johns Hopkins, and colleagues, is beginning to offer another interpretation.

Mammen: What we do see is that in the people we’ve recruited who are 80 year olds their thyroid function in general is less active than people we recruit in their 70s. Even though the people in their 70s travel on a nice steady path and the people in their 80s travel on a nice steady path the older population is enriched for people with slightly lower thyroid function. So it’s an indirect evidence that maybe higher TSHs in older people are not disease related and shouldn’t be treated.  :30

Mammen says a whole constellation of observations of aging people has caused many physicians to step back and examine what constitutes normal aging and what might even be beneficial. She says studies from animals clearly demonstrate that lower metabolic rates in aging animals translates to longer lifespans. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: There are good reasons to consider reconstruction after mastectomy, Elizabeth Tracey reports

Women who have breast reconstruction after a mastectomy report improved quality of life, many studies have found. Women must be getting that message as more of them are choosing reconstruction, recent data from the Agency for Healthcare Research and Quality indicate, showing many more women having the surgery, especially those over the age of 65. Gedge Rosson, a breast reconstruction expert at Johns Hopkins, comments.

Rosson: In our patients here at Hopkins we have definitely found patient’s quality of life improved just as much as patients who are younger, so if someone is healthy enough to have surgery, and you always have options of having some type of reconstruction that are shorter procedures and then there are some fancier reconstructions that are more lengthy procedures but for a healthy patient it shouldn’t matter what your age is and certainly we have plenty of patients who are over 65.   :27

Rosson encourages women to explore all their options when it comes to reconstruction. At Johns Hopkins, I’m Elizabeth Tracey.

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