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Anchor lead: A large study using aspirin in healthy older people increased their risk of cancer, Elizabeth Tracey reports
Healthy elderly people given daily aspirin in a study known by the acronym ASPREE didn’t have fewer cardiovascular events, but they did have higher death rates than those not taking the drug, including an increased risk for cancer. Erin Michos, a cardiologist at Johns Hopkins, comments.
Michos: What was the surprise in ASPREE was actually these was deaths from bleeding but there were actually more cancer deaths in the aspirin arm. The reason why that was really surprising is that previous data has suggested that aspirin has a benefit in colorectal cancer so the fact that cancer was more elevated is surprising and might need further confirmation. But I think the overall message from this is it should be really alarming, that we shouldn’t be using aspirin so broadly in primary prevention. :27
Michos credits the many strategies now in place to reduce cardiovascular disease risk with rendering aspirin obsolete in this role, such as blood pressure control and statin use. At Johns Hopkins, I’m Elizabeth Tracey.
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Anchor lead: Does it help to have a complete genetic assessment when it comes to lung cancer? Elizabeth Tracey reports
Lung cancer is often the result of known mutations abbreviated EGFR and ALK, and these are routinely tested for around the country. Now a new study suggests that a more complete genetic assessment really doesn’t add much and is much more expensive. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, comments.
Nelson: I think that it hints that there are things that are being used in the community the stuff that’s being used is the meat and potatoes stuff that drives the drugs that we know about. I suspect that broad based genetic testing of cancers will become more and more common because it will be easier to do, more accessible. And the number of drugs that may be helpful will increase over time. I think the cost is going to go down. :20
Nelson notes that broad based testing is often a part of clinical trials.
Nelson: It’s clearly worth testing for the EGFR and ALK mutations. I think still for lung cancer it’s worthwhile thinking about participating in a clinical trial. :09
At Johns Hopkins, I’m Elizabeth Tracey.
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Anchor lead: Can delivering stimulation across the skull help depression? Elizabeth Tracey reports
Depression can be very hard to treat. Now a technique called transcranial magnetic stimulation or TMS appears to hold some promise. Kyrana Tsapkini, a researcher at Johns Hopkins who is using another type of transcranial stimulation called TDCS for speech disorders, says it’s important to make the distinction.
Tsapkini: TMS is a magnetic stimulation it is very much more expensive machine. It really targets particular areas of the brain. Cannot do it at home. Seems a great tool for depression. TDCS is a much easier to use machine. Can be an adjunct to regular speech therapists office. :19
Some people have attempted to use TDCS for depression.
Tsapkini: It has to do in my opinion with a little bit of despair in the field of good medications that are available. So they’re really desperate and anything may help. :11
Tsapkini urges anyone with depression to seek help for the condition rather than attempt to treat it themselves. At Johns Hopkins, I’m Elizabeth Tracey.
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Anchor lead: Should you use a transcranial stimulation machine on your own? Elizabeth Tracey reports
Transcranial direct stimulation or TDCS delivers a small electrical current across the skull to the brain, and new research by Kyrana Tsapkini and colleagues at Johns Hopkins shows it helps some people with speech disorders. The machines are available for consumer purchase, with some enthusiasts using them at home for things like memory improvement. Tsapkini says caveat emptor.
Tsapkini: One session is not enough. We stimulate for three weeks straight every single day. What it does so if you put some current in a particular neuron what it does it makes the neuron fire easier. You have to pair it with a task. It does not work if I just watch TV and turn it on at home. Or do nothing. It strengthens the connection. :26
Tsapkini says there’s lots of ongoing research evaluating TDCS in people with memory impairment and those without, but that for now, a do it yourself approach probably isn’t likely to be fruitful. At Johns Hopkins, I’m Elizabeth Tracey.
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Anchor lead: Can transcranial stimulation help people who are having trouble with speech? Elizabeth Tracey reports
Transcranial direct current stimulation or TDCS sends a small electrical current through the skull to stimulate certain areas of the brain. Now research by Kyrana Tsapkini and colleagues at Johns Hopkins has shown it can help people with certain types of disorders affecting speech.
Tsapkini: We use TDCS as an adjunct to speech therapy. We found that the answer depends on what variant you are talking about. The disorder has very different pathologies, phenotypes, and some of them of course are mixed. :19
Tsapkini says those variants that are the result of an Alzheimer type pathology really aren’t helped, but others are.
Tsapkini: It improves their writing more than regular spelling therapy. And that is sustained for two months. :08
Tsapkini plans more longer term studies to evaluate the technique and says MRI may help pinpoint who is most likely to benefit. She also hopes to study whether the technique can be used by patients themselves at home. At Johns Hopkins, I’m Elizabeth Tracey.
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Anchor lead: Most people shouldn’t be taking aspirin to prevent cardiovascular disease, Elizabeth Tracey reports
Aspirin really doesn’t help otherwise healthy older people avoid cardiovascular disease, a major new trial published in the New England Journal of Medicine reveals. Erin Michos, a cardiologist at Johns Hopkins, says this negative result may be interpreted in light of current therapies.
Michos: I think for most people now the concern for harm outweighs the benefit. And I think the reason why there’s this discrepancy with these more modern trials compared to the old aspirin trials is that in a modern contemporary era when we’re using a lot more statin therapy when we’re having blood pressure control, when smoking rates are really low, the use of aspirin probably has less impact on heart disease prevention than it did decades ago when we didn’t have the same modern prevention therapy that we do now. :32
Michos notes that everyone should have their risk factors for cardiovascular disease assessed as this remains the number one cause of death. At Johns Hopkins, I’m Elizabeth Tracey.
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Anchor lead: Doctors may not be adequately describing risks and benefits of cancer screening, Elizabeth Tracey reports
When people with significant risk factors for lung cancer talked with their doctors about the risks and benefits of screening, those discussions lasted about a minute, a recent study found. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says this study illustrates the changing face of physician-patient interaction.
Nelson: I have found even when I believe adequately informing someone about a choice, very often the response will be I understand these things what would you do? In some ways medicine has evolved from a very paternalistic thing which is you have this problem we need to do this, to here are the options, which one would you like to select? And I think adequately explaining so that the options are understood and then providing an opinion I think both of those are going to be part of the solution. :29
Many medical decisions fall under the so-called ‘shared decision making’ model, where a fully informed patient participates with their provider to decide a course of action. Nelson notes that such a partnership requires substantial education on the part of both physician and patient. At Johns Hopkins, I’m Elizabeth Tracey.
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