There’s no question that tests to detect cancer before it causes any problems can save lives. But such tests can also cause harm through overdiagnosis and overtreatment. A study published yesterday in JAMA Internal Medicine indicates that the majority of people aren’t informed by their doctors that early warning cancer tests may detect slow-growing, or no-growing, cancers that will never cause symptoms or affect health. Undergoing surgery, chemotherapy, or radiation for such cancers provides no benefits and definite harms. The researchers found that only 9.5% of people were informed by their doctors of the risk of overdiagnosis and possible overtreatment. Compare that to 80% who said they wanted to be informed of the possible harms of screening before having a screening test. Informing patients about the risks of screening isn’t easy to do in a brief office visit. It’s complicated information. And the researchers suggest that many doctors don’t have a good grip on relative benefits and harms of screening.
What’s bad for the heart is often bad for the brain. High cholesterol, high blood pressure, diabetes, and unhealthy “hardening” of the arteries increase the risk of mental decline or dementia later in life. A study published online today in Neurology shows that older people with the stiffest arteries are more likely to show the kinds of damage to brain tissue often seen in people with dementia. The study adds support to the “two hit” theory of dementia. It suggests that the accumulation of Alzheimer’s-linked amyloid protein in the brain may not pose problems until damage to small blood vessels that nourish the brain nudges them over into dementia. There may be a silver lining to this line of research: Efforts to improve cardiovascular health can also protect the brain.
Women with early-stage HER-2 positive breast cancer may benefit by taking a drug called pertuzumab (Perjeta) before undergoing breast surgery. By shrinking breast tumors before surgery, the drug is expected to lead to less invasive operations and a greater chance of a cure. Perjeta was initially approved in 2012 to treat late-stage breast cancer that had spread to other parts of the body. Yesterday the FDA approved it for pre-surgery use. Keep in mind that the use of Perjeta before surgery has only been approved for women with HER-2 positive breast cancer. In this form of the disease, which affects accounts for one in five cases of breast cancer, the malignant cells overproduce something called human epidermal growth factor receptor-2. Such tumor cells tend to be more aggressive than other types of breast cancer cells.
In many men diagnosed with prostate cancer, the cancer cells grow so slowly that they never break free of the gland, spread to distant sites, and pose a serious risk to health and longevity. Instead of embarking on immediate treatment, a growing number of men choose active surveillance, in which doctors monitor low-risk cancers closely and consider treatment only when the disease appears to make threatening moves toward growing and spreading. A new Harvard study shows that the aggressiveness of prostate cancer at diagnosis remains stable over time for most men. If confirmed, then prompt treatment can be reserved for the cancers most likely to pose a threat, while men with slow-growing, benign prostate cancer—which is unlikely to cause problems in a man’s lifetime—can reasonably choose active surveillance.
What doctors call “routine” back pain can really, really hurt. Surprisingly, the best treatment is usually quite conservative—over-the-counter pain relievers, ice and heat, and gentle exercise. Yet for decades, many doctors have been ordering more and more unnecessary tests, narcotics, and referrals to surgery. A new study of 24,000 people treated for back pain from 1999 through 2010 shows that many were not treated according to established guidelines, which promote treatment with over-the-counter pain relievers and physical therapy when appropriate, and advise against early referral for MRI or CT scans, the use of narcotics, or early referral to other physicians for injections or surgery. For a first-time bout with low back pain, or another go-round with it, try cold and heat, rest followed by gentle exercise, and over-the-counter pain relievers, such as acetaminophen or an NSAID like aspirin, ibuprofen, or naproxen.
An old, aspirin-like drug called salsalate could help control blood sugar in people with type 2 diabetes. In the TINSAL-T2D trial, 286 volunteers took pills containing either salsalate or a placebo for nearly a year. Over the course of the trial, those in the salsalate group had lower blood sugar levels, and some were even able to reduce dosages of other diabetes medications they were taking. Experts aren’t exactly sure how salsalate helps control blood sugar, but its effectiveness supports the idea that inflammation plays a role in type 2 diabetes. Although the results are promising, what we really need to know about salsalate (or any new or repurposed drug) is how its long-term benefits and risks stack up against each other. The trial was too small and too short to determine those risks. According to the researchers, such “outcomes require continued evaluation before salsalate can be recommended for widespread use” by people with type 2 diabetes.
A lot is known about diabetes. But a discovery that could change how this disease is treated shows just how much more there is to learn. A team of Harvard Medical School researchers has discovered a hormone called betatrophin made by liver and fat cells that signals the body to make more insulin-producing beta cells. A report of their work appears in this month’s issue of the prestigious scientific journal Cell. In mice with diabetes, experimentally turning on the production of betatrophin inside liver and fat cells caused an increase in beta cells and a dramatic improvement in blood sugar. It will, of course, take much more research in mice—and then in humans—to determine if this newly discovered hormone can serve as a treatment for diabetes. So it’s too soon to get excited that the discovery of betatrophin will translate directly into a new treatment for diabetes. But it is another example of the human body’s power to naturally repair itself.
Beginning in March, 2013, reports started to come out of Eastern China that a new “bird flu” virus was loose and causing infections in humans. The new virus is called H7N9. Should we in the U.S. be worried? Neither I nor anyone I know can give a confident answer to that question. So far the news is reassuring. A report from the U.S. Centers for Disease Control and Prevention (CDC), and another from a team from China in this week’s New England Journal of Medicine, indicate that so far the new H7N9 virus has not clearly spread from one person to another, and has not spread outside of Eastern China. Even so, every public health agency around the world is keeping a close eye on China. That’s because a virus that cannot spread easily from one person to another can change or swap genes—and suddenly be capable of spreading easily.
In the past decade, a remarkable series of experiments from laboratories all over the world has begun to show what causes aging—and how to slow it. In the latest example of such aging research, two of my Harvard Medical School colleagues, cardiologist Richard T. Lee (co-editor in chief of the Harvard Heart Letter) and stem cell biologist Amy Wagers and their teams have found a substance that rejuvenates aging hearts in mice. The researchers joined the circulation of an old mouse with a thick, stiffened heart to that of a young mouse. After four weeks, the heart muscle of the old mouse became dramatically thinner and more flexible. The team then identified a substance called growth differentiation factor 11 (GDF11) as the probable “anti-aging” substance. It’s too soon to tell if this discovery will ever help humans with heart failure. But it reveals that there are substances naturally present in all living things that cause aging and that retard it. By understanding them, we may someday be able to slow aging.
On Monday, Dr. Joseph E. Murray passed away at age 93. A long-time member of the Harvard Medical School faculty, Murray pioneered the field of organ transplantation. This great achievement, for which he was honored with the Nobel Prize in Medicine in 1990, has given the gift of life to hundreds of thousands of people destined to die young. But his success did not come easily. Not only did Murray attempt to do something others judged impossible, but kept trying in the face of sometimes withering criticism from peers. Murray’s team successfully performed the first organ transplant, a kidney donation from one young man to his twin brother. Over the next decade, Murray and his colleagues learned how to quiet the immune system to make it possible to transplant organs between unrelated people.