Latest news with #JAMAOncology
Time of India
02-08-2025
- Health
- Time of India
Artificial sweetener consumption linked to less effective cancer treatment
London: In patients with melanoma or non-small cell lung cancer, consuming high levels of the artificial sweetener sucralose contributes to diminished responses to immunotherapy and poorer survival, researchers reported in Cancer Discovery. When the researchers had 132 patients with advanced melanoma or non-small cell lung cancer answer detailed diet history questionnaires, they found that high consumption of sucralose was linked with lower effectiveness of immunotherapies across a range of cancer types, stages and treatment methods. In experiments with mice, the researchers found that sucralose shifts the composition of microbes in the intestines, increasing bacterial species that degrade arginine, an amino acid that is essential for key immune cells called T cells. "When arginine levels were depleted due to sucralose-driven shifts in the microbiome, T cells couldn't function properly," study leader Abby Overacre of the University of Pittsburgh said in a statement. "As a result, immunotherapy wasn't as effective in mice that were fed sucralose." Laying the groundwork for a solution to the problem, the same researchers also found in the mice that supplements that boosted levels of arginine mitigated the negative effects of sucralose on immunotherapy, an approach they now hope to test in humans. "It's easy to say, 'Stop drinking diet soda,' but when patients are being treated for cancer, they are already dealing with enough, so asking them to drastically alter their diet may not be realistic," Overacre said. "That's why it's so exciting that arginine supplementation could be a simple approach to counteract the negative effects of sucralose on immunotherapy." LOW-GRADE IS NOT THE SAME AS LOW-RISK IN PROSTATE CANCER A low-grade prostate tumor is not necessarily low-risk, new research suggests. Biopsy results showing low-grade prostate cancers can sometimes lead to underestimation of disease risk and omission of surgery or radiation in patients who might benefit from such treatments, researchers warned in JAMA Oncology. Among roughly 117,000 men in their study with prostate biopsy results indicating a Grade Group 1, or GG1, tumor - the slowest-growing kind - one in six had intermediate- or high-risk cancer when other factors such as prostate-specific antigen levels in the blood and tumor sizes were also considered, according to the report. Such higher risk cancers are often treated with radiation therapy or removal of the prostate, the researchers noted. "We don't want to miss aggressive cancers that initially present as Grade Group 1 on biopsy," study coauthor Dr. Bashir Al Hussein of Weill Cornell Medicine said in a statement. "Such underestimation of risk could lead to undertreatment and poor outcomes." Current guidelines that advise regular monitoring - rather than treatment - for men with low-grade prostate tumors were based on studies that examined entire prostate glands after removal from patients. Biopsies test only small areas of the prostate, so they can miss more advanced or aggressive cancer cells, providing an incomplete picture, the researchers said. Some cancer experts have been suggesting recently that GG1 tumors are so slow-growing that they shouldn't even be considered malignant. The new study results could help inform those discussions, the researchers said. "There is a misunderstanding that low grade and low risk are the same," study coauthor Dr. Jonathan Shoag of Case Western Reserve University said in a statement. "Here, we show clearly that they are not." (To receive the full newsletter in your inbox for free sign up here)
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First Post
30-07-2025
- Health
- First Post
Not just smokers: Doctors flag new risk factors for throat cancer in India
An increasing number of throat cancer cases are being diagnosed among non-smokers in India, particularly men under 60. Experts link this rise to HPV infections, lifestyle changes and environmental exposures. Read here read more Throat cancer, once predominantly associated with tobacco and smoking is increasingly affecting non-smokers in India, particularly men under the age of 60. Medical experts are now sounding the alarm over a dramatic epidemiological shift, citing the human papillomavirus (HPV) as a key driver of this growing trend. 'Traditionally, oropharyngeal cancers in India were largely seen in smokers and tobacco chewers. But now, a growing number of patients, especially men in their 50s—are being diagnosed without any history of smoking,' said Dr Mandeep Singh Malhotra, Director of Surgical Oncology at CK Birla Hospital, Delhi. STORY CONTINUES BELOW THIS AD Dr Malhotra highlighted that areas most commonly affected include the tonsils, base of the tongue, posterior pharyngeal wall and tissues above the voice box. HPV i****nfection the d****riving f****orce The primary factor behind this shift, he said, is the rising incidence of HPV infections which are closely linked to changes in sexual behaviour. 'Increased prevalence of oral sex compared to previous generations has led to higher exposure to HPV, a known carcinogen for the oropharynx,' Dr Malhotra said. A 2023 study published in The Lancet Regional Health – Southeast Asia supports this, reporting that HPV-positive oropharyngeal cancers are on the rise in India, echoing trends observed in Western countries over the past two decades. Other contributing factors include excessive alcohol consumption, poor oral hygiene, a diet low in antioxidants, vegetables and environmental exposure to petrochemicals, wood dust and industrial pollution. Distinct b****iology and b****etter p****rognosis HPV-related throat cancers are biologically different from those caused by tobacco, says Dr. Malhotra. 'They tend to respond much better to chemotherapy and have a higher cure rate, even though they can present at more advanced stages with larger neck nodes. In contrast, cancers linked to smoking and alcohol are often more aggressive and harder to treat.' A 2023 meta-analysis published in JAMA Oncology found that five-year survival rates for HPV-positive oropharyngeal cancer were above 80%, significantly better than the 50-60% rates seen in HPV-negative cases. Breakthroughs in treatment: TORS and bio-Selection Treatment advancements such as Transoral Robotic Surgery (TORS) have revolutionised outcomes, particularly for early-stage patients. 'TORS is minimally invasive, leaves no external scars or bone cuts, and enables faster recovery,' he added. For advanced cases, oncologists are now adopting a 'bio-selection' approach. Patients first receive 2–3 cycles of chemotherapy to assess tumour shrinkage. If the tumour reduces by 50–80%, less invasive options like TORS or radiation can be pursued. If not, a radical surgery followed by radiation becomes necessary. 'This strategy allows us to personalise treatment based on tumour biology rather than a one-size-fits-all approach, ultimately reducing complications and improving survival outcomes,' said Dr Malhotra. According to the Indian Council of Medical Research (ICMR), India sees over 1.3 lakh new cases of head and neck cancers annually, with oropharyngeal cancer forming a significant portion. Globally, WHO estimates that HPV is responsible for up to 70% of oropharyngeal cancers in developed countries, a number now reflecting similar patterns in India. STORY CONTINUES BELOW THIS AD As the medical community adapts to these evolving patterns, awareness and early detection remain key. 'Vaccination against HPV, improved oral hygiene and safe sexual practices are preventive strategies that must be prioritised,' Dr Malhotra said.
Medscape
21-07-2025
- Health
- Medscape
Prevention, Screening, Treatment: Impact on Cancer Deaths
This transcript has been edited for clarity. Hello. I'm Dr Maurie Markman from City of Hope, and I'd like to discuss a very important study. I think many of you may have heard about this, but it's important to emphasize what these investigators reported in terms of the impact of what we are doing in the cancer world today and, in my opinion, what the focus needs to be on in the future. The paper I'm referring to is "Estimation of Cancer Deaths Averted From Prevention, Screening, and Treatment Efforts, 1975-2020," published in JAMA Oncology . This was a very interesting effort; there was modeling done, and assumptions were made, in order to do what these investigators did. But this is, I think, very high-quality and reasonable data science. The paper outlines the assumptions made in coming to the conclusions reached by these investigators. They looked at breast, cervix, colorectal, lung, and prostate cancers — obviously, major cancers — and specifically looked at what the impact has been over the past 45 years of these three different strategies in averting deaths: prevention, screening, and actual treatment. The bottom line, as reported by these investigators, is that over this 45-year period, 5.94 million deaths have been averted in these five cancers combined, due to the efforts of countless numbers of individuals, researchers, clinicians, public health officials, government regulators, etc. It's an incredible and an enormously positive contribution to society and to individual patient health. They note, and this is a powerful message, that 8 of the 10 deaths, 80%, that had been averted were due to efforts in cancer prevention and screening. It may come as a surprise to some, but not to all, because of our often very intense focus and money spent on treatments for established and advanced cancers over the past decades. There's no intent either in this paper or by me to denigrate — in any way, shape, or form — the enormous efforts that have been made in treatment. But if you look at the question of deaths averted, the vast majority have come from prevention and screening efforts. And clearly, there's cost involved in these efforts, but far less than that associated with development of treatments. They're even more specific in this paper: Screening, according to these investigators, has been responsible for essentially all reduction in cervix cancer, which we certainly know from the enormous contributions of the Pap smear screening and now HPV screening: 25% of breast cancer deaths were averted due to screening; 56% from prostate cancer; 79% of deaths from colorectal cancer; and, of course, from lung cancer, 98% of the impacts on cancer deaths has resulted from a reduction in smoking. So, overall a tremendous impact, a positive impact. So many individuals and organizations avert deaths, but it's critical to remember the role of prevention and screening. And as we move forward to the future, as we look at the epidemic we have of obesity in this country and the concern about the risk of alcohol on the risk for cancer, it is important to remember the critical role to the present but also for the future of prevention and screening. Thank you for your attention.
Medscape
12-06-2025
- Health
- Medscape
Early FIT Screening Tied to Big Reduction in CRC Mortality
A new analysis provided 'strong' support for starting fecal immunochemical test (FIT) screening at ages 40-49 rather than at the currently recommended age of 50. An exploratory initiative that offered FIT screening to residents aged 40-49 years in two Taiwan municipalities gave researchers an opportunity to test whether early screening made a real difference in colorectal cancer (CRC) mortality and incidence. They found that it did. Both outcomes were 'significantly lowered' with early screening compared with regular screening (starting at age 50), the authors found. Those who underwent early screening had lower CRC incidence (26.1 vs 42.6 per 100,000 person-years) and mortality (3.2 vs 7.4 per 100,000 person-years), with similar results after propensity score-matched analyses and in an extended nonadherence adjustment model. The study was published online in JAMA Oncology . Both Early and Regular Screening Are Best Researchers analyzed a community-based FIT screening cohort of more than 500,000 Taiwanese residents aged 40-49 years between 2001 and 2009 who also then had an opportunity to undergo regular screening at age 50 or older. Participants were categorized into four subcohorts based on early FIT screening at ages 40-49 and regular CRC screening at 50 years or older: Those who underwent both early and regular screening, those who underwent only early screening, those who underwent only regular screening, and those who refused regular screening. Participants were followed up until 2019 to compare CRC incidence and mortality across subcohorts. To reduce self-selection bias, a delayed screening design and propensity score matching were used, restricting analyses to participants who underwent regular screening. Of the 263,125 included participants, 55.8% were women. A total of 39,315 participated in early and regular screening, whereas 223,810 participated in only regular screening. The early screening group had lower CRC incidence (26.1 vs 42.6 per 100,000 person-years) and mortality (3.2 vs 7.4 per 100,000 person-years). In propensity score-matched analyses, early screening significantly reduced CRC incidence (adjusted relative risk [aRR], 0.79) and mortality (aRR, 0.61). The findings persisted in an extended nonadherence adjustment model across all four subcohorts, showing a 25% reduction in incidence (aRR, 0.75) and a 34% reduction in mortality (aRR, 0.661). The authors noted that CRC incidence and mortality were lower for the group participating in both early and regular screening than for the group participating in only regular screening. 'This difference was particularly evident in the three key age groups — age 50-54 years, 55-59 years, and 60-64 years — who derived the greatest benefit from early-age screening during follow-up (approximately 10-15 years after recruitment at age 40-49 years),' the authors wrote. Furthermore, the findings showed that FIT screening at ages 40-49 required fewer tests to prevent one CRC case than regular screening and was therefore cost-effective. However, the authors concluded, 'whether early screening policies are generalizable to other populations should be evaluated carefully.' 'Essential' to Inform Practice In a related editorial, Thejus Jayakrishnan, MD, of the Dana-Farber Cancer Institute, Harvard Medical School, Boston, and colleagues noted that the authors had limited information on established CRC risk factors in the study population or on the proportion of individuals in each group who tested positive on FIT and who subsequently followed through with a colonoscopy, factors that could affect outcomes. Nevertheless, they wrote, 'This analysis adds to the current limited body of literature — comprised mainly of observational studies, colonoscopy registry studies, and modeling studies — that suggests that initiating screening at an age younger than 50 may lead to public health benefits. Until randomized clinical trials are conducted and results available, observational studies such as this will be essential to inform policy and practice,' although external validation of the findings in different countries is needed. The study was supported by the Health Promotion Administration, Ministry of Health and Welfare of the Taiwanese government. Lead author Han-Mo Chiu, MD, PhD, National Taiwan University, Taipei, Taiwan, reported receiving grants from the Taiwanese government during the conduct of the study, as well as personal fees from Boston Scientific, Olympus Medical, and Fujifilm Medical System outside the submitted work. No other disclosures were reported. Two coauthors of the editorial declared receiving personal fees and grants from commercial entities outside the submitted work.
Medscape
19-05-2025
- Health
- Medscape
Cancer's Toll Raises Suicide Risk for Spouses
This transcript has been edited for clarity. Hello. I'm Dr Maurie Markman from City of Hope. I'd like to briefly discuss a very difficult topic, but one that I believe needs to be more openly discussed — not necessarily the specifics of the topic, but the implications of findings. The paper I'm referring to is entitled, 'Suicide attempt and suicide death among spouses of patients with cancer.' This was reported in JAMA Oncology . What we're looking at here in this analysis are data from Denmark. There are a number of countries, particularly in Scandinavia, that have a national registry of diseases, treatments, and outcomes. We are relying here on data from Denmark, but I would have no reason to believe it's any different than what we might see in the United States. We're looking at registry data from 1986 to 2016. The analysis was performed in August 2022. Again, what they were looking at here is the risk of suicide attempts among spouses of individuals with cancer. Clearly, we were looking at registries that relate to cancer, and then they would also have other registries related to attempted suicide or actual suicide deaths, a nd they were matching these databases. It's obviously complex registry data, which of course, we would not have in the United States, but it's potentially very relevant. T he term they used was exposed individuals, these were the spouses of individuals with cancer. There were 409,000 individuals, and they compared that to over 2 million individuals who would be unexposed. These must be individuals in the population, presumably age matched, without cancer. They saw that the risk of a suicide attempt among spouses of patients with cancer was much higher than the population without cancer,particularly notable in the first year after diagnosis. The hazard ratio of those at risk versus not at risk for a suicide attempt was 1.45, and 2.56 for suicide death for the exposed compared to the unexposed, two-and-a-half-time risk. It's noted in the paper that there was even a higher risk — and I think the numbers will get smaller here — if that family member was diagnosed with an advanced-stage cancer or if the individual died of cancer. This is not surprising. Clearly there's much to be discussed here, but the most important point to be made is the stress — both psychological and financial, fear, risk of depression (particularly in an individual who might already have some concerns) — is very real, and this paper makes it very palpable. As emphasized in the paper, b ehavioral support, social work support, and financial support over time, particularly at the beginning of the cancer journey, is really important. What we can do as individuals, as family, as friends, but also as a healthcare establishment, either at an individual physician level or at a public health level, to help families and to help spouses through this journey is critical to potentially avoidsuicide and certainly suicide deaths. This is a very complex subject and a very personal subject for many individuals but a very important one. Thank you for your attention.
