Study boosts hope of ‘liquid biopsies’ for cancer screening
patient has her blood drawn for a liquid biopsy during an appointment at
a hospital in Philadelphia. Scientists have the first major evidence
that such blood tests hold promise for screening people for cancer. (AP
Photo/Jacqueline Larma, File)
Scientists have the
first major evidence that blood tests called liquid biopsies hold
promise for screening people for cancer. Hong Kong doctors tried it for
a type of head and neck cancer, and boosted early detection and one
measure of survival.
The tests detect
DNA that tumors shed into the blood. Some are used now to monitor cancer
patients, and many companies are trying to develop versions of these for
screening, as possible alternatives to mammograms, colonoscopies and
other such tests. The new study shows this approach can work, at least
for this one form of cancer and in a country where it’s common.
“This work is very
exciting on the larger scale” because it gives a blueprint for how to
make tests for other tumor types such as lung or breast, said Dr. Dennis
Lo of Chinese University of Hong Kong. “We are brick by brick putting
that technology into place.”
He led the study,
published Wednesday by the New England Journal of Medicine. Lo
is best known for discovering that fetal DNA can be found in a mom’s
blood, which launched a new era of non-invasive testing for pregnant
The study involved nasopharyngeal
cancer, which forms at the top of the throat behind the nose. It’s a
good test case for DNA screening because it’s an aggressive cancer where
early detection matters a lot, and screening could be tried in a
population where the cancer is most common - middle-aged Chinese men.
Also, the Epstein-Barr virus is
involved in most cases, so tests could hunt for viral DNA that tumors
shed into the blood in large quantities, rather than rare bits of cancer
About 20,000 men
were screened, and viral DNA was found in 1,112, or 5.5 percent. Of
those, 309 also had the DNA on confirmatory tests a month later. After
endoscope and MRI exams, 34 turned out to have cancer.
More cases were
found at the earliest stage - 71 percent versus only 20 percent of a
comparison group of men who had been treated for nasopharyngeal cancer
over the previous five years. That’s important because early cases often
are cured with radiation alone, but more advanced ones need chemotherapy
and treatment is less successful.
seemed to improve how many survived without worsening disease - 97
percent at three years versus 70 percent of the comparison group.
Only one person who
tested negative on screening developed nasopharyngeal cancer within a
estimate 593 people would need to be screened at a total cost of $28,600
to identify one cancer case. It may be worth it in Hong Kong, but maybe
not in places like the U.S. where the disease is rare, and more people
would have to be screened at a greater cost to find each case, said Dr.
Richard Ambinder of Johns Hopkins School of Medicine, who wrote a
commentary in the journal.
Still, “this is
showing that liquid biopsies have great promise,” he said. “This is an
advance that will indeed save lives.”
The study was
sponsored by an Asian foundation and the Hong Kong government. Lo and
some other authors founded Cirina, a Hong Kong-based company focused on
early cancer detection, and get royalties related to DNA blood tests. In
May, Cirina merged with Grail Inc., a California company working on
cancer screening blood tests with more than $1 billion from drug
companies and big-name investors such as Jeff Bezos and Bill Gates.
Pope Francis to Belgian Catholics: Stop offering euthanasia
Francis has ordered a Belgian Catholic charity to stop offering
euthanasia in its psychiatric hospitals. (AP Photo/Andrew Medichini,
London (AP) - Pope Francis
has ordered a Belgian Catholic charity to stop offering euthanasia in
its psychiatric hospitals.
In May, the Brothers of Charity
group announced it would allow doctors to perform euthanasia at its 15
psychiatric hospitals in Belgium, one of only two countries - along with
the Netherlands - where doctors are legally allowed to kill people with
mental health problems, at their request.
To qualify, people must be in a
state of “unbearable suffering” and at least three doctors, including
one psychiatrist, must be consulted.
The charity said in a statement
that euthanasia would only be performed if there were “no reasonable
treatment alternatives” and that such requests would be considered with
“the greatest caution.”
“We respect the freedom of doctors
to carry out euthanasia or not,” the group said, noting that this
freedom was “guaranteed by law.”
The Vatican press office said this
week that the pope had asked the Belgians not to perform euthanasia.
The Catholic Church opposes
euthanasia and the Holy See has begun investigating the decision to
allow the procedure, which was made by the group’s lay board of
The Belgian charity’s
administrative headquarters in Rome issued a statement in May, arguing
that allowing euthanasia “goes against the basic principles” of the
“This is the very first time a
Christian organization states that euthanasia is an ordinary medical
practice that falls under the physician’s therapeutic freedom,” wrote
the charity’s superior general, Rene Stockman, who delivered the request
from Pope Francis via two letters.
“This is disloyal, outrageous and
Mattias De Vriendt, a spokesman for
the Belgium charity, said it had received the Vatican’s request but had
not yet responded.
“We will take our time in the next
few weeks to evaluate these letters,” de Vriendt said. He said the
charity’s hospitals had received requests from patients seeking
euthanasia recently but could not say whether any procedures had been
The vast majority of patients
seeking euthanasia in Belgium have a fatal illness like cancer or a
degenerative disease. While the number of people euthanized for
psychiatric reasons accounts for only about 3 percent of Belgium’s
yearly 4,000 euthanasia deaths, there has been a threefold increase in
the past decade.
Critics have previously raised
concerns about Belgium’s liberal approach to euthanasia while advocates
say that people with mental health illnesses should be granted the same
autonomy as those with physical diseases.
The American Psychiatric
Association says that doctors should not prescribe any methods to people
who are not terminally ill to help them die.
Doctor told to stop marketing 3-person baby technique
The Food and Drug Administration warned a New York fertility
doctor this month to stop marketing an experimental procedure
that uses DNA from three people - a mother, a father and an egg
donor - to avoid certain genetic diseases. (AP Photo/Andrew
Linda A. Johnson, AP
regulators on Friday warned a New York fertility doctor to stop
marketing an experimental procedure that uses DNA from three
people - a mother, a father and an egg donor - to avoid certain
John Zhang, used the technique to help a Jordanian couple have a
baby boy last year.
to the Food and Drug Administration, Zhang said his companies
wouldn’t use the technology in the U.S. again without
permission, yet they continue to promote it.
procedure is not approved in the U.S., and Congress has barred
the FDA from even reviewing proposals to conduct such
receptionist at Zhang’s New Hope Fertility Clinic in New York
said late Friday that no one was available to comment. Zhang
heads the clinic and a related company, Darwin Life Inc.
website touts having achieved the “first live birth” using this
technology, along with other advanced fertility treatments it
offers. The FDA’s letter to Zhang cites several other marketing
claims, including a reference to “the first proven treatment for
certain genetic disorders.”
of the boy was disclosed last September. The mother carries DNA
that could have given her child Leigh syndrome, a severe
neurological disorder that usually kills within a few years of
experimental technique involves removing some of the mother’s
DNA from an egg, and leaving the disease-causing DNA behind. The
healthy DNA gets slipped into a donor’s egg, which is then
fertilized. As a result, the baby inherits DNA from both parents
and the egg donor - producing what’s been called “three-parent
babies” - though the DNA contribution from the egg donor is very
carry DNA in two places, the nucleus of the cell and in
structures called mitochondria, which lie outside the nucleus.
The technique is designed to transfer only DNA of the nucleus to
the donor egg.
journal report on the case said the procedure was done at the
New York clinic and the embryo was taken to Mexico, where it was
implanted. The procedure isn’t illegal in Mexico.
a report from a panel of U.S. government advisers said it is
ethical to begin testing this approach in pregnancy as long as
the first studies follow strict safety steps. The studies must
include women at high risk of passing on a severe disease and,
at first, implant only male embryos, so the alterations wouldn’t
pass to future generations.
The FDA had
requested the report, though the law against such experiments
remains in force.
regulators last year approved “cautious use” of the technique,
and this year issued its first license to use it.
born last year through Zhang’s clinic is not the first to
inherit DNA from three people. In the 1990s, some children were
born after researchers used a different technique. But federal
regulators intervened, and the field’s interest now has passed
to the new approach.
Hints that lifestyle changes might
guard against dementia
section of a human brain with Alzheimer’s disease is on display at the
Museum of Neuroanatomy at the University at Buffalo, in Buffalo, N.Y.
(AP Photo/David Duprey, File)
Washington (AP) - Seek a
good education. Control blood pressure and diabetes. Get off the couch.
There are some hints, but no proof yet, that these and other lifestyle
changes just might help stave off dementia.
A provocative report in the British
journal Lancet Thursday, July 20, raised the prospect that a third of
dementia cases around the world could be delayed or even prevented by
avoiding key risks starting in childhood that can make the brain more
vulnerable to memory loss in old age.
A recent U.S. report was much more
cautious, saying there are encouraging clues that a few lifestyle
changes can bolster brain health and that more research is critical.
Still, it’s never too early to try,
said Lancet lead author Gill Livingston, a psychiatry professor at
University College London.
“Although dementia is diagnosed in
later life, the brain changes usually begin to develop years before,”
Early next year, a $20 million U.S.
study will begin rigorously testing if some simple day-to-day activities
truly help older adults stay sharp.
“We are in a frustrating position
science-wise in terms of what are our options?” said cognitive
neuroscientist Laura Baker of Wake Forest School of Medicine in North
Carolina, who will lead the new study to find out.
In the meantime, Alzheimer’s
specialists say there’s little down side to following some common-sense
Consider physical activity, crucial
for heart health. “If in fact it should also improve the prospects for
cognitive function and dementia, all the better,” said Dr. Richard
Hodes, director of the U.S. National Institute on Aging and an avid
“Increased health of the body
supports increased health of the brain,” Baker added.
Here’s the latest from this week’s
Alzheimer’s Association International Conference on possible ways to
guard your brain:
A Lancet-appointed panel created a
model of dementia risks throughout life that estimates about 35 percent
of all dementia cases are attributable to nine risk factors - risks that
people potentially could change.
Their resulting recommendations:
Ensure good childhood education; avoid high blood pressure, obesity and
smoking; manage diabetes, depression and age-related hearing loss; be
physically active; stay socially engaged in old age.
The theory: These factors together
play a role in whether your brain is resilient enough to withstand years
of silent damage that eventually leads to Alzheimer’s.
changing these or other lifestyle factors really help?
Last month, the U.S. National
Academies of Sciences, Engineering and Medicine reported there’s little
rigorous proof. That report found some evidence that controlling blood
pressure, exercise and some forms of brain training - keeping
intellectually stimulated - might work and couldn’t hurt.
Why? What’s good for the heart is
generally good for the brain. In fact, high blood pressure that can
trigger heart attacks and strokes also increases risk for what’s called
And exercising your gray matter may
bulk up the brain, whether it’s from childhood education or learning a
new language as an adult. The more you learn, the more connections your
brain forms, what scientists call cognitive reserve. Some U.S. studies
have suggested that generations better educated than their grandparents
have somewhat less risk of dementia.
Other factors have less scientific
support. Studies show people with hearing loss are more likely to
experience memory problems, and have speculated that it’s because
hearing loss leads to depression and social isolation - or that the
brain works harder to deal with garbled sound, at the expense of other
thinking skills. But so far there aren’t studies proving hearing aids
reverse that risk.
In fact, the strongest evidence
that lifestyle changes help comes from Finland, where a large,
randomized study found older adults at high risk of dementia scored
better on brain tests after two years of exercise, diet, cognitive
stimulation and social activities.
Would those strategies help
Americans, who tend to be sicker, fatter and more sedentary than
Scandinavians? The Alzheimer’s Association is funding a study to find
out, with enrollment of 2,500 cognitively healthy but high-risk older
adults to begin next year.
try on your own? They’ll test:
- Walking - supervised, so no
cheating. Wake Forest’s Baker puts seniors on treadmills at the local
YMCA to avoid bumpy sidewalks. She advises exercise newbies to start
slow - about 10 minutes a day for a few days - and work up to longer
walks, and go with a buddy so it’s harder to back out.
- A diet that includes more leafy
greens, vegetables, whole grains, fish and poultry than the typical
- Certain brain games and what
Baker called an “intellectual stimulation barrage,” outings and other
steps that keep people social, not sitting home on a computer, while
they exercise their brains.
- Improving control of medical
conditions like high blood pressure and diabetes that are toxic to the
Hearing is believing: Speech may be
a clue to mental decline
In this July
6, 2017 photo, Kim Mueller, left, administers a test to Alan Sweet, where he
describes an illustration, as part of a University of Wisconsin-Madison
study on dementia. (AP Photo/Carrie Antlfinger)
Your speech may, um,
help reveal if you’re uh ... developing thinking problems. More pauses,
filler words and other verbal changes might be an early sign of mental
decline, which can lead to Alzheimer’s disease, a study suggests.
Researchers had people
describe a picture they were shown in taped sessions two years apart. Those
with early-stage mild cognitive impairment slid much faster on certain
verbal skills than those who didn’t develop thinking problems.
“What we’ve discovered
here is there are aspects of language that are affected earlier than we
thought,” before or at the same time that memory problems emerge, said one
study leader, Sterling Johnson of the University of Wisconsin-Madison.
This was the largest
study ever done of speech analysis for this purpose, and if more testing
confirms its value, it might offer a simple, cheap way to help screen people
for very early signs of mental decline.
Don’t panic: Lots of
people say “um” and have trouble quickly recalling names as they age, and
that doesn’t mean trouble is on the way.
“In normal aging, it’s
something that may come back to you later and it’s not going to disrupt the
whole conversation,” another study leader, Kimberly Mueller, explained. “The
difference here is, it is more frequent in a short period,” interferes with
communication and gets worse over time.
The study was discussed
Monday at the Alzheimer’s Association International Conference in London.
About 47 million people
worldwide have dementia, and Alzheimer’s is the most common type. In the
U.S., about 5.5 million people have the disease. Current drugs can’t slow or
reverse it, just ease symptoms. Doctors think treatment might need to start
sooner to do any good, so there’s a push to find early signs.
impairment causes changes that are noticeable to the person or others, but
not enough to interfere with daily life. It doesn’t mean these folks will
develop Alzheimer’s, but many do - 15 to 20 percent per year.
To see if speech
analysis can find early signs, researchers first did the picture-description
test on 400 people without cognitive problems and saw no change over time in
verbal skills. Next, they tested 264 participants in the Wisconsin Registry
for Alzheimer’s Prevention, a long-running study of people in their 50s and
60s, most of whom have a parent with Alzheimer’s and might be at higher risk
for the disease themselves. Of those, 64 already had signs of early decline
or developed it over the next two years, according to other neurological
tests they took.
In the second round of
tests, they declined faster on content (ideas they expressed) and fluency
(the flow of speech and how many pauses and filler words they used). They
used more pronouns such as “it” or “they” instead of specific names for
things, spoke in shorter sentences and took longer to convey what they had
“Those are all
indicators of struggling with that computational load that the brain has to
conduct” and supports the role of this test to detect decline, said Julie
Liss, a speech expert at Arizona State University with no role in the work.
She helped lead a study
in 2015 that analyzed dozens of press conferences by former President Ronald
Reagan and found evidence of speech changes more than a decade before he was
diagnosed with Alzheimer’s. She also co-founded a company that analyzes
speech for many neurological problems, including dementia, traumatic brain
injury and Parkinson’s disease.
Researchers could not
estimate the cost of testing for a single patient, but for a doctor to offer
it requires only a digital tape recorder and a computer program or app to
Alan Sweet, 72, a
retired state of Wisconsin worker who lives in Madison, is taking part in
the study and had the speech test earlier this month. His father had
Alzheimer’s and his mother had a different type of dementia, Lewy body.
“Watching my parents
decline into the awful world of dementia and being responsible for their
medical care was the best and worst experience of my life,” he said. “I want
to help the researchers learn, furthering medical knowledge of treatment and
Participants don’t get
individual results - it just aids science.
Another study at the
conference on Monday, led by doctoral student Taylor Fields, hints that
hearing loss may be another clue to possible mental decline. It involved 783
people from the same Wisconsin registry project. Those who said at the start
of the study that they had been diagnosed with hearing loss were more than
twice as likely to develop mild cognitive impairment over the next five
years as those who did not start out with a hearing problem.
That sort of
information is not strong evidence, but it fits with earlier work along
Family doctors “can do
a lot to help us if they knew what to look for” to catch early signs of
decline, said Maria Carrillo, the Alzheimer’s Association’s chief science
officer. Hearing loss, verbal changes and other known risks such as sleep
problems might warrant a referral to a neurologist for a dementia check, she
Audio of example test: