These are prostate cancer cells as imaged with electron microscopy and artificial colors. (© Cancer Research UK, Electron Microscopy Unit)

Mass General researchers use metabolomic imaging to accurately diagnose tumors

Pathology laboratories may soon find it possible to identify prostate cancer without a biopsy. A new technology under development at Massachusetts General Hospital demonstrates the potential to improve the accuracy of prostate cancer diagnosis. Some studies have demonstrated that nearly a quarter of initial biopsies of the prostate gland may generate false-negative results because the biopsy specimen failed to extract cells from existing cancerous tumors.

To improve the detection of prostate cancer, researchers at Massachusetts General Hospital (MGH) are investigating a new technique that may give doctors a way to locate even small tumors and to provide an accurate determination of a prostate tumor’s prognosis without using a biopsy.

In a report published in the January 27 online issue of Science Translational Medicine, the MGH researchers say they are using spectroscopic analysis of the biochemical makeup of prostate glands to map the location and size of prostate tumors. Though the technique is still in the developmental stage, they hope to move the technique to clinical trials within two years.

The study’s senior author is Leo L. Cheng, M.P.P., Ph.D., who is Assistant Professor of Radiology and Pathology at Harvard Medical School. He works in the MGH Imaging and Pathology departments.

In the published study, researchers described how metabolomic imaging utilizing a clinical magnetic resonance scanner helped them locate tumors in prostate glands previously removed from cancer patients.

The research builds on a 2005 study in which Cheng and his colleagues found that magnetic resonance spectroscopy could distinguish prostate cancer from benign tissue. Using a malignancy index extracted from the spectroscopy information, researchers were also able to more accurately forecast of a tumor’s prognosis than traditional pathology studies.

According to an abstract of the new study on the Science Translational Medicine website, “This calculated malignancy index is linearly correlated with lesion size and demonstrates a 93 to 97% overall accuracy for detecting the presence of prostate cancer lesions, suggesting the potential clinical utility of this approach.”

An article in the February 1 issue of Science Daily quoted Cheng, saying, “Collectively analyzing all the metabolites measurable with a 7-Tesla MR scanner maps out prostate cancer in a way that cannot be achieved by any other current radiological test or by analyzing changes in a single metabolite. It detects tumors that cannot be found with other imaging approaches and may give us information that can help determine the best course of treatment.”

Pathologists will recognize how this technology may radically change the way prostate cancer is diagnosed. It could significantly reduce the need for a prostate biopsy and perhaps eventually make the procedure obsolete. Current estimates are that about one million prostate biopsies are done each year in the United States. Prostate biopsies represent a significant part of the test volume for many clinical pathology laboratories. A significant decline in the number of prostate biopsies collected annually would dramatically alter the work flow and revenue base for many pathology laboratories.

Credit: Technology Review

Several recent deals could make tests more common

MIT Technology Review, February 22, 2010, by Emily Singer  —  Even though nearly 2,000 genetic tests are available today, most Americans have never taken one. (Save, perhaps, for newborn screening.) That may soon change, as the nation’s largest businesses responsible for managing prescription benefits, Medco and CVS Caremark, delve into the DNA testing business. Taken together, the two companies cover more than 100 million Americans.

In the industry’s jargon, Medco and CVS Caremark are known as pharmacy-benefit managers, acting as middlemen between insurers or employers and their customers or employees to negotiate cheaper drug prices, and to develop tools to improve the prescription process. These companies largely took over the prescription drug industry 15 years ago, and they may now do the same for genetic testing.

Earlier this month, Medco announced that it had acquired DNA Direct, a genetic testing startup based in San Francisco. The announcement follows a similar deal by CVS Caremark in December, when it increased its ownership share in Generation Health, a New Jersey-based startup created to analyze the effectiveness of genetic tests. “There is consumer demand right now,” says Robert Epstein, Medco’s chief medical officer. “People want to know–I’ve just been diagnosed with cancer, what tests do I need?”

While the majority of existing genetic tests screen for rare, single-gene disorders, a number are available for more common conditions–substantially increased risk for certain cancers, blood clots, or cardiac abnormalities, as well as genetically determined differences in an individual’s response to specific drugs. But use of the tests has not caught on, for a variety of reasons. Physicians don’t understand them, patients aren’t aware of them, and it’s not yet clear how effective they are at both improving a patient’s long-term outcome and decreasing health costs.

Medco is targeting all of those gaps. The company has already made some strides in pharmacogenomics–using genetic testing to personalize prescription drugs. Medco’s pharmacists call physicians and patients to offer the appropriate genetic test for a prescribed drug and then help interpret the results. “Physicians understand the concept of pharmacogenomics, but they don’t really feel comfortable interpreting the results,” says Pat Deverka, a physician and researcher at the Institute for Pharmacogenomics and Individualized Therapy at the University of North Carolina, in Chapel Hill. A recent survey by Medco found that while almost all physicians polled recognized that genetic profiles may influence a reaction to a drug, only 10 percent believed they were adequately informed about pharmacogenetic testing.

That problem is likely to grow. “There are still a relatively small number of drugs where pharmacogenomics actually plays a role, but this could drastically expand over the next five years,” says Scott Weiss, a physician at Harvard Medical School and interim director of the Partner’s Healthcare Center for Personalized Genetic Medicine. “Antidepressants, asthma meds, anti-arrhythmia drugs, lipid-lowering drugs–some of the biggest sellers in terms of drug use nationally could potentially have pharmacogenetic implications.”

Medco is also funding studies to evaluate the cost-effectiveness of specific pharmacogenomics tests, including those for the blood thinner warfarin and the breast cancer drug tamoxifen. The company will announce results of a study conducted in collaboration with the Mayo Clinic at the American College of Cardiology conference next month.

By acquiring DNA Direct, Medco greatly expanded its ability to offer genetic tests and the decision-making tools needed to put them into practice. “We were concentrated on a dozen pharmacogenomic tests,” says Epstein. DNA Direct, on the other hand, “has expertise in 1,000 to 2,000 tests.”

Founded in 2005, DNA Direct began as a direct-to-consumer genetic testing company. The company has gradually expanded its offerings, developing decision-making software to help physicians and patients decide when genetic testing is appropriate and what to do with the results. It has also created a network of genetic counselors to answer questions, as well as partnerships with insurers to determine which tests should be covered for which patients.

Medco plans to launch a new set of tools based on DNA Direct’s existing infrastructure and present them to clients this summer. “Patients are going to see the principles of personalized medicine presented to them rather dramatically,” says Edward Abrahams, executive director of the Personalized Medicine Coalition, a Washington, DC-based advocacy organization comprised of payors, providers, industry, academia and patient advocacy groups., February 22. 2010  —  WASHINGTON — The government is taking steps to curb use of some long-acting asthma drugs taken by millions, issuing safety restrictions Thursday to lower an uncommon but potentially life-threatening risk that asthma could worsen suddenly.

The Food and Drug Administration’s warnings cover the drugs Advair, Symbicort, Foradil and Serevent. The FDA said they should be used only by asthmatics who can’t control their lung disease with other medications — and then only for the shortest time possible.

Nor should LABA-containing drugs ever be used without simultaneous use of a different asthma-controlling medication, such as an inhaled corticosteroid — a move that specifically targets two of the drugs, Foradil and Serevent, the FDA said.

Why? These four drugs contain an ingredient that relaxes muscles around stressed airways, called a long-acting beta agonist or LABA. While they’re very helpful at preventing day-to-day symptoms for some patients, the way LABA-containing drugs work also sometimes masks that inflammation is building in the airways. That means patients may not realize a serious asthma attack is brewing until they’re gasping for air.

The FDA cited studies that showed an increased risk of hospitalization and even some deaths, particularly among children. One study found three extra adverse events — mostly hospitalizations — for every thousand patients who took a LABA-containing drug compared to another asthma medication, said FDA’s Dr. Gerald Dal Pan.

It’s hard to translate how big a risk that really is to the average person, but “it’s probably not going to be a major problem,” said Dr. Thomas Casale of the American Academy of Allergy, Asthma & Immunology.

Still, “there was a tendency to overuse” these medications, Casale added, saying too many doctors prescribed Advair or its relatives before trying standard treatment.

The big change: FDA’s advice that patients quit the LABA-containing drugs as soon as their asthma is under control and go back to standard medications such as inhaled corticosteroids for day-to-day maintenance.

“We want to emphasize to our patients that they should not stop using a LABA until they consult with their physicians,” Casale stressed. “This is going to be a personal decision based on how well the patient’s asthma is under control.”

Medical guidelines already urge people to use a LABA together with an inhaled corticosteroid to relieve inflammation. Advair and Symbicort combine both kinds of medicine in one inhaler. Over a year ago, the FDA’s scientific advisers had urged that LABA-only medications, Foradil and Serevent, no longer be used to treat asthma — and that none of the four drugs be used in children.

The FDA said Thursday it was taking a somewhat stronger step. People with other lung diseases, such as chronic obstructive pulmonary disease or COPD, use the drugs without the asthma risk, and just saying they shouldn’t be used for asthma would have little practical effect, said Dr. John Jenkins, FDA’s director of new drugs. So FDA labeled LABA-containing medications as contraindicated without simultaneous use of a different asthma-controlling medication — a legal term with more enforcement muscle to limit prescription. FDA will monitor that, to see if doctors follow the rules.

“Our goal is to overall reduce the use of LABAs, to manage the risk while at the same time keeping them available for those patients who really need them,” said Jenkins, a pulmonologist.

“The reality is the available options to treat asthma are not that great,” he added. For patients not well-controlled by inhaled corticosteroids alone, “their options for additional therapy are, in and of themselves, drugs with a lot of risk.”

Other warnings:

–Children and teens should be prescribed only the combination LABA drugs to ensure compliance with both medications. That mostly happens today, as pediatric use of the single-agent drugs has plummeted with publicity about the risk.

–Manufacturers also will be required to study whether combination LABA use indeed lowers the risk.

Advair and Serevent are marketed by GlaxoSmithKline, Foradil by Novartis AG and Symbicort by AstraZeneca.

On the Net:

FDA info:

Michael F. Roizen, MD, and Mehmet C. Oz, MD

The Sweet Way to Save Your Colon

Colon cancer starts when a few bad cells go wild. But munching on sweet, juicy apples could help keep those troublemakers in line.

Credit quercetin, a cancer-fighting flavonoid found in abundance in apples. In a lab study, this anticancer compound appeared to slap the handcuffs on precancerous cells, keeping them from dividing, and even encouraging them to die off.

Quercetin Quiets Inflammation
Quercetin seems to work by controlling levels of cancer-fueling inflammation. And if it has the same effect in human subjects — as lab studies using human cells suggest it might — then loading up on quercetin-rich produce could lower colon cancer risk anywhere from 6 percent to 35 percent, researchers posit.

 There’s Something About Produce
Maybe it isn’t just the fiber in fruits and vegetables that helps keep your colon healthy. Maybe it’s also the quercetin and other healthy nutrients you get not only from apples but from onions, green and black tea, and buckwheat, too. Either way, your colon thanks you. So keep on fighting the good fight with these other colon-friendly treats:

  • Whole grains: Fiber doesn’t take all the credit here. It’s also the vitamins, minerals, and cell-protective

                      phenols that help..

  • Bananas: It’s the B6 that may have colon-protective powers..
  • Seafood: Fish and shrimp eaters tend to have healthier colons..
  • Garlic, leeks, and chives: This savory family guards against a whole bunch of cancers..

by Michael F. Roizen, MD, and Mehmet C. Oz, MD

According to a large 22-year study, men who eat fish and shrimp five times a week have a 40 percent lower risk of colorectal cancer. Just get it broiled, not fried, and go light on the butter.

What’s Fish Got That Colons Love?
Researchers aren’t sure why frequently eating fish has such a protective effect on colon health. The omega-3 fatty acids and the vitamin D in fish might get the credit. Or it could simply be that fans of fish eat less red meat — something known to raise colon cancer risk. Regardless, grab that mahimahi burger instead of the beef patty.
Eating fish protects not only your colon but lots of other important body parts, too. Here’s what else benefits:

by Michael F. Roizen, MD, and Mehmet C. Oz, MD

For most people, the healthy fats in fish provide a huge benefit to your heart and overall health — even with a little mercury. Skeptical? Get this: Eating one to two 6-ounce servings of omega-3-rich fish each week reduces your risk of dying from heart disease by 36 percent! And your all-cause mortality rate drops by 17 percent.

Soon-to-be or currently breastfeeding moms need to be especially careful to avoid excess mercury. Still, most people can do their heart and body right by eating one or two servings a week of omega-3-rich fish that is relatively low in mercury. Unfortunately, most fish contain some mercury, thanks to industrial processing. But the less time fish spend simply living in a mercury-laden environment or eating other fish containing mercury, the lower the contamination levels will be. So for low-mercury fish, we’re talking small fish that don’t eat many other fish (or fish meal) and don’t have a long life span. Here are five good choices:

1. Salmon (wild): 1 gram of omega-3 fatty acids per 2 ounces of fish;* 0.014 parts per million mercury concentration

2. Herring: 1 gram of omega-3 fatty acids per 1 ounce of fish;* 0.044 parts per million mercury concentration

3. Sardines: 1 gram of omega-3 fatty acids per 2-3 ounces of fish;* 0.016 parts per million mercury concentration

4. Trout (freshwater): 1 gram of omega-3 fatty acids per 3-4 ounces of fish;* 0.072 parts per million mercury concentration

5. Pollock: 1 gram of omega-3 fatty acids per 6.5 ounces of fish;* 0.041 parts per million mercury concentration

*Oil content varies widely, depending on species, season, environment, diet, and packing and cooking methods.

Here’s the list of fish to avoid:

  • King mackerel: 0.73 parts per million mercury concentration
  • Shark: 0.99 parts per million mercury concentration
  • Swordfish: 0.98 parts per million mercury concentration
  • Tilefish (Gulf of Mexico): 1.45 parts per million mercury concentration

So where does the beloved tuna fall? Pretty close to the middle of the road, actually, with mercury concentration ranging from 0.12 to 0.69 parts per million, depending on what kind of tuna you eat. And you’ll need to eat anywhere from 3.5-12 ounces to get 1 gram of omega-3 fatty acids, depending on how you take your tuna: Fresh tuna has the most and canned chunk light tuna has the least. But chunk light tuna also has the least mercury.

Keep in mind that oil content estimates can be fairly rough, despite the best research efforts. A fish-oil supplement is a surefire way to get the omega-3 fatty acids you want and need. But talk to your doctor first. Fish-oil supplements are dangerous for certain people.

by Michael F. Roizen, MD, and Mehmet C. Oz, MD

The omega-3s in fatty fish (like salmon) not only help your heart stay healthy, but they seem to keep kidney cancer away, too. Women in a study who ate fatty fish on a fairly regular basis lowered their risk of kidney cancer by 44 percent.

Mega Omegas
It’s no fish tale! Almost 15 years of data show that when salmon and other fatty fish (like sardines and herring) regularly show up on your dinner plate, you could be giving kidney cancer the big kiss-off.

Researchers suspect that certain omega-3 fats in the fish may change the immune response of cancer cells in a way that thwarts their invasive process. But it’s got to be fatty fish; slim swimmers (like cod) can have 20 to 30 times less omega-3s.

Fatty fish are also chock-full of vitamin D, which may play a protective role as well.

by Michael F. Roizen, MD, and Mehmet C. Oz, MD

Generally, what’s harmful to your heart also is also harmful to your brain. Make no mistake about it: While fried potato skins are busting your buttons, there’s also a portion that gets shuttled up through your arteries to your gray matter.

Saturated fats, for example, clog arteries that lead to your brain, putting you at risk of stroke, while omega-3 fatty acids — the good fats found in fish — are helpful for your brain because they help keep your arteries clear. They also alter your neurotransmitters and reduce depression.

These are the best foods to keep your brain and your RealAge young:

Food Why Recommended
Nuts Nuts contain monounsaturated fats to keep your arteries clear, as well as levels of precursors of serotonin to boost mood. 1 ounce of nuts a day is just right. (More is fine, but be careful of calorie overload.) An ounce is about 12 walnuts or 24 almonds. Men: 3.3 years younger.

Women: 4.4 years younger.

especially wild salmon, whitefish, tilapia, catfish, flounder, mahi mahi
Fish contain artery-clearing omega-3 fatty acids. Aim for 13.5 ounces of fish a week, or 3 servings, each about the size of your fist. 2.8 years younger.
Soybeans Soybeans contain heart- and artery-healthy protein, fiber, and fats. 1 cup of soybeans a day. 0.4 years younger.
Tomato juice and spaghetti sauce Tomatoes contain folate, lycopene, and other nutrients to keep arteries young. 8 ounces a day of juice or 2 tablespoons of spaghetti sauce a day. At least 1 year younger.
Olive oil, nut oils, fish oils, flaxseed, avocados All of these foods contain heart-healthy monounsaturated fats. 25% of daily calories should be healthy fats 3.4 years younger.
Real chocolate(at least 70% cocoa) Real chocolate increases dopamine release and provides flavonoids, which keep arteries young.    

by Michael F. Roizen, MD, and Mehmet C. Oz, MD

Your blood pressure could be lower just by indulging more in this sweet tropical treat: bananas.

Cheap and plentiful year-round, bananas are bursting with potassium. And a review of several major studies suggests that people who add the potassium equivalent of an extra 1 1/2 to 2 bananas to their day could drop their blood pressure 2 to 3 points.

More Points for Potassium
Dropping BP by 2 or 3 points is nothing to sneeze at. In fact, it’s enough to lower stroke risk. In other research, people with the highest potassium intake levels cut their stroke risk by a whopping 38 percent compared with the people who got the least potassium. This magical mineral works by encouraging your kidneys to filter more pressure-boosting sodium out of your bloodstream. It also helps tiny blood vessels relax and makes pressure sensors in artery walls function more efficiently.
Aim for 3,000 milligrams a day of potassium to get optimal RealAge benefits. But don’t rely on pills; they can be dangerous if you have kidney problems. Go with fruits and veggies instead — not just bananas but prunes, watermelon, baked potatoes with the skin, mushrooms, tomatoes, and other produce, too. Produce will also give you a head start on these important blood pressure control strategies:

  • Slash the sodium. Fresh produce is naturally low in salt. And licking the salt habit can lower your blood pressure even if it’s just a bit high..
  • Mine more minerals. Fruits and veggies pack not just potassium but calcium and magnesium as well, two additional pressure-pampering minerals..
  • Seek a sleeker you. Low-cal fruits and veggies can help you hit a healthy weight, which is important for your blood pressure..

Did you know? Nearly 90 percent of adults will develop high blood pressure by age 65.

by Michael F. Roizen, MD, and Mehmet C. Oz, MD

Recent research shows how a sleep deficit does more than foster cappuccino cravings. A lack of enough sleep may also increase your risk for weight gain –even if you’re not overeating.

Sleepless and Sinking
In a study, middle-aged women who slept 5 hours or less per night gained more weight than the women getting 7 or more hours of shut-eye nightly. And the sleepless set was at much higher risk of gaining significant weight — as much as 33 pounds — during the 16-year study.   Women who slept 6 or fewer hours nightly also tended to gain a bit more weight than the 7-hour sleepers.

Haywire Hormones
The truly big surprise of the study? The short sleepers weren’t raiding the cookie jar. In fact, they took in about 50 fewer calories than their skinnier, longer-sleeping peers. All of which left the researchers to speculate that a lack of sleep may somehow depress metabolism, so people burn fewer calories around the clock. Missing out on deep, restorative REM sleep could also alter hormones in as yet undiscovered ways linked to higher body weights. Better hit the hay happy — and sleep better — with these steps: