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We provide the same Preventive Executive Physical Program as received by the President of the United States.


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USPSTF Recommends Low-Dose Aspirin to Prevent CVD, Colorectal Cancer in Some Patient Groups

Aspirin 2The U.S. Preventive Services Task Force, in a draft statement, is recommending low-dose aspirin to prevent both cardiovascular disease and colorectal cancer in adults aged 50 to 59 years who have a 10-year CVD risk of 10% or greater (grade B recommendation). Patients aged 60 to 69 should talk to their clinicians about whether the benefits of daily aspirin outweigh the risks (grade C).

Patients using aspirin as a preventive must have a life expectancy of at least 10 years and be willing to take it daily for that length of time. The USPSTF notes that patients at increased risk for bleeding shouldn’t use daily aspirin.Aspirin 3

The task force says there is insufficient evidence to make a similar recommendation for adults younger than 50 years or older than 70 years (both grade I statements).  The task force previously published separate recommendations on aspirin use for preventing CVD (2009) and colorectal cancer (2007); this is the first update to address the combined benefit.

Source: Journal Watch


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Air Pollution Tied to Brain Aging

air pollution 3Air pollution is known to increase the risk for stroke and other cerebrovascular disorders. But now researchers have found it is also linked to premature aging of the brain.

The study, in the May issue of Stroke, used data on 943 men and women over 60 who were participants in a larger health study. Researchers did M.R.I. examinations and gathered data on how close the people lived to major highways. They also used satellite data to measure particulate matter smaller than 2.5 micrometers, or PM 2.5, a form of pollution that easily enters the lungs and bloodstream.air pollution 1

After controlling for health, lifestyle and socioeconomic factors, they found that compared with people exposed to the lowest levels of PM 2.5, those with the highest exposure had a 46 percent increased risk for covert brain infarcts, the brain damage commonly called “silent strokes.”

They also found that each additional two micrograms per cubic meter increase in PM 2.5 was linked to a decrease in cerebral brain volume equivalent to air pollution 2about one year of natural aging.

“We’re seeing an association between air pollution and potentially harmful attacks on the brain,” said the lead author, Elissa H. Wilker, a researcher at Beth Israel Deaconess Medical Center. “This helps us to better understand the mechanisms related to air pollution and clinically observed outcomes.”

Source: New York Times


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Lung Cancer Screening

lung cancer 3Lung cancers is the leading cause of cancer related mortality in the United States, with 159,000 deaths estimated in 2014.  Age older than 55 years and smoking are the strongest risk factors for lung cancer.  Smoking cessation is the main intervention to prevent lung cancer in 20% of Americans who continue to smoke, but only 15% of cessation efforts succeed.  Outcomes in lung cancers depend crucially on the stage of diagnosis, with 5-year survival for non-small cell lung cancer estimates at 71% – 90% for stage IA and 42% – 75% for stage IB cases, compared with less than 10% for those diagnosed with stage IV.  Currently only 15% of lung cancer cases are diagnosed at stage I, and large trials have not supported the value of chest radiography or sputum cytology for screening.  Low-dose computed Lung Cancer 1tomography (CT) has emerged as a potentially useful screening method, with 55% – 85% of detected cancers found to be stage I.  Approximately 9 million Americans would potentially be eligible for this screening guideline, divided roughly equally between current smokers and former smokers who have quit within the past 15 years.

Source: JAMA

The Presidential Healthcare Center’s Executive Physicals include cancer screening and tumor marker tracking.


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Scientists Find Lung Cancer Can Lie Hidden for 20 Years

Lung cancer can lie dormant for more than 20 years before turning deadly, helping explain why a disease that kills more than 1.5 million a year worldwide is so persistent and difficult to treat, scientists said on Thursday.

lung cancerTwo papers detailing the evolution of lung cancer reveal how after an initial disease-causing genetic fault — often due to smoking — tumor cells quietly develop numerous new mutations, making different parts of the same tumor genetically unique.

By the time patients are sick enough to be diagnosed with cancer, their tumors will have developed down multiple evolutionary pathways, making it extremely hard for any one targeted medicine to have an effect.

The findings show the pressing need to detect lung cancer before it has shape-shifted into multiple malignant clones.

“What we’ve not been able to understand before is why this is really the emperor of all cancers and one of the hardest diseases to treat,” said Charles Swanton, an author on one of the papers from Cancer Research UK’s London Research Institute.

“Previously, we didn’t know how heterogeneous these early-stage lung cancers were.”

Lung cancer is the world’s deadliest cancer, killing an estimated 4,300 people a day, according to the World Health Organization. Around 85 percent of patients have non-small cell lung cancer (NSCLC), the type analyzed in the two studies.

To get a clearer understanding of the disease, the two groups of British and American scientists looked at genetic variability in different regions of lung tumors removed during surgery and worked out how genetic faults had developed over time.

What they found was an extremely long latency period between early mutations and clinical symptoms, which finally appeared after new, additional faults triggered rapid disease growth.

In the case of some ex-smokers, the initial genetic faults that started their cancer dated back to the time they were smoking cigarettes two decades earlier. But these faults became less important over time and more recent mutations were caused by a new process controlled by a protein called APOBEC.

The research was published in the journal Science.

Ramaswamy Govindan of Washington University School of Medicine, who was not involved in the studies, said better understanding of such genetic alterations was key to developing more effective treatments.

There are also hopes for a new generation of immunotherapy drugs that boost the immune system’s ability to detect and fight tumors, which could be particularly applicable to lung cancer.

“The large number of mutations may be the tumor’s Achilles heel because every time a new mutation forms there is a chance for the immune system to recognize it,” Swanton told Reuters.lung cancer 2

Immunotherapy drugs from companies such as Bristol-Myers Squibb, Merck & Co, Roche and AstraZeneca are already undergoing tests in lung cancer, with data on Bristol’s medicine Opdivo due later this year.

Apart from better drugs, a critical challenge is to find improved ways to detect lung cancer before it develops the multiple genetic faults that eventually trigger rapid tumor growth and spread.

Currently, doctors use computerized tomography (CT) to detect lung cancer — but by the time a nodule is big enough to be spotted it on a scan it may contain a billion genetically diverse cancer cells.

For the future, oncologists are pinning hopes on a new approach, known as liquid biopsy, that may be able to detect signs of cancer much earlier from DNA circulating in the blood.

The current prognosis for NSCLC is grim, with most patients diagnosed when the disease has already spread and only around 15 percent surviving for at least five years after that.

Source: Reuters


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Report: Pancreatic Cancer to Become Second Most Deadly by 2030

Pancreas

Pancreas

By 2030, the top cancer killers in the United States will be lung, pancreas and liver, according to a new report published Monday in the American Association for Cancer Research’s journal.

Lung cancer is already the top killer overall, but pancreatic and liver cancer will surpass the cancers currently considered the second and third leading causes of death, researchers say. Right now, second most dangerous is breast cancer for women and prostate cancer for men; and third is colorectal cancer for both men and women.

Researchers looked at trends in cancer incidence and death rates between 2006 and 2010, and used that data — combined with expected U.S. demographic changes — to predict numbers for 2030.

Overall, the cancer-related death rate has been decreasing, researchers say, as a result of improved screening and treatment options. Yet while deaths from breast, prostate and colon cancers are projected to drop, deaths caused by liver, pancreatic, bladder and leukemia cancers are expected to increase.

In fact, liver and pancreatic cancers will surpass breast and prostate to become the second and third-leading causes of cancer-related deaths, the researchers say.

“We’ve been able to turn the tide in other cancers, with an investment in (research),” said lead author Lynn Matrisian, vice president of scientific and medical affairs at the Pancreatic Cancer Action Network, which funded the study. “We’re hoping that with increased effort … we will be able to impact and change those projections.”

The rate of pancreatic cancer has been slowly increasing for the past 15 years, says Dr. Otis Brawley, chief medical officer of the American Cancer Society. Some of that rise can be attributed to the prevalence of obesity and diabetes.

“Many Americans are not aware that the combination of obesity, high-caloric intake and lack of physical activity is the second-leading cause of cancer in the U.S.,” Brawley said. “It is linked to at least 12 types of cancer, of which these are two. This is an American problem … the rise in pancreatic cancer is not as severe as in Europe where obesity is less of an issue.”

Overall, the number of cancer cases is expected to increase over the next 16 years, due to the rapidly aging population. In 2010, the United States had about 1.5 million cases of cancer; in 2030, researchers expect that number to reach 2.1 million.

“We’re living much longer in the United States, so the number of people 65 age and older will be much greater,” Matrisian said. “And that’s, of course, one of the biggest risk factors for cancer: Age.”

Lung, breast, prostate and colorectal cancers are currently the most common in the United States. Known as the “big four,” these cancers have the highest incidence rates and receive the most research funding from the National Cancer Institute.

This is unlikely to change by 2030, the researchers say, except for colorectal cancer, which is expected to be surpassed by thyroid, melanoma and uterine cancers in total number of cases.

“The decrease in colorectal cancer, falling from the top four incidence and top two in deaths, seems to be primarily the result of advances in colorectal cancer screening,” the report authors write.

The dramatic increase in thyroid cases is not a new epidemic, they say, but simply an increase in the number of cases being diagnosed. And while thyroid cancer has a 98% five-year survival rate, only 6% of pancreatic cancer patients are alive five years after diagnosis.

The pancreas is difficult to scan with current imaging technologies, Matrisian says, because of its location in the body. And pancreatic tumors are often surrounded by dense tissue that render drugs useless. Surgery is the only treatment known to cure pancreatic cancer, but less than 20% of cases are operable, the report says.

“If we want to change the death rate for these diseases, it is necessary to increase the investment in understanding them and identifying early detection strategies,” the report says.

Source: CNN