Health Newsfeed – Johns Hopkins Medicine Podcasts

Anchor lead: Should cancers be sequenced again if they recur? Elizabeth Tracey reports

When cancers recur, they are genetically different from when they were first detected, especially after many treatments. With evidence from a new federal study of tumor sequencing clearly demonstrating its benefit, William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says sequencing recurrent cancer may also be helpful.

Nelson: As cancers appear and are treated and improve and relapse or regress even after initial improvement oftentimes that’s because of a sort of a genetic instability, they acquire new and different defects. Those defects favor the cancer growing even despite the treatment that may have been effective before. It’s very plausible that as we learn more and more about it, is that at that occasion, you’ve responded to surgery for a long time, your cancer comes back, is this a time to re-sequence it?  :30

Nelson notes that sequencing is both easier and less expensive than ever. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: A big new project shows the benefit of genetic sequencing of cancers, Elizabeth Tracey reports

Should you have your cancer sequenced? A very large new federal study suggests the answer is more convincingly than ever, yes. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, explains.

Nelson: They called it the match trial. They had gotten biopsies or tissues from almost 6000 cases and they sequenced almost all of them. They found some gene defects that matched a treatment choice in 37.6%. The most common gene defects they saw are ones that don’t have very good treatments for yet. It does suggest that DNA sequencing, there are enough reasons that guide treatment decisions that many if not most cancers will ultimately be sequenced.  :30

Nelson says common mutations or changes in DNA found in many cancers are being actively investigated as targets for new therapies, and predicts many more such agents becoming available soon. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: How might a growth factor and cancer be related? Elizabeth Tracey reports

Insulin-like growth factor or IGF1 helps kids grow, but is also implicated in the development of several types of cancer, a new large study finds. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says levels of IGF1 rise in sedentary people who consume a lot of carbohydrates in their diet.

Nelson: The mechanism presumably is IGF1 levels are typically higher among people who are overfed, for lack of a better description, with diminished physical activity. This is one of the regulators that one gets when you consume high carbohydrate diets, and remember this is IGF1 levels being higher significantly before the cancer develops. That may be a connection by which some of those things do affect the risk for these cancers.  :26

Nelson says this may also be one reason obesity is also associated with many cancers and the good news is, it is a risk factor that can be modified in both those without cancer currently and cancer survivors. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Some cancers are associated with an increased level of a growth factor in the blood, Elizabeth Tracey reports

Insulin like growth factor one, abbreviated IGF1, is a hormone that helps children grow, but is also associated with certain cancers. Now a very large European study has shown just which cancers are impacted. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, explains.

Nelson: They looked at 30 different types of cancer. I think 23,000 or more developed a cancer in that observation time. What they found was an increased risk with higher IGF1 levels for colorectal cancer, breast cancer, and prostate cancer. Now each of these had been indicted if you will as being associated by smaller studies, so this confirms that on a larger scale. They did not see an association with lung cancer, bladder cancer, pancreatic cancer, that was one to question, endometrial cancer, that’s cancer of the uterus, or kidney cancer.  :32

Nelson notes that even the authors of the study are uncertain about why the growth factor is associated with some cancers and not others. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: A huge study shows the HPV vaccine prevents cancer of the cervix, Elizabeth Tracey reports

Human papilloma viruses cause cancer, and the vaccine against them prevents cancer of the cervix in women, a huge study of over a one and a half million Swedish women shows. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes the results.

Nelson: What this group does is finally get enough people followed for long enough that they can get a sense for is cervical cancer itself actually prevented? What they found was that among people who were vaccinated only 19 cases of cervical cancer, among the unvaccinated more than five hundred cases. That’s as clear as can possibly be the vaccine definitely prevents cervical cancer in addition to the premalignant condition.   :27

Nelson says the very few cases of cervical cancer among women who were vaccinated probably shows they were already exposed to the virus before they received the vaccine, which is now routinely given to girls around 12 years of age. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Covid-19 is not taking a holiday, Elizabeth Tracey reports

What are your plans for Thanksgiving? Christmas? Lisa Maragakis, an infectious diseases expert at Johns Hopkins, says it’s a sure bet Covid-19 won’t be taking a holiday, and holiday gatherings have the potential to infect large numbers of people at once.

Maragakis: We really see prominent examples of what we call superspreader events. What we think happens is a group gathers together and if they have the  unfortunate circumstance of having someone in their midst that has a high viral load, a lot of virus that is being shed, and the perfect conditions of being indoors, particularly if those individuals are talking or singing or shouting, and the airflow dynamics are just right, we have superspreader events. Large large numbers, potentially tens or even hundreds of people can contract the virus at that one event.   :34

Maragakis says creativity may help here, perhaps planning an outdoor activity to visit with friends and family. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Having had Covid-19 doesn’t give you a free pass, Elizabeth Tracey reports

People who’ve had Covid-19 still need to keep their masks on, physically distance themselves from others and wash their hands while the pandemic continues. That’s according to Lisa Maragakis, an infectious disease expert at Johns Hopkins.

Maragakis: Those who have had the infection it is important to continue the same types of precautions that we’re recommending for everyone. You might actually still be shedding virus even if you’re not in isolation precautions and the possibility that reinfection or at least carriage- picking up the virus and carrying it and transmitting it to others, is still possible. So until we know more, each of us regardless of our past infection status or if you find out that you have some antibodies to it, we’re still recommending that everyone practice the precautions.  :32

Maragakis says that as the science advances it has become clear that public health measures do help reduce the rate of infection with Sars-CoV2 as well as the flu. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: How common is infection with Covid-19 a second time? Elizabeth Tracey reports

At least three people have been reported to develop second Covid-19 infections after having confirmed infection previously, raising worries about immunity to the infection. Aaron Milstone, an infectious diseases expert at Johns Hopkins, describes what’s known.

Milstone: There have been two or three reports of true second infection with the virus. We don’t know enough about those people yet to know whether or not they have a problem with their immune system that may make them susceptible to infections. But at this point we have more and more data that when people get the virus they develop antibodies to the virus. They’ve been a few recent studies that showed those antibodies lasting three or four months after the infection, which is great news. So I think we are optimistic that people will not get reinfected with the virus, although it still is early to say that reinfections won’t happen.  :33

Milstone says that if you suspect you’re experiencing reinfection, seek medical attention to confirm that with testing. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: What is the proper schedule for flu vaccines? Elizabeth Tracey reports

As many people obtain the flu vaccine this year, some questions remain. Aaron Milstone, an infectious diseases expert at Johns Hopkins, answers a few of them.

Milstone: Do people need to get a second vaccine this year for influenza? And the only time that people get a second dose of the influenza vaccine is if it’s the first time they’ve ever received a vaccine so that’s usually in children when they’re getting their first dose, they would get a second dose during the same season. The other question we’ve gotten is will you be able to get the coronavirus, the Sars-CoV2 vaccine, when it becomes available if you’ve gotten the flu vaccine. And getting a flu vaccine will have no impact on your ability to get the Covid vaccine when it comes out.  :31

Milstone notes that there are different formulations of influenza vaccines that are suitable for different groups of people, such as the elderly, but your provider will know which is appropriate. He says the most important message is to get vaccinated, as promptly as possible. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: In the midst of the pandemic flu vaccines are more important than ever, Elizabeth Tracey reports

Can you tell the difference between Covid-19 and the flu? Most likely not, and even experts rely on testing to make the call. That’s important because treatments are so different, and it’s another reason to make sure you avoid the flu by getting the flu vaccine. Lisa Maragakis, an infectious disease expert at Johns Hopkins, comments.

Maragakis: We have different formulations of the influenza vaccine available generally targeted to different segments of the population. The recommendation is that anyone over the age of six months needs to get an influenza vaccine. So that’s the most important message. We want everyone to get their vaccine before the virus starts circulating and it takes time for your immune system to respond to vaccination, it could take anywhere from ten to fourteen days. So get your vaccine now, that will give yourself time to respond to the vaccine and be protected before the virus circulates.  :33

At Johns Hopkins, I’m Elizabeth Tracey.