Health Topics – Johns Hopkins Medicine Podcasts

Anchor lead: A mutation known to increase cancer risk in women is also important in some men, Elizabeth Tracey reports

Gene mutations known as BRCA may dramatically increase a woman’s risk for breast and ovarian cancers, and now a study shows that for some men with advanced prostate cancer, these same mutations may be the culprit. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says this knowledge has at least two implications. 

Nelson: It’s become evident that men who have prostate cancer that has spread throughout the body, has been treated with attempts to choke off supply of the male hormone to those cancers, the prevalence of BRCA gene defects is remarkably high. Those men can be treated substantially differently than those men that don’t have that gene defect. Family members of this person who had prostate cancer, who carries a BRCA gene, they have the same kind of risks, if they are women, that women who carry these genes have, because they carry that gene. And so there’s some thought about so-called cascade testing, who else should be tested.  :34

At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: How can guidelines for health be translated to choices people make? Elizabeth Tracey reports

Comprehensive guidelines for reducing cancer risk have recently been released from the American Cancer Society, covering diet, alcohol use, and exercise. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says the key to adoption of these guidelines is most likely a public health approach that would help reduce infectious disease risk and overall health.

Nelson: Maybe as we begin to build public health assets around the country rather than just monitoring when an infection shows up and doing contact tracing maybe we can start to address these root causes in a public health conformation. Can we begin to deploy programs with measured accountability for our ability to limit obesity, promote physical activity, ensure the intake of plant foods away from these food deserts where they’re hard to get ahold of and really think about that as a public health goal, not just the control of infectious diseases.  :31

Nelson says the current pandemic helps bring such an approach sharply into focus. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Avoiding the development of cancer may also mean avoiding alcohol, Elizabeth Tracey reports

Don’t drink alcohol. That’s the take home from recently released guidelines from the American Cancer Society on reducing one’s risk for cancer. William Nelson, director of the Kimmel Cancer Society at Johns Hopkins, says previous data notwithstanding, the bulk of the evidence seems to support this.

Nelson: If you see people who report on a survey that they only consume low or moderate amounts of alcohol and they have lower risks for cardiovascular disease or cancer is that because of the alcohol they drink or is that because of the kind of person that they are? I think the game goes around to low or moderate alcohol consumption and I think the challenge to making the recommendations is its difficult to know whether it’s the alcohol itself or the lifestyle that one has selected. With that in mind most of the data do line up that alcohol itself is not helpful to you in its physiology vis a vis cancer risk.    :35

At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: A plant based diet may be best for reducing one’s risk of cancer, Elizabeth Tracey reports

Cancer risk may be decreased by consuming a diet largely based on plants, the American Cancer Society has affirmed in their most recent guidelines for reducing one’s risk of cancer. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says they also point out what to avoid eating.

Nelson: Diet, they were all over a pretty healthy diet before, really emphasizing plant foods. They think that should be a pattern you eat at all ages so you can build a pattern of dietary consumption. And they like a variety of vegetables, particularly dark green, red, orange, beans, peas, fruits and whole grains, and they really would like people to not eat as much red and processed meat, sugar sweetened beverages and highly processed foods and refined grain products. :27

Nelson notes that such a diet also reduces obesity and cardiovascular risk, as well as promoting longevity. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: The American Cancer Society has new recommendations on how to reduce your risk for cancer, Elizabeth Tracey reports

Almost one in five cancers in the US could be prevented with better lifestyle choices, the American Cancer Society states in their new guidelines. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says physical activity is one factor.

Nelson: In particular what they’ve done this time compared to their previous recommendation is they’ve kind of increased their thoughts as to how much physical activity you should get in your life. An adult should engage in at least 150 minutes of moderate intensity or 75 minutes, hour and 15 minutes of vigorous intensity each week, that was what they previously recommended. Now they say double it basically. 150 to 350 moderate intensity, 75 to 150 vigorous intensity a week.  :30

Nelson says the benefits of exercise for stress reduction, improving sleep quality and weight control contribute to how it may help reduce cancer risk, so this is a goal that’s well worth attempting. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: COVID-19 disease seems to have more than one phase, especially in those who have severe illness, Elizabeth Tracey reports

COVID-19 disease is so mild in some that they show no symptoms, while those who go on to develop severe disease seem to have at least two phases to the illness. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, comments.

Garibaldi: I think it probably is true that there’s the initial injury that happens because of the virus replicating, directly damaging the epithelial cells and other parts of the body, and then there’s the immune system’s response to it. Whether or not we find out down the road if there’s even some component of autoimmunity, that’s driving some of the inflammation we’re seeing after initial injury, I think that remains to be seen. But it certainly would make sense that in that setting, an anti-inflammatory like a glucocorticoid, could potentially shut down that secondary inflammation, and calm things down.  :29

Garibaldi says this observation may explain why the patients who seem to benefit from dexamethasone treatment are those with severe disease requiring mechanical ventilation, while those with more mild disease didn’t, as a recent study found. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: A large trial in the UK finding that a steroid can help people with severe COVID-19 also points the way to getting results quickly, Elizabeth Tracey reports

RECOVERY is the acronym for a large, randomized trial underway in the UK designed to quickly evaluate potential treatments for COVID-19. Recent results include the use of dexamethasone in patients with the disease who were on ventilators. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, applauds the approach.

Garibaldi: This is exactly the way you want to go about things if you want to get data quickly. You want it to be a large population and broadly representative of the patients who might be ill presuming with so many centers that they probably had a pretty good slice of what the population looks like. And you really want to try to do these on a larger scale because we’ve seen a lot of these small single arm trials that show promise for repurposing drugs that are already available. We’ve seen very clearly how small studies can be misleading and once you actually get larger data you realize okay, for whatever reason that one study showed a benefit but overall this is not the way we want to go.  :33

At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Can a steroid called dexamethasone help people with severe COVID-19 disease? Elizabeth Tracey reports

In people with severe COVID-19 disease who were on ventilators, using a steroid drug called dexamethasone reduced mortality by about a third, a very large study called the RECOVERY trial found. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, comments.

Garibaldi: What I think we’re really interested in seeing from this study is that it didn’t look like there was a benefit overall it was just in the patients with severe disease who were mechanically ventilated so does that mean that there was a harm in the other patients who got it? Whenever you start modulating the immune system in response to an infection you have to be concerned about secondary infections, other complications of steroids. We really need to dig into it to understand is this something that should be given to all patients? Is there only a subset of patients that should get it or is it really something that should become standard of care.  :30

Garibaldi says the complete data was not available when results were announced and the study was not peer-reviewed. He’s hopeful the results will bear up as they are analyzed. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: As many as half the tests available for Sars-CoV2 may not provide reliable results, Elizabeth Tracey reports

If you get tested for COVID-19, whether you suspect you might be infected or have been in the past, can you trust the results? An analysis in the British Medical Journal says maybe not, as many assays for antibodies are flawed and may provide either false negative or false positive results. Patricia Davidson, dean of the Johns Hopkins School of Nursing, comments.

Davidson: We’ve seen many examples where going too fast, not adhering to best practices has caught us short. We’ve even seen that in the scientific world, where in the race to get information out people haven’t looked at the quality of data and engaged in normal controls.  The number of assays out there is of concern because we know that the free market will sell these to people perhaps who have less capacity to discern them.   :31

Davidson is especially concerned about low and middle income countries, where these types of substandard tests are very difficult to detect and remove from the market. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: How many people in the US have actually had COVID-19? Elizabeth Tracey reports

More than ten times the official number of reported cases of COVID-19 in the United States is likely a better estimate of just how widespread the infection has been, a study by the Centers for Disease Control and Prevention suggests. Patricia Davidson, dean of the Johns Hopkins School of Nursing, explains.

Davidson: They looked at samples from nearly 12,000 cases. They demonstrated that the burden of COVID-19 may be more than 10 times greater than what we thought. They collected these samples between March and May from six regions: Connecticut, Florida, Missouri, New York City, Utah and Washington state. It will be very interesting to see as these studies continue what the prevalence ends up being.   :30

The study looked at antibodies in the blood to determine exposure. Ongoing studies will look at additional sites as well as collect additional samples. At Johns Hopkins, I’m Elizabeth Tracey.