Medical Bulletin 12/February/2024

Here are the top medical news highlights of the day:

Study finds significant and rapid health benefits from quitting smoking at any age

A recent study by University of Toronto researchers reveals that individuals who quit smoking experience substantial increases in life expectancy within a few years.

The study, published in NJEM Evidence, showed that people who quit smoking before age 40 can expect to live almost as long as those who never smoked whereas those who quit at any age return close to never-smoker survival 10 years after quitting, and about half that benefit occurs within just three years.

“Quitting smoking is ridiculously effective in reducing the risk of death, and people can reap those rewards remarkably quickly,” said Prabhat Jha, a professor at the University of Toronto’s Dalla Lana School of Public Health and Temerty Faculty of Medicine, and executive director of the Centre for Global Health Research at Unity Health Toronto.

An observational study of 1.5 million adults across the U.S., UK, Canada, and Norway tracked over 15 years revealed that smokers aged 40 to 79 faced nearly three times the risk of death compared to non-smokers, resulting in an average loss of 12 to 13 years of life. However, former smokers reduced their risk of death to 1.3 times higher than non-smokers. Quitting smoking at any age was linked to increased survival, with those abstaining for less than three years gaining up to six years in life expectancy.

“Many people think it’s too late to quit smoking, especially in middle age,” said Jha. “But these results counter that line of thought. It’s never too late, the impact is fast and you can reduce risk across major diseases, meaning a longer and better quality of life.”

The findings suggest that quitting smoking reduces the risk of dying from vascular disease and cancer, in particular. Former smokers also reduced their risk of death from respiratory disease, but slightly less so, likely due to residual lung damage.

Reference: DOI: 10.1056/EVIDoa2300272

Novel method could revolutionize breast cancer detection

According to a study published on 9th February 2024, in Radiology: Imaging Cancer, a journal of the Radiological Society of North America (RSNA), an innovative breast imaging technique boasts high sensitivity in cancer detection while significantly reducing false positives.

Mammography effectively detects early breast cancer but loses sensitivity in dense breast tissue due to the masking effect of dense fibro-glandular tissue. As nearly half of screening candidates have dense breasts, many necessitate further imaging, typically MRI, post-mammography.

Low-dose positron emission mammography (PEM), a type of mammography, offers enhanced diagnostic accuracy with radiation levels. With its high sensitivity and minimal false positives, PEM could lower healthcare expenses by reducing unnecessary follow-ups compared to MR. Moreover, it offers radiation levels similar to mammography, eliminating the discomfort of breast compression for patients.

For the study, 25 women (median age: 52) diagnosed with breast cancer underwent low-dose PEM with the radiotracer 18F-FDG. PEM images taken at one- and four-hours post-injection were reviewed by breast radiologists, correlating findings with lab results.PEM demonstrated similar performance to MRI, detecting 24 of 25 invasive cancers (96%) with a low false positive rate of only 16%, compared to MRI's 62%.

“The integration of these features—high sensitivity, lower false-positive rates, cost-efficiency, acceptable radiation levels without compression, and independence from breast density—positions this emerging imaging modality as a potential groundbreaking advancement in the early detection of breast cancer,” said study lead author Vivianne Freitas, M.D., M.Sc., assistant professor at the University of Toronto. “As such, it holds the promise of transforming breast cancer diagnostics and screening, complementing or even improving current imaging methods, marking a significant step forward in breast cancer care.”

The technology could also play a crucial role in interpreting uncertain mammogram results, evaluating the response to chemotherapy and ascertaining the extent of disease in newly diagnosed breast cancer, including involvement of the other breast.

“While the full integration of this imaging method into clinical practice is yet to be confirmed, the preliminary findings of this research are promising, particularly in demonstrating the capability of detecting invasive breast cancer with low doses of fluorine-18-labeled FDG,” Dr. Freitas said. “This marks a critical first step in its potential future implementation in clinical practice.”

Reference: “Breast Cancer Detection Using a Low-Dose Positron Emission Digital Mammography System.” Collaborating with Dr. Freitas were Xuan Li, Ph.D., Anabel Scaranelo, Ph.D., Frederick Au, M.D., Supriya Kulkarni, M.D., Sandeep Ghai, M.D., Samira Taeb, M.Sc., Oleksandr Bubon, Ph.D., Brandon Baldassi, M.Sc., Borys Komarov, M.Sc., Shayna Parker, M.Sc., Craig A. Macsemchuk, B.Sc., Michael Waterston, M.Sc., M.A., Kenneth O. Olsen, B.Sc., M.B.A., and Alla Reznik, Ph.D.

Brain connectivity patterns vary between pre-term and term infants

A new study from King's College Londonreveals unique patterns in the moment-to-moment activity and connectivity of brain networks between term and pre-term infants after scanning 390 babies.

The study, published in Nature Communications, revealed that these dynamic brain connectivity patterns in infants were associated with developmental milestones such as movement, language, cognition, and social behaviour 18 months later.

"Although we know how influential brain connectivity is on development, we know little about the patterns of dynamic functional connectivity in early life, and how they link to the way our brains mature. By analysing brain scans from 390 babies, we have begun to identify different transient states of connectivity that could potentially provide insight into how the brain is developing at this age and what behaviours and functions these patterns are linked to as the baby grows older." said Dr DafnisBatallé, Senior Lecturer in Neurodevelopmental Science at the Institute of Psychiatry, Psychology & Neuroscience, King's College London.

Researchers employed advanced techniques to analyze functional Magnetic Resonance Imaging (fMRI) data from 324 full-term infants and 66 pre-term infants (born before 37 weeks gestation). They evaluated the moment-to-moment changes in connectivity during the time the baby was in thescanner, offering a dynamic perspective.

The study utilized different methods to analyse fluctuating brain connectivity, one assessing patterns across the entire brain and another focusing on regional patterns. Six distinct brain states were identified, with three encompassing the whole brain and three restricted to specific regions (occipital, sensorimotor, and frontal). Comparison between term and pre-term infants indicated that varied connectivity patterns were associated with pre-term birth. For instance, pre-term infants exhibited increased time spent in frontal and occipital brain states compared to term infants.

"This is a real step forward in the use of imaging techniques to investigate how brain activity is continually changing in early life and how this provides a platform to support subsequent developmental milestones in childhood. The difference between term and pre-term babies suggests that time spent in or outside the womb shapes brain development. We now need to try and find out if it is possible to use these insights to identify and help those who need some additional support." concluded professor Grainne McAlonan, Interim Director of NIHR Maudsley BRC and Professor of Translational Neuroscience.

Reference: Lucas G. S. França, Judit Ciarrusta, Oliver Gale-Grant, Sunniva Fenn-Moltu, Sean Fitzgibbon, Andrew Chew, Shona Falconer, Ralica Dimitrova, Lucilio Cordero-Grande, Anthony N. Price, Emer Hughes, Jonathan O’Muircheartaigh, Eugene Duff, Jetro J. Tuulari, Gustavo Deco, Serena J. Counsell, Joseph V. Hajnal, Chiara Nosarti, Tomoki Arichi, A. David Edwards, Grainne McAlonan, DafnisBatalle. Neonatal brain dynamic functional connectivity in term and preterm infants and its association with early childhood neurodevelopment. Nature Communications, 2024; 15 (1) DOI: 10.1038/s41467-023-44050-z