Medical Bulletin 18/ December/ 2024
Here are the top medical news for the day:
AI Powered Blood Test Detects Earliest Stage of Breast Cancer: Study Finds
A new screening method that combines laser analysis with a type of AI is the first of its kind to identify patients in the earliest stage of breast cancer, according to a study published in the Journal of Biophotonics.
The fast, non-invasive technique reveals subtle changes in the bloodstream that occur during the initial phases of the disease, known as stage 1a, which are not detectable with existing tests, the team says.
Using the new method, researchers were able to spot breast cancer at the earliest stage by optimising a laser analysis technique – known as Raman spectroscopy – and combining it with machine learning, a form of AI.
The new technique works by first shining a laser beam into blood plasma taken from patients. The properties of the light after it interacts with the blood are then analysed using a device called a spectrometer. A machine learning algorithm is then used to interpret the results, identifying similar features and helping to classify samples.
In the pilot study involving 12 samples from breast cancer patients and 12 healthy controls, the technique was 98 per cent effective at identifying breast cancer at stage 1a. The test could also distinguish between each of the four main subtypes of breast cancer with an accuracy of more than 90 per cent, which could enable patients to receive more effective, personalised treatment, the team says.
Reference: Tipatet, K.S., Hanna, K., Davison-Gates, L., Kerst, M. and Downes, A. (2024), Subtype-Specific Detection in Stage Ia Breast Cancer: Integrating Raman Spectroscopy, Machine Learning, and Liquid Biopsy for Personalised Diagnostics. J. Biophotonics e202400427. https://doi.org/10.1002/jbio.202400427
Self-Test for HPV Becomes Important Component of Cervical Cancer Screening: Researchers
Analyses of self-tests for human papillomavirus (HPV) can be used to divide HPV-positive women into three risk groups, according to a new study from Karolinska Institutet and Queen Mary University of London published in PLOS Medicine. This method could be important for enhancing cervical cancer screening.
"Self-testing for HPV has become an important component in cervical screening. It reaches women who would not otherwise participate," says Jiayao Lei, assistant professor at the Department of Medical Epidemiology and Biostatistics and Department of Clinical Science, Intervention and Technology, who is the lead author of the study.
The study, conducted in primary care centres in England, included 855 women with a positive HPV self-test, i.e. indicative of HPV infections, and had a subsequent clinician-sample. It was found that 71 of these women (8.3%) had the severe cervical precancer or cancer.
The researchers looked at the details of the HPV test results on self-sample and used a new method to assess the risk of severe cellular changes. The risk stratification is based on the variant of the HPV virus and the amount of virus present in the self-test. Using this, they divided the women into three risk groups: high, medium and low risk. Women with HPV type 16 and a low Ct value (<30) had the highest risk of severe cervical precancer or cancer.
"About 40 % of women in our high-risk group had been diagnosed with the severe cervical precancer or cancer that requires treatment. Therefore, our recommendation for the future is that this group be referred directly for further investigation with colposcopy," says Jiayao Lei.
More than half of those who tested positive were in the low-risk group, with a 4% probability of being diagnosed with severe cervical precancer or cancer within 12 months.
Reference: "Human papillomavirus genotype and cycle threshold value from self-samples and risk of high-grade cervical lesions: A post hoc analysis of a modified stepped-wedge implementation feasibility trial" Jiayao Lei, Kate Cuschieri, Hasit Patel, Alexandra Lawrence, Katie Deats, YouScreen trial team, Peter Sasieni, Anita W. W. Lim, PLOS Medicine, online December 12 2024, doi: 10.1371/journal.pmed.1004494.
IAS-USA Releases 2024 Recommendations for HIV Treatment and Prevention
On the occasion of World AIDS Day on 1 December 2024, the International Antiviral Society-USA (IAS-USA) has published new international guidelines for the treatment and prevention of HIV. The findings are published in JAMA Network. The updated recommendations were developed by a panel of volunteer medical experts.
An international panel of leading experts in HIV research and clinical care identified and reviewed the latest evidence from peer-reviewed literature and conference presentations published between June 2022 and October 2024, as well as data provided by antiretroviral manufacturers. Here is an overview of the recommendations for HIV treatment, prevention and care.
Tailored antiretroviral therapy
The panel recommends that antiretroviral therapy should be tailored to the individual's needs, especially for those who cannot tolerate certain HIV drugs. Long-acting injectable therapies are highlighted as a valuable option to help patients adhere to their treatment plans.
HIV prevention strategies
For people at increased risk of HIV exposure, the guidelines emphasise the use of pre-exposure prophylaxis, available as daily oral medication or long-acting injectable options. In addition, doxycycline is recognised as an effective post-exposure prophylaxis to prevent sexually transmitted infections.
Comprehensive care for people living with HIV
The panel stresses the importance of a holistic approach to HIV care. This includes prevention of cardiovascular disease, management of substance use disorders and monitoring of weight changes that may occur during antiretroviral therapy.
Addressing disparities in access to care
Recognising persistent inequities in access to HIV care and prevention, the guidelines recommend targeted solutions to address gaps in underserved communities. Suggested interventions include: expanding access to video telemedicine and mobile health units; using smartphone reminders for medication or injections; and providing adherence support through traditional methods such as pill boxes and regular check-ins by phone or text.
Reference: Gandhi RT, Landovitz RJ, Sax PE, et al. Antiretroviral Drugs for Treatment and Prevention of HIV in Adults: 2024 Recommendations of the International Antiviral Society–USA Panel. JAMA. Published online December 01, 2024. doi:10.1001/jama.2024.24543
Can Dietary Changes Aid in Slowing Prostate Cancer Growth?
A study, published in the Journal of Clinical Oncology, show that a diet low in omega-6 and high in omega-3 fatty acids, combined with fish oil supplements, significantly reduced the growth rate of prostate cancer cells in men with early-stage disease.
To determine whether diet or supplements can play a role in managing prostate cancer, the UCLA-led team conducted a prospective clinical trial, called CAPFISH-3, that included 100 men with low risk or favorable intermediate risk prostate cancer who chose active surveillance. Participants were randomly assigned to either continue their normal diet or follow a low omega-6, high omega-3 diet, supplemented with fish oil, for one year.
Participants in the intervention arm received dietary personalized counseling by a registered dietician nutritionist, either in-person, through telehealth or by phone. Patients were guided on healthier, lower fat alternatives for high fat/high calorie foods, and on reducing consumption of foods with higher omega-6 content. The goal was to create a favorable balance of their intake of omega-6 and omega-3 fats and make participants feel empowered to control how they change their behavior. They were also given fish oil capsules for extra omega-3s. The control group did not get any dietary counseling or take fish oil capsules.
The researchers tracked changes in a biomarker called the Ki-67 index, which indicates how fast cancer cells are multiplying -- a key predictor of cancer progression, metastasis and survival.
Same site biopsies were obtained at the start of the study and again after the one-year mark, using an image fusion device that helps track and locate the cancer sites.
Results showed that the low omega-6, omega-3 rich diet and fish oil group had a 15% decrease in the Ki-67 index, while the control group saw a 24% increase.
Researchers did not find any differences in other cancer growth markers, such as Gleason grade, which are commonly used to track prostate cancer progression.
The investigators caution that further research is necessary to confirm the long-term benefits of omega-3 fatty acids and lowering omega-6 in managing prostate cancer.
Reference: https://www.uclahealth.org/news/release/low-omega-6-omega-3-rich-diet-and-fish-oil-may-slow-prostate
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