Medical Bulletin 04/ December/ 2024 - Video

A series of five papers, published in The Lancet Oncology by a University of Pittsburgh-led international team, highlights critical public health challenges related to cancer control in the eight countries that form the South Asian Association for Regional Cooperation (SAARC) and the Rohingya refugee population in Bangladesh. The series underscores barriers contributing to significant disparities in cancer outcomes and identifies actionable solutions to address these challenges in one of the most comprehensive efforts to understand this region’s cancer burden.

The papers call for a comprehensive, coordinated approach to address the cancer burden in South Asian Association for Regional Cooperation countries Afghanistan, Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan and Sri Lanka.

Although cancer incidence rates in South Asian Association for Regional Cooperation countries are lower compared to the rest of the world, mortality rates are higher. Cancer incidence is on the rise, with lung, breast, oral and cervical cancers the most common. This is largely due to late-stage diagnoses because of a severe shortage of early detection programs, limited access to treatments and inadequate healthcare infrastructure.

In the series of papers, researchers describe barriers specific to each South Asian Association for Regional Cooperation country and those that are common across the region. These include a lack of awareness about cancer symptoms, risk factors such as smoking and chewing betel nut, cultural stigmas, myths that cancer is untreatable or contagious, lack of access to health care facilities in rural and remote areas, financial difficulties faced by many patients and their families and insufficient government investment in cancer care.

A major barrier to cancer care is the shortage of trained cancer care professionals in South Asian Association for Regional Cooperation nations — including oncologists, medical physicists, radiation technologists and oncology nurses —driven by insufficient educational and training programs. Additionally, the South Asian Association for Regional Cooperation countries face disparities in cancer research funding and a lack of infrastructure to support large-scale comprehensive cancer treatment efforts.

Other key recommendations include expanding cancer registries to improve data collection that will inform policy decisions for cancer control efforts and strengthen research capacity; launching public health campaigns to promote prevention; promoting early detection and awareness of cancer risk factors; and fostering regional collaboration and partnerships to ensure better access to cancer treatment. The papers emphasize that regional networks could play a significant role in advocacy and resource mobilization, particularly for countries with limited health care budgets.

Reference: 1. Cancer care and outreach in the South Asian Association for Regional Cooperation (SAARC) region: overcoming barriers and addressing challenges, Huq, M Saiful et al. The Lancet Oncology, Volume 25, Issue 12, e650 - e662

2. Cancer care and outreach in South Asian Association for Regional Cooperation (SAARC) countries: from epidemiology and the National Cancer Control Programme to screening, diagnosis, and treatment, Huq, M Saiful et al. The Lancet Oncology, Volume 25, Issue 12, e639 - e649

3. Cancer education and training within the South Asian Association for Regional Cooperation (SAARC) countries, Huq, M Saiful et al. The Lancet Oncology, Volume 25, Issue 12, e663 - e674

4. Cancer research in South Asian Association for Regional Cooperation (SAARC) countries, Huq, M Saiful et al. The Lancet Oncology, Volume 25, Issue 12, e675 - e684

5. Cancer prevention, care, and outreach among the Rohingya refugee population in Bangladesh. Chowdhury, Mohiuddin A K et al. The Lancet Oncology, Volume 25, Issue 12, 1533 - 1536

McGill University scientists have discovered that pregnancy may trigger a natural immunity to boost protection against severe flu infection.

Contrary to the common belief that pregnancy increases vulnerability to infections, researchers found that it strengthened an immune defense in mice, blocking the Influenza A virus from spreading to the lungs, where it can cause severe infection.

“Our results are surprising because of the current dogma, but it makes sense from an evolutionary perspective,” said co-lead author Dr. Maziar Divangahi, Professor in McGill’s Faculty of Medicine and Health Sciences and Senior Scientist at the Research Institute of the McGill University Health Centre.

“A mother needs to stay healthy to protect her developing baby, so the immune system adapts to provide stronger defenses. This fascinating response in the nasal cavity is the body’s way of adding an extra layer of protection, which turns on during pregnancy.”

The researchers used a mouse model to observe how a certain type of immune cell activates in the nasal cavity of mice during pregnancy, producing a powerful molecule that boosts the body’s antiviral defenses, especially in the nose and upper airways.

“Influenza A virus remains among the deadliest threats to humanity,” said first author Julia Chronopoulos, who carried out the research while completing her PhD at McGill. “This natural immunity in pregnancy could change the way we think about flu protection for expectant mothers.”

“The broader population could also benefit, as our findings suggest the immune response we observed could be replicated beyond pregnancy,” said co-lead author Dr. James Martin, Professor in McGill’s Faculty of Medicine and Health Sciences and Senior Scientist at the RI-MUHC. This could mean new nasal vaccines or treatments that increase protective molecules, known as Interleukin-17.

Reference: Julia Chronopoulos et al., Pregnancy enhances antiviral immunity independent of type I IFN but dependent on IL-17–producing γδ+ T cells in the nasal mucosa.Sci. Adv.10,eado7087(2024).DOI:10.1126/sciadv.ado7087

New research findings from the Texas A&M University School of Public Health indicate that exposure to even low levels of arsenic poses significant health risks, including an increased risk of kidney cancer.

Their findings, published in Environmental Pollution, examined the relationship between kidney cancer rates and arsenic levels in drinking water across 240 Texas counties. The team analyzed cancer data from the Surveillance, Epidemiology, and End Results on 28,896 cases of cancer among adults in Texas aged 20 and older, alongside water testing data from the Texas Department of State Health Services and the Texas Water Development Board.

The analysis found that exposure to between 1 and 5 parts per billion raised kidney cancer risk by 6 percent, and exposure above 5 parts per billion raised the risk by 22 percent. In addition, the risk of cancer increased by 4 percent with each doubling of water arsenic levels.

“This suggests that even low-level arsenic exposure in drinking water may be associated with an increased risk of kidney cancer, which aligns with previous research indicating an association between this exposure and lung, bladder and skin cancers,” Taehyun Roh, with the Department of Epidemiology and Biostatistics said.

Researchers noted that their study design can indicate associations between factors but not causality and recommended that future studies focus on individual-level and biometric data — rather than the county-level data used here — to better assess the effects of factors such as lifestyle, family history of kidney cancer and other possible sources of arsenic exposure.

A new review published in The Aging, compiles findings from recent studies on how sleep problems—such as insomnia, sleep apnea, and disrupted sleep cycles—can worsen dementia and accelerate cognitive decline. It also emphasizes the profound impact of these sleep disorders on caregivers, who often face burnout and emotional stress.

Such issues go beyond causing fatigue—they accelerate memory loss, increase confusion, and raise the risk of behavioral symptoms like agitation. Addressing sleep challenges is critical to improving quality of life for both patients and their caregivers. Caregivers, who often support loved ones around the clock, face significant stress when dealing with these sleep disorders.

“This situation creates a vicious cycle where caregiver distress exacerbates patient symptoms, further increasing the burden on caregivers.”

This review also explores how other illnesses, common in older adults with dementia, worsen sleep disturbances. Conditions such as diabetes, thyroid dysfunction, heart disease, and anxiety disrupt sleep, and poor sleep then worsens both the dementia and the underlying illnesses. For instance, untreated sleep apnea can significantly accelerate cognitive decline in people with dementia.

In conclusion, this review highlights the critical need for a more comprehensive approach to dementia care.

Reference: Mukherjee, U., Sehar, U., Brownell, M., & Reddy, P. H. (2024). Sleep deprivation in dementia comorbidities: focus on cardiovascular disease, diabetes, anxiety/depression and thyroid disorders. Aging.