This page links to 10 sub-articles that discuss the leading health risks faced by Asian Americans. Becoming aware of these peculiar risks in time to affect lifestyle changes or secure medical help that can eliminate the biggest causes of deaths and debilitating illnesses for this population.
Some factors that disproportionately affect Asian Americans include smoking, low rates for cancer screening, low rates for mental health service use, and poor knowledge of health issues.
It’s also important to note variations of risks among this heterogeneous segment. For example, one in ten Japanese and Vietnamese Americans are underweight, but almost one-half of Filipino Americans are overweight or obese.
Asian Americans had the highest annual percentage increase of HIV/AIDS of all ethnic groups in the US between 2001 and 2004: 2.4% for men and 14.3% for women. Its potential coinfection with tuberculosis and hepatitis B make HIV/AIDS an even greater concern within in the Asian American community.
Hepatitis B is the most significant health disparity affecting Asian Americans in the US: 10% of Asian Americans are infected with chronic hepatitis B compared with .1% of Caucasians. One in seven Vietnamese Americans is a chronic carrier of hepatitis B.
The Asian American population has the highest tuberculosis case rate of any ethnic group: 24 times greater than Caucasians. Additionally, 80% of the population in many Asian countries test positive in tuberculin tests, while only 5-10% of the US population test positive.
20% of Asian women older than 50 have osteoporosis and over 50% of them are at risk. Asian American women are at a higher risk for developing osteoporosis compared with Caucasian women.
Asian American women older than 65 have a suicide rate of 11.6 per 100,000—more than double the rate for Caucasian women in that age group. Out of over 2,000 Asian Americans aged 18 or older, 2.7% reported having attempted suicide at some point in their lives and 9.1% of the group reported having had suicidal thoughts.
Lung cancer is the second most prevalent cancer among Asian American men and third among Asian American women. Lung cancer rates among Southeast Asian Americans are 18% higher than among Caucasians and Chinese Americans have the highest death rates for lung cancer among Asian American groups.
Asian Americans are a high –risk group for diabetes type 2. The risk for type 2 diabetes occurs at a lower BMI for Asian Americans compared to other ethnic groups. Additionally, while diabetes was the seventh leading cause of death in the US in 2006, it ranked as the fifth among Asian Americans.
The incidence rates of liver cancer in Asian American groups are 1.7 to 11.3 times higher than the rate among Caucasians. Additionally, Vietnamese American males have the highest incidence rates of liver cancer out of any other group in the US. Asian Americans are three times more likely to die of liver cancer than Caucasians.
Asian American women have one of the highest rates of cervical cancer in the US and Vietnamese American women in particular have an incidence rate five times higher than Caucasian women.
Scientists at Nanjing Medical University have created pigs that have been genetically modified to grow organs that can be transplanted into humans. The first litter of these GM pigs will be born within the next six months.
“The genetically modified piglets could bring hope to people who are in need of organ transplants but have failed to find a donor,” said Zhao Zijian, head of the Metabolic Disease Research Center at Nanjing Medical University. The research group has been working with GM technology since 1998 to replace pig genes that cause rejection of organs transplanted into humans.
“Just as people with different blood types cannot accept blood transfusions from one another, pig organs were rejected by all human recipients before I replaced a certain sugar molecule with a human gene,” said Dai Yifan, deputy director of the research center.
Dai successfully bred the transplantation-friendly GM pigs in a laboratory at Revivicor Inc in the United States and took cells back to China earlier this year from which he plans to clone thousands of pigs.
The first brood will be born in five or six months in Nanjing. They and their organs will be used for more experiments to verify suitability as donors of hearts, kidneys and livers.
Due to a shortage of organ donors only 10,000 out of 1 million people with kidney disease and 300,000 with liver disease awaiting a transplant are saved each year.
Organs from GM pigs have been tested in the United States since 2002. They have kept monkeys alive for up to 400 days. Such temporary transplants could potentially help keep human patients alive while waiting for human transplant organs.
Scientists from the Chinese Academy of Agricultural Sciences first bred GM pigs in November 2010. Clinical trials on humans have not been carried out anywhere in the world.
The Nanjing Medical Center research group will apply for permission to conduct human clinical experiments after the pigs have grown enough, said Dai. No one can say whether the government will allow the transplanting of pig organs into humans on an experimental basis.
Some transplant surgeons question whether transplanting pig organs won’t create risk of humans being infected with animal diseases.
The center is already constructing sterile pigsties that are “as clean as an operating room”, said Dai. “The sterile environment will mean there are no viruses on the pigs that could cause diseases among humans.”
Researchers say that a drug used to treat enlarged prostates may also slow the growth of tumors in men with low-risk prostate cancer who opt to be monitored instead of getting treated right away.
A study found that men taking the drug Avodart were less likely to see their cancer worsen over the next three years than men taking dummy pills.
Doctors say the results may persuade more men to choose medical monitoring, or “watchful waiting,” instead of immediate treatment. Many people are being treated now for cancers that are not life-threatening, and suffering urinary or sexual side effects.
The study of GlaxoSmithKline PLC’s drug will be presented later this week at a cancer conference in Florida.
The world is becoming a heavier place, especially in the West.
Obesity rates worldwide have doubled in the last three decades even as blood pressure and cholesterol levels have dropped, according to three new studies.
People in Pacific Island nations like American Samoa are the heaviest, one of the studies shows. Among developed countries, Americans are the fattest and the Japanese are the slimmest.
“Being obese is no longer just a Western problem,” said Majid Ezzati, a professor of public health at Imperial College London, one of the study’s authors.
In 1980, about 5 percent of men and 8 percent of women worldwide were obese. By 2008, the rates were nearly 10 percent for men and 14 percent for women.
That means 205 million men and 297 million women weighed in as obese. Another 1.5 billion adults were overweight, according to the obesity study.
Though richer countries did a better job of keeping blood pressure and cholesterol levels under control, researchers said people nearly everywhere are piling on the pounds, except in a few places including central Africa and South Asia. The studies were published Friday in the medical journal, Lancet.
The research confirms earlier trends about mounting obesity and the three papers provide the most comprehensive, recent global look at body mass index, cholesterol and blood pressure. Body mass index is a measurement based on weight and height.
Experts warned the increasing numbers of obese people could lead to a “global tsunami of cardiovascular disease.” Obesity is also linked to higher rates of cancer, diabetes and is estimated to cause about 3 million deaths worldwide every year.
In an accompanying commentary, Sonia Anand and Salim Yusuf of McMaster University in Hamilton, Ontario, said the global forecast for heart disease was “dismal and comprises a population emergency that will cost tens of millions of preventable deaths” unless countries take quick action.
Even without the encroaching empire of Western fast food, Ezzati said waistlines are already expanding in parts of Latin America, the Middle East, and Western and Southern Africa.
Among rich countries, the U.S. had the highest average body mass Index, at 28. Rates were the lowest in Japan, ranging between 22 for women and 24 for men. Women in Belgium, France, Finland, Italy and Switzerland also stayed trim, with virtually no change in their BMI.
People with a BMI of 18-24 are considered to have a healthy weight. Those with a BMI of 25 or above are overweight and people with a BMI of 30 or more are classified as obese.
Two other studies also published in the Lancet on Friday surveyed blood pressure rates and cholesterol levels. Western countries including Canada, South Korea and the U.S. had some of the lowest blood pressure rates thanks to medication, while rates are highest in Portugal, Finland and Norway.
Cholesterol levels were highest in countries like Iceland and Germany and lowest in Africa.
Ezzati said national measures like reducing salt content in prepared foods or banning transfats could make a big dent in lowering blood pressure and cholesterol rates.
He added that it was uncertain if the world’s obesity rates had peaked and predicted other health complications would soon follow. “We don’t know how much worse the obesity problem will get,” he said. “While we can manage blood pressure and cholesterol with medication, diabetes will be a lot harder.”
Only about half of U.S. adults with high levels of bad cholesterol get treatment for it. Worse, not all those treated are managing to control the problem, according to a new government report.
In all, as many as two out of three Americans with high levels of bad cholesterol do not have their problem under control, the Centers for Disease Control and Prevention said Tuesday.
That means only about 23 million of the 71 million adults with worrisome bad cholesterol levels keep it in check, perhaps because many don’t eat wisely, exercise or take prescribed medications, experts said.
High cholesterol “remains out of control in this country,” said Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention.
Cholesterol is a waxy, fat-like substance found in many foods that can clog blood vessels. The new study focused on LDL or “bad cholesterol.” That kind accounts for most of the body’s cholesterol and is considered a contributor to strokes and heart attacks. LDL shouldn’t be over 160 for healthy people and should be below 100 for those with heart disease or diabetes.
The study included 4,300 adults from 2005-2008. Participants were counted as having too much bad cholesterol if a blood test showed high levels or they said they were on cholesterol-lowering medicine.
Overall, one in three had high levels of bad cholesterol. That proportion has been holding steady for roughly 10 years, after a previous decline. It also found high levels of bad cholesterol were most common in the elderly, and among Mexican-Americans.
Treatment rates, meanwhile, have been improving. The research showed nearly 50 percent were getting treatment, compared to about 28 percent in the years 1999-2002.
And thanks to increasing use of cholesterol medications, the proportion of people who are controlling their bad cholesterol rose from about 1 in 6 a decade ago to 1 in 3 recently, according to the CDC.
Frieden said treatment successes have also put a dent in total cholesterol levels for U.S. adults. The CDC had reported that the average total cholesterol reading has dropped to ideal levels in recent years.
It’s possible for someone to have excessive bad cholesterol but still have a good total cholesterol reading, CDC officials noted.
Treatment is much more common in people with health insurance than in the uninsured, the new study found. Nevertheless, nearly four out of five with uncontrolled high cholesterol said they had some form of health insurance.
The results are not surprising, said Dr. Valentin Fuster, head of New York City’s Mount Sinai Heart Center and a past president of the American Heart Association.
Cholesterol medications usually work well, but patients tends to become erratic in taking medication after six months to a year, especially if they feel well. And the health care system often doesn’t do enough to pay and persuade doctors and nurses to stay on top of their patients, he said.
“These people need very strict follow-up, or sooner or later things fall apart,” Fuster said.
Bad cholesterol can be lowered not only with medications, but also exercise and low-fat and high-fiber diets, health officials say.
The CDC on Tuesday also released research findings that half of Americans with high blood pressure are not currently getting treatment. That report echoes a study published last year in the Journal of the American Medical Association.
Also on Tuesday, an international health journal published a study concluding that most people with high total cholesterol are not getting the treatment they need.
The study looked at more than 79,000 adults in eight countries, including the United States, and found diagnosis and treatment varied from country to country. Diagnosis of problematic cholesterol levels was highest in the United States, and lowest in Thailand, for example. The study was published in the Bulletin of the World Health Organization.
Federal health officials said Wednesday they are investigating a possible link between breast implants and a very rare form of cancer, raising new questions about the safety of devices which have been scrutinized for decades.
The cancer, known as anaplastic large cell lymphoma, attacks lymph nodes and the skin and has been reported in the scar tissue which grows around an implant. The Food and Drug Administration is asking doctors to report all cases of the cancer so the agency can better understand the association.
The agency has learned of just 60 cases of the disease worldwide, among the estimated 5 million to 10 million women with breast implants. The agency reviewed the scientific literature going back to 1997 along with information provided by international governments and manufacturers.
Most of the cases were reported after patients sought medical care for pain, lumps, swelling and other problems around the surgical site.
“We are very interested in trying to understand more specifically which patients may be at more risk and which breast implants may present a higher risk,” said Dr. William Maisel, FDA’s chief scientist for devices, on a call with reporters. The agency saw no difference in cancer rates between patients with saline versus silicone implants. There was also no difference between patients who got the implants for cosmetic reasons versus those who underwent reconstructive surgery after breast cancer.
Because the disease is so rare, FDA researchers suggested the issue may never be completely resolved.
“A definitive study would need to collect data on hundreds of thousands of women for more than 10 years. Even then, causality may not be conclusively established,” the agency said.
Still, the FDA said it is working with the American Society of Plastic Surgeons to register patients with the cancer and track them over time.
Breast implants are marketed in the U.S. by Allergan Inc. and Johnson & Johnson’s Mentor Corp. Those companies will be required to update the labeling for their products to reflect the cancer reports.
A handful of researchers have published papers on instances of the lymphoma in breast implant patients over the last three years, prompting FDA’s review. Some research suggests bits of silicone can leak into cells around the implant, triggering the cancer. Even saline implants include trace amounts of silicone to help them maintain their shape.
The lymphoma is an aggressive form of cancer though it is often curable, according to experts. Treatments include radiation, chemotherapy and a bone marrow transplant, if the disease returns.
Reports of the cancer among women with breast implants have been reported anecdotally for years, according to Dr. Jasmine Zain, a lymphoma specialist at New York University’s Langone Medical Center.
“We’ve seen it from time to time over the years, but this is the first time the FDA actually looked at all the case reports and made a statement,” Zain said.
The FDA pulled silicone breast implants off the market in 1992, saying manufacturers had not provided medical data showing their safety and effectiveness. At the time, there were worries about a connection to a variety of diseases, including cancer and lupus. Alarming cases of ruptures added to the concern.
But in 2006 the agency returned the implants to the market after most studies failed to find a link between silicone breast implants and disease.
The approval came with conditions, including a requirement that the companies complete 10-year studies on women who have already received the implants to study leaks, as well conduct new decade-long studies of the safety of the devices in 40,000 women.
The FDA said the companies have continued to pursue those studies, though several of them have enrolled less than half of the patients needed to make them statistically significant.
Dr. Diana Zuckerman said the studies “will be completely useless unless the FDA can convince the companies to do more to keep women in their studies.” Zuckerman’s group, National Research Center for Women & Families, opposed the FDA’s decision to re-approve silicone implants.
Wells Fargo analyst Larry Biegelsen, who covers the medical device industry, said the negative media coverage over the issue could hurt implant sales.
“At this point, we do not expect breast implants to be removed from the market, but sales growth could be negatively impacted by the media coverage,” Biegelsen wrote in a note to investors.
There’s new hope for an overlooked epidemic: Two powerful drugs are nearing the market that promise to help cure many more people of liver-attacking hepatitis C — even though most who have the simmering infection don’t know it yet.
Surprisingly, two-thirds of hepatitis C sufferers are thought to be baby boomers who’ve harbored since their younger, perhaps wilder, years a virus that can take two or three decades to do its damage.
What could be a treatment revolution is spurring the government to consider if it’s time to start screening aging baby boomers for hepatitis C, just like they get various cancer checks.
“We’re entering a whole new era of therapy,” says Dr. John Ward, hepatitis chief at the Centers for Disease Control and Prevention. “We really want to begin that clarion call for action for this population who’s at risk.”
Today’s two-drug treatment for hepatitis C cures only about 40 percent of people with the most common variety of the virus, and causes some grueling side effects. Now major studies show that adding a new drug —either Vertex Pharmaceuticals’ telaprevir or Merck & Co.‘s boceprevir — can boost those cure rates as high as 75 percent. And they allow some people to cut treatment time in half, to six months, thus lessening how long they must deal with those side effects.
If the Food and Drug Administration approves the drugs — a decision widely expected this summer — they would be the first that work by directly targeting the hepatitis C virus. Specialists draw comparisons to the early 1990s when potent combination therapies emerged to treat AIDS. Many recently diagnosed patients are postponing therapy to await these new drug cocktails in hopes of a better chance at a faster cure, says Dr. Paul Pockros, hepatology chief at the Scripps Clinic in La Jolla, Calif., who helped test telaprevir.
However, the bigger impact could come if more people get tested for hepatitis C, a blood-borne virus. It’s often stigmatized as a risk only to people who inject illegal drugs. But the virus could have begun festering from a blood transfusion before 1992, when testing of the blood supply began.
Lapses in infection control in health facilities still occasionally expose people today. So could even a one-time experiment with drugs way back in college, something doctors are reluctant to ask a now middle-aged, button-downed patient to reveal, says Ward.
“It cuts across every segment of society,” adds Dr. Arun Sanyal of Virginia Commonwealth University, past president of the American Association for the Study of Liver Diseases. “I can tell you our hepatitis C treatment clinic is a great social equalizer.”
About 3.2 million Americans, and 170 million people worldwide, have chronic hepatitis C. In the U.S., new infections have dropped dramatically — although the disease’s toll is rising as people infected decades earlier reach ages where their livers start showing damage. Hepatitis C already is a leading cause of liver transplants, and it kills about 12,000 U.S. patients a year, a number expected to triple within 20 years.
Most people find out they’re infected like Brian Graham of Briarcliff Manor, N.Y., during a routine check-up that spotted elevated liver enzymes. He’d never heard of hepatitis C and had no obvious risk factors. But tests showed the virus had begun to scar his liver. So over the last decade he tried three rounds of traditional treatments, with increasingly tough side effects, to no avail.
“I didn’t want to die of liver disease or cancer or suffer the prospect of having to tee up for a liver transplant. Scary stuff,” says Graham, now 56.
Enter the new drugs. They work by blocking an enzyme named protease that’s key for the virus to reproduce. But they must be taken together with standard medications — ribavirin pills plus injections of interferon-alpha — that are thought to boost the immune system.
According to studies presented at a recent medical meeting, 67 percent to 75 percent of patients given treatment including either boceprevir or telaprevir, respectively, had what doctors call a cure. That’s defined as no sign of the hepatitis C virus six months after their last dose. Importantly, only about a quarter of black patients are helped by standard therapy but adding one of the new drugs more than doubled their cure rates.
People getting their first-ever treatment did best, but the studies also found improvements in hard-to-treat patients like Graham.
“The fourth time did the trick,” says Graham, who volunteered for an early telaprevir study and says he’s been hepatitis-free for three years.
The new drugs do add side effects to the flulike symptoms and other complaints of existing treatment. Telaprevir’s main risk is a rash that is sometimes severe, and boceprevir’s is anemia.
“The future looks very bright beyond telaprevir and boceprevir,” notes Dr. Fred Poordad of Cedars-Sinai Medical Center in Los Angeles, who has studied both drugs and consults for several companies. He points to additional drugs in earlier-stage testing that promise to target more types of hepatitis C and perhaps eventually allow for pill-only, interferon-free treatment.
Manufacturers haven’t said how much the new drugs will add to the price of treatment that already can cost $30,000, albeit far cheaper than a liver transplant.
A stickier issue: Not everyone suffers serious liver damage and it’s hard to predict who will, raising questions about exactly who needs treatment even as drug companies help push for more screening.”
That’s a concern, acknowledges Jeff Levi of the nonprofit Trust for America’s Health, also a screening proponent. But when to treat is a doctor-patient decision, and “anyone with chronic infection you do want to be monitoring so you can intervene at the right moment,” he adds.
Plus, people with hepatitis C should avoid alcohol and consider other liver-protection steps — and know how to avoid infecting others, he stresses.
Stay tuned: The CDC has begun a study at four hospitals — in New York, Detroit, Houston and Birmingham, Ala. — to see if a one-time hepatitis C test for baby boomers makes sense. Among the boomers, black men in their 50s are at particular risk. CDC plans new guidelines next year.
Meanwhile, “start that conversation” at a routine doctor’s visit by asking about hepatitis C risks and testing, Ward advises boomers.
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EDITOR’s NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
Federal health regulators are limiting a key ingredient found in Vicodin, Percocet and other prescription painkillers that have been linked to thousands of cases of liver damage each year.
The Food and Drug Administration said Thursday it will cap the amount of acetaminophen in the drugs at 325 milligrams per capsule. Current products on the market contain doses of up to 700 milligrams.
Acetaminophen is a ubiquitous pain reliever found in Tylenol, Nyquil and thousands of other medicines used to treat headaches, fever and sore throats. The ingredient is also used at larger doses in prescription combination drugs that mix it with narcotic drugs like oxycodone.
Those products are not dangerous by themselves but can cause toxic overdoses when patients combine them with a second acetaminophen-containing drug like Tylenol.
FDA officials said the labeling on prescription drugs often does not make it clear that they contain acetaminophen, instead using abbreviations for the ingredient like ‘APAP.’
“One of the real challenges we have is that patients taking these products don’t know they’re taking acetaminophen at all,” said FDA deputy director for new drugs, Dr. Sandra Kweder, in a telephone briefing with reporters. “They don’t realize that they are overdosing.”
The FDA said it is working with pharmacies and other medical groups to develop standard labeling for acetaminophen, though that is not part of Thursday’s action.
Agency officials said the drugs will still be effective at lower doses.
“The amount of acetaminophen in these products has gradually crept up over the years,” Kweder said. “If you look at these products 20 to 30 years ago, many did not contain high doses of acetaminophen.”
The restrictions announced Thursday will not affect over-the-counter products like Tylenol and Theraflu. The FDA said it is still considering limits on those products, which involves a more complicated rule-making process than prescription products. For now, over-the-counter products will actually be permitted to contain higher doses of the drug — up to 500 milligrams per pill or capsule.
Acetaminophen is the leading cause of liver failure in the U.S. and sends 56,000 people to the emergency room annually. About 200 of them die, and the FDA estimates 120 of those deaths are linked to prescription drugs with acetaminophen.
The FDA said it would add a boxed warning, the strongest type, to all prescription drugs containing acetaminophen.
Vicodin is marketed by Abbott Laboratories, while Percocet is marketed by Endo Pharmaceuticals. Vicodin combines acetaminophen with hydrocodone, while Percocet contains oxycodone. Both formulas also are available in cheaper generic versions. U.S. sales of all drugs in the group topped $6 billion in 2009, according to health industry data firm IMS Health.
“Acetaminophen is a bit like salt, in that it works so well that people put it in almost everything,” said Erik Gordon, a professor at the University of Michigan’s Ross School of Business who follows the pharmaceutical industry. “But it has the same downside in that at the end of day you have no idea how much is in your system.”
The maximum dose of the ingredient under FDA safety guidelines is 4,000 milligrams per 24-hour period.
The FDA restrictions come more than a year and a half after a high-profile meeting where a panel of 37 expert physicians narrowly voted to eliminate drugs like Vicodin completely.
Regulators said they decided against that action because of the widespread use of the drugs, which were prescribed roughly 200 million times last year, according to the FDA.
“We thought this was a more reasoned and reasonable action to take,” Kweder said.
The FDA is not required to follow the panel’s advice, though it often does. The same panel recommended lowering the dose of acetaminophen found in over-the-counter products.
Nearly one in four heart defibrillators may be implanted for questionable reasons without solid evidence that the devices will help, according to a first-of-its-kind analysis. Implanted defibrillators shock the heart back into a normal rhythm when it starts beating irregularly. They can prevent sudden death in people with advanced heart failure, but researchers haven’t found a benefit for other patients.
Patients who’ve had a recent heart attack or recent bypass surgery aren’t good candidates for defibrillators, for example. Guidelines don’t recommend them for people newly diagnosed with heart failure either and those so sick that they have very limited life expectancies won’t be helped.
But in the new study, which examined nearly four years of national data, 22 percent of the implant surgeries were in patients who fit one of those categories.
Some may have been appropriate, said lead author Dr. Sana Al-Khatib of Duke University School of Medicine in Durham, N.C., but it’s likely that many were done despite the research evidence.
“It’s lack of knowledge. It’s ignorance. It’s not keeping track of the guidelines,” she said. “And we may have some physicians who don’t agree with the guidelines or don’t think the guidelines apply to their patients.”
The study, appearing in Wednesday’s Journal of the American Medical Association, examined national registry data from nearly 112,000 patients in 2006-2009.
The researchers found that the patients who got implants according to guidelines were less likely to die in the hospital and suffer complications than the patients whose surgeries clearly fell outside the guidelines.
The surgeries cost thousands of dollars, raising questions about wasted resources, Al-Khatib said. “It’s all about improving the quality of care,” she said.
The 22 percent rate is disturbingly high, said Dr. Douglas Zipes of the Indiana University School of Medicine in Indianapolis. He wasn’t involved in the study but has helped write research-based guidelines for the devices.
“If the patient is not benefiting, we shouldn’t be doing it,” Zipes said. He noted that doctors with special training in heart rhythms, had slightly better rates of evidence-based implants than did other types of doctors in the study.
Doctors should follow guidelines, he said, and patients should choose a specialist with training in heart rhythm problems.
A blood test so sensitive that it can spot a single cancer cell lurking among a billion healthy ones is moving one step closer to being available at your doctor’s office.
Boston scientists who invented the test and health care giant Johnson & Johnson will announce Monday that they are joining forces to bring it to market. Four big cancer centers also will start studies using the experimental test this year.
Stray cancer cells in the blood mean that a tumor has spread or is likely to, many doctors believe. A test that can capture such cells has the potential to transform care for many types of cancer, especially breast, prostate, colon and lung.
Initially, doctors want to use the test to try to predict what treatments would be best for each patient’s tumor and find out quickly if they are working.
“This is like a liquid biopsy” that avoids painful tissue sampling and may give a better way to monitor patients than periodic imaging scans, said Dr. Daniel Haber, chief of Massachusetts General Hospital’s cancer center and one of the test’s inventors.
Ultimately, the test may offer a way to screen for cancer besides the mammograms, colonoscopies and other less-than-ideal methods used now.
“There’s a lot of potential here, and that’s why there’s a lot of excitement,” said Dr. Mark Kris, lung cancer chief at Memorial Sloan-Kettering Cancer Center in New York. He had no role in developing the test, but Sloan-Kettering is one of the sites that will study it this year.
Many people have their cancers diagnosed through needle biopsies. These often do not provide enough of a sample to determine what genes or pathways control a tumor’s growth. Or the sample may no longer be available by the time the patient gets sent to a specialist to decide what treatment to prescribe.
Doctors typically give a drug or radiation treatment and then do a CT scan two months later to look for tumor shrinkage. Some patients only live long enough to try one or two treatments, so a test that can gauge success sooner, by looking at cancer cells in the blood, could give patients more options.
“If you could find out quickly, ‘this drug is working, stay on it,’ or ‘this drug is not working, try something else,’ that would be huge,” Haber said.
The only test on the market now to find tumor cells in blood — CellSearch, made by J&J’s Veridex unit — just gives a cell count. It doesn’t capture whole cells that doctors can analyze to choose treatments.
Interest in trying to collect these cells soared in 2007, after Haber and his colleagues published a study of Mass General’s test. It is far more powerful than CellSearch and traps cells intact. It requires only a couple of teaspoons of blood and can be done repeatedly to monitor treatment or determine why a drug has stopped working and what to try next.
“That’s what got the scientific community’s interest,” Kris said. Doctors can give a drug one day and sample blood the next day to see if the circulating tumor cells are gone, he explained.
The test uses a microchip that resembles a lab slide covered in 78,000 tiny posts, like bristles on a hairbrush. The posts are coated with antibodies that bind to tumor cells. When blood is forced across the chip, cells ping off the posts like balls in a pinball machine. The cancer cells stick, and stains make them glow so researchers can count and capture them for study.
The test can find one cancer cell in a billion or more healthy cells, said Mehmet Toner, a Harvard University bioengineer who helped design it. Researchers know this because they spiked blood samples with cancer cells and then searched for them with the chip.
Studies of the chip have been published in the journals Nature, the New England Journal of Medicine and Science Translational Medicine. It is the most promising of several dozen that companies and universities are rushing to develop to capture circulating tumor cells, said Bob McCormack, technology chief for Veridex.
The agreement announced Monday will have Veridex and J&J’s Ortho Biotech Oncology unit work to improve the microchip, including trying a cheaper plastic to make it practical for mass production. No price goal has been set, a company official said, but the current CellSearch test costs several hundred dollars.
The companies will start a research center at Mass General and will have rights to license the test from the hospital, which holds the patents.
In a separate effort, Mass General, Sloan-Kettering, University of Texas M.D. Anderson Cancer Center in Houston and Dana-Farber Cancer Institute in Boston will start using the test this year. They are one of the “dream teams” sharing a $15 million grant from the Stand Up to Cancer telethon, run by the American Association for Cancer Research.
Already, scientists have been surprised to find that more cancer patients harbor these stray cells than has been believed. In one study, the test was used on men thought to have cancer confined to the prostate, “but we found these cells in two-thirds of patients,” Toner said.
This might mean that cancer cells enter the blood soon after a tumor starts, or that more cancers have already spread but are unseen by doctors.
Or it could mean something else entirely, because researchers have much to learn about these cells, said Dr. Minetta Liu, a breast cancer specialist at Georgetown University’s Lombardi Comprehensive Cancer Center. She led a session on them at the recent San Antonio Breast Cancer Symposium and has been a paid speaker for Veridex. She hopes the cells will someday aid cancer screening.
“The dream is, a woman comes in for her mammogram and gets a tube of blood drawn,” so doctors can look for cancer cells in her blood as well as tumors on the imaging exam, she said.
That’s still far off, but Mass General’s test already is letting doctors monitor patients without painful biopsies. Like Greg Vrettos, who suffered a collapsed lung from a biopsy in 2004, when he was diagnosed with lung cancer.
“It had spread to both lungs and they couldn’t operate,” said Vrettos, 63, a nonsmoker and retired electrical engineer from Durham, N.H. Tests from the biopsy showed that he was a good candidate for the drug Iressa, which he has taken ever since. He goes to Boston every three months for CT scans and the blood test.
“They could look at the number of cancer cells and see that it dropped over time. It corresponded with what the scans were showing,” Vrettos said of doctors looking at his blood tests.
The test also showed when he had a setback last January and needed to have his treatment adjusted.
“I think it’s going to be revolutionary,” he said of the test.
