TIME Cancer

Scientists Discover a New Way to Predict Blood Cancer

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Scientists may be able to detect cancer risk in the blood much, much earlier

Two different groups of researchers have unintentionally come to the same conclusion: some people have a marker in their blood that signals an increases risk of developing blood cancers like leukemia or lymphoma. Two new studies published Wednesday in the New England Journal of Medicine reveal that certain mutations that are not present at birth but instead develop as a person ages—called somatic mutations—may be indicators for later blood cancers.

According to DNA blood samples collected from healthy people, the researchers were able to show that people with certain somatic mutations in their blood were 10 times as likely than for people without the mutations to develop these rare cancers. Those who carried the mutations had a 5% risk of developing the cancers within five years after having their DNA sampled and tested.

The findings were discovered by researchers at the Broad Institute of MIT and Harvard, Harvard Medical School, and Harvard-affiliated hospitals, but not all together. In one study, researchers thought it would be possible to detect these mutations in blood, given the likelihood that getting blood cancers increases with age. They found this to be true, and they also found that the mutations indicated a higher risk for other diseases like type 2 diabetes, coronary heart disease, and ischemic stroke. The latter findings still need to be confirmed.

The researchers of the second study were initially looking at something completely separate. When they started their study, they were analyzing whether somatic mutations had anything to do with the risk for schizophrenia. But during their research they discovered that the mutations they found were concentrated in specific genes: cancer genes. By following the patients in their study, they discovered a link between the mutations and a high risk for blood cancer.

In a statement, the study authors say having similar findings from both approaches corroborates each others’ findings.

Steven McCarroll, a senior author of the second study and an assistant professor of genetics at Harvard Medical School, says the research is still too early for there to be any clinical benefit for patients.

“I imagine there’s some debate about whether some people might want the information, but today there’s not a way for people to benefit medically from having the information,” McCarroll tells TIME, because there’s no surgery they can undergo or preventive drug they can take. “But, I am hopeful over the next couple of years that a lot of people will start working on this because it will open the door to new strategies for early detection and prevention.”

TIME Cancer

U.S. Smoking Rate Hits Historic Low

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And the number of people who say they smoke every day has dropped, too

Cigarette smoking among American adults has hit at an all-time low, health officials said Wednesday.

The percentage of smokers over the age of 18 dropped from 20.9% in 2005 to 17.8% in 2013, according to a new Centers for Disease Control and Prevention (CDC) report. That’s the lowest rate of smoking adults since the CDC started tracking the numbers via its National Health Interview Survey in 1965. Over the course of eight years, the number of U.S. smokers dropped from 45.1 million to 42.1 million, the report reveals.

Still, the CDC worries too many Americans still smoke, and a Nov. 13 report from the agency showed that a high number of young people still smoke, putting millions at risk for premature death.

The good news for health officials is that people seem to be cutting back, if not quitting. The number of people who smoke every day has dropped nearly 4% from 2005 to 2013, and the proportion of smokers who smoke only some days has increased. Of course, smoking less habitually still poses tremendous danger for the health.

“Though smokers are smoking fewer cigarettes, cutting back by a few cigarettes a day rather than quitting completely does not produce significant health benefits,” said Brian King, a senior scientific adviser with the CDC’s Office on Smoking and Health, in a statement.

Cigarette smoking continues to be the leading cause of preventable death among Americans, reportedly racks up $289 billion a year in medical costs and productivity loss.

Around 70% of all cigarette smokers want to kick the habit, and if a smoker quits by the time they turn 40, they can gain almost all of the 10 years of life expectancy they lose by smoking.

Americans who want to quit smoking can call 1-800-QUIT-NOW for free counseling and resources, or visit the CDC’s antismoking tips site here.

TIME Research

6 Breath Tests That Can Diagnose Disease

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A new study uses breath to diagnoses diabetes, but other diseases like cancer and obesity may be breath-detectable too

A new study shows that it may be possible to diagnose type 1 diabetes in kids even before the onset of severe illness.

Currently, about one in four kids with type 1 diabetes don’t know they have it until they start having life-threatening symptoms. However, a new study published in the Journal of Breath Research shows researchers might be able to diagnose the disease by detecting a chemical marker (acetone) in the breath that makes it smell sweet, but indicates a build-up of chemicals in the blood (ketones) that occurs when a person’s insulin levels are low. High levels of acetone in the breath can indicate high levels of ketones in the blood. The hope is that if proven effective, this breath test will help physicians make a diagnosis earlier.

Growing research suggests breath tests can be used to detect a variety of diseases, from diabetes to various cancers. Research is still early in some areas—and there are other factors beyond disease that can result in chemical markers in the blood and breath—but some medical institutions are already using the tests of a variety of diagnosis.

Type 1 Diabetes
In the new study, researchers collected compounds in the breath from 113 children and adolescents between the ages 7 and 18. They also measured the kids’ blood-sugar and ketone levels. They found a link between higher levels of acetone in the breath and ketones in the blood. “Our results have shown that it is realistically possible to use measurements of breath acetone to estimate blood ketones,” said study author Gus Hancock, a professor at Oxford in a statement. “We are working on the development of a small hand-held device that would … help to identify children with new diabetes.”

Colorectal Cancer
In a small study published in 2012 in the British Journal of Surgery, researchers from the the University Aldo Moro of Bari in Italy collected the breath of 37 patients with colorectal cancer and 41 healthy control participants. The researchers were measuring the amount of volatile organic compounds (VOCs) in the participants’ breath, with the thought being that cancer tissues and cells may release distinct chemicals. The researchers were able to identify 15 of 58 specific compounds that were correlated with colorectal cancer. Based on this, the were also able to distinguish between cancer patients and healthy patients with 75% accuracy.

Lung Cancer
In 2013, researchers from the University of Latvia used an electronic nose-like device to identify a unique chemical signature in lung cancer patients. As TIME has previously reported, there are several groups who think this process can be standardized for cancer with further research. In June, scientists at the American Society of Clinical Oncology meeting in Chicago presented a device they think has real promise.

Obesity
There are obviously a number of ways that obesity can be diagnosed without a breath test, but a 2013 study published in the Journal of Clinical Endocrinology & Metabolism found that obese people had unique markers in their breath, too. Researchers at Cedars-Sinai Medical Center studied the breath of 792 men and women trying to detect methane. Those with higher levels of methane and hydrogen gases in their breath also tended to be heavier with a BMI around 2.4 points greater than those with normal gas levels. The hope, the researchers say, is that a test could be developed that could detect a type of bacteria that may be involved in both weight and levels of gas in the breath. There may be ways to clinically curb that bacteria growth.

Lactose Intolerance
Johns Hopkins Medicine uses breath testing to help diagnose lactose intolerance. Patients drink a lactose-heavy drink and clinicians will analyzed the breath for hydrogen, which is produced when lactose isn’t digested and is fermented by bacteria.

Fructose Intolerance
Johns Hopkins also uses breath tests to assess whether an individual is allergic or intolerant to fructose, a sugar used to sweeten some beverage and found naturally in foods like onions, artichokes, and wheat. The test is similar to a breath test for lactose intolerance. Patients will drink a cup of water with dissolved fructose and over a three hour period, clinicians will test their breath. Once again, a high presence of hydrogen can indicate that the patient is not properly digesting it.

TIME Cancer

The Hidden Dangers of Medical Scans

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Medical imaging tests are exposing more of us to potentially cancer-causing radiation. Here's when you really need that scan—€”and when you should just say no

Over the past ten years, Jill Nelson, 52, a health coach, personal trainer and counselor in Chicago, has received at least seven computed tomography (CT) scans and close to 30 sets of X-rays for a variety of health ailments—from two separate disk fusions in her spine to a worrisome-looking spot on her lung. That’s on top of the 10 or so mammograms she has had since age 35, plus dozens of dental X-rays. “With all that radiation, I’m surprised I don’t glow,” she says. “It makes me a little uneasy—in trying to get my health problems diagnosed, did I increase my risk of cancer?”

Jill’s concern is shared by a growing number of doctors and medical organizations, who are worried about the soaring use of medical imaging tests that rely on ionizing radiation. This radiation can damage your cells’ DNA, which may, over time, lead to cancer. The more you’re exposed to, the riskier it is. And thanks to the increase in CT scans—which typically emit far higher doses of radiation than traditional X-rays or even other imaging tests like mammograms—exposure has risen dramatically. In 1980, only about 3 million CT scans were performed in the United States. By 2013, that number had skyrocketed to 76 million.

Exactly how dangerous are all those zaps? In 2009, National Cancer Institute researchers estimated that the 72 million CT scans performed in 2007 could lead to as many as 29,000 future cases of cancer. And a couple of years ago, when the Institute of Medicine looked broadly at the environmental causes of breast cancer, it concluded that one factor that’s strongly associated with risk of developing the disease is ionizing radiation.

HEALTH.COM: 9 Everyday Sources of Radiation

That sounds scary—and it is. “Limiting exposure to medical radiation should be on every woman’s cancer-prevention list,” says Rebecca Smith-Bindman, MD, professor of radiology, epidemiology, biostatistics and health policy at the University of California, San Francisco. Yet the tests are widely overused, research finds. “About a third of CT scans are clinically unnecessary or could be avoided by using conventional X-rays or an imaging test that doesn’t use radiation, like ultrasound or MRI,” says David J. Brenner, PhD, director of the Center for Radiological Research at Columbia University Medical Center.

The challenge is figuring out whether the CT your doctor wants you to have is essential or not—a judgment call that is difficult for the average person to make. CT scans can, in fact, be lifesaving. “They’ve revolutionized medicine in almost every area you can imagine, including helping prevent unnecessary exploratory surgeries and diagnosing and treating cancers, heart disease and stroke, ” Brenner says. Price and time can also be a factor since CT scans are cheaper and faster than an MRI. (For a cost comparison of common imaging tests, go to health.com/scan-costs.)

Understanding the risks of medical radiation—as well as the real benefits—will better prepare you to make the best decision no matter when you’re faced with it. Here’s what you must know to avoid unneeded radiation.

Weighing the rewards and risks

When you receive a traditional X-ray, a small amount of radiation passes through your tissues in order to create a two-dimensional image of your insides in shades of gray. Air is black because it doesn’t absorb any X-rays, while bones are white because they absorb a lot, and organs are somewhere in between.

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CT scanners, on the other hand, rotate around the body, sending numerous X-ray beams (and multiple times the amount of radiation) from a variety of angles. A computer processes the data to create three-dimensional pictures, providing a far more detailed view. “CTs allow us to see behind and around structures in the body in three dimensions with exquisite resolution,” Brenner says. As a result, they’re an indispensable tool in diagnosing all sorts of frightening health problems, such as finding small, early cancers (particularly in the lungs, liver and kidneys) or spotting internal injuries after a serious accident.

“They can detect differences between normal and abnormal tissue about 1,000 times better than a traditional X-ray,” says Richard Morin, PhD, professor of radiologic physics at the Mayo Clinic in Jacksonville, Fla. “Before CTs, if we suspected cancer in the abdomen or internal organs, we had to cut the patient open and do exploratory surgery, which could mean a weeks-long hospital stay. Now with a single scan we can confidently make the call in minutes, and the patient walks out the door afterward. If it’s an appropriately ordered exam, the benefit is far, far greater than any radiation risk.”

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But the ease and accuracy of CTs has also fueled an alarming level of overuse. Have a headache that prompts a trip to the ER? Odds are good you’ll get a CT, even though current guidelines say that doctors shouldn’t perform imaging tests on patients with migraines or chronic headaches. Brain scans, whether a CT or an MRI, are worthwhile only if you have a headache with other worrisome symptoms, such as weakness or numbness on one side of your body, explains Brian Callaghan, MD, a neurologist at the University of Michigan. Even so, he and his colleagues recently found that about one in eight headache-related doctor visits result in a brain scan—and nearly half those patients are getting CTs, even though MRIs are more effective for peering into the brain.

“The goal isn’t to eliminate CTs but to use them more prudently,” Dr. Smith-Bindman says. “When my son did a head-dive out of a tree and was vomiting afterward, the ER doc recommended a CT scan to rule out a brain bleed, and I was happy to have the test. Five years later, when he hit his head skiing, it was pretty clear he just had a concussion, and the ER doc didn’t think a CT was necessary, so we didn’t get it. Doctors and patients need to step back a little and say, ‘Yes, this is a great test, but is it really necessary?’ If you have a CT when it’s not necessary, it won’t do any good—which means it can only do harm.”

The radiation equation

X-rays and CT scans use so-called ionizing radiation, which contains enough energy to penetrate the body—and can damage DNA in your cells. Any damage that isn’t repaired can lead to DNA mutations, and those glitches in a cell’s programming center can, over many years, lead to cancer.

And we know that it does. “There’s not a single cancer-causing agent that has been studied more thoroughly than ionizing radiation,” Dr. Smith-Bindman says. Survivors of the atomic bombs in Hiroshima and Nagasaki who were exposed to even very low doses were more likely to get practically every type of cancer, from leukemia to lung cancer. Nursing mothers who were treated with radiation for breast infections—a common practice in the 1920s and ’30s—developed breast cancer at higher rates than those who weren’t. Those of us who’ve had more sunburns (caused by the sun’s ultraviolet radiation) are at higher risk of getting skin cancer. And the newest studies reveal that children who undergo CT scans of the head, abdomen or chest are more likely to develop brain cancer and leukemia over the next 10 years.

For reasons that are unclear, women seem to be slightly more sensitive to radiation than men. Children are more vulnerable than adults; not only do their growing bodies and rapidly multiplying cells put them at a higher risk, they also have far more years ahead of them during which they could develop cancer.

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However, it’s important to note that our bodies are able to repair damage done to our cells by low levels of radiation. “If they weren’t, everyone who goes out in the sun would get skin cancer,” points out James Brink, MD, radiologist in chief at Massachusetts General Hospital.
The poison is in the dose, says John Boice, ScD, president of the National Council on Radiation Protection and Measurements and professor of medicine at Vanderbilt University. And the effects of exposure might be cumulative. “What may happen is that our bodies repair damage from small doses, but at higher doses our repair mechanisms are overwhelmed,” Dr. Brink explains. “And after that, subsequent exposure to radiation may propel the damaged cells farther down the path toward cancer.”

The actual danger to an individual receiving a scan (or even two or three) is relatively low. The overall risk of the average woman getting cancer at some point in her lifetime is about 38 percent; getting a single CT scan raises that risk to perhaps 38.001 percent, Boice explains. But since no one knows who is most likely to be affected, there is an element of radiation roulette at play.

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What’s more, we’re marinating in low-level radiation every day. The average person in the United States receives about 3 millisieverts (mSv) of radiation per year (more if you live at a high altitude) from the sun and naturally occurring radiation in the environment, such as radon gas. To put medical radiation in that context, a dental X-ray is equivalent to about one day of natural radiation, while a single chest X-ray is equivalent to about 10 days. A mammogram adds up to about seven weeks of natural radiation—but even that level, doctors say, poses a relatively small risk, especially when compared with the danger of missing a malignant tumor already growing in your breast. A regular-dose chest CT, on the other hand, exposes you to about two years’ worth of natural background radiation, or 7 mSv. Some of the Japanese survivors of atomic bombs were probably exposed to between 5 and 20 mSv on the low end. The trouble is, we don’t fully know how much our bodies can handle.

What doctors don’t know can hurt us

The issue of medical radiation is now on most physicians’ and medical societies’ radars; just this fall, the American Heart Association called for doctors to learn about, and discuss with patients, the risks of radiation exposure from cardiovascular imaging tests. So it’s surprising—and concerning—how spotty regulations still are. For instance, dosages aren’t standardized across imaging centers, which means that one hospital or clinic may be delivering up to 50 times as much radiation as another facility, according to Dr. Smith-Bindman. “If machines are set too low, they provide blurry, unusable images, but the vast majority are set higher than they need to be,” she says. This is in part because it’s not a simple matter of pressing one button and lowering the dose. “There are formulas you need to use to set up a new protocol,” Dr. Smith-Bindman explains.

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And because most older machines, many of which are still in use, don’t have warning systems to alert technologists when radiation levels are set too high, mistakes can happen. The most publicized CT-related overdoses occurred between 2008 and 2010, when several hospitals in California and one in Alabama seriously over-radiated more than 400 patients. The problem was discovered after patients reported losing their hair. Since then, new technology has been created to alert technologists if the dose is too high—and new federal legislation is in the works that would require radiology centers to adopt modern imaging equipment standards by 2016.

Still, the more common problem is that too many scans are being done in the first place, particularly in the ER, where doctors sometimes order CTs before they’ve fully evaluated a patient, Dr. Smith-Bindman says. But doctors in general have come to rely heavily on these tests. One reason: Many MDs today have a lower tolerance for ambiguity than ever before and have learned to trust images to give them definitive answers, even when other methods, including a risk-free physical exam, can provide the information needed.

In addition, physicians in private practice may feel financial pressure to recoup the cost of expensive equipment. “Research has found that if a neurologist, say, owns a CT scanner, the percentage of patients getting scans is higher than what’s typically done in a radiology clinic and much higher than in similar doctors’ practices without scanners,” Morin says. Add to the mix the possibility of being sued over a misdiagnosis, and you have a recipe for overuse.

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Making scans safer

Avoiding unnecessary medical radiation starts with speaking up and being your own best advocate (see 5 Questions to Ask Before You Have That Scan, page 117). At the same time, multiple industry efforts are under way to lower exposures from CTs. One initiative, Choosing Wisely (choosingwisely.org), helps doctors and patients understand which procedures and tests—including imaging tests—are unnecessary or commonly overused. Radiologists are leading the charge to make scans safer: Image Wisely, a program created by the American College of Radiology (ACR) and the Radiological Society of North America, is focused on optimizing the amount of radiation used in imaging studies and eliminating inessential CTs and other scans. The ACR has also created the Dose Index Registry in an effort to compare dosage information across facilities. About a third of the 3,000 or so scanning facilities in the U.S. are members, which means they get updates on the dosages other centers are using for similar tests, explains Morin, who was the founding chair of the registry. (For more on finding the best place to get a scan, go to health.com/safe-scan.)

HEALTH.COM: 5 Medical Tests to Think Twice About

Meanwhile, companies that manufacture scanners are developing new technology to lower the radiation doses. “They’ve fine-tuned the equipment so you can produce high-quality images with lower doses,” Morin says. Even so, when you need to get a CT scan, it’s always a good idea to ask if they can scan using the lowest dose possible, Dr. Smith-Bindman says. If you’re smaller or thinner, technicians can often get a clear image at a lower dose. (The bigger your body, the more radiation you require, since fat absorbs some of the beams.) Avoid unnecessary radiation from even low-level sources, like dental X-rays, which you probably don’t need every year unless you have ongoing problems with tooth decay.

The idea is not to refuse all medical radiation but to do your best to discriminate between what’s essential and what’s not. “I always tell my friends to say to their doctors who recommend CTs, ‘I’m happy to have the test, but I’d like you to help me understand why I really need it,'” Dr. Smith-Bindman says. “Medicine often doesn’t change until patients start asking questions. And when it comes to medical radiation, it’s time to start asking.”

5 Questions to ask before you have that scan
“When a doctor prescribes a medication, she always talks about the risks and benefits,” says Rebecca Smith-Bindman, MD. “Now we need to start having that same kind of discussion about medical imaging.” In addition to the obvious “Why do I need this test?” ask these key questions—especially if your doc suggests a CT scan.

1. “Will the outcome of the test change the treatment I’m likely to receive?” If the answer is no, the test may not be necessary, Dr. Smith-Bindman points out.

2. “Are there alternatives without radiation, like ultrasound or MRI?” In some cases, such as many abdominal CT scans, other scans work as well or better, Dr. Smith-Bindman says.

3. If you’ve just had a scan at another facility, ask, “Is there a reason to repeat the scan I just had?” Notes John Boice, ScD: “It doesn’t make sense to do tests twice, yet it does happen.”

4. If a CT scan is crucial, ask, “Is there a way to minimize the dose?” Doctors may be able to use a lower-dose technique, particularly if you’re petite.

5. After a CT scan, ask, “How much radiation was I exposed to?” Write it down so you have a record.

You probably don’t need a CT for… Question your doc if she recommends a CT for these health problems.

Concussion: Concussions can be diagnosed by symptoms alone. But it’s valid to do a CT if the doctor suspects a skull fracture or brain bleed, says Robert Cantu, MD, clinical professor of neurosurgery at Boston University School of Medicine.

Sinus infection: This everyday health problem can generally be diagnosed through symptoms and a physical exam, says the American Academy of Allergy, Asthma & Immunology.

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Headache: If you do need a scan, MRI is the test of choice, unless a doctor suspects a stroke or brain hemorrhage, according to the American Headache Society.

Appendicitis in children: It’s best to use ultrasound first, then follow up with a CT if the ultrasound is inconclusive, according to the American College of Radiology.

Back pain: Most cases improve on their own within a month, so it doesn’t make sense to expose yourself to unnecessary radiation. If the pain continues, ask your doctor about an MRI.

How much radiation you get from…
Airport backscatter scan: .0001 mSv
Bone-density scan: 0.001 mSv
Dental posterior bite-wing X-ray series (two to four images): 0.005 to 0.055 mSv*
Two days in Denver: 0.006 mSv
Panoramic dental X-rays (standard single image): 0.009 to 0.024 mSv*
Cross-country flight: 0.04 mSv
Single chest X-ray: 0.1 mSv
Digital mammogram: 0.4 mSv
Average yearly dose from the sun and other environmental sources: 3 mSv
Chest CT: 7 mSv
Virtual (CT) colonoscopy: 10 mSv

PET/CT (often used to diagnose cancer): 25 mSv

Smoking a pack a day for a year: 53 mSv

*Dose can vary based on the type of machine used.

Your anti-radiation diet
Antioxidants from food can sop up the free radicals that cause DNA damage. And some research has hinted that what you eat may shield your body from radiation’s harmful effects. A 2009 study of airline pilots, who tend to be exposed to elevated levels of ionizing radiation, found that those with diets highest in vitamins C and E, beta-carotene, beta-cryptoxanthin (found in pumpkin, papaya and red peppers) and lutein-zeaxanthin (in leafy greens, egg yolks and squash) had fewer biomarkers of cumulative DNA damage.

Researchers in Toronto have recently shown that taking antioxidants before a scan can reduce the number of DNA breaks caused by the radiation. Published results are expected within the next six months. Says researcher Kieran Murphy, MD, professor of radiology at the University Health Network Toronto: “In light of what we’ve found, making sure you have a diet rich in antioxidant-packed fruits and vegetables could be beneficial.”

This post originally appeared on Health.com

TIME Cancer

Scientists Develop New Way to Treat HPV-Related Cancer

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A drug already off-patent may provide better treatment for cervical cancer

A drug called cidofovir that’s already used to target viruses could also be used as part of a novel way to treat cervical cancer.

In new research presented at an annual Symposium on Molecular Targets and Cancer Therapeutics in Barcelona, Spain, researchers tested cidofovir in tandem with chemotherapy and found that the drug caused shrinkage of cervical cancer tumors in all of the trial participants, and in 80% of the patients the tumors disappeared completely. The combination also showed no toxic side effects.

The clinical trial was small with only 15 women, who received doses of the drug weekly for two weeks, and then every two weeks after chemoradiation started.

One of the side effects of cidofovir can be kidney damage, but there was no damage observed in the participants, suggesting the dosage was safe. The researchers hope to move on to a phase II and phase III trial to look at how the drug impacts overall survival.

In the U.S. alone, about 12,000 women get cervical cancer each year. Human papillomavirus (HPV) is a very common STD, and it’s also the most common cause of cervical cancer. But cervical cancer is a common disease worldwide, and the researchers, lead by Eric Deutsch, a professor of radiation oncology at the Institut Gustave Roussy, Villejuif, France, say they see their drug treatment being very cost effective for low-income countries since it’s now available off patent.

That’s another reason it’s hard to get the support for the research. “This is also why it has taken us more than ten years to move from the first preclinical data to a phase I trial,” said Deutsch in a statement. “Due to lack of interest and support from the pharmaceutical industry, the trial had to be performed with 100% academic funding.”

TIME ebola

Ebola Among Top 3 Health Concerns for Americans: Study

A protester dressed in protective equipment demonstrates in Brisbane
A protester dressed in protective equipment demonstrates, calling for for G20 leaders to address the Ebola issue, near the G20 leaders summit venue in Brisbane Nov. 15, 2014 Jason Reed—Reuters

Health care costs and access came in first and second places

The U.S. may only have seen four cases of Ebola, but the virus is still one of the top three health worries for Americans, according to a new poll.

The disease was mentioned by 17% of adults surveyed by Gallup’s annual Health and Health Care survey as their principle medical concern, coming after only health care cost (19%) and access (18%).

The cost of health care in particular has been prominent on the list for over a decade and is likely to remain so, says Gallup. Next came obesity and cancer, which were both cited by 10% of respondents as the nation’s “most urgent health problem.”

The Gallup poll was based on 828 telephone interviews conducted Nov. 6-9 with Americans aged 18 and older living in all 50 U.S. states and the District of Columbia.

TIME health

Death is Not Only for the Dying

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I would give anything to not have experienced the last week of my wife’s life

I occasionally flip my car radio to the right wing AM station to get my blood pumping and to keep up on what people with a different worldview are thinking. When I did this last week, I wasn’t too surprised to hear the topic of the afternoon call-in program was Brittany Maynard, a terminally ill California woman who moved to Oregon to take advantage of the state’s death with dignity law and end her own life.

The fact that an attractive young woman made this decision and shared it with the world had caught the media’s attention and reignited debate on the issue of physician-assisted suicide. Her story also caught my interest, having gone through the slow and painful cancer death of my own wife.

Listening to the call-in program last week, I felt empathy right away for the first caller, a widower who had recently lost his wife to heart disease. But then the caller said that Brittany’s husband should have talked her out of her decision. He was sure that her husband would regret losing her before the last possible moment. The caller said that he would give anything to have one more hour with his wife. I’m sure that is a common attitude, especially if the loved one has died suddenly, but it is not my experience. I would give anything to not have experienced the last week of my wife’s life.

As I see it, Brittany gave her husband a gift. She gave him a gift by preventing painful images from being burned into his brain. He will not have memories of his beloved gradually losing her mind and control over her bodily functions. He will not have memories of watching the person he loves most moaning in pain, and not being able to do anything about it. He will not have memories like the ones I have—of vomit and bedsores and things so horrible that I cannot bring myself to type them into this keyboard. He will not have memories of reaching the point where he started wishing that his wife, his partner of 38 years who he loved with all his heart, would die. Those memories don’t go away; they come back in dreams and nightmares.

I’m not sure that my wife would have taken advantage of a law like Oregon’s if it had existed here in California. Her method of coping with cancer was to ignore it as much as possible. She did not talk about the disease, and certainly did not make any plans related to dying. If I tried to bring it up, she would quickly cut me off with: “Are you giving up on me?” This may seem like foolish denial, but I don’t think it was. She realized that her time was short, and decided to eliminate unpleasant things from her life as much as possible. Thinking or talking about disease and death were unpleasant, so she didn’t do it.

Instead we went on camping trips to our favorite remote areas of the Sierras and the Mojave Desert. We spent time with dear friends and our first grandson. The summer before her death in October 2008, our two daughters rather hurriedly put together lovely weddings for themselves. To the very end, she stayed in our home surrounded by people who loved her. In spite of chemotherapy and intestinal obstructions, the last year of her life was a good time. The last week was not.

Nobody really tells you about death. You learn about it as you go along. The hospice nurses are wonderful. They prepare you, in a way, and are good about answering questions, but by the time you know what questions to ask, it’s too late. You also hear half-truths and little white lies, like: “We can keep her comfortable by just upping the dose of morphine.” They don’t tell you ahead of time how you are supposed to do that when she can no longer swallow, nor do they mention that the dose of morphine necessary to keep her “comfortable” is eventually the same as the dose that will stop her breathing. They don’t tell you what to do when she asks for a pill to “just get this over with.” They do reassure you that those horrible moans and gasps are worse for you than for her.

They are probably right. By then, I was sure that her essence was gone; she did not know what was happening. Still, it was horrible for me, and for what purpose?

From my wife’s death I did gain a deeper understanding of what it means to be human. One surely does not understand the full human experience without going through a great loss. I learned that grief is a physical pain that is built into our biochemistry. I learned how important good friends are when you need them. I learned that a family can come through truly bad times, that a life can be put back together after being uprooted. I would have learned all of this without that last week.

I thank Brittany Maynard for showing the world a better way. It took bravery on her part, and it was a gift to her loved ones. It will also be a gift to all of us if it gets us to think about how we want to die, and what memories we want to leave behind.

John La Grange is a retired commercial fisherman living in Solana Beach, California. He met his wife while they were students at UCSD. After 38 years of marriage, she died of ovarian cancer in 2008. He wrote this for Zocalo Public Square.

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MTV Reality Star Diem Brown Dies at 32

Us Weekly's 2014 Most Stylish New Yorkers Celebration
TV Personality Diem Brown attends Us Weekly's 2014 Most Stylish New Yorkers Celebration at Diamond Horseshoe at the Paramount Hotel on Sept. 10, 2014 in New York City. Mychal Watts—WireImage/Getty Images

First diagnosed with ovarian cancer at age 23

Diem Brown, known for her time on MTV’s Real World/Road Rules Challenge, has died of cancer at age 32, according to a report Friday.

The reality star was first diagnosed with ovarian cancer at age 23. She recovered, but was diagnosed again in 2012, People reports. The disease later spread to her colon and stomach and, more recently, to her liver and lymph nodes.

Despite an emergency hysterectomy, she had frozen her eggs and very much hoped to have a family some day. “I’m going to have a family and get married and the whole American, 2½ kids, white-picket fence dream,” she said in October.

Read more at People

TIME Cancer

Young Smokers Put Millions at Risk, CDC Says

Kid Smoker
Diverse Images/UIG/Getty Images

5.6 million young people under age 17 could die early

Over 1 in 5 high school students use tobacco products, and unless rates drop significantly, 5.6 million young people under age 17 will die early from a smoking-related illness, according to a recent report from the Centers of Disease Control and Prevention (CDC).

Among young people who use tobacco products, over 90% are using nicotine vectors like cigarettes, cigars, hookahs and pipes. The vast majority of smokers try their first cigarette by the time they turn 18. The findings were published Thursday in the CDC’s Morbidity and Mortality Weekly Report.

The CDC analyzed its National Youth Tobacco Survey and report that in 2013, 22.9% of high school students and 6.5% of middle schoolers said they had used tobacco in the last 30 days. Those rates are slightly down from 2012, where 23.3% of high school students and 6.7% of middle schoolers said they’d used some form of tobacco in the last month. Unfortunately, the new numbers still show that close to 50% of all high schoolers and almost 18% of all middle schoolers have used a tobacco product at least once.

What about e-cigarettes? They’re still less popular than the traditional products: 4.5% of high schoolers and 1.1% of middle schoolers said they used them in the last month. How great of a problem e-cigarettes are for public health is still debated, but the products do contain nicotine, so therefore considered unsafe for kids.

One item of particular concern to the FDA are cigars, because they are taxed at a lower rate and often made to look like cigarettes, even having fruity flavors. Some are not regulated by the FDA in the way cigarettes are, which experts cite as a major concern.

Cigarette smoking kills more than 480,000 Americans every year, and for each death, there are about 32 people living with a smoking-related illness. It costs the U.S. economy billions in medical costs and loss in productivity. One strategy to make smoking less appealing to young people (besides the long list of terrifying health risks, like lung cancer) is by hiking up the price of tobacco, and launching more youth-targeted social campaigns, the CDC says.

Smokers can get free help quitting by calling 1-800-QUIT-NOW.

TIME Cancer

The Cancer Breakthrough With Big Implications

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Lung cancer cell STEVE GSCHMEISSNER—Getty Images/Science Photo Library RM

Screening tumors could lead to smarter decisions about which cancer treatments will work best for individual patients

Once you’ve been diagnosed with cancer, you’re sent for a dizzying array of tests — but most of them are focused on you, as the living host of the tumors, and not on the malignant growths themselves.

That may soon change, as researchers report in the journal Science. Some cancer centers already take biopsies of tumors and run them through genetic tests, to get a better sense of what’s driving the cancer. That information can be helpful in deciding which of the growing number of targeted anti-cancer drugs will work best to stop those growths.

MORE: Promising New Cancer Treatment Uses Immune Cells

But the down side of these powerful drugs is that tumors become resistant to them relatively quickly, often within a year or two. So to find better ways of stopping such resistance from developing, Jeffrey Engelman and his co-senior author Cyril Benes from Massachusetts General Hospital took tumor testing one step further. They actually allowed some of those tumor cells — from lung cancers — to grow in a lab dish. That made it possible to throw various anti-cancer drugs at them to see how the cancer cells responded — providing a valuable window into how the tumors inside the body might react.

They found, not surprisingly, that hitting tumors with combinations of targeted drugs could effectively shut down the cancer cells’ ability to resist the treatment. When they transplanted the human tumors into mice, those given the combination of drugs saw their growths shrink, and the drugs remained active nearly twice as long as the single drug in suppressing tumor growth. The findings could help doctors to tailor cancer treatments specifically to individual patients and help them to avoid drug resistance and ultimately improve their chances of surviving their cancer.

MORE: Here’s How Well Your Genes Can Predict Your Breast Cancer Risk

“It’s a substantial step,” says Engelman of the results. “Because before we just had the genetic information but we wouldn’t have the cells alive so that we could test what types of therapies might work.”

He and Benes stress that they haven’t used their screening method yet to guide any patient treatment decisions, but hope that will happen soon. They’re encouraged by the fact that their method identified several mutations that might be driving cancer that hadn’t been known before, thus opening up the number of drugs that target these abnormalities that patients could take.

“Sometimes there are genetic mutations in genes that we can’t target [with a drug]. Sometimes there is ambiguity in genetics — we know the mutations but we don’t know what they mean, or there are multiple mutations together and we don’t know how to treat them. And sometimes we don’t know what mutations are driving the cancer,” says Engelman. But by testing the actual tumor cells against well known drugs or drug combinations, researchers wouldn’t have to know the answers to all of these questions. Instead they could cut straight to the arguable most important outcome — finding the best drugs for treating a particular patient’s cancer. Ultimately, the researchers see such drug screening as going hand in hand with genetic screening – the gene tests would identify the known mutations, and that would inform which drugs to test tumor cells against.

Before that happens, Engleman and Benes admit that more refinements need to be made in their process. Now, it takes two to six months to grow the tumor cells properly in order to be screened by the drugs. That time needs to be shrunk to a weeks or even days if doctors and patients can take advantage of the information. But they’re confident that will happen. “We know ways to cut this shorter,” says Engelman. “What’s exciting is that this technology make you think you have a real shot at getting there. And we’re going to take that shot.”

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