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Most men with prostate cancer can avoid or delay harsh treatments, long-term study confirms | CNN

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CNN
—

Most men who are diagnosed with prostate cancer can delay or avoid harsh treatments without harming their chances of survival, according to new results from a long-running study in the United Kingdom.

Men in the study who partnered with their doctors to keep a close eye on their low- to intermediate-risk prostate tumors – a strategy called surveillance or active monitoring – slashed their risk of the life-altering complications such as incontinence and erectile dysfunction that can follow aggressive treatment for the disease, but they were no more likely to die of their cancers than men who had surgery to remove their prostate or who were treated with hormone blockers and radiation.

“The good news is that if you’re diagnosed with prostate cancer, don’t panic, and take your time to make a decision” about how to proceed, said lead study author Dr. Freddie Hamdy, professor of surgery and urology at the University of Oxford.

Other experts who were not involved in the research agreed that the study was reassuring for men who are diagnosed with prostate cancer and their doctors.

“When men are carefully evaluated and their risk assessed, you can delay or avoid treatment without missing the chance to cure in a large fraction of patients,” said Dr. Bruce Trock, a professor of urology, epidemiology and oncology at Johns Hopkins University.

The findings do not apply to men who have prostate cancers that are scored through testing to be high-risk and high-grade. These aggressive cancers, which account for about 15% of all prostate cancer diagnoses, still need prompt treatment, Hamdy said.

For others, however, the study adds to a growing body of evidence showing that surveillance of prostate cancers is often the right thing to do.

“What I take away from this is the safety of doing active monitoring in patients,” said Dr. Samuel Haywood, a urologic oncologist at the Cleveland Clinic in Ohio, who reviewed the study, but was not involved in the research.

Results from the study were presented on Saturday at the European Association of Urology annual conference in Milan, Italy. Two studies on the data were also published in the New England Journal of Medicine and a companion journal, NEJM Evidence.

Prostate cancer is the second most common cancer in men in the United States, behind non-melanoma skin cancers. About 11% – or 1 in 9 – American men will be diagnosed with prostate cancer in their lifetime, and overall, about 2.5% – or 1 in 41 – will die from it, according to the National Cancer Institute. About $10 billion is spent treating prostate cancer in the US each year.

Most prostate cancers grow very slowly. It typically takes at least 10 years for a tumor confined to the prostate to cause significant symptoms.

The study, which has been running for more than two decades, confirms what many doctors and researchers have come to realize in the interim: The majority of prostate cancers picked up by blood tests that measure levels of a protein called prostate-specific antigen, or PSA, will not harm men during their lifetimes and don’t require treatment.

Dr. Oliver Sartor, medical director of the Tulane Cancer Center, said men should understand that a lot has changed over time, and doctors have refined their approach to diagnosis since the study began in 1999.

“I wanted to make clear that the way these patients are screened and biopsied and randomized is very, very different than how these same patients might be screened, biopsied and randomized today,” said Sartor, who wrote an editorial on the study but was not involved in the research.

He says the men included in the study were in the earliest stages of their cancer and were mostly low-risk.

Now, he says, doctors have more tools, including MRI imaging and genetic tests that can help guide treatment and minimize overdiagnosis.

The study authors say that to assuage concerns that their results might not be relevant to people today, they re-evaluated their patients using modern methods for grading prostate cancers. By those standards, about one-third of their patients would have intermediate or high-risk disease, something that didn’t change the conclusions.

When the study began in 1999, routine PSA screening for men was the norm. Many doctors encouraged annual PSA tests for their male patients over age 50.

PSA tests are sensitive but not specific. Cancer can raise PSA levels, but so can things like infections, sexual activity and even riding a bicycle. Elevated PSA tests require more evaluation, which can include imaging and biopsies to determine the cause. Most of the time, all that followup just isn’t worth it.

“It is generally thought that only about 30% of the individuals with an elevated PSA will actually have cancer, and of those that do have cancer, the majority don’t need to be treated,” Sartor said.

Over the years, studies and modeling have shown that using regular PSA tests to screen for prostate cancer can do more harm than good.

By some estimates, as many as 84% of men with prostate cancer identified through routine screening do not benefit from having their cancers detected because their cancer would not be fatal before they died of other causes.

Other studies have estimated about 1 to 2 in every five men diagnosed with prostate cancer is overtreated. The harms of overtreatment for prostate cancer are well-documented and include incontinence, erectile dysfunction and loss of sexual potency, as well as anxiety and depression.

In 2012, the influential US Preventive Services Task Force advised healthy men not to get PSA tests as part of their regular checkups, saying the harms of screening outweighed its benefits.

Now, the task force opts for a more individualized approach, saying men between the ages of 55 and 69 should make the decision to undergo periodic PSA testing after carefully weighing the risks and benefits with their doctor. They recommend against PSA-based screening for men over the age of 70.

The American Cancer Society endorses much the same approach, recommending that men at average risk have a conversation with their doctor about the risks and benefits beginning at age 50.

The trial has been following more than 1,600 men who were diagnosed with prostate cancer in the UK between 1999 and 2009. All the men had cancers that had not metastasized, or spread to other parts of their bodies.

When they joined, the men were randomly assigned to one of three groups: active monitoring or using regular blood tests to keep an eye on their PSA levels; radiotherapy, which used hormone-blockers and radiation to shrink tumors; and prostatectomy, or surgery to remove the prostate.

Men who were assigned monitoring could change groups during the study if their cancers progressed to the point that they needed more aggressive treatment.

Most of the men have been followed for around 15 years now, and for the most recent data analysis, researchers were able get follow-up information on 98% of the participants.

By 2020, 45 men – about 3% of the participants – had died of prostate cancer. There were no significant differences in prostate cancer deaths between the three groups.

Men in the active monitoring group were more likely to have their cancer progress and more likely to have it spread compared with the other groups. About 9% of men in the active monitoring group saw their cancer metastasize, compared with 5% in the two other groups.

Trock points out that even though it didn’t affect their overall survival, a spreading cancer isn’t an insignificant outcome. It can be painful and may require aggressive treatments to manage at that stage.

Active surveillance did have important benefits over surgery or radiation.

As they followed the men over 12 years, the researchers found that 1 in 4 to 1 in 5 of those who had prostate surgery needed to wear at least one pad a day to guard against urine leaks. That rate was twice as high as the other groups, said Dr. Jenny Donovan of the University of Bristol, who led the study on patient-reported outcomes after treatment.

Sexual function was affected, too. It’s natural for sexual function to decline in men with age, so by the end of the study, nearly all the men reported low sexual function, but their patterns of decline were different depending on their prostate cancer treatment, she said.

“The men who have surgery have low sexual function early on, and that continues. The men in the radiotherapy group see their sexual function drop, then have some recovery, but then their sexual function declines, and the active monitoring group declines slowly over time,” Donovan said.

Donovan said that when she presents her data to doctors, they point out how much has changed since the study started.

“Some people would say, ‘OK, yeah, but we’ve got all these new technologies now, new treatments,’ ” she said, such as intensity-modulated radiation therapy, brachytherapy and robot-assisted prostate surgeries, “but actually, other studies have shown that the effects on these functional outcomes are very similar to the effects that we see our study,” she said.

Both Donovan and Hamby feel the study’s conclusions still merit careful consideration by men and their doctors as they weigh treatment decisions.

“What we hope that clinicians will do is use these figures that we’ve produced in these papers and share them with the men so that newly diagnosed men with localized prostate cancer can really assess those tradeoffs,” Donovan said.

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When we’ll be able to 3D-print organs and who will be able to afford them | CNN

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What if doctors could just print a kidney, using cells from the patient, instead of having to find a donor match and hope the patient’s body doesn’t reject the transplanted kidney?

The soonest that could happen is in a decade, thanks to 3D organ bioprinting, said Jennifer Lewis, a professor at Harvard University’s Wyss Institute for Biologically Inspired Engineering. Organ bioprinting is the use of 3D-printing technologies to assemble multiple cell types, growth factors and biomaterials in a layer-by-layer fashion to produce bioartificial organs that ideally imitate their natural counterparts, according to a 2019 study.

This type of regenerative medicine is in the development stage, and the driving force behind this innovation is “real human need,” Lewis said.

In the United States, there are 106,800 men, women and children on the national organ transplant waiting list as of March 8, 2023, according to the Health Resources & Services Administration. However, living donors provide only around 6,000 organs per year on average, and there are about 8,000 deceased donors annually who each provide 3.5 organs on average.

The cause of this discrepancy is “a combination of people who undergo catastrophic health events, but their organs aren’t high enough quality to donate, or they’re not on the organ donor list to begin with, and the fact that it’s actually very difficult to find a good match” so the patient’s body doesn’t reject the transplanted organ, Lewis said.

And even though living donors are an option, “to do surgery on someone who doesn’t need it” is a big risk, said Dr. Anthony Atala, director of the Wake Forest Institute for Regenerative Medicine. “So, living related donors are usually not the preferred way to go because then you’re taking an organ away from somebody else who may need it, especially now as we age longer.”

Atala and his colleagues were responsible for growing human bladders in a lab by hand in 2006, and implanting a complicated internal organ into people for the first time — saving the lives of three children in whom they implanted the bladders.

Every day, 17 people die waiting for an organ transplant, according to the Health Resources & Services Administration. And every 10 minutes, another person is added to the waitlist, the agency says. More than 90% of the people on the transplant list in 2021 needed a kidney.

“About a million people worldwide are in need of a kidney. So they have end-stage renal failure, and they have to go on dialysis,” Lewis said. “Once you go on dialysis, you have essentially five years to live, and every year, your mortality rate increases by 15%. Dialysis is very hard on your body. So this is really motivating to take on this grand challenge of printing organs.”

“Anti-hypertensive pills are not scarce. Everybody who needs them can get them,” Martine Rothblatt, CEO and chairman of United Therapeutics, said in June 2022 at the Life Itself conference, a health and wellness event presented in partnership with CNN. United Therapeutics was one of the conference sponsors.

“There is no practical reason why anybody who needs a kidney — or a lung, a heart, a liver — should not be able to get one,” she added. “We’re using technology to solve this problem.”

To begin the process of bioprinting an organ, doctors typically start with a patient’s own cells. They take a small needle biopsy of an organ or do a minimally invasive surgical procedure that removes a small piece of tissue, “less than half the size of a postage stamp,” Atala said. “By taking this small piece of tissue, we are able to tease cells apart (and) we grow and expand the cells outside the body.”

This growth happens inside a sterile incubator or bioreactor, a pressurized stainless steel vessel that helps the cells stay fed with nutrients — called “media” — the doctors feed them every 24 hours, since cells have their own metabolism, Lewis said. Each cell type has a different media, and the incubator or bioreactor acts as an oven-like device mimicking the internal temperature and oxygenation of the human body, Atala said.

“Then we mix it with this gel, which is like a glue,” Atala said. “Every organ in your body has the cells and the glue that holds it together. Basically, that’s also called ‘extracellular matrix.’”

This glue is Atala’s nickname for bioink, a printable mixture of living cells, water-rich molecules called hydrogels, and the media and growth factors that help the cells continue to proliferate and differentiate, Lewis said. The hydrogels mimic the human body’s extracellular matrix, which contains substances including proteins, collagen and hyaluronic acid.

The non-cell sample portion of the glue can be made in a lab, and “is going to have the same properties of the tissue you’re trying to replace,” Atala said.

The biomaterials used typically have to be nontoxic, biodegradable and biocompatible to avoid a negative immune response, Lewis said. Collagen and gelatin are two of the most common biomaterials used for bioprinting tissues or organs.

From there, doctors load each bioink — depending on how many cell types they’re wanting to print — into a printing chamber, “using a printhead and nozzle to extrude an ink and build the material up layer by layer,” Lewis said. Creating tissue with personalized properties is enabled by printers being programmed with a patient’s imaging data from X-rays or scans, Atala said.

“With a color printer you have several different cartridges, and each cartridge is printing a different color, and you come up with your (final) color,” Atala added. Bioprinting is the same; you’re just using cells instead of traditional inks.

How long the printing process takes depends on several factors, including the organ or tissue being printed, the fineness of the resolution and the number of printheads needed, Lewis said. But it typically lasts a few to several hours. The time from the biopsy to the implantation is about four to six weeks, Atala said.

A 3D printer seeds different types of cells onto a kidney scaffold at the Wake Forest Institute for Regenerative Medicine.

The ultimate challenge is “getting the organs to actually function as they should,” so accomplishing that “is the holy grail,” Lewis said.

“Just like if you were to harvest an organ from a donor, you have to immediately get that organ into a bioreactor and start perfusing it or the cells die,” she added. To perfuse an organ is to supply it with fluid, usually blood or a blood substitute, by circulating it through blood vessels or other channels.

Depending on the organ’s complexity, there is sometimes a need to mature the tissue further in a bioreactor or further drive connections, Lewis said. “There’s just a number of plumbing issues and challenges that have to be done in order to make that printed organ actually function like a human organ would in vivo (meaning in the body). And honestly, this has not been fully solved yet.”

Once a bioprinted organ is implanted into a patient, it will naturally degrade over time — which is OK since that’s how it’s designed to work.

“You’re probably wondering, ‘Well, then what happens to the tissue? Will it fall apart?’ Actually, no,” Atala said. “These glues dissolve, and the cells sense that the bridge is giving way; they sense that they don’t have a firm footing anymore. So cells do what they do in your very own body, which is to create their own bridge and create their own glue.”

Atala and Lewis are conservative in their estimates about the number of years remaining before fully functioning bioprinted organs can be implanted into humans.

“The field’s moving fast, but I mean, I think we’re talking about a decade plus, even with all of the tremendous progress that’s been made,” Lewis said.

“I learned so many years ago never to predict because you’ll always be wrong,” Atala said. “There’s so many factors in terms of manufacturing and the (US Food and Drug Administration regulation). At the end of the day, our interest, of course, is to make sure the technologies are safe for the patient above all.”

Whenever bioprinting organs becomes an available option, affordability for patients and their caregivers shouldn’t be an issue.

They’ll be “accessible for sure,” Atala said. “The costs associated with organ failures are very high. Just to keep a patient on dialysis is over a quarter of a million dollars per year, just to keep one patient on dialysis. So, it’s a lot cheaper to create an organ that you can implant into the patient.”

The average kidney transplant cost was $442,500 in 2020, according to research published by the American Society of Nephrology — while 3D printers retail for around a few thousand dollars to upward of $100,000, depending on their complexity. But even though low-cost printers are available, pricey parts of bioprinting can include maintaining cell banks for patients, culturing cells and safely handling biological materials, Lewis said.

Some of the major costs of current organ transplantation are “harvesting the organ from the donor, the transport costs and then, of course, the surgery that the recipient goes through, and then all the care and monitoring,” Lewis said. “Some of that cost would still be in play, even if it was bioprinted.”

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She flatlined three times, lost both legs and had a failing heart. Yet she told doctors she’s ‘the luckiest person on this planet’ | CNN

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CNN
—

Her smile is bright, cheery, sometimes goofy and always contagious. But pictures can’t completely capture her upbeat, positive vibe. At 21, Claire Bridges has a mature spirit that amazes those who love her as well as the doctors who had to operate on her heart and remove both legs to save her life.

“She had a will to live, perseverance and a sort of twinkle in her eye — I tell all my patients that’s half the battle,” said Dr. Dean Arnaoutakis, a vascular surgeon at the University of South Florida Health in Tampa who amputated Bridges’ legs after complications from Covid-19.

“Most people would be despondent and feel like life had cheated them,” said Dr. Ismail El-Hamamsy, a professor of cardiovascular surgery at the Icahn School of Medicine at Mount Sinai in New York City, who operated on Bridges’ heart.

“But she told me, ‘I feel like I’m the luckiest person on this planet. I have my whole life ahead of me. I can have kids, a future, so many things to look forward to.’

“There was not once that I looked into her eyes that I didn’t feel her positiveness was true and genuine,” he said. “Claire’s story is one of just incredible resilience and positivity.”

Bridges left the hospital on her 21st birthday, more than two months after being admitted. Here she is with her brother Will.

In January 2022, Bridges was a 20-year-old model with her own apartment, a gaggle of friends and a part-time job as a bartender in St. Petersburg, Florida. She was a vegan and “exceptionally healthy,” according to her mother, Kimberly Smith.

When she caught Covid-19 that month, no one expected her be hospitalized. She was fully vaccinated and boosted.

But Bridges had been born with a common genetic heart defect: aortic valve stenosis, a mutation of the valve in the heart’s main artery, the aorta. Instead of having three cusps, or flaps, that let oxygen-rich blood flow from the heart into the aorta and to the rest of the body, people with aortic valve stenosis are often born with just two. The condition makes the heart work extremely hard to do its job, often causing breathlessness, dizziness and fatigue.

“I could work out and stuff, but I could never play sports,” she told CNN. “I couldn’t run. I couldn’t overexert myself.”

Her mom added, “We could really tell she began to learn her limits as she got older — she would get out of breath, stop and take a break.”

Before her surgeries, Bridges enjoyed roller-skating.

Whether due to her heart or another unknown reason, Covid-19 hit Bridges hard. Her health quickly spiraled out of control.

“Extreme fatigue, cold sweats — progressively every single day it would get harder to try to eat or drink anything,” she recalled. “Then one day my mom found me unresponsive and rushed me to the hospital. I flatlined three times that night.”

Bridges was put on dialysis, a ventilator and an exterior pump for her failing heart. She slipped into psychosis.

“I was thinking that everyone was trying to kill me, but I was holding on,” she said, adding that she then saw a bright light and her late grandfather.

“He was sitting on a bench, fishing, and he was wearing a baseball cap,” she said. “Then I saw my parents through a window. I don’t know if I actually did or if it was in my delusion, but I thought, ‘I can’t leave them like this.’ And my body just literally wouldn’t give up.”

While Bridges’ spirit battled on, doctors struggled to save her life. Her organs began to shut down, further weakening her frail heart. Blood wasn’t reaching her extremities, and tissues in both legs began to die.

Surgeons tried to save as much of her legs as possible. First, they opened tissue in both legs to reduce swelling, then amputated one ankle. Finally, there was no choice: Both legs had to be removed.

Doctors gathered around her bed to break the news.

“I remember looking up at them and saying, ‘Well, thank you for saving my life. And oh, can I have bionic legs?’ ” Bridges said.

“Everyone was totally shocked that she was taking it so well,” Smith recalled about her daughter. “But my entire family knew that if this tragedy had to happen to any of us, it would be Claire who would handle it the best. Upbeat and positive, that’s Claire.”

Bridges had a successful modeling career before she contracted Covid-19.

Losing her legs was only part of Bridges’ struggle back to health. “There were so many things that she could have died from while she was in the hospital,” Smith said.

Malnourished, Bridges was put on a feeding tube. She vomited, rupturing part of her small intestine, and “nearly bled out,” Smith said. To save her, doctors had to do an emergency transfusion — a dangerous procedure due to her weak heart.

“She almost died while getting the emergency transfusion because they had to pump the blood in so fast,” Smith said. “Then the next day she bled again, but they caught it in time.”

Bridges developed refeeding syndrome, a condition in which electrolytes, minerals and other vital fluids in a malnourished body are thrown out of balance when food is reintroduced, causing seizures, muscle and heart weakness, and a coma in some cases. Without quick treatment, it can lead to organ failure and death.

In another blow, her hair began to fall out, likely due to the loss of proper nutrition. Her family and friends came to her rescue.

“I knew that the only way to stop me from sobbing every time I pulled chunks of hair out of my head was to just get rid of it all,” Bridges said. “I told my brother Drew I was thinking about shaving my head, and without missing a beat, he immediately looked at me and said, ‘I’ll shave mine with you.’

“Then it snowballed into everyone telling me they would shave their heads, too,” Bridges said with a smile. “It was actually an extremely sweet, fun and freeing time — plus I’ve always wanted to shave my head, so I got to cross it off my bucket list!”

First row (from left): Luba Omelchenko, a friend, and Claire Bridges.
Second row (from left): Andy Beaty, a friend; Jaye Scoggins, Beaty's mother; Anna Bridges-Brown, Claire's sister; and Kimberly Smith, Claire's mother.
Third row: Kristen Graham, a friend who shaved everyone's heads.

Bridges credits her friends and family — along with members of the community who organized fundraisers or reached out on social media — for her upbeat attitude throughout the ordeal.

“I am very blessed to have such an amazing family and also friends and people in my community that are like family,” she said. “People I didn’t know, people that I haven’t spoken to since elementary school or high school were reaching out to me.

“Yes, I allowed myself to grieve, and there were dark days. But honestly, my friends and my family surrounded me with so much love that I never had a second to really think negatively about my legs or how I look now.”

Bridges’ heart presented another hurdle: Already frail before her prolonged illness, it was now severely damaged. She needed a new valve in her aorta, and soon.

“We always knew Claire would need an open-heart surgery at some point,” her mother said. “Doctors wanted her as old as possible before they replaced the valve because the older you are, the bigger you are, and there’s less chance of needing another operation soon after.”

Bridges with her modeling agent, Kira Alexander. Bridges lost nearly 70 pounds during her hospitalization.

Her doctors reached out to Mount Sinai’s El-Hamamsy, an expert in a more complicated form of aortic valve replacement called the Ross procedure.

“Anybody who has an anticipated life expectancy of 20 years or more is definitely a potential candidate for the Ross,” El-Hamamsy said, “and it’s a perfect solution for many young people like Claire.”

Unlike more traditional surgeries that replace the malfunctioning aortic valve with a mechanical or cadaver version, the Ross procedure uses the patient’s own pulmonary valve, which is “a mirror image of a normal aortic valve with three cusps,” El-Hamamsy said.

“It’s a living valve, and like any living thing, it’s adaptable,” the surgeon said. “It becomes like a new aortic valve and performs all the very sophisticated functions that a normal aortic valve would do.”

The pulmonary valve is then replaced with a donor from a cadaver, “where it matters a little less because the pressures and the stresses on the pulmonary side are much lower,” he said.

Bridges with Dr. Ismail El-Hamamsy, the surgeon who replaced the failed valve in her heart.

The use of a replacement part from the patient’s own body for the aortic valve also eliminates the need for lifelong use of blood thinners and the ongoing risk of major hemorrhaging or clotting and stroke, El-Hamamsy said. And because the new valve is stronger than the malfunctioning valve it replaces, patients aren’t as likely to need future surgeries.

“Ross is the only replacement operation for the aortic valve that allows patients to have a normal life expectancy,” he said, “and a completely normal quality of life with no restrictions, no modifications to their lifestyle and a very good durability of the operation.”

The Ross procedure is more technically challenging than inserting a tissue valve or a mechanical valve, “some of the simplest operations that we as cardiac surgeons would ever do,” El-Hamamsy said.

Because the operation takes a high level of technical skill, it’s only available in a few surgical facilities at this time.

“It requires dedicated surgeons who want to commit their practice to the Ross procedure and who have the technical skills and expertise to do that,” he added. “Patients need to know they should be undergoing the surgery in a Ross-certified facility.”

When El-Hamamsy first met Bridges in a video call last spring, he wasn’t sure he would be able to do the surgery. Only 127 pounds before she got sick, Bridges had lost nearly 70 pounds during her hospitalization.

“She was so emaciated. There was no way I could take her into the operating room the way she was,” El-Hamamsy said. “I never expected that she would recover so quickly and keep her amazingly positive mentality.”

Slowly, over many months, Bridges fought her way back to health. In rehab, she began to learn to walk with prosthetic lower limbs. As she got stronger, she has continued one of her favorite activities — rock climbing.

Bridges climbs a rock wall using prosthetic limbs.

“At six months, I could hardly recognize her — she had gained weight back, her skin had fully healed over at the amputation sites, and she was a completely different-appearing person to the malnourished and debilitated girl I had met in the hospital,” said Arnaoutakis, the vascular surgeon.

The heart operation was successfully done in December. Today, Bridges is in the middle of cardiac rehabilitation and looking forward to being fitted for prosthetic blades — J-shaped, carbon-fiber lower limbs that will allow her to run on a track for the first time in her life.

She’s also returned to modeling, proud to show the world how well she has survived.

Bridges has returned to modeling after her surgeries.

El-Hamamsy isn’t surprised. “I told her from the day I met her on that Zoom, ‘It will be such a privilege to look after you because you’ve inspired me. I’ve never met a young person with this level of maturity and outlook on life.’

“I still think of Claire every once in a while when I bump into difficulty with life or whatever. It’s a reminder that happiness and positivity is a choice. Claire made that choice.”

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Some experts say more women should consider removing fallopian tubes to reduce cancer risk | CNN

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CNN
—

“Knowledge is power,” says Samantha Carlucci, 26. The Ravena, New York, resident recently had a hysterectomy that included removing her fallopian tubes – and believes it saved her life.

The Ovarian Cancer Research Alliance is drawing attention to the role of fallopian tubes in many cases of ovarian cancer and now says more women, including those with average risk, should consider having their tubes removed to cut their cancer risk.

About 20,000 women in the US were diagnosed with ovarian cancer in 2022, according to the National Cancer Institute, and nearly 13,000 died.

Experts have not discovered a reliable screening test to detect the early stages of ovarian cancer, leading them to rely on symptom awareness to diagnose patients, according to OCRA.

Unfortunately, symptoms of ovarian cancer often don’t present themselves until the cancer has advanced, causing the disease to go undetected and undiagnosed until it’s progressed to a later stage.

“If we had a test to detect ovarian cancer at early stages, the outcome of patients would be significantly better,” said Dr. Oliver Dorigo, director of the division of gynecologic oncology in the Department of Obstetrics and Gynecology at Stanford University Medical Center.

Until such a test is widely available, some researchers and advocates suggest a different way to reduce the risk: opportunistic salpingectomy, the surgical removal of both fallopian tubes.

Research has found that nearly 70% of ovarian cancer begins in the fallopian tubes, according to the Ovarian Cancer Research Alliance.

Doctors have already been advising more high-risk women to have a salpingectomy. Several factors can raise risk, including genetic mutations, endometriosis or a family history of ovarian or breast cancer, according to the US Centers for Disease Control and Prevention.

If they accept that they won’t be able to get pregnant afterward and if they are already planning on having pelvic surgery, it can be “opportunistic.”

“We are really talking about instances where a surgeon would already be in the abdomen anyway,” such as during a hysterectomy, said Dr. Karen Lu, professor and chair of the Department of Gynecologic Oncology and Reproductive Medicine at MD Anderson Cancer Center.

Although OCRA shifted its recommendation to include women with even an average risk of ovarian cancer, some experts continue to emphasize fallopian tube removal only for women with a high risk. Some are calling for more research on the procedure’s efficacy in women with an average risk.

Fallopian tubes are generally 4 to 5 inches long and about half an inch thick, according to Dorigo. During an opportunistic salpingectomy, both tubes are separated from the uterus and from a thin layer of tissue that extends along them from the uterus to the ovary.

The procedure can be done laparoscopically, with a thin instrument and a small incision, or through an open surgery, which involves a large incision across the abdomen.

The procedure adds roughly 15 minutes to any pelvic surgery, Dorigo said.

Unlike a total hysterectomy, in which a woman’s uterus, ovaries and fallopian tubes are removed, the removal of the tubes themselves does not affect the menstrual cycle and does not initiate menopause.

The risks associated with an opportunistic salpingectomy are also relatively low.

“Any surgery carries risk … so you do not want to enter any surgery without being thoughtful,” Lu said. “The risk of a salpingectomy to someone that is already undergoing surgery, though, I would say is minimal.”

Many women who have had the procedure say the benefit far outweighs the risk.

Carlucci had her fallopian tubes removed in January during a total hysterectomy, after testing positive for a genetic condition called Lynch syndrome that multiplied her risk of many kinds of cancers, including in the ovaries.

Several members of her family have died of colon and ovarian cancer, she said, and it prompted her to look into the available options.

Knowing that she could choose an opportunistic salpingectomy, which greatly decreased her chances of ovarian cancer, gave her hope.

As part of the total hysterectomy, it eliminated her risk of ovarian cancer.

“You can’t change your DNA, and no amount of dieting and exercise or medication is going to change it, and I felt horrible,” Carlucci said. “When I was given the news that this would 100% prevent me from ever having to deal with any ovarian cancer in my body, it was good to hear.”

Carlucci urges any woman with an average to high risk of ovarian cancer to talk to their doctor about the procedure.

“I know it seems scary, but this is something that you should do, or at the very least consider it,” she said. “It can bring so much relief knowing that you made a choice to keep you here for as long as possible.”

Monica Monfre Scantlebury, 45, of St. Paul, Minnesota, had a salpingectomy in March 2021 after witnessing a death related to breast and ovarian cancer in her family.

In 2018, Scantlebury’s sister was diagnosed with stage IV breast cancer at 27 years old.

“She went on to fight breast cancer,” Scantlebury said. “During the beginning of the pandemic, in March of 2020, she actually lost her battle to breast cancer at 29.”

During this period, Scantlebury herself found out that she was positive for BRCA1, a gene mutation that increases a person’s risk of breast cancer by 45% to 85% and the risk of ovarian cancer by 39% to 46%.

After meeting with her doctor and discussing her options, she decided to have a salpingectomy.

Her doctor told her she would remove the fallopian tubes and anything else of concern that she found during the procedure.

“When I woke up from surgery, she said there was something in my left ovary and that she had removed my left ovary and my fallopian tubes,” Scantlebury said.

Her doctor called about a week later and said there had been cancer cells in her left fallopian tube.

The salpingectomy had saved her life, the doctor said.

“We don’t have an easy way to be diagnosed until it is almost too late,” said Scantlebury, who went on to have a full hysterectomy. “This really saved my life and potentially has given me decades back that I might not have had.”

Audra Moran, president and CEO of the Ovarian Cancer Research Alliance, is sending one message to women: Know your risk.

Moran believes that if more women had the power of knowing their risk of ovarian cancer, more lives would be saved.

“Look at your family history. Have you had a history of ovarian cancer, breast cancer, colorectal or uterine in your family? Either side, male or female, father or mother?” Moran said. “If the answer is yes, then I would recommend talking to a doctor or talking to a genetic counselor.”

The alliance offers genetic testing resources on its website. A genetic counselor assess people’s risks for varying cancers based on inherited conditions, according to the US Bureau of Labor Statistics.

Carlucci and Scantlebury agree that understanding risk is key to preventing deaths among women.

“It’s my story. It’s her story. It’s my sister’s story … It is for all women,” Scantlebury said.

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Among seniors, Black men more likely to die after surgery than their peers, new study suggests | CNN

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CNN
—

Among older patients, Black men may have a higher chance of dying within 30 days following surgery than their peers, according to a new study.

The study, published Wednesday in the medical journal BMJ, suggests that this inequity could be driven by outcomes following elective surgery, for which death was 50% higher for Black men than for White men – information that can be helpful for physicians as they plan procedures for patients.

Previously, separate research published in 2020 came to similar findings among children, showing that, within 30 days from their surgeries, Black children were more likely to die than White children.

“While a fair bit is known about such inequities, we find in our analyses that it’s specifically Black men who are dying more, and they are dying more after elective surgeries, not urgent and emergent surgeries,” study lead Dr. Dan Ly, assistant professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at the University of California, Los Angeles, said in a news release.

“Our findings point to possibilities such as poorer pre-optimization of co-morbidities prior to surgery, delays of care due to structural racism and physician bias, and worse stress and its associated physical burden on Black men in the United States,” Ly said in the news release.

Researchers at the University of California, Los Angeles analyzed Medicare data on more than 1.8 million beneficiaries, ages 65 to 99, who underwent one of eight common surgical procedures. The data came from 2016 to 2018, and the researchers examined how many patients died during their hospital stay or within 30 days after surgery.

The researchers found that dying after surgery overall was higher in Black men compared with White men, White women, and Black women. Dying after surgery was 50% higher for Black men than for White men after elective surgeries, the data suggest, but for non-elective surgeries, there was no difference between Black and White men, although mortality was lower for women of both races.

Among the Black men in the study, about 3% of them died following surgery overall compared with 2.7% of White men, 2.4% of White women and 2.2% of Black women. These differences were relatively larger for elective surgeries, and appeared within a week after surgery and persisted for up to 60 days after surgery, the researchers found. In a separate analysis, the researchers found that Hispanic men and Hispanic women showed a lower overall mortality than Black men.

“Our study has shed light on the fact that Black men experience a higher death rate after elective surgery than other subgroups of race and sex. Further research is needed to understand better the factors contributing to this observation, and to inform efforts to develop interventions that could effectively eliminate such disparity,” Dr. Yusuke Tsugawa, the senior author of the study and associate professor of medicine at UCLA David Geffen School of Medicine, said in an email.

The study did not explore what could be driving the disparity but Tsugawa said that “several factors” could potentially play a role.

“The structural racism may at least partially explain our findings. For example, Black patients living in neighborhoods with predominantly Black residents tend to live close to hospitals that lack resources to provide high quality healthcare,” Tsugawa said in the email. “It is possible that Black men in particular face especially high cumulative amounts of stress and allostatic load, which refers to the cumulative burden of chronic stress and life events, potentially leading to a higher death rate after surgery among this population.”

The new study “validates” that racial inequities exist in health care, said Dr. Georges Benjamin, executive director of the American Public Health Association, who was not involved in the study.

“Obviously it’s concerning when you see such a large disparity,” Benjamin said, referring to the differences in how many patients died after surgery in the study findings.

“Here’s another example that these disparities are real, and I think it helps inform people – physicians, health systems, providers of care – that the disparity is already there,” he said. “So, when they’re looking at providing surgical care to their patients, they should be informed that, statistically, some of their patients may not do well 30 days out after surgery, and so they need to put extra care in both providing care and understanding the health status of those patients when they go to surgery.”

The new study findings also raise many questions about health systems and what happens when a patient is discharged home after surgery and their ability to safely recover from a procedure, said Dr. Utibe Essien, assistant professor of medicine at the David Geffen School of Medicine at UCLA, who was not involved in the study.

“As a generalist, I’m really thinking about that part as well and how we can engage with our surgical colleagues to make sure our patients who are from underrepresented groups are leading healthy lives after they’ve gone under the knife so to speak,” Essien said, adding that more research could help determine which types of elective surgeries may have seen more significant disparities than other types – and what would be needed to reduce the disparities.

“Would we find something different with more rare, complicated surgeries? It’s possible and that goes back to the type of hospitals where patients are getting their care,” Essien said.

“How close is a hospital really connected to an academic medical center that knows the latest and greatest surgical procedures? Do they have the technology to be able to do some really innovative and safe work?” he said. “Looking into ways at the hospital level that we can address these disparities, I think, is going to be important.”

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Beware the budget butt lift, regulators warn amid social media-inspired boom | CNN

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In hindsight, Nikki Ruston said, she should have recognized the red flags.

The office in Miami where she scheduled what’s known as a Brazilian butt lift had closed and transferred her records to a different facility, she said. The price she was quoted – and paid upfront – increased the day of the procedure, and she said she did not meet her surgeon until she was about to be placed under general anesthesia.

“I was ready to walk out,” said Ruston, 44, of Lake Alfred in Central Florida. “But I had paid everything.”

A few days after the July procedure, Ruston was hospitalized due to infection, blood loss, and nausea, her medical records show.

“I went cheap. That’s what I did,” Ruston recalled recently. “I looked for the lowest price, and I found him on Instagram.”

People like Ruston are commonly lured to office-based surgery centers in South Florida through social media marketing that makes Brazilian butt lifts and other cosmetic surgery look deceptively painless, safe, and affordable, say researchers, patient advocates, and surgeon groups.

Unlike ambulatory surgery centers and hospitals, where a patient might stay overnight for observation after treatment, office-based surgery centers offer procedures that don’t typically require an inpatient stay and are regulated as an extension of a doctor’s private practice.

But such surgical offices are often owned by corporations that can offer discount prices by contracting with surgeons who are incentivized to work on as many patients per day as possible, in as little time as possible, according to state regulators and physicians critical of the facilities.

Ruston said she now lives with constant pain, but for other patients a Brazilian butt lift cost them their lives. After a rash of deaths, and in the absence of national standards, Florida regulators were the first in the nation to enact rules in 2019 meant to make the procedures safer. More than three years later, data shows deaths still occur.

Patient advocates and some surgeons – including those who perform the procedure themselves – anticipate the problem will only get worse. Emergency restrictions imposed by the state’s medical board in June expired in September, and the corporate business model popularized in Miami is spreading to other cities.

“We’re seeing entities that have a strong footprint in low-cost, high-volume cosmetic surgery, based in South Florida, manifesting in other parts of the country,” said Dr. Bob Basu, a vice president of the American Society of Plastic Surgeons and a practicing physician in Houston.

During a Brazilian butt lift, fat is taken via liposuction from other areas of the body – such as the torso, back, or thighs – and injected into the buttocks. More than 61,000 buttock augmentation procedures, both butt lifts and implants, were performed nationwide in 2021, a 37% increase from the previous year, according to data from the Aesthetic Society, a trade group of plastic surgeons.

As with all surgery, complications can occur. Miami-Dade County’s medical examiner has documented nearly three dozen cosmetic surgery patient deaths since 2009, of which 26 resulted from a Brazilian butt lift. In each case, the person died from a pulmonary fat embolism, when fat entered the bloodstream through veins in the gluteal muscles and stopped blood from flowing to the lungs.

No national reporting system nor insurance code tracks outcomes and patient demographics for a Brazilian butt lift. About 3% of surgeons worldwide had a patient die as a result of the procedure, according to a 2017 report from an Aesthetic Surgery Education and Research Foundation task force.

Medical experts said the problem is driven, in part, by having medical professionals like physician assistants and nurse practitioners perform key parts of the butt lift instead of doctors. It’s also driven by a business model that is motivated by profit, not safety, and incentivizes surgeons to exceed the number of surgeries outlined in their contracts.

In May, after a fifth patient in as many months died of complications in Miami-Dade County, Dr. Kevin Cairns proposed the state’s emergency rule to limit the number of butt lifts a surgeon could perform each day.

“I was getting sick of reading about women dying and seeing cases come before the board,” said Cairns, a physician and former member of the Florida Board of Medicine.

Some doctors performed as many as seven, according to disciplinary cases against surgeons prosecuted by the Florida Department of Health. The emergency rule limited them to no more than three, and required the use of an ultrasound to help surgeons lower the risk of a pulmonary fat clot.

But a group of physicians who perform Brazilian butt lifts in South Florida clapped back and formed Surgeons for Safety. They argued the new requirements would make the situation worse. Qualified doctors would have to do fewer procedures, they said, thus driving patients to dangerous medical professionals who don’t follow rules.

The group has since donated more than $350,000 to the state’s Republican Party, Republican candidates, and Republican political action committees, according to campaign contribution data from the Florida Department of State.

Surgeons for Safety declined KHN’s repeated interview requests. Although the group’s president, Dr. Constantino Mendieta, wrote in an August editorial that he agreed not all surgeons have followed the standard of care, he called the limits put on surgeons “arbitrary.” The rule sets “a historic precedent of controlling surgeons,” he said during a meeting with Florida’s medical board.

In January, Florida state Sen. Ileana Garcia, a Republican, filed a draft bill with the state legislature that proposes no limit on the number of Brazilian butt lifts a surgeon can perform in a day. Instead, it requires office surgery centers where the procedures are performed to staff one physician per patient and prohibits surgeons from working on more than one person at a time.

The bill would also allow surgeons to delegate some parts of the procedure to other clinicians under their direct supervision, and the surgeon must use an ultrasound.

Florida’s legislature convenes on March 7.

Consumers considering cosmetic procedures are urged to be cautious. Like Ruston, many people base their expectations on before-and-after photos and marketing videos posted on social media platforms such as Facebook, Snapchat, and Instagram.

“That’s very dangerous,” said Basu, of the American Society of Plastic Surgeons. “They’re excited about a low price and they forget about doing their homework,” he said.

The average price of a buttocks augmentation in 2021 was $4,000, according to data from the Aesthetic Society. But that’s only for the physician’s fee and does not cover anesthesia, operating room fees, prescriptions, or other expenses. A “safe” Brazilian butt lift, performed in an accredited facility and with proper aftercare, costs between $12,000 and $18,000, according to a recent article on the American Society of Plastic Surgeons’ website.

Although Florida requires a physician’s license to perform liposuction on patients who are under general anesthesia, it’s common in the medical field for midlevel medical practitioners, such as physician assistants and nurse practitioners, to do the procedure in office settings, according to Dr. Mark Mofid, who co-authored the 2017 Aesthetic Surgery Education and Research Foundation task force study.

By relying on staffers who don’t have the same specialty training and get paid less, office-based surgeons can complete more butt lifts per day and charge a lower price.

“They’re doing all of them simultaneously in three or four different rooms, and it’s being staffed by one surgeon,” said Mofid, a plastic surgeon in San Diego, who added that he does not perform more than one Brazilian butt lift in a day. “The surgeon isn’t doing the actual case. It’s assistants.”

Basu said patients should ask whether their doctor holds privileges to perform the same procedure at a hospital or ambulatory surgery center, which have stricter rules than office surgery centers in terms of who can perform butt lifts and how they should be done.

People in search of bargains are reminded that cosmetic surgery can have other serious risks beyond the deadly fat clots, such as infection and organ puncture, plus problems with the kidneys, heart, and lungs.

Ruston’s surgery was performed by a board-certified plastic surgeon she said she found on Instagram. She was originally quoted $4,995, which she said she paid in full before surgery. But when she arrived in Miami, she said, the clinic tacked on fees for liposuction and for post-surgical garments and devices.

“I ended up having to pay, like, $8,000,” Ruston said. A few days after Ruston returned home to Lake Alfred, she said, she started to feel dizzy and weak and called 911.

Paramedics took her to an emergency room, where doctors diagnosed her with anemia due to blood loss, and blood and abdominal infections, her medical records show.

“If I could go back in time,” she said, “I wouldn’t have had it done.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Best medications for low back pain, according to new research | CNN

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CNN
—

Ouch, that aching back! Perhaps it’s from sitting too long, picking up a heavy object, a sudden slip or fall, or an aging spine — whatever the cause, sudden pain in the lower back is a common complaint.

In fact, low back pain is the leading cause of years lived with disability globally, with neck pain coming in at No. 4, according to the 2016 Global Burden of Disease Study. Low back pain is called “acute” when symptoms last between one and 12 weeks and “chronic” when the pain lasts three months or longer.

People often reach for over-the-counter pain medication to help. But which type of pain med is most effective?

A new study, published Wednesday in the Journal of Orthopaedic Research, attempted to find out. Researchers culled through mountains of published studies and found 18 randomized clinical trials that focused specifically on lower back pain that lasted no more than 12 weeks.

The study looked at the following types of analgesics: aspirin; acetaminophen (Tylenol, Paracetamol and Panadol); and nonsteroidal anti-inflammatory drugs, called NSAIDs for short, of which there are many.

Some common NSAIDs are ibuprofen (Advil, Motrin, PediaCare); naproxen (Aleve, Naxen, Naprosyn, Stirlescent); and celecoxib (Celebrex, Elyxyb), which is not available over the counter.

Researchers also included muscle relaxers in the study, which are not available without a prescription.

The study found the very best medication for acute lower back pain was a combination of an NSAID combined with a prescription muscle relaxer — that combo was effective in reducing pain and disability by the end of one week.

However, muscle relaxers don’t work in quite the way you might think, said Dr. Eliana Cardozo, assistant professor of rehabilitation medicine at the Icahn School of Medicine at Mount Sinai in New York City.

“They don’t go to the muscle and relax it. Instead, they work centrally in our brain where they make us sleepy and that kind of relaxes our body,” said Cardozo, who was not involved in the study.

“It’s hard to use them during the day for pain,” she added. “Personally I like to use muscle relaxers for people having pain at night.”

Combining an NSAID with acetaminophen was associated with a greater improvement than taking an NSAID alone, the study found.

“But when I looked at the actual data in the study, I can’t say that it really makes enough of a difference to add the two medicines — it was only a very small benefit,” Cardozo said.

Taking acetaminophen alone did not reduce pain significantly, the study found.

The results of the study only apply to lower back pain that isn’t ongoing and chronic, stressed the study’s corresponding author, Dr. Filippo Migliorini of the department of orthopedic, trauma, and reconstructive surgery, Universitätsklinikum Aachen in Germany.

Before any such intervention is recommended, the physician should be sure to rule out any “possible specific cause of pain that may require specific actions or diagnostics, for example, a history of cancer or recent trauma,” Migliorini and his coauthors wrote.

Another issue with using pain medications is they have potentially serious side effects. Acetaminophen is not recommended during pregnancy, and it can cause rash, hives and breathing difficulties. Only 4,000 milligrams of acetaminophen can be taken per day. An overdose can lead to liver damage or liver failure, according to the National Library of Medicine.

Side effects from NSAIDs can include indigestion, diarrhea, headaches, dizziness, allergic reactions, and “in rare cases, problems with your liver, kidneys or heart and circulation, such as heart failure, heart attacks and strokes,” the UK National Health Service noted.

Using NSAIDs for some time can lead to stomach ulcers, which can cause internal bleeding and anemia, the NHS said.

“If someone’s perfectly healthy and they have no other issues, then it’s fine to take NSAIDs around the clock for a week — but only a week,” Cardozo said. “And if someone has high blood pressure, asthma, heart disease or a peptic ulcer, those people should not be taking NSAIDs constantly.”

It’s estimated 4 out of 5 people will experience low back pain in their lives, according to the Cleveland Clinic. Due to ongoing deterioration of the spongy disks between back vertebrae, anyone older than 30 is at higher risk for low back pain.

So are people with excess weight due to the increase in pressure on joints and disks, along with people who smoke, drink a lot of alcohol or have a sedentary lifestyle, according to the Cleveland Clinic. Even people with depression and anxiety are at greater risk.

People with prior episodes of acute low back pain are at risk for ongoing, chronic symptoms, according to the North American Spine Society.

Antidepressants are not recommended for the treatment of low back pain, according to clinical guidelines developed by the society. Nor are oral or intravenous steroids. “Opioid pain medications should be cautiously limited and restricted to short duration for the treatment of low back pain,” the guidelines state.

However, over-the-counter gels and creams containing capsicum, or chile peppers, are recommended, and it’s possible that spinal manipulative therapy may help, although studies are mixed.

Exercise is highly recommended: “Remaining active is preferred and likely results in better short-term outcomes than does bed rest,” the guidelines said.

“People can start some exercises right away, such as gentle stretching and core stabilizing exercises, which can strengthen the back,” Cardozo said. “Now these are not sit ups or crunches — so seeing a physical therapist to get some starting exercises can be very helpful.”

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President Carter is on hospice care, but what is it? Our medical analyst explains | CNN

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CNN
—

On Saturday, the Carter Center announced that former US President Jimmy Carter will be receiving hospice care at his home in Georgia.

“After a series of short hospital stays, former US President Jimmy Carter today decided to spend his remaining time at home with his family and receive hospice care instead of additional medical intervention,” according to the statement. “He has the full support of his family and his medical team.”

The 98-year-old Carter is the oldest living US president in history. He has survived metastatic brain cancer and faced a number of health scares, including brain surgery following a fall in 2019.

As Carter opted for hospice care, CNN Medical Analyst Dr. Leana Wen and I thought that many people might be unfamiliar with hospice care beyond a vague understanding that some people receive it toward the end of life. There can be benefits and blessings for the person receiving the care and their loved ones, but there are also some common misconceptions about what it involves.

I asked Dr. Wen, an emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health, to guide us through some questions.

CNN: What is hospice care and who qualifies for it?

Dr. Leana Wen: Hospice care is a type of specialty medical care for people near the end of their lives that focuses on maximizing comfort for the patient and support for the patient and their family. That includes reducing physical pain and tending to the psychological, emotional and spiritual needs of the patient and the family.

Generally, to qualify for hospice care, the patient must have an incurable medical condition with an anticipated life expectancy of less than six months. The types of medical conditions that patients have include end-stage cancer, advanced dementia, heart failure and chronic obstructive pulmonary disease.

CNN: Where do patients receive hospice care and who provides it?

Wen: Hospice care is an approach to medical care, not a specific place, so it can be provided in a number of different settings. The choice of settings is up to the patient and family. Providers are an interdisciplinary team of physicians, nurses, home health aides, pharmacists and others who will tend to the patient no matter what setting they choose.

Many patients opt to receive hospice care in their homes, where they can be in familiar surroundings. The hospice team helps to provide equipment, supplies and staff to assist the family to care for their loved one. They provide regular home visits and are generally available around the clock for concerns as they come up.

Hospice can also be delivered in a nursing home or at the hospital. In addition, there are specialized hospice centers.

CNN: What are some common misconceptions of hospice care?

Wen: There is a misconception that hospice care is “giving up” on medical care. Actually, hospice care is a specific type of compassionate medical care for patients in the last stages of incurable disease to live as fully and comfortably as they can. A primary aim of hospice care is to manage the patient’s symptoms so that the patient’s last days can be spent with their loved ones, with dignity and the highest quality possible.

A second misconception is that once a patient enters hospice care, they can no longer receive any medical treatment. This is not true. Patients receive medicines to help their symptoms and alleviate their pain. They and their families can also choose to leave hospice at any point and resume, say, active treatment for their cancer.

I’ve also heard people say that hospice care is only for people with a few days to live. This is also not the case. Often, patients don’t begin hospice care soon enough to take full advantage of the help it offers. Beginning it earlier may help provide months — rather than days — of quality time with loved ones.

CNN: What are the benefits and blessings of this type of care?

Wen: In modern medicine, the tendency is to approach diseases as something to be cured. Unfortunately, this is not always possible. The patient may choose not to continue certain treatments that cause severe pain when there is slim chance for a cure. When there is limited time left to live, that patient may wish to minimize suffering and to prioritize spending the remaining time with their loved ones.

I know the benefits and blessings of hospice care firsthand. My mother was diagnosed with metastatic breast cancer in her 40s. She fought her cancer valiantly, undergoing multiple rounds of surgery, radiation and chemotherapy for eight years. Unfortunately, she had multiple recurrences.

During the final recurrence, it became clear that a cure was not possible and that she had limited time — as it turns out, weeks — to live. She opted to enter hospice care, with the aim to spend her final days at home, rather than in the hospital, and with the aim of alleviating her pain and suffering rather going through yet another round of chemotherapy. I understood and supported her decision, and it was important to me and my family to give her what she wanted, which was the highest quality of life with the least amount of suffering.

CNN: Does insurance cover hospice care?

Wen: Most hospice patients are eligible for Medicare, which provides for hospice care through Medicare Hospital Benefit. Medicaid also pays for hospice care in many states, and many private insurers will cover it. For patients who don’t have insurance, there are some community programs that offer sliding scale coverage or free care.

CNN: What’s the difference between hospice and palliative care?

Wen: There are physicians, nurses and other medical professionals who specialize in hospice and palliative medicine; these are very much complementary and related fields of medicine that share a similar philosophy.

Palliative care, like hospice care, also prioritizes easing suffering, improving the quality for the patient, and delivering that care in a way that centers the patient and family. But differently from hospice care, the patient doesn’t have to forgo curative treatment – palliative care can be provided together with curative treatment. Over time, if it becomes apparent that the patient is likely to die within six months, palliative care can transition over to hospice care.

Both hospice and palliative care are important specialty medical services that are underutilized, and can offer much support and comfort to many more patients and families.

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Dementia risk rises if you live with chronic pain, study says | CNN

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CNN
—

Chronic pain, such as arthritis, cancer or back pain, lasting for over three months, raises the risk of cognitive decline and dementia, a new study found.

The hippocampus, a brain structure highly associated with learning and memory, aged by about a year in a 60-year-old person who had one site of chronic pain compared with people with no pain.

When pain was felt in two places in the body, the hippocampus shrank even more — the equivalent of just over two years of aging, according to estimates in the study published Monday in the journal Proceedings of the National Academy of Sciences, or PNAS.

“In other words, the hippocampal (grey matter volume) in a 60-y-old individual with (chronic pain) at two body sites was similar to the volume of (pain free) controls aged 62-y-old,” wrote corresponding author Tu Yiheng and his colleagues. Tu is a professor of psychology at the Chinese Academy of Sciences in Beijing.

The risk rose as the number of pain sites in the body increased, the study found. Hippocampal volume was nearly four times smaller in people with pain in five or more body sites compared with those with only two — the equivalent of up to eight years of aging.

“Asking people about any chronic pain conditions, and advocating for their care by a pain specialist, may be a modifiable risk factor against cognitive decline that we can proactively address,” said Alzheimer’s disease researcher Dr. Richard Isaacson, a preventive neurologist at the Institute for Neurodegenerative Diseases of Florida. He was not involved in the new study.

The study analyzed data from over 19,000 people who had undergone brain scans as part of the UK Biobank, a long-term government study of over 500,000 UK participants between the ages of 40 and 69.

People with multiple sites of body pain performed worse than people with no pain on seven of 11 cognitive tasks, the study found. In contrast, people with only one pain site performed worse on only one cognitive task — the ability to remember to perform a task in the future.

The study controlled for a variety of contributing conditions — age, alcohol use, body mass, ethnicity, genetics, history of cancer, diabetes, vascular or heart problems, medications, psychiatric symptoms and smoking status, to name a few. However, the study did not control for levels of exercise, Isaacson said.

“Exercise is the #1 most powerful tool in the fight against cognitive decline and dementia,” he said via email. “People affected by multisite chronic pain may be less able to adhere to regular physical activity as one potential mechanism for increased dementia risk.”

Equally important is a link between chronic pain and inflammation, Isaacson said. A 2019 review of studies found pain triggers immune cells called microglia to create neuroinflammation that may lead to changes in brain connectivity and function.

People with higher levels of pain were also more likely to have reduced gray matter in other brain areas that impact cognition, such as the prefrontal cortex and frontal lobe — the same areas attacked by Alzhemier’s disease. In fact, over 45% of Alzheimer’s patients live with chronic pain, according to a 2016 study cited by the review.

The study was also not able to determine sleep deficits — chronic pain often makes getting a good night’s sleep difficult. A 2021 study found sleeping less than six hours a night in midlife raises the risk of dementia by 30%.

Globally, low back pain is a leading cause of years lived with disability, with neck pain coming in at No. 4, according to the 2016 Global Burden of Disease Study. Arthritis, nerve damage, pain from cancer and injuries are other leading causes.

Researchers estimate over 30% of people worldwide suffer with chronic pain: “Pain is the most common reason people seek health care and the leading cause of disability in the world,” according to articles published in the journal The Lancet in 2021.

In the United States alone, at least 1 in 5 people, or some 50 million Americans, live with long-lasting pain, according to the US Centers for Disease Control and Prevention.

Nearly 11 million Americans suffer from high-impact chronic pain, defined as pain lasting over three months that’s “accompanied by at least one major activity restriction, such as being unable to work outside the home, go to school, or do household chores,” according to the National Center for Complementary and Integrative Health.

Chronic pain has been linked to anxiety, depression, restrictions in mobility and daily activities, dependence on opioids, increased health care costs, and poor quality of life. A 2019 study estimated about 5 million to 8 million Americans were using opioids to manage chronic pain.

Pain management programs typically involve a number of specialists to find the best relief for symptoms while providing support for the emotional and mental burden of pain, according to John Hopkins Medicine.

Medical treatment can include over-the-counter and prescription medications to stop the pain cycle and ease inflammation. Injections of steroids may also help. Antidepressants increase the amount of serotonin, which controls part of the pain pathway in the brain. Applying brief bursts of electricity to the muscles and nerve endings is another treatment.

Therapies such as massage and whirlpool immersion and exercises may be suggested by occupational and physical therapists. Hot and cold treatments and acupuncture may help as well.

Psychologists who specialize in rehabilitation may recommend cognitive and relaxation techniques such as meditation, tai chi and yoga that can take the mind off fixating on pain. Cognitive behavioral therapy is a key psychological treatment for pain.

Going on an anti-inflammatory diet may be suggested, such as cutting back on trans fats, sugars and other processed foods. Weight loss may be helpful as well, especially for back and knee pain, according to Johns Hopkins.

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A childbirth myth is spreading on TikTok. Doctors say the truth is different | CNN

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CNN
—

Ashley Martinez has four sons and is pregnant with the daughter she’s wanted for years.

Last month, she posted a video online imploring doctors to prioritize her life, not the life of her unborn baby, if complications arise when she is in labor and it comes down to that choice.

The San Antonio, Texas, resident is due in May and is one of a number of pregnant people who have recently posted “living will” videos on TikTok.

Martinez had an emergency C-section during her last pregnancy after her umbilical cord came out before her baby, a rare but dangerous condition known as an umbilical cord prolapse that can deprive a baby of vital blood flow and oxygen.

Martinez described her last delivery as terrifying. Eight months after the Supreme Court reversed Roe v. Wade, ending a constitutional right to abortion, she said she worries about what would happen if she faced similar challenges again.

Since the ruling in June, a number of US states have criminalized abortions, leading to some fears that doctors would prioritize the life of the unborn child during a medical emergency.

Martinez lost her mother to non-Hodgkin’s lymphoma at a young age, and the thought of her children going through a similar tragedy terrifies her.

“Having to go into another delivery where I’m going to have a C-section, it’s scary for me,” said the 29-year-old. “My fourth pregnancy was my only C-section. I’ve always thought about not being here for my kids just because of what I went through growing up without my mom.”

More than a dozen US states have banned or severely restricted access to abortions following the Supreme Court’s decision eight months ago. The abortion bans have led to legal chaos as advocates take the fight to courtrooms.

Even so, several ob/gyns told CNN that a hard choice between saving a mother and baby’s lives at childbirth, like the one outlined in the TikTok videos, is highly unlikely.

This trend on TikTok has sparked a flurry of dueling videos among pregnant women and other people. Some have posted videos telling doctors in such situations to prioritize their unborn babies first, and criticizing those who expressed a different view.

Martinez concedes that her mother, who died at 25, would likely have chosen to save her child first if she could.

“My mother, she didn’t have a choice, you know?” Martinez said. “The message that I want to send is just basically nobody is wrong or right in this situation. In both situations, it is a hard decision to pick your children over your unborn baby.”

In Texas, where Martinez lives, abortions are banned at all stages of pregnancy – unless there’s a life-threatening medical emergency.

Dr. Franziska Haydanek, an ob/gyn in Rochester, New York, who shares medical advice on TikTok, said she’s noticed many “living will” videos in recent months.

In most of the videos, a woman appears alongside a written message saying something like, “If there are complications during childbirth, save me before the baby.” Some people, including Martinez, reference their children in their decision and even show them in the video.

One was posted by Tuscany Gunter, 22, a woman whose baby is due in April. Abortion after 20 weeks of pregnancy is illegal in her home state of North Carolina, and Gunter told CNN she filmed her message in solidarity with others who said they would choose themselves first.

“I wanted to make it known where I stand and to stand up with other women who are getting bashed online for saying they would rather be saved first over their baby,” said Gunter, who lives in Fayetteville.

“As a mother to three young children, I cannot dump the emotional trauma of losing their mother on them as children and expect them to cope. While I would be crushed to lose a baby, I need to think of my other living children as well … And I know the baby that passed would be safe without ever having to experience any pain or sadness.”

Another woman, Leslie Tovar of Portland, Oregon, said that even though her state has no legal restrictions on abortion, she posted her video because she feared doctors would prioritize saving her unborn child to avoid legal ramifications in the post-Roe v. Wade era.

“I have two other kids at home who need mom. I can’t bear the thought of my two young boys ages 6 and 4 without their mom,” she said.

All three women said they’ve had these conversations with their partners, who agreed they should be saved first.

Of her husband, Tovar said, “His exact words were, ‘We could always have another baby later in life but there is never replacing the mother of my boys, I couldn’t do this without you.’”

It’s true that complications occasionally come up during a pregnancy that lead doctors to recommend delivery to save the mother’s life, medical experts said.

If this is done before a fetus is viable – under 24 weeks – the chances of the baby’s survival are low, said Dr. Elizabeth Langen, a maternal-fetal medicine physician at the University of Michigan Von Voigtlander Women’s Hospital.

Roe v. Wade’s reversal did make terminating such pregnancies more complicated, Langen and Haydanek say.

In cases involving a baby that’s not viable, it could mean that even when the baby is unlikely to survive and the mom’s health is at risk, the priority will be on saving the baby due to fear of legal ramifications, Langen said.

But both doctors say these scenarios don’t occur during the birth of a viable baby. In that instance, Roe v. Wade is “less involved,” Haydanek said.

“We do everything in our efforts to save both (mother and baby),” she said. “I can’t think of a time where the medical team has had to make a decision about who to save in a viable laboring patient. It’s just not a real scenario in modern medicine – just one we are seeing played out on TV.”

Hospitals have enough resources – obstetrics and neonatal intensive care unit teams, for example – to meet the needs of both the mother and the baby, Haydanek and Langen said.

“We’re usually doing our best to take care of both the mom and the baby. And there’s very rarely a circumstance where we will do something to harm the mom in order to have the benefit of the baby,” added Langen.

“If mom’s health is deteriorating, ultimately, she’s not going to be able to support baby’s wellbeing,” Langen said. “And so generally, what we encourage folks to do is really support mom’s health, because that’s in the best interest of both mother and baby.”

Abortion rights demonstrators hold signs outside the US Supreme Court in Washington after the court overturned Roe v. Wade in June 2022.

Both doctors said it’s important for patients to talk to their health care providers about their medical concerns and share their “living will” wishes with loved ones in case there are complications during labor that require partners to make medical decisions.

However, those decisions will not involve doctors asking your partner whose life should come first, they said.

“Before getting in a fight with your partner about who they choose to save, know that there isn’t a situation where we will ask them that,” said Haydanek, who has called the TikTok trend “horribly anxiety inducing.”

She said it’s come up so many times in recent months that she made her own TikTok video to reassure expectant parents.

“Please don’t feel like you have to make this choice,” she says in the video. “I know firsthand how much anxiety there can be in pregnancy … but it’s just not a situation that you’re gonna find yourself in.”

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