Anchor lead: More people should now be screened for lung cancer, Elizabeth Tracey reports
More people now meet the criteria for lung cancer screening, if new guidelines from the United States Preventive Services Task Force are implemented. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes the update.
Nelson: They have proposed to change the guidelines by dropping the age to start screening from 55 years old to 50 years old. That may be more beneficial to African Americans at risk for lung cancer because if you look at the age distribution when they develop the disease it is at a little bit younger age. And then they backed off on the pack year recommendation from 30 pack years to 20 pack years. That may actually benefit women. Women seem to be more likely to get lung cancer by smoking less than men do.   :31
Nelson reminds everyone that the single best strategy for avoiding lung cancer is not to smoke, or to stop as quickly as possible, since after 15 years your risk drops to that of a never-smoker. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Are people who have advanced cancer at high risk for opioid overdose? Elizabeth Tracey reports
People with advanced cancers are often on opioid medications. A new study examines whether they are at higher risk for overdose death as a result. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says the most recent data seems to conclude they are not.
Nelson: The opiate epidemic may be important in the care of cancer patients but the risk for death related to opiates is substantially less and of course we’re asking our oncologists and palliative care specialists to walk a very fine line in this space. No one wants anyone to have to suffer with cancer pain particularly if they’re nearing the end stages of their life where every moment is precious in order to interact with family members. You’d like them to be awake with the amount of dignity they can muster, free of pain and able to live out their life as best as they can.   :33
Nelson says federal agency oversight takes cancer diagnoses into account. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Shorter courses of radiation for cancer therapy will work for most, Elizabeth Tracey reports
Radiation therapy for cancer used to be given over weeks, but modifications to the technique have allowed the time course to be compressed for most patients. Now a Johns Hopkins study shows that many doctors aren’t using the shorter course. William Nelson, director of the Kimmel Cancer Center, explains the data.
Nelson: Now that they can aim better, damage to the normal tissues is stunningly less. They can deliver it over a week. with that in mind, this group looked at the Medicare database. What they found was that among 382 radiation oncologists a third of them still used the prolonged course of treatment, had not converted over to using the shorter term course. They were typically older, more likely to practice in the South, or the middle of the country. The rate of adoption of a new technology hasn’t been as rapid as I think many people think.  :34
Nelson says anyone who needs radiation therapy should ask their physician about the shorter course. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Should you resume routine cancer screening tests? Elizabeth Tracey reports
Since the COVID-19 pandemic began, routine screening tests for cancer have fallen dramatically, a study by medical records vender EPIC shows. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says surveys point to fear of infection.
Nelson: As we’re open for business there is still a little bit of reticence. The screening and early detection has not bounced back very quickly. There are some survey tools out that all say the same thing, that many people are reticent to visit healthcare facilities at all. They feel that this is the kind of place that you might be at high risk to catch a Sars-CoV2 infection. Nothing could be farther from the truth. Look, these are the risks here, these are the risks there, its time to pay attention to your cancer screening, and oh, by the way to your blood pressure checks, your cholesterol screening, and many other things that you may have deferred.  :34
Nelson notes that underserved populations also need to think about routine screenings to avoid some of the conditions that put them at high risk for COVID-19 infections. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: It’s time to resume routine cancer screenings, Elizabeth Tracey reports
Are you avoiding cancer screening tests because of the COVID-19 pandemic? A recent study shows that many people are. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says the numbers are startling.
Nelson: Clearly cancer is an illness that is not going to go away by having people stay at home. What this article dives into is what about the screening itself? The study itself came from a medical records vendor EPIC and they looked in their medical records database. What they saw is between March 19 and April 20 compared to steady state eleven or twelve weeks last year they saw a stunning in appointments for cancer screening. They were down at least 68% for cervical cancer, colonoscopy down 86% and mammography down 94%.  :34
Nelson notes that there’s no question that catching cancer early is most likely to result in good outcomes, so resuming screening is your best strategy. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Does it help to have a complete genetic assessment when it comes to lung cancer? Elizabeth Tracey reports
Lung cancer is often the result of known mutations abbreviated EGFR and ALK, and these are routinely tested for around the country. Now a new study suggests that a more complete genetic assessment really doesn’t add much and is much more expensive. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, comments.
Nelson: I think that it hints that there are things that are being used in the community the stuff that’s being used  is the meat and potatoes stuff that drives the drugs that we know about. I suspect that broad based genetic testing of cancers will become more and more common because it will be easier to do, more accessible. And the number of drugs that may be helpful will increase over time. I think the cost is going to go down. :20
Nelson notes that broad based testing is often a part of clinical trials.
Nelson: It’s clearly worth testing for the EGFR and ALK mutations. I think still for lung cancer it’s worthwhile thinking about participating in a clinical trial.  :09
At Johns Hopkins, I’m Elizabeth Tracey.

In this month's podcast, Johns Hopkins Kimmel Cancer Director William Nelson discusses screening strategies for all cancers, will active surveillance on some cancer be less expensive in the long run and treatment options for HER2 positive breast cancers.
Program notes:
0:26 Screening for cancers on a population basis
1:26 Find cancers that would never get big and threaten life
2:26 How do we distinguish which cancers are going to be aggressive
3:27 How to appropriately engage patients
4:30 Will active surveillance be less expensive?
5:02 Twenty years of prostate cancer
6:02 Either prostatectomy or surveillance
6:50 HER2 positive breast cancer
7:50 Two drug combination helps
8:50 A bit of a price for treatment
9:35 End

Anchor lead: Some women taking breast cancer medicines stop because of their cost, Elizabeth Tracey reports
If you were taking a medicine to keep your breast cancer from coming back, why would you stop? A recent study points to cost as one compelling factor.  William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says neither regulation of insurance coverage nor negotiation of drug prices is likely to prove effective.
Nelson: Much of it is the need for better therapy. I think if you have therapy that’s effective more effective therapy is always going to be the avenue to more cost-effective therapy. One of the bigger issues related to the cost of care is the cost of marginally effective care it ends up being huge because the effectiveness isn’t there. I think that we have the ability to collect data and increasingly will, and we need to collect data about how effective these treatments are, and I believe at that point there’s going to be a very strong incentive for the value of care and then people are going to pay for the value of care. :32
Nelson asserts that things like electronic medical records will provide data on the most efficacious therapies. At Johns Hopkins, I’m Elizabeth Tracey.

In this month's podcast, Johns Hopkins Kimmel Cancer Director William Nelson discusses drugs approved by the FDA including those that help cancer with the BRCA gene, the cost of breast cancer treatment and the financial burdens of cancer care and treatment.
Program Notes:
0:26 PARP inhibitors
1:27 Cancers that don’t have BRCA defects another drug helps
2:26 Are ones approved by FDA
2:40 Physical properties of cells and metastasis
3:41 inhibition might help
3:50 Costs of breast cancer treatment
4:51 More for trastuzumab
5:51 Ready to engage in life and what is the financial burden?
6:51 Value in care needed
7:15 Data on childhood cancer survival
8:32 End

Johns Hopkins Kimmel Cancer Director William Nelson discusses early detection of prostate cancer and the outcomes, possible issues that may arise with radiation therapy and your bowels, and using cord blood to treat leukemia patients in this month's podcast.
Program notes:
0:20 Early prostate cancer outcomes
1:21 All treatments equally effective
2:23 Bowel problems with radiation therapy
3:23 Wait and then treat
4:00 Use of cord blood in leukemia patients
5:00 Maybe bone marrow registry
6:05 Relapse did not differ
7:11 Checkpoint inhibitor failure
8:15 Interferon signaling escape mechanism
9:39 End

Johns Hopkins Kimmel Cancer Director William Nelson discusses changes to physical exams, the HPV vaccine, new information regarding breast cancers in this month's podcast.
Program notes:
0:20 Changes to physical exam?
1:20 An app loaded onto a smartphone
2:21 The right kind of devices
3:03 The HPV vaccine
4:02 Need three injections
5:05 If pediatricians are the problem
5:40 Holy grail with regard to some breast cancers?
6:41 Found progenitor cells that had the receptor
7:42 Treated a few women with drug
8:42 May have similar mechanisms of action
9:44 End

In this month's Cancer News Review, Kimmel Cancer Center director Bill Nelson discusses various environmental risks for cancer and an immunotherapy strategy using polio.
Program notes:
0:24 Exercise and cancer risk
1:21 Melanoma increased risk
2:15 Air pollution and cancer
3:15 More people migrating to cities
3:40 Ten most common cancers and the deadliest ones
4:40 Polio virus and a brain tumor
5:40 Remove barriers to clinical use
6:40 Get viruses to destroy cancer cells
7:41 If a mutant gene is targeted
8:40 Also true in immunotherapy
9:24 End

In this month's Cancer News Review, Kimmel Cancer Center director Bill Nelson comments on a link between marriage and cancer survival, as well as the high burden of cancer costs.
Program notes:
0:20 Married people with cancer
1:20 Other things that explain?
2:21 Toxic effects of economic stress of cancer treatment
3:21 As drug treatments have gotten better
4:24 Typical cancer patient having outpatient treatment
5:23 Two to three times more likely to suffer bankruptcy
6:29 Proposed CMS rule
7:21 Trim percent and use a flat fee
8:15 Incentivizing oncologists
9:15 End

This month, Kimmel Cancer Center director Bill Nelson discusses Vice President Joe Biden's national Cancer Moonshot, Stand Up 2 Cancer and team science.
Program notes:
0:21 The administration says
1:22 Many strategies are bearing fruit
2:22 Make sure we get the full benefit
3:21 Stand Up to Cancer model
4:23 Not so much competition
5:24 Something everyone recognizes we need
6:25 The team science approach is the way forward
7:56 End

Kimmel Cancer Center director Bill Nelson starts off the new year by discussing prostate cancer screening guidelines, the accessbility of breast cancer care, the genomic sequencing of pediatric cancers, and a new drug for leukemia.
Program notes:
0:18 USPSTF PSA guidelines and prostate cancer
1:20 Hundreds of thousands of diagnoses to save a few lives
2:17 Will mortality rise?
3:20 Rate of PSA rise
4:11 Surgery and survival in breast cancer
5:11 Need to build health systems to reduce inequities
6:01 Germ line mutations in pediatric cancers
7:01 Quirky findings
8:10 New leukemia drug for CLL
9:05 Results were stunning
10:01 End

Johns Hopkins Kimmel Cancer Director William Nelson discusses top cancer news during October 2015.
Program notes:
0:22 Low nicotine cigarette impact
1:25 Smoked less
2:27 Strategy to make less attractive
2:45 Cancer in elephants
3:45 Studies of lymphocytes too
4:30 HPV lesion clearance
5:33 Randomized to a vaccine
6:30 Mouse avatar use
7:30 Why don’t treatments work?
8:30 May be where this is headed
9:30 End

Johns Hopkins Kimmel Cancer Director William Nelson discusses top cancer news during September 2015.
Program Notes:
0:11 Treatment of advanced prostate cancer
1:12 Improved overall survival
2:11 Real flurry of new agents
2:27 Active surveillance
3:27 More threatened by other health maladies
4:11 Treatment of DCIS
5:11 99% had no additional problems
6:11 A moving target?
6:35 Ongoing debate on aspirin or NSAIDs and colorectal cancer
7:35 Reduced risk by 27%
8:20 Who is best to take it?
9:20 End

Johns Hopkins Kimmel Cancer Director William Nelson discusses top cancer news during July 2015.
Program Notes:
0:14 A blood test for pancreas cancer
1:14 Biomarker potential
2:22 Five day fast and cancer risk
3:23 About 3% weight reduction
4:23 One that gets the results that you want
5:12 Guideline for physicians to talk about cost/benefit of cancer treatment
6:12 Effectiveness of treatment, toxicity, and quality of life, and what was the cost
7:14 Out of pocket costs most important for patients
8:14 Try to inform patients fully
8:52 End

Johns Hopkins Kimmel Cancer Director William Nelson discusses top cancer news during May 2015.
Program Notes:
0:34 Sun-related cancer
1:32 500 mg nicotinamide daily
2:30 Standardized genetic tests
3:32 National Institute of Standards and Technology
4:32 Altered DNA sequence in cancer
4:47 Premenopausal women with breast cancer and family history
5:49 Did not find a difference at all
6:49 Look at how we classify cancers for treatment
7:20 Asthma and prostate cancer
8:30 Inflammation involved
9:21 Complexity to immune response
10:20 End

Johns Hopkins Kimmel Cancer Director William Nelson discusses top cancer news during August, 2014.
Program notes:
Program notes:
0:22 Radical prostatectomy and lifestyle factors
1:20 If you’ve had this treatment control weight and don’t smoke
2:21 Not just generally healthier but prostate ca better
2:39 Does vasectomy increase risk for prostate cancer?
3:35 Real cause and effect?
4:32 Inflammation might lead to prostate cancer
5:35 Probably is some relationship
6:35 Shouldn’t be a dominant determinant re: vasectomy
7:01 Breast reconstruction timing
8:02 If done with mastectomy are there more complications?
9:02 Many options so see a team of experts
9:49 End