September 18, 2009
NIH Podcast Episode #0093
Balintfy: Welcome to the 93rd episode of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health—the nation's medical research agency. I'm your host Joe Balintfy. Coming up in this episode, we’re focusing on cancer. We’ll have reports on cancer prevention in Africa, and signing up for breast cancer research in the US, plus we’ll have an interview about a research initiative using modern genomic technologies to fight childhood cancers. But first, a recent study sheds light on low bone density in young women. That's next on NIH Research Radio.
(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT)
Delay in Diagnosis of Menopause-like Condition in Young Women Linked to Low Bone Density
Balintfy: A recent study has found that a delay in diagnosing a menopause-like condition in women and young girls is linked to low bone density. This may increase risk for osteoporosis and fractures later in life. Belle Warring has more in this report.
Waring: According to researchers at the Eunice Kennedy Shriver National Institute of Child Health and Human Development, women and young girls with a menopause-like condition face an increased risk of low bone density. This may lead to osteoporosis, which makes bones weak and more likely to break.
Dr. Nelson: Bone health is like our bank account.
Waring: Dr. Lawrence M. Nelson is head of the Integrative Reproductive Medicine Unit at NICHD:
Dr. Nelson: We need to build strong bones when we're young to help us avoid osteoporosis when we're older. And it turns out that the hormones that come from the ovary that cause women to have regular cycles actually help them build strong bones.
Waring: Estrogen is the hormone produced in the ovaries; and it helps bones absorb calcium. Dr. Nelson says that the menstrual cycle is linked to the function of the ovary and when women and teens are having regular menstrual cycles, it’s a sign that their ovary is making the hormones they need.
Dr. Nelson: This is something positive about the menstrual cycle.
Waring: Yet in one out of 100 women under the age of 40, the ovaries prematurely stop making estrogen. Dr. Nelson studied this.
Dr. Nelson: We worked with women that have a problem called primary ovarian insufficiency. It used to be called premature menopause, meaning that young women stopped having menstrual periods; and they may also get the symptoms of hot flashes and vaginal dryness that comes along with estrogen deficiency.
Waring: Dr. Nelson explains that one finding of a recent study, published in the Journal of Clinical Endocrinology & Metabolism, is that the menstrual cycle helps build strong bones.
Dr. Nelson: Another major finding is, if the menstrual cycles become irregular before age 20, this puts those women at greater risk of having a bone density below normal.
Waring: Because the main symptom of primary ovarian insufficiency—irregular or stopped menstrual periods—may be overlooked, delays in diagnosis are common.
Dr. Nelson: The longer women had to wait before the doctors find out that their ovaries weren’t working right because they weren't having periods regularly, the more at risk they were for having an abnormally low bone density.
Waring: Dr. Nelson adds that by diagnosing the condition early, and replacing needed hormones, these women can protect their bones from weakness and fractures. He also stresses the importance of nutrition.
Dr. Nelson: Vitamin D is very important in helping build strong bones. And calcium in your diet is very important in helping build strong bones.
Waring: African-American women generally have less risk for low bone density than white women have. Yet Dr. Nelson says this study had some surprising results.
Dr. Nelson: So we found that black women and Asian women were at more risk because they were having more problems making sure they have enough calcium and vitamin D.
Waring: Dr. Nelson urges women to see their doctors:
Dr. Nelson: Women of color who are having irregular menstrual cycles should get in and get evaluated especially because they’re at increased risk of abnormally low bone density, compared with white women. The data suggest that if they correct their vitamin D and their calcium levels and intake, then they'll be at less risk of developing osteoporosis.
Waring: Dr. Nelson also stresses that adolescent women should not delay seeking treatment:
Dr. Nelson: The teen years are a critical time for building bone for young women. And if young teenagers are not having the hormones from their ovary and they're missing vitamin D and they're having inadequate calcium intake, and if they’re not taking their hormone replacement in this condition of primary ovarian insufficiency, they’re at increased risk too. So mothers and daughters need to be paying attention to the menstrual cycle as a vital sign and as a sign that their hormones are there to help them build strong bones.
Waring: For more information on primary ovarian insufficiency, visit www.nichd.nih.gov. This is Belle Waring, National Institutes of Health, Bethesda, Maryland.
Cancer in Africa: Focus on Prevention
Balintfy: Up next, Kristine Crane files two reports on cancer. She explains how healthcare in Africa has focused on infectious diseases, but more attention is being given to the continent’s increasing problem with cancer. Africa lags behind in information, infrastructure and resources to deal with the magnitude of the disease. Here’s her first report.
Crane: In Africa, healthcare has focused on fighting infectious diseases. But over the past two decades, cancer has become a growing concern.
Masalu: The cancer state in many African countries is very poor.
Crane: Dr. Nestory Masalu is an oncologist from Tanzania who participated in the National Cancer Institute's cancer prevention course in July. Dr. Masalu says Africa faces a cancer crisis.
Masalu: Because the majority of the cases arrive for medical attention at a very late stage.
Crane: Dr. Masalu says Africa lacks information and resources on cancer.
Masalu: People, they don't know what the cancer is. They don't know the risks associated with cancer. So the information is not there. And then two, the early detection is not there. The facilities that can deliver the best treatment are not there. Like Tanzania until last year had only one cancer center, and the country has a population of about forty million inhabitants.
Crane: Five months ago, Dr. Masalu started Tanzania's second oncology clinic, in Mwanza, the city where he grew up. He also started a screening program in the villages.
Masalu: We will be going to the health centers in the villages. We will screen, give the pre-information to the village leaders, to the religious leaders, so that women will come, who are eligible to be screened. We will screen them. And train local staff where we go.
Crane: One problem is that few African oncologists practice in Africa. Dr. Masalu says he is one of only a handful of oncologists in his native Tanzania. Most African oncologists trained in the west don’t return home. Dr. Masalu came back to Tanzania last year after his medical training in Italy. He says prevention is the key to fighting cancer in Africa, especially since the costly treatments for late-stage disease used in the West are out of reach for most Africans.
Masalu: For the time that I've been in Italy, five years, I saw only one case of cervical cancer. When I reached my country, 70 percent of the cases were cervical cancer, advanced. So I kind of changed my idea, because in Italy I was more someone who relied on treatment. But when I went to Africa, I changed my mind completely and said I think prevention is the key in Africa. So this course actually came at the right time.
Crane: Dr. Masalu was one of several international participants in the five-week summer course sponsored by the cancer prevention fellowship program. People came from thirty-six countries for the course. This is Kristine Crane at the National Institutes of Health, Bethesda, Maryland.
Army of Women
Balintfy: Kristine’s reports also reflect the many visiting voices that can be heard here at NIH. For this next story, about breast cancer research, she interviewed Dr. Susan Love, who spoke at the National Cancer Institute recently. Again, here’s Kristine Crane:
Crane: Most research on breast cancer has focused on finding a cure.
Love: My goal is not a cure for breast cancer. My goal is to prevent breast cancer altogether.
Crane: Dr. Susan Love, the renowned breast surgeon at the helm of the Army of Women, says to prevent cancer we must change the environment that causes it.
Love: To alter the environment means large epidemiological studies to figure out what the factors are. I worry that we're spending so much time on molecular biology that we’re losing sight of those kinds of studies. We could know every gene in lung cancer and not know that smoking was related if we don’t do these large epidemiological studies. And that’s why we launched the Health of Women cohort.
Crane: That cohort includes women in Dr. Love’s Army. Researchers can enlist these women for studies on many health issues, not just breast cancer. Dr. Love says these women are helping revolutionize scientific research.
Love: It’s time for women to take the next step. Beyond just raising money for research, but actually participating in the research. The Army of Women is a real evidence that they’re willing to do that. Since October we have 300,000 women, the majority of which do not have breast cancer and have no family history of breast cancer, who are ready to be in studies to figure out the cause of breast cancer. That’s remarkable. And that shows you, the public is really ready to be there.
Crane: The Army of Women also includes women whose cancer has recurred, or spread to other organs. Dr. Love is especially interested in studying the habits of these long term survivors.
Love: I’m always meeting these women who had 28 positive nodes, twenty years ago, didn’t take chemo, and are fine. Well, the treatment covers the first maybe five years. And we don’t really study these long-term survivors. What about the women with metastatic disease, that are six, eight years out? What are they doing differently? There must be lifestyle and other issues that are contributing to their success. And if you have a million women, you’re going to have enough women that you can start to answer these questions.
Crane: The Army hopes to enlist one million women. The way it works is women receive emails about the studies that Dr. Love’s scientific committee has approved. The women reply to those they want to participate in.
Love: It costs nothing for the women to participate. They just sign up online and receive the emails. And they’re not signing up to be in a study. They’re just signing up that they’re willing to hear about studies. So it’s a great thing in this economy, where you don’t have to spend money and you can still be doing good.
Crane: Women interested in joining the Army can sign up online at www.armyofwomen.org. This is Kristine Crane at the National Institutes of Health.
Balintfy: Anyone interested in participating in medical research can get information about clinical trials at www.clinicaltrials.gov. Stay tuned now for an interview on pediatric cancer, right after this public service announcement.
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The NCI TARGET Initiative
Balintfy: In the United States, each year there are over 12,000 children diagnosed with cancer, and there are over 2,000 children who die of cancer. At the National Cancer Institute, research efforts are underway to dramatically reduce the burden of cancer and improve the lives of cancer patients and their families. One NCI supported program is the Therapeutically Applicable Research to Generate Effective Treatments initiative, called TARGET. In this interview, we talked to Dr. Malcolm Smith of NCI to learn more about TARGET, how it is making an impact, and its expansion plans.
Dr. Smith: So, TARGET is several studies. There are several TARGET projects. There’s a TARGET project for acute lymphoblastic leukemia, and a TARGET project for neuroblastoma.
Balintfy: So Dr. Smith, can you explain more about the current projects or cancers – like acute lymphoblastic leukemia, or A-L-L – are these the focus of TARGET?
Dr. Smith: Again, the Acute Lymphoblastic Leukemia is one disease that we’re focusing on. This is the most common type of cancer in children, and even though many children with A-L-L do well with current treatments, nonetheless there are a number who don’t and for whom current best available treatment is not effective, and so we need new treatments for A-L-L. So that’s one project. The neuroblastoma is a second project. Neuroblastoma is a solid tumor that occurs in children, and for—the type of neuroblastoma that develops in children that are one or two years of age or older is one of the most aggressive types of cancers that occurs in children.
Balintfy: What kind of progress is being made?
Dr. Smith: Well, we’ve made several important discoveries that do have clinical implications, and I can highlight one of these. The A-L-L project identified mutations in a family of genes called the JAC family, and these JAC family mutations in the A-L-L really appear to be driver mutations for a subset of the A-L-L cases that we studied. And so these mutations really could be the key to identifying more and better treatments for the group of children who have leukemia with JAC mutations, particularly important because these -- the JAC-mutated leukemia does particularly poorly, and even with best available treatment, most children with this form of leukemia eventually have their leukemia come back.
So we’re moving forward in several directions to try to translate the JAC family mutations discovery into the clinic. We’re doing pre-clinical studies to show that the JAC — to determine if the JAC-mutated leukemias can be killed by JAC-inhibitor drugs that are actually already in the clinic for adult cancers.
And we’re actually beginning to develop a clinical trial for one of these JAC-inhibitor drugs, which is for children with cancer, and that will be the first step of translating from the discovery of the JAC mutations into clinical trials where we really define or determine whether the JAC-inhibitor drugs are effective treatments for this type of leukemia.
Balintfy: Dr. Smith, what’s next for TARGET?
Dr. Smith: We do hope to expand soon to include additional cancers. Dr. Niederhuber, who is the director of the National Cancer Institute, has announced that TARGET will be expanding, and so we’re working now to move forward on that expansion. The expansion will actually occur in two different ways. One way is to add additional childhood cancers, and so we hope to be adding at least several additional childhood cancers. The other way is by expanding the scope of the genes that we’re sequencing. So, now when we’re looking for mutated genes in one of the cancers we’re studying, we’re only sequencing 100 or slightly more genes. Since there are 23,000 genes in the human genome, we’re actually studying less than 1 percent of the genes that might be mutated. And so in the expansion, we hope to be sequencing thousands of genes for each cancer that we study, and perhaps sequencing all 23,000 human genes.
Balintfy: But how does understanding genes and genetic changes in cancer, how does that help better diagnose and treat cancer patients?
Dr. Smith: There are two analogies that can help people understand how understanding the genetic changes can lead to better treatments. One analogy is to think of these genetic changes as identifying the genes that really make up the motor that drives the cancer cell, and drives the growth and survival of the cancer cells. So if you can understand the motor of the cancer cell and the different parts of the motor of the cancer cell, really what the cancer cell depends on for driving it, then you may be able to block the motor from working and kill the cancer cells. The other analogy that helps in understanding how these genetic changes could lead to more effective treatments is to think of the changes as identifying the genes that are the Achilles’ heels of the cancer cell. And so these are the things, these changes in the cancer cells are changes that distinguish the cancer cell from a normal cell, and so they may be the weak link that helps us to develop treatments that kill the cancer cells but don’t do excessive harm to normal cells.
Balintfy: Thank you Dr. Malcolm Smith. For more information about TARGET, visit the website target.cancer.gov.
And that’s it for this episode of NIH Research Radio. Please join us again on Friday, October 2nd when our next edition will be available for download. I'm your host, Joe Balintfy. Thanks for listening.
NIH Research Radio is a presentation of the NIH Radio News Service, part of the News Media Branch, Office of Communications and Public Liaison in the Office of the Director at the National Institutes of Health in Bethesda, Maryland, an agency of the US Department of Health and Human Services.