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Lung Cancer Screening

We screen for breast cancer with mammography, colon cancer with colonoscopy, and prostate cancer with blood tests and exams – why not lung cancer?

If you’re a smoker or a former smoker, or even if you’ve had significant second-hand smoke exposure, you’ve probably worried about your chances of getting lung cancer, and whether there is anything you can do about it. Perhaps you even asked your doctor about getting an x-ray; he or she may have told you that there is no proof that it helps. That’s because a national study done years ago showed no benefit from getting chest X-rays, and therefore it’s not recommended.

The studies

However, since 2000, Swedish has participated in an international study – the International Early Lung Cancer Action Project (I-ELCAP) - to see whether CT scans or CAT scans – very highly detailed X-rays – might be able to find lung cancer earlier and improve cure rates. The study was begun by a group of investigators from Cornell University in New York. They knew that CT scans were very sensitive and would probably show a lot of abnormalities, and that most of them wouldn’t be cancer, so they worked out a system to determine which abnormalities were likely to be cancer. Their system worked, and they showed that when lung cancer was discovered through their screening system the cure rate was over 80%. That’s remarkable, because the normal cure rate for lung cancer is only 15%.

Because of their success, the National Cancer Institute (NCI) began a randomized study with over 50,000 participants. Half of them got annual CT scans and the other half got only chest X-rays. The results were just completed and were very exciting. The group that got CT scans had 20% fewer deaths from lung cancer than the other group!

The results are still being analyzed and there are concerns about safety from too many interventions, radiation exposure, and cost. It will take time to work through these issues, and there is still no general endorsement of lung cancer screening. However, several national organizations now cautiously support screening in high risk groups that meet the criteria for the national study.

Who should get screened, and how?

Change your clock this weekend: it may help your ticker

Here’s a great reason to remember to turn your clocks back and sleep in an extra hour this weekend: it may be good for your heart.

More than 1.5 billion people reset their clocks every year, turning clocks backward by an hour in the fall and forward by an hour in the spring. These transitions can disrupt internal biologic rhythms and influence the duration and quality of sleep. But does losing or gaining that one hour have health consequences? A 2008 report in the New England Journal of Medicine by Dr. Janszky and colleagues suggests that it does. The authors showed that there is a significant increase in the daily rate of heart attack in the first few days after we “spring ahead” and get an hour less of sleep, but that in the first few days after we “fall back” and gain an hour of sleep, there are fewer heart attacks.

Sleep deprivation carries a high risk. Sleeping less than 5-6 hours per night is associated with significant increase in the risk of heart disease, stroke, diabetes, obesity and depression. But 40% of Americans...

Early warning device for heart attacks

The symptoms of a heart attack can vary from person to person, but what if you had an early warning system that would alert you to go to the hospital before the first sign of trouble? Doctors here at Swedish are testing out a new device they hope could do just that.

In early January 2010 Swedish became the first medical center in western Washington to begin participation in the ALERTS Pivotal U.S. Trial for the AngelMed Guardian implantable cardiac monitor and alert system. The system is designed to reduce the time it takes patients to get to an emergency room during an impending heart attack.

The AngelMed Guardian System ® is designed to track significant changes in the heart’s electrical signal and then alert patients to seek medical attention. The objective of the ALERTS Pivotal Study is to provide an assessment of the safety and effectiveness of the AngelMed Guardian System.

“If the Guardian system proves to be effective in the early detection and warning of potentially life-threatening heart conditions, we may be able to shift the paradigm for early treatment at the onset of heart attacks,” said Swedish Heart & Vascular Institute interventional cardiologist Mark Reisman, M.D., principle investigator for this study at Swedish.

According to the American Heart Association, one of every five deaths in the United States is attributable to coronary heart disease. Further, 50 percent of heart-attack fatalities occur within one hour of symptom onset and occur before the patient even reaches the hospital.

SNI award from NIH - 2.2M

Swedish Neuroscience Institute was awarded a 7-year, $2.2M grant by the National Institute of Neurological Disease and Stroke (NINDS) to participate in the NeuroNEXT program, a national consortium of 25 neuroscience centers of excellence that will conduct early-stage clinical trials. John W. Henson, MD, FAAN, and Daniel S. Rizzuto, PhD, will lead the effort at Swedish. Swedish Neuroscience Institute was the only non-university hospital chosen to participate, highlighting the value of Swedish’s investments in research and clinical infrastructure. For more information about NeuroNEXT click here

David Newell, M.D., co-authors cover article in Journal of Neurosurgery

David Newell, M.D., neurosurgeon and co-executive director of the Swedish Neuroscience Institute (SNI), co-authored the cover article in the September Journal of Neurosurgery on the results of a study using ultrasound for the treatment of brain hemorrhage. The study involved 33 patients with spontaneous intracerebral hemorrhage who were screened for inclusion in a SNI clinical study known as “SLEUTH” (Safety of Lysis with Ultrasound in the Treatment of Intracerebral and Intraventricular Hemorrhage). Read the abstract and full text of the article. Read background information on the study. Watch a related video on WebMD.

Personalized medicine is the future of healthcare

If you were diagnosed with cancer or another disease, wouldn’t you want your treatment and medicines to be as unique as you are?

This is a growing trend in medicine where the type of treatment a patient gets depends on their DNA.

A few weeks ago, Dr. Hank Kaplan of the Swedish Cancer Institute spoke with KING5 about the I-SPY clinical trial (click here to watch the KING5 story).

The usual treatment for breast cancer may be surgery, followed by chemotherapy, possibly radiation and as a last resort, a clinical trial.

The I-SPY clinical trial turns that thinking upside down by actually extracting DNA from a tumor to figure out which new drug will likely work best, then giving it to the patient first, even before surgery.

"The goal of the I-SPY trial is really to develop a faster and cheaper way to develop new drugs for breast cancer . We're hoping that this is a new paradigm that will work for other kinds of cancer too," said Dr. Kaplan.

Emerging therapies in multiple sclerosis

Multiple sclerosis is unique among neurological diseases in that there are currently eight treatments for this one condition that have received approval by the U.S. Food and Drug Administration (FDA). Five of these drugs require subcutaneous or intramuscular injection, two are administered intravenously, and fingolimod, the newest agent on the block, is given orally. None are considered curative, but these disease-modifying therapies (DMT) have led to a reduction in relapse rates and the progression of disability.

Despite this progress, each of the drugs comes with side effects, including flu-like symptoms with the interferons, lipoatrophy with glatiramer, progressive multifocal leukodystrophy (PML) with natalizumab, and congestive heart failure or leukemia with mitoxantrone. As the first oral agent for MS, fingolimod created great expectations prior to FDA approval. Its popularity, however, has been surprisingly limited, presumably due to the potential for unknown long-term risks. The occur rence of PML with natalizumab demonstrated to MS neurologists and patients the potential risks associated with new drugs.

Additional DMTs in the pipeline may increase MS-management effectiveness in coming years, although safety will continue to be a major consideration in the use of these drugs. For instance, oral cladribine was on the verge of FDA approval in early March when the agency referred the drug back for more safety studies. This drug is already used in intravenous form for the management of hairy cell leukemia, but it is being studied for use with remitting relapsing MS because of its apoptotic effects on lymphocytes. If cladribine is ultimately approved for use, the risk of infection and neoplasms may limit its use.

Other oral agents being studied include:

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