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Science Policy Around the Web – June 8, 2018

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By: Sarah L. Hawes, PhD

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source: pixabay

Treatment Guidelines

Good News for Women With Breast Cancer: Many Don’t Need Chemo

Completion of a large, international clinical study headed by Dr. Joseph A. Sparano of Montefiore Medical Center in New York spells out excellent news for early-stage breast cancer patients. These patients are typically asked to endure both chemo and endocrine therapies after tumor removal. Endocrine therapy to block the hormone estrogen results in side effects similar to menopause and can increase risk of uterine cancer. Notoriously toxic chemo therapy can damage heart and nervous tissue, compromise patient immune systems, and increase risk of leukemia.

Since 2004, genetic test such as Oncotype DX Breast Cancer Assay have provided a small number of women confidence that chemotherapy is not needed to treat their cancer. Following surgical removal of small, non-metastasized breast tumors, tissue is genetically tested to determine whether chemotherapy is advisable as a next step. A very low Oncotype DX tumor score (≤10) indicates cancer with a low risk of recurring, so that chemotherapy is not needed. A very high tumor score of (≥25) indicates a more persistent cancer, and the need for chemotherapy to suppress its recurrence. But most breast cancers return an intermediate tumor score – falling between 10 and 25.

Not knowing what else to do, physicians treating patients with intermediate scores have dutifully followed the 2000 National Cancer Institute recommendation that all pre-metastasis breast cancer patients receive chemo therapy to avoid recurrence and metastasis. Now, Dr. Sparano’s study indicates that many do not need it.

The study, called TAILORx, will be published in The New England Journal of Medicine. It began in 2006 and – with funding from the US and Canadian governments, philanthropic groups, and the company which makes Oncotype DX – followed over 9,000 breast cancer patients aged 18 to 75 for a median duration of seven years. Seventy percent of these women had intermediate tumor scores. With their informed consent, participating women were assigned at random to receive either endocrine therapy alone, or else in combination with chemotherapy.

Over the course of the study, the rates of survival and clearance of cancer were no different between these two groups. This means that for a majority of patients whose cancer is detected at an early stage, toxic chemo therapy provides no added benefit and can be safely avoided. The study results also clarified that, for women younger than 50 (median age at diagnosis is 62 in the US), chemotherapy is still advisable if tumor scores are above 16.

Coauthor Dr. Ingrid A. Mayer from Vanderbilt expressed excitement, noting that with these research findings “we can spare thousands and thousands of women from getting toxic treatment that really wouldn’t benefit them. This is very powerful. It really changes the standard of care.”

(Denise Grady, New York Times)

Basic Science

Scientists race to reveal how surging wildfire smoke is affecting climate and health

A record 2017 wildfire season inflicted serious health and economic challenges throughout the western United States. Over two million acres burned in California and Montana alone, flooding the closest towns with smoke carrying nearly 20 times the acceptable limit of particulate matter set by the Environmental Protection Agency for weeks on end.

The frequency of wildfires is projected to increase, yet a fundamental understanding of their billowing byproduct – smoke – is lacking. Thankfully the next two years will see over $30 million in spending by two cooperative research programs investigating the chemistry, physics, and environmental and public health implications of wildfire smoke. One research campaign is being funded and run by the National Science Foundation (NSF); the other is a joint endeavor by the National Aeronautics and Space Administration (NASA) and the National Oceanic and Atmospheric Administration (NOAA).

“This is definitely the largest fire experiment that has ever happened,” says Carsten Warneke of NOAA’s Earth System Research Laboratory in Boulder, Colorado. Old data on wildfire smoke lacks detail, being largely garnished by satellite observation of established fires. The new research will gather data at all atmospheric levels, using satellites as well as aircraft to fly through and sample smoke plumes and employing researchers on the ground to test low-lying smoke. Sampling will begin in the first 24 hours to monitor fast dynamics of smoke chemistry as it passes through different atmosphere levels and interacts with clouds, potentially seeding ice crystals and impacting weather. In addition to wildfires, researchers will study the smoke released by controlled burns for farming and forestry.

The goal of these large scale research campaigns, Warneke says, is “to do the whole picture at one time and understand how the whole thing plays together.” Newly generated data will enable scientists to predict the rates and types of pollutants released based on the composition of land burned – including density of vegetation or man-made structures – and what that means for climate, weather, and human health.

(Warren Cornwall, Science Magazine)

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Written by sciencepolicyforall

June 8, 2018 at 6:03 pm

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