The 2 Minute Medicine Podcast Episode 55

In this episode, we begin with a discussion about our article of the week. Our article of the week comes from The Lancet Oncology and is entitled “Low-dose CT for lung cancer screening in a high-risk population (SUMMIT): a prospective, longitudinal cohort study.” Then in the second half of the episode, we begin with a discussion about a new, three-in-one therapy for endometriosis. Then we take a closer look at a planned Center for Disease Control and Prevention study for connections between vaccines and autism. After that, we examine the effects of extended durations of space flight on human health. Finally, we discuss the relationship between eating well and healthy aging.

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Transcript

Transcript

[Deepti] Welcome to the 2 Minute Medicine Podcast, summarizing the latest medical studies, curated and written by practicing physicians.

For our full suite of daily medical study summaries and updates written by practicing doctors, please visit our website at 2minutemedicine.com to start reading new daily content right now, for free. On this podcast, twice a month, we cover the latest in health care news and research evidence. We are your hosts Deepti and Andrew. 

[Andrew] Our article of the week comes from The Lancet Oncology and is entitled “Low-dose CT for lung cancer screening in a high-risk population (SUMMIT): a prospective, longitudinal cohort study.”

Low-dose CT screening for lung cancer has been shown to reduce lung cancer-related mortality in high-risk individuals, but uptake remains low. This cohort study assessed the implementation of low-dose CT screening in a diverse UK population, providing insights into real-world service delivery and demonstrating the feasibility of large-scale lung cancer screening. The primary endpoints included the proportion of individuals who chose to undergo screening, incidence of screen-detected and total lung cancers, number of participants needed to screen to detect one lung cancer, stage at diagnosis, and number of participants referred for diagnostic investigations. Between April 2019 and May 2021, 18581 individuals attended a lung health check, and 85.4% of eligible individuals chose to participate in the study, with 12773 individuals included in the study. In the baseline screening round, 2.0% of participants were diagnosed with lung cancer after a positive screen, and 2.0% of participants had other actionable findings, including suspected extra-thoracic malignancy. The sensitivity of the low-dose CT screening protocol for detecting lung cancer was 97.0%, the specificity was 95.2%, with a false-positive rate of 4.8%, a positive predictive value was 30.3%, and a negative predictive value was 99.9%. The number needed to screen to detect one lung cancer was 49.0. Referrals to the multidisciplinary lung cancer team occurred in 93.8% of participants with positive baseline scans. Among those diagnosed with lung cancer, 79.3% were diagnosed at stage I or II, 14.2% were diagnosed with stage III disease, and 6.1% with stage IV disease. In those with stage 1 disease, 85.2% underwent surgical resection compared with 70.8% with stage II disease and 75.7% with stage III disease. The strengths of this study include the sample size, and the limitations include screening those at high risk of cancer, rather than the whole population. Overall, this study showed that large-scale lung cancer screening can be feasible and effective.

[Andrew] Now, let’s take a look at the Scan. 

The Story: Relugolix combination therapy, marked under the brand name Ryeqo, is the first daily pill for treating endometriosis and has been approved by the National Health Service (NHS) for use in England and Wales.

So, what is endometriosis?

Endometriosis is a chronic gynecologic disease in which tissue similar to the inner lining of the uterus grows outside of the uterine cavity. It affects approximately 10-15% of women of reproductive age and diagnosis is often delayed, leading to avoidable suffering. Endometrial tissue, like normal uterine tissue, reacts to a woman’s natural hormonal cycle and proliferates under the influence of estrogen. However, its presence in unnatural locations leads to chronic pelvic pain, pain with menstruation or vaginal intercourse, excessive vaginal bleeding, recurrent urinary tract infections, and even infertility.

[Deepti] You may be wondering, how is endometriosis currently treated?

There is unfortunately no cure for endometriosis and treatment targets symptom management. Nonsteroidal anti-inflammatory agents are cheap but weak and carry the risk of kidney disease and stomach and small intestine ulcers. Combined hormonal contraceptives are commonly prescribed for endometriosis although their effectiveness is equivocal.  Surgery is reserved for patients who fail to respond to drugs and consists of removing endometrial lesions or removing the uterus and/or ovary and fallopian tubes in patients with no desire for future pregnancy. This may temporarily reduce pain but symptoms often return and patients require further operations.

And how does Relugolix combination therapy, or Ryeqo work?

Relugolix blocks the estrogen “control hormone”, thereby decreasing estrogen levels, the hormone responsible for endometrial tissue proliferation. However, low estrogen can lead to menopause-like symptoms such as hot flashes, weak bones, vaginal dryness, and irritability. Ryeqo solves this issue by combining relugolix with two other hormones, estradiol and norethisterone acetate, to optimize the body’s estrogen levels. This three-in-one tablet provides patients suffering from endometriosis with convenience, more choices, and even hope for those who have seemingly exhausted all options.

Next, let’s take a closer look at vaccines and autism.

[Andrew] On February 28, 1998, Andrew Wakefield, a former British doctor, infamously published an article in The Lancet, a prestigious medical journal, linking the measles, mumps, and rubella vaccine to autism. The paper has since been retracted by its co-authors and the journal, numerous studies have refuted its findings, and Andrew Wakefield was de-licensed and found guilty of deliberate fraud. However, it took nearly two decades for the United Kingdom’s (UK) immunization rates to recover, and measles outbreaks in the UK in 2008 and 2009 and the current outbreak in the United States (US) have been attributed to low vaccination rates.

Nearly 30 years later, the belief that vaccines cause autism remains strong. Earlier this month, The US Department of Health and Human Services (HHS) asked the Centers for Disease Control and Prevention (CDC) to study potential connections between vaccines and autism. HHS spokesman Andrew Nixon said, “As President Trump said in his Joint Address to Congress, the rate of autism in American children has skyrocketed. CDC will leave no stone unturned in its mission to figure out what exactly is happening.” President Trump and Robert F. Kennedy, Secretary of HHS, have both linked autism to vaccines. However, advocates for people with autism are pushing against this announcement. Alison Singer, president of the Autism Science Foundation, said, “Even just the notion that the government needs to study this is harmful. It will plant seeds of fear, […] parents will withhold vaccines, and children will die.” Next, let’s discuss American astronaut Sunita Williams and Butch Wilmore. 

[Deepti]  On June 5, 2024, American astronauts Sunita Williams and Butch Wilmore launched into space for an eight-day mission. Over nine months later, they finally returned to Earth after mechanical issues with their Boeing Starliner spacecraft unexpectedly extended their stay. At 286 consecutive days, well over the average six-month duration of International Space Station (ISS) missions, Ms. Williams and Mr. Wilmore’s prolonged stay is the sixth-longest in National Aeronautics and Space Administration (NASA) history.

While many of us dream of traveling to space, recovering from “the most extreme environment that humans have ever encountered” can take years. NASA uses the acronym “RIDGE” to summarize spaceflight hazards: Space Radiation, Isolation and Confinement, Distance from Earth, Gravity fields, and Hostile/Closed Environments. As the body shifts from gravity to weightlessness, its muscles, heart, and blood vessels no longer have to fight against gravity and weaken, with weight-bearing bones losing an average of 1%-1.5% of their density every month. Fluids within the body are also not pulled down by gravity and drift upwards, potentially leading to brain swelling and changes in the eye. Even things we can’t see, such as radiation and microbes, are more dangerous in space. Despite these risks, Ms. Williams had no regrets, telling reporters, “I love being up here in space. It’s just fun, you know?”

[Andrew] Last but not least, lets discuss a  recent study which found that specific diets during midlife can increase the chances of “healthy aging”. The study, published Monday in Nature Medicine, a prestigious medical journal, followed over 100,000 individuals from 1986 to 2016. Participants were assessed for their diet and for “healthy aging”, which the study defined as “surviving to the age of 70 years without the presence of 11 major chronic diseases (e.g. cancer, diabetes, kidney failure, etc.) and with no impairment in cognitive function, physical function or mental health”.

The study examined the association between healthy aging and long-term adherence to eight healthy dietary patterns. While it is widely known that healthy eating correlates with healthy aging, the study identified specific relationships. For example, the Alternative Health Eating Index was most strongly associated with maintaining physical function, mental health, and healthy aging overall. 

[Deepti] The Planetary Health Diet Index was most strongly associated with maintaining cognitive health and surviving to 70 years old. Indeed, Blue Zones, geographical areas with exceptionally high life expectancies and low rates of chronic disease, have dietary patterns similar to those identified in this study. As Dr. Marta Guasch-Ferré, the principal investigator, said, “It’s not just about living longer but also maintaining good health in the later stages of life.”

[Andrew] Thank you for joining us today for this episode of the 2 Minute Medicine Podcast. New episodes come out every other week and all of our content has been curated and written by practicing physicians. We would like to thank Alex Xiang, Daniel Goldshtein, and Samuel Chan for contributing to this week’s episode

Please head to our website at 2minutemedicine.com to learn more and to access all of our content including medical study summaries, visual abstracts, excerpts from our Classics book series which is available on Amazon, and The Scan, which is our medical newsletter.

New episodes come out every other week and all of our content has been curated and written by practicing physicians.