DEAR MAYO CLINIC: I am in my 30s and overweight, but I thought I was too young to worry about cholesterol. I just learned my cholesterol is high. I know diet and exercise are important. Do I need medication? 

ANSWER: Cholesterol is a type of fat in our blood. Our bodies need a small amount of cholesterol to build the structure of cell membranes, make certain hormones and help with metabolism, such as producing vitamin D. The catch: We don't need too much cholesterol. 

Atherosclerosis, also known as narrowing of the arteries, happens when cholesterol builds up and blocks blood flow. This buildup is called plaque, which can clog arteries and can burst, leading to a blood clot. Atherosclerosis can cause heart problems such as chest pain (angina) or heart attack. It also can lead to problems in the brain, including transient ischemic attack, stroke, peripheral artery disease in the legs or arms, and even kidney failure.

Cholesterol and triglycerides are types of lipids. They travel in our blood by attaching to proteins. Adults 20 and older should ask their healthcare team about their lipid profile and how to interpret the numbers. 

• Low-density lipoprotein (LDL) cholesterol: We call LDL "bad" cholesterol. Below 100 milligrams per deciliter (mg/dl) is optimal for healthy people in the absence of coronary artery disease. If you have heart disease, your LDL should be below 70 mg/dl. Treatment decisions to reach appropriate levels need to be based on personal risk factors.

• High-density lipoprotein (HDL) cholesterol: We call HDL "good" cholesterol. It absorbs cholesterol in the blood and brings it to the liver, which flushes it from the body. For females, it should be above 50 mg/dl. For males, it should be above 40 mg/dl.

• Triglycerides: Triglycerides are a type of fat we use for energy. If you have too high of a triglycerides level, it can cause heart disease. Less than 150 mg/dl is optimal. 

• Total cholesterol: This is the sum of LDL and HDL cholesterol plus 20% of triglyceride levels. A total cholesterol level below 200 mg/dl is desirable.

Some people who are overweight may get heart disease not because their LDL is high but, rather, because their HDL is low and their triglycerides are high. That relationship can cause heart disease as much or even more than just high LDL cholesterol. These lipid abnormalities are significant for young people in their 30s or 40s who are overweight. Their triglyceride levels increase, and their HDL lowers. They're becoming prediabetic. Their LDL is staying the same, but they're still heading to heart disease. 

Treating high cholesterol depends on individual risk. The higher the risk — for example, with someone who already had a heart attack — a higher percent of reduction is needed. Medication to lower cholesterol can reduce LDL by about 60% to 65%. Lifestyle changes can reduce LDL by 10% to 15%. 

Several medications can help manage lipids. Discuss options with your healthcare team.

The body's ability to handle cholesterol is genetically determined. Genetic disorders that raise cholesterol levels are common. Familial hypercholesterolemia usually is caused by a genetic mutation preventing the body from clearing cholesterol. People with the condition are more likely to require medication to reduce their cholesterol levels. 

For people with genetic disorders that expose them to elevated cholesterol since birth, heart disease can happen at a younger age. So we start treating their high cholesterol with medication at a young age. 

Beyond medication, lifestyle modifications help manage lipids:

• Limit meat and dairy intake; they have saturated fat, which raises LDL cholesterol.
• Consume more fish, soluble fiber, fruit and vegetables. 
• Avoid diets high in carbohydrates, particularly refined carbs like sugar and white flour. They raise the blood sugar level quickly, raising triglycerides. Reducing simple refined carbohydrates helps lower triglycerides and weight because you store less fat. 
• Control your weight. It lowers your triglycerides and improves your HDL levels. 
• Exercise about 150 minutes of aerobic activity a week at a moderate intensity. Moderate intensity means you must breathe through your mouth. If you're breathing through your nose, that is low intensity. Exercise prevents cholesterol from building up, but it doesn't change LDL concentration levels. You must burn about 2,000 calories a week to lower LDL concentration. However, exercise helps lower triglyceride levels and maintain weight loss. 
• Do strength training at least twice a week. It helps your cardiovascular and muscular systems. Not everything we do to prevent heart disease is about cholesterol. 

The National Heart, Lung and Blood Institute recommends people get their first cholesterol screening between ages 9 and 11, and repeat it every five years. For men 45 to 65 and women 55 to 65, cholesterol screenings should occur every one to two years. Over 65? Test annually. More frequent testing may be needed for people who have or are at risk for coronary artery disease. — Regis Fernandes, M.D., Cardiovascular Medicine, Mayo Clinic, Phoenix

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Dr. Jesse Bracamonte, a Mayo Clinic family medicine physician, says it's important to seek medical advice if the condition persists. Getting evaluated can help identify and treat any underlying health conditions.

Watch: The Mayo Clinic Minute

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Sometimes, cold feet simply mean you need warmer socks. But if your feet are always cold, no matter the weather, it might be something more.

"Anything from circulatory problems, not having adequate blood flow, heart condition problems, immune or autoimmune conditions such as like having thyroid disease, and sometimes nerve or neuropathic problems. Having nerve disorders can cause cold feet," says Dr. Bracamonte.

Where to start? He offers a few immediate steps.

"Warm socks, lifting your feet, staying hydrated, diet, nutrition is really important. Exercise is important. And, obviously, if you smoke, don't smoke," he says.

If your feet remain to feel cold but are not cold to the touch, it might be time to see your healthcare team.

"There are certain tests that it can easily be done to ensure that you have no circulatory issues, and a few blood tests may be warranted just to make sure you have no autoimmune issues or even signs of anemia," Dr. Bracamonte says.

Related posts:

• Tapping regenerative sciences to unlock mysteries of peripheral neuropathy
• Mayo Clinic Minute: What may be causing your hands and feet to tingle

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Dr. Richard Sharpe Jr., a Mayo Clinic radiologist, says it's crucial to talk with your healthcare team to find the screening method that is right for you. An MRI is one option.

Watch: The Mayo Clinic Minute

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"The first thing to know if you get notified is that dense breast tissue is completely normal. 

Half of all women will have dense tissue," says Dr. Sharpe.

He says dense breasts are identified through a mammogram. Additional testing is the next step.

"The most widely available supplemental screening test for women with dense tissues is probably an ultrasound of the breast or an MRI," says Dr. Sharpe. "There have been lots of studies showing that MRI is the most sensitive test for finding breast cancer."

An MRI is meant to be used along with a mammogram, not instead.

"MRI is the most sensitive test we have for finding breast cancer. It can see through density. It can find hard-to-see, small cancers," says Dr. Sharpe.

But it's not for everyone. You'll lie face down on a table and then guided into the MRI machine."Some patients that have challenges with claustrophobia might struggle to be comfortable in the smaller space of the MRI scanner," explains Dr. Sharpe.

The benefit is clear, he says.

"Women with dense tissue or high risk for breast cancer that undergo breast MRI, we are able to see cancers that would be hiding from the mammogram."

Supplemental screening options

Other supplemental screening options include molecular breast imaging (MBI), ultrasound and contrast-enhanced mammography. 

Dr. Sharpe says choosing what screening method works for you is an individual decision that should be made with your healthcare team, but he says it's important to start with your annual screening.

"The most important thing for women to know is that you should get your annual mammogram, starting at age 40. Also, if you have dense tissue, consider a supplemental screening, another imaging test looking at the breast tissues in a different way — and you should get that exam regularly as well," he says.

"The most important thing for women to know is that you should get your annual mammogram, starting at age 40. Also, if you have dense tissue, consider a supplemental screening, another imaging test looking at the breast tissues in a different way — and you should get that exam regularly as well," he says.

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Dr. Jesse Bracamonte, a Mayo Clinic family physician, explains more about the health benefits of vitamin C in this Mayo Clinic Minute.

Watch: The Mayo Clinic Minute

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Want to keep the common cold away this winter?  Just drink more orange juice packed with vitamin C, right?

"We know that vitamin C does help your immune system function well. It helps with wound healing, helps with even collagen and joint protection, and even some tendon protection," says Dr. Bracamonte. "Overall, though, vitamin C taken in extra doses to prevent common colds hasn't proven true."

While it doesn't prevent you from getting a cold, Dr. Bracamonte says there is some limited research that additional vitamin C might speed up the recovery process slightly in some people. 

"So if you were going to have a common cold that lasts about seven days, it may cut it down about 13 hours," says Dr. Bracamonte.

He says you should be getting an adequate amount of vitamin C if you're including fruits and vegetables in your diet. But if you want to pump up the vitamin C even more, you could try a daily supplement.

"Most cases, it's 500 milligrams of vitamin C. Too much of anything is not necessarily a good thing. You just want to be mindful of how much you're taking, and you're not exceeding the recommendations of the daily allowance," says Dr. Bracamonte.

He says it's best to talk with your healthcare team before taking any new supplements.

Additional resources:

• Is too much vitamin C harmful?
• Mayo Clinic Minute: Do you need more vitamin D in the winter?

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Growing mini-organs to find new treatments for complex disease

Mayo Clinic investigators are growing three-dimensional human intestines in a dish to track disease and find new cures for complex conditions such as inflammatory bowel disease. These mini-organs function like human intestines, with the ability to process metabolites that convert food into energy on a cellular level and secrete mucus that protects against bacteria. These 3D mini-intestines in a dish, known as "organoids," provide a unique platform for studying the intricacies of the human gut.

"We think this has the potential to revolutionize the way we approach disease research. We hope to save time and resources and avoid the development of therapies that fail upon translation into patients," says Charles Howe, Ph.D., who leads the Translational Neuroimmunology Lab. "Understanding which treatments show potential for success in human organoids could dramatically accelerate the rate of new therapies for patients with unmet needs."

Brain stimulation shows promise in treating drug addiction

Physicians use neurostimulation to treat a variety of human disorders, including Parkinson's disease, tremor, obsessive-compulsive disorder and Tourette syndrome. A Mayo Clinic neurosurgeon and his colleagues believe one form of that treatment, called deep brain stimulation (DBS), is poised to solve one of the most significant public health challenges: drug addiction.

"Drug addiction is a huge, unmet medical need," says Kendall Lee, M.D., Ph.D., who has published nearly 100 journal articles on DBS along with his colleagues. Key to treating it, he says, is cutting off the pleasurable "high" that comes with the addiction — which DBS potentially can do.

A new class of AI aims to improve cancer research and treatments

Mayo Clinic researchers have invented a new class of artificial intelligence (AI) algorithms called hypothesis-driven AI, which is a significant departure from traditional AI models that learn solely from data. The researchers note that this emerging class of AI offers an innovative way to use massive datasets to help discover the complex causes of diseases, such as cancer, and improve treatment strategies.

"This fosters a new era in designing targeted and informed AI algorithms to solve scientific questions, better understand diseases and guide individualized medicine," says co-inventor Hu Li, Ph.D., a Mayo Clinic systems biology and AI researcher. "It has the potential to uncover insights missed by conventional AI."

What's lurking in your body? Mayo probes health risks of tiny plastic particles

Similar to natural elements like iron and copper, people can ingest, absorb, or even inhale microplastics and nanoplastics and their chemical additives. A landmark study published in the New England Journal of Medicine links microplastics and nanoplastics found in plaques of human blood vessels to a potential increased risk of heart attack, stroke or death.

"Plastics have made our lives more convenient and spurred many medical advances, but we must understand their impact on human health for the years to come," says Konstantinos Lazaridis, M.D., the Carlson and Nelson Endowed Executive Director for Mayo Clinic's Center for Individualized Medicine.

Mayo Clinic researchers' new tool links Alzheimer's disease types to rate of cognitive decline

Mayo Clinic researchers have discovered a series of brain changes characterized by unique clinical features and immune cell behaviors using a new corticolimbic index tool for Alzheimer's disease, a leading cause of dementia. The tool categorizes Alzheimer's disease cases into three subtypes according to the location of brain changes and continues the team's prior work, demonstrating how these changes affect people differently. Uncovering the microscopic pathology of the disease can help researchers pinpoint biomarkers that may affect future treatments and patient care.

"Our team found striking demographic and clinical differences among sex, age at symptomatic onset and rate of cognitive decline," says Melissa Murray, Ph.D., a translational neuropathologist at Mayo Clinic.

Mayo scientists explore swabs for early endometrial, ovarian cancer detection

Early detection improves treatment outcomes for endometrial and ovarian cancers, yet far too often, women are diagnosed when in advanced stages of these diseases. Unlike many other cancers, there are no standard screenings for early detection of endometrial and ovarian cancers. Mayo Clinic researchers have uncovered specific microbial signatures linked to endometrial and ovarian cancers, and they are working toward developing innovative home swab tests for women to assess their susceptibility.

"This research not only brings us closer to understanding the microbial dynamics in cancer, but also holds the potential to transform early detection and treatment strategies to positively impact women's health globally," says Marina Walther-Antonio, Ph.D., an assistant professor of surgery leading this research.

Reversing racism's toll on heart health

People who experience chronic exposure to racism may be affected by factors such as intergenerational trauma, reduced access to healthcare, differential treatment in healthcare settings and psychological distress. These negatively affect heart health and can have a cumulative effect throughout a person's life. Researchers from Mayo Clinic and the University of Minnesota published a paper which provides a new framework describing how racism affects heart health among people of color in Minnesota. The researchers are focused on reversing these disparities.

"This framework will help scientists explore and measure how chronic exposure to racism, not race, influences health outcomes," says Sean Phelan, Ph.D., a Mayo Clinic health services researcher. "This will help enable researchers to design interventions that address the root causes of these disparities and improve heart health for people of color everywhere."

Teamwork and research play a key role in Mayo Clinic's first larynx transplant

A team of six surgeons and 20 support staff combined expertise from the Department of Otolaryngology and the Department of Transplantation in an extraordinary 21-hour operation at Mayo Clinic. The team transplanted a donor larynx to a 59-year-old patient with cancer whose damaged larynx hampered his ability to talk, swallow and breathe. This groundbreaking surgery was only the third larynx transplant in the U.S., and the world's first known successful total larynx transplant performed in a patient with an active cancer as part of a clinical trial.

"All transplants are complex, but there are more tissue types and moving parts with laryngeal transplantation than other transplants," says David Lott, M.D., lead surgeon. "Mayo Clinic's team science approach made it possible for us to offer this type of transplant on a scale that was previously unattainable."

Space: A new frontier for exploring stem cell therapy

Two Mayo Clinic researchers say that stem cells grown in microgravity aboard the International Space Station have unique qualities that could one day help accelerate new biotherapies and heal complex disease. The research analysis by Abba Zubair, M.D., Ph.D., a laboratory medicine expert and medical director for the Center for Regenerative Biotherapeutics at Mayo Clinic in Florida, and Fay Abdul Ghani, Mayo Clinic research technologist, finds microgravity can strengthen the regenerative potential of cells. 

"Studying stem cells in space has uncovered cell mechanisms that would otherwise be undetected or unknown within the presence of normal gravity," says Dr. Zubair. "That discovery indicates a broader scientific value to this research, including potential clinical applications."

Mayo Clinic’s largest-ever exome study offers blueprint for biomedical breakthroughs

Mayo Clinic's Center for Individualized Medicine has achieved a significant milestone with its Tapestry study. It generated Mayo's largest-ever collection of exome data, which includes genes that code for proteins—key to understanding health and disease.  

Researchers analyzed DNA from over 100,000 participants of diverse backgrounds, providing important insights into certain genetic predispositions to support personalized and proactive medical guidance.  "The implications of the Tapestry study are monumental," says Konstantinos Lazaridis, M.D., the Carlson and Nelson Endowed Executive Director for the Center for Individualized Medicine. "As this study continues to inform and transform the practice of personalized medicine, it also sets a new standard for how large-scale medical research can be conducted in an increasingly digital and decentralized world."   

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news. 

Media contact:

• Colette Gallagher, Mayo Clinic Communications, newsbureau@mayo.edu

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PHOENIX, Ariz. — Mayo Clinic surgeons recently performed 10 organ transplants within 24 hours, setting a record for both the hospital and the state of Arizona.

On Nov. 19, Mayo Clinic teams worked around the clock to complete seven kidney transplants and three liver transplants. Transplant center colleagues rose to the challenge with one goal in mind: Saving as many lives as possible, says Bashar Aqel, M.D., director of Mayo Clinic Transplant Center in Arizona.

"Ten people received a second chance at life in a single day," Dr. Aqel says. "This milestone would not have been possible without the generous gift of organ donation, advances in technology and the dedication of our highly specialized team."

Heading into the record-setting day, three living-donor kidney transplants were already scheduled. But by evening, the team realized the magnitude of the day ahead of them as precious organs continued to become available. Organ perfusion devices proved critical, enabling the livers and some of the kidneys to be kept viable outside the donor's body for a longer period of time prior to transplant. The team also had to overcome logistical hurdles, ensuring enough operating room space was available to perform all the surgeries.

"Every day, an estimated 17 people die waiting for an organ transplant," Dr. Aqel says. "We are doing what we can to try to reverse that trend with innovation and organ perfusion to save more lives."

John Churan is among the 10 patients celebrating a second chance — one he never thought he would get. He was diagnosed with multiple myeloma 16 years ago, and when his kidney began to fail in 2020, his diagnosis appeared grim. But thanks to a stem cell treatment at Mayo Clinic, he went into full remission from the cancer, and he was eligible for a kidney transplant. His wife of 36 years, Julia Churan, stepped forward to donate her kidney and was a match.

"I would not be here without Mayo Clinic," John Churan says. "I am so grateful for the care I have received and the incredible gift my wife has given me."

###

About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Heather Carlson Kehren, Mayo Clinic Communications, newsbureau@mayo.edu

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On Dec. 18, 2023, the world went silent for Thomas Campbell. The active and vibrant 70-year-old lost his hearing in his left ear when he was 33 years old. And without much warning, on that December day, his hearing went out in his right ear, leaving him completely unable to hear.

When other medical centers couldn't help, Thomas turned to Mayo Clinic for answers. Dr. Nicholas Deep, a Mayo Clinic otolaryngologist, had a plan. 

Watch: Hope, healing, hearing: How a cochlear implant helps a man hear again

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In an instant, Thomas feared he would never hear the laughter of his grandkids again.

"I started getting this weird, you know, weird kind of weird noises, and hearing just subsided. And then, they just went out," says Thomas.

Thomas lost hearing in his left ear nearly 40 years ago, likely from exposure to loud industrial noises. Now, suddenly, the hearing in his right ear was gone.

"All kinds of things are just flashing through your mind — you know, got grandkids, can't hear anything. How am I going to get around? How am I going to communicate? You know, it's just, it's just … it's pretty, uh, pretty emotional," he shares.

After seeing multiple doctors who couldn't help, Thomas turned to Mayo Clinic and Dr. Deep.

"This is a person who was getting by with one ear — very busy running a business — that all of a sudden was sidelined by complete, profound, bilateral hearing loss. We treat hearing loss, sudden hearing loss, as an ENT, as an emergency. And so, of course, we got him right in. We got him a hearing test, confirmed the hearing loss and started working to rehabilitate his right ear," Dr. Deep says.

But rehabilitating that ear would take time. And Dr. Deep had another idea.

"His left ear has been deaf for over 35 years, and so I brought up the conversation of a cochlear implant," says Dr. Deep. "Those nerve synapses and connections between that ear and the brain, although they haven't been stimulated in many years, they can be revived, and so I felt confident that we could certainly get him back online." 

The surgery itself was less than an hour.

"The cochlear implant has two components: an internal component that we place the time of surgery, and the external component, which is the microphone. That's sort of like a hearing aid, but it sticks on by a magnet," Dr. Deep says.

Implanting the cochlear device was one step. Next was programming the device.

"An audiologist's job is to make the implant work. So we are actually determining what sound is sent through the implant to get the patient hearing optimally," shares Dr. Courtney Kolberg, a Mayo Clinic audiologist who worked with Thomas to program the implant.

She says success for patients is about collaboration.

"The patient journey is really a journey that we take together," Dr. Kolberg says.

And for Thomas, it's been quite the journey.

"I can't say enough about it — about the implant, the doctor — about Mayo Clinic. That's just been unbelievable. Hearing grandkids again … pretty incredible," says Thomas.

Thomas continues to work with Dr. Deep and team to help restore his full hearing. He will have surgery soon to have a second cochlear device implanted.

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There is new hope in the fight against glioblastoma, the deadliest and most aggressive form of primary brain cancer.

Currently there is no cure, but results of a new study conducted at Mayo Clinic show patients experienced improved overall survival while maintaining quality of life after undergoing a novel approach to treatment.

Watch: Breakthrough in the fight against glioblastoma

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Richard Casper was one of the study participants. The Arizona man enrolled in the clinical trial at Mayo Clinic in Phoenix after his diagnosis of glioblastoma in 2019. Richard was given only months to live, but his family says thanks to his strength, perseverance, and innovative medical care, he survived nearly double the amount of time.

"To be almost two and a half, three years in after being told you only have a few months, it's quite remarkable," says Susan Casper, Richard's daughter.

Richard succumbed to the disease in 2023. During the treatment, his family says he had little to no side effects. In the months before his passing, Richard stated, "I feel great. If someone didn't tell me I have the glioblastoma, I wouldn't even know it."

The clinical trial was led by Dr. Sujay Vora, a radiation oncologist at Mayo Clinic in Arizona. The small, single-arm study incorporated the use of advanced imaging technology combined with cutting-edge radiation therapy in patients over the age of 65 with newly diagnosed World Health Organization (WHO) grade 4 malignant glioblastoma.

"The patients lived longer than we expected. This patient population is expected to live six to nine months. Our average survival was 13.1 months. There were some patients that were out closer to two years. The results exceeded our expectations. We are very pleased," says Dr. Vora.

The study is published in The Lancet Oncology.

Why is glioblastoma so deadly?

Glioblastoma is among the most challenging cancers to treat. The disease is aggressive and invades healthy brain tissue with hairlike tentacles. "That is why doing a complete surgery is very difficult, as compared to say breast cancer, where a lumpectomy can be performed to remove not only the tumor, but a healthy rim of tissue around it," explains Dr. Vora.

Surgery for glioblastoma presents a different set of obstacles. "When it comes to glioblastoma, it is challenging to do that level of surgery. You try to surgically remove whatever you can safely without leaving the patient worse off after surgery."

Another factor that makes glioblastoma so lethal is that it can be fast- growing and unresponsive to treatment.

"These cancer cells are quite challenging to overcome," says Dr. Vora. "There are some patients we see after their surgery, and by the time we are ready to start their treatment, they've already had a recurrence of the disease."

An estimated 14,500 people will be diagnosed with glioblastoma in the U.S this year. "In the best of circumstances the average survival rates are in the 14-15 month range. But for patients 65 and older, the group that was the focus of our study, patients do even worse. The prognosis for this population is between six and nine months," says Dr. Vora.

Symptoms of glioblastoma

• Headache
• Nausea and vomiting
• Confusion or decline in brain function
• Memory loss
• Personality changes
• Vision changes
• Speech difficulties
• Trouble with balance
• Muscle weakness
• Seizures

Attacking glioblastoma with a triad

For the clinical trial, Dr. Vora and his team mapped out a plan that would allow them to be more intentional and precise with treating the location of the glioblastoma.

The imaging incorporated the use of ¹⁸F-DOPA PET and contrast-enhanced MRI. "¹⁸F-DOPA PET is an amino acid tracer that can cross the blood brain barrier, and it can accumulate within the glioblastoma cells itself," says Dr. Vora.

Researchers combined these images to determine the location of the most metabolically active "hot spots" of the cancer in the brain.

Taking aim with proton beam therapy

Study investigators used one of the most advanced forms of radiation treatment, called proton beam therapy.

"With standard radiation, the beams go through the brain tissue, so there's an entrance dose and the exit dose. But with proton beam therapy, we dial up how deeply we want the radiation to go," explains Dr. Vora. "It drops off its energy in the tumor, and then there's basically no radiation after that. It allows us to be more preferential into the delivery of radiation and protect more of the healthy surrounding tissue."

During proton beam therapy, a patient lies on a table while the machine rotates around the patient's head targeting the tumor with an invisible beam. The patient is awake for the procedure. It is painless with many patients reporting fewer to no side effects.

Unlike traditional radiation for glioblastoma, which is typically delivered over the course of three to six weeks, treatment with proton beam therapy for the study was conducted in one to two weeks.

"I am hopeful that this is the first step of many where we can continue to move the needle and allow patients to live longer and live well," says Dr. Vora. "The goal is to improve the outcomes for our patients allowing them to spend more time with their families."

Nadya's story

2022 was a tough year for Nadya El-Afandi. She was on the verge of celebrating a long but successful battle with breast cancer.

"Out of the blue, I had a seizure. I went to the hospital, they did an MRI. After additional tests they told me the news: 'You have a glioblastoma,'" recalls Nadya. She asked her doctor if she should continue her breast cancer treatment. "He said, 'No'-meaning the glioblastoma would kill me before the breast cancer."

Nadya was not about to give up.

Nadya is a wife and mother of four children. She lives just outside of Rochester, Minnesota. "My children said to me, 'Mom, you're a unicorn. Of course you'll live.' My mother has had a number of medical conditions and we never expected her to live this long. And she's still alive and with us," says Nadya. "My children have also said, 'You've got grandma's blood in you. You will live.'"

Nadya is receiving care at Mayo Clinic in Rochester. That's where she learned about a new clinical trial called SAGA, or stereotactic ablative radiation treatment for glioblastoma. The phase 2 clinical trial is building upon Dr. Vora's research and studying a larger group of patients. The study is being led by Dr. William Breen, radiation oncologist at Mayo Clinic in Rochester.

It has been 15 months since Nadya began treatment for glioblastoma. So far, there is no sign the glioblastoma has returned. "Nadya has already exceeded the time that's expected time to have a tumor recurrence, and she continues to do well," says Dr. Breen. "Nadya is beyond some measures of what the average, overall survival time would be."

While Nadya's progress in encouraging, Dr. Breen says it is important to note that it is too early to draw any conclusions about safety or efficacy of this approach to treatment until the study is completed.

Meanwhile, Nadya is focused on living her life to the fullest. Fifteen months after undergoing treatment, Nadya embarked on an adventure to Hawaii, where she spent time taking helicopter tours, snorkeling and hiking.

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• All-Star pitcher Liam Hendriks shares how he closed out cancer at Mayo Clinic in Arizona
• Cancer is tough. Evelyn Owens is tougher
• https://cancerblog.mayoclinic.org/2021/12/21/glioblastoma-in-older-adults-improving-survival-and-quality-of-life/
• https://cancerblog.mayoclinic.org/2024/05/15/technology-clinical-trials-offer-hope-after-glioma-diagnosis/

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PHOENIX — Mayo Clinic announces the results of an innovative treatment approach that may offer improvement in overall survival in older patients with newly diagnosed glioblastoma while maintaining quality of life. Glioblastoma is the most lethal type of primary brain cancer due to its aggressive nature and its treatment-resistant characteristics. It is the most common form of primary brain cancer. Each year an estimated 14,500 people in the U.S. are diagnosed with the disease. Results of Mayo Clinic's phase 2, single-arm study are published in The Lancet Oncology.  

Sujay Vora, M.D., radiation oncologist at Mayo Clinic, led a team of researchers investigating the use of short-course hypofractionated proton beam therapy incorporating advanced imaging techniques in patients over the age of 65 with newly diagnosed World Health Organization (WHO) grade 4, malignant glioblastoma.

Results showed that 56% of participants were alive after 12 months and the median overall survival was 13.1 months." As compared to prior phase 3 studies in an older population having a median survival of only six to nine months, these results are promising," says Dr. Vora. "In some cases, patients with tumors that have favorable genetics lived even longer, with a median survival of 22 months. We are very excited about these results."

Glioblastoma is among the most challenging cancers to treat. The disease invades healthy brain tissue with hairlike tentacles, making surgical removal intricate. Surgeons must carefully balance removing as much of the tumor as possible while avoiding harm to critical areas of the brain responsible for essential functions such as movement and speech. Additionally, the tumor's cellular composition and its ability to evade therapies further challenge treatment efforts.

Standard radiation therapy is commonly used to treat glioblastoma and can be effective. However, a limitation is that it also exposes healthy brain tissue to radiation, potentially causing collateral, unintended damage. For the Mayo Clinic study, investigators used one of the most innovative and advanced forms of radiation treatment, called proton beam therapy. The cutting-edge, nonsurgical form of radiation therapy destroys cancer cells with targeted precision while minimizing side effects to surrounding healthy tissue.

Mayo investigators mapped the target area in the patient's brain by combining the advanced imaging technologies, including ¹⁸F-DOPA PET and contrast-enhanced MRI. "Combining advanced imaging allowed us to determine the most metabolically active, or aggressive, regions of the glioblastoma," says Dr. Vora.

Treatment was completed in one to two weeks instead of the traditional three to six weeks. "The advanced imaging along with the proton beam therapy allowed us to be more focused with radiation and protect surrounding healthy brain tissue from the effects of radiation. We were able to see that patients tolerated the treatments well and lived longer than we expected."

According to Dr. Vora, the study at Mayo Clinic is the first clinical trial of its kind investigating the use of short-course hypofractionated proton beam therapy incorporating advanced imaging technology, including ¹⁸F-DOPA PET and contrast-enhanced MRI targeting, for patients 65 and older with newly diagnosed glioblastoma.

The study included patients from Arizona and Minnesota. One of the study participants, Richard Casper, lived nearly two years longer than his prognosis. "I feel great. If someone didn't tell me I had the glioblastoma, I wouldn't even know it," reported Casper after undergoing treatment. He succumbed to the disease in 2023. "We miss our dad dearly," says his daughter, Susan Casper. "We will forever be grateful for the extra time we had with our father. The time gave us a chance to make memories that will last us a lifetime. It was also important to my father to participate in this study in hopes of helping others fight glioblastoma."

A larger, randomized clinical trial is now underway at Mayo Clinic. One of the study participants is Nadya El-Afandi, a wife and mother of four, who lives in St. Paul, Minnesota. She was diagnosed with glioblastoma in 2022. El-Afandi is now 15 months post-treatment with no sign of glioblastoma. "I feel wonderful," says El-Afandi. "I've had my fourth MRI, and we're not seeing any return of the glioblastoma."

El-Afandi is back to her regular activities and just returned from a trip to Hawaii, where she spent time snorkeling and hiking. "We are living on the edge of medical miracles, and we are riding that tide. There's no cure for glioblastoma yet, but I've been able to take advantage of this medical opportunity, and it has given me a quality of life that is just outstanding," adds El-Afandi.

While El-Afandi's results are encouraging, William Breen, M.D., radiation oncologist and principal investigator of the current study says it is too early to draw any conclusions about the safety and efficacy of the treatment until the study is complete. "Our goal is to transform the way we treat glioblastoma using shorter courses of radiation to minimize the burden on patients and their families and help them complete safe and effective treatment in a shorter amount of time."

The clinical trial, known as SAGA, or stereotactic ablative radiation treatment for glioblastoma, includes patients from Arizona, Florida and Minnesota. "We are now adding another component that builds upon Dr. Vora's work to help us best visualize the tumor," says Dr. Breen.

Meanwhile El-Afandi is focusing on living her life to the fullest. "I'm so grateful," says El-Afandi. "Every day is the best day, and I'm going to enjoy every minute of it."

The study was funded by The Kemper and Ethel Marley Fund in Cancer Research and the Lawrence W. and Marilyn W. Matteson Fund in Cancer Research. For a detailed list of the authors and disclosures, see the full paper here.

Press kit, including b-roll, photos and interviews, available here.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Marty Hames, Mayo Clinic Communications, newsbureau@mayo.edu

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• (VIDEO) Breakthrough in the fight against glioblastoma
  

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PHOENIX — You may be familiar with a range of tips for living a healthy life: Watch your weight, exercise, eat nutritious food and don’t smoke, for example. What if you could combine these lifestyle factors with a host of other variables to learn your risk of developing specific diseases, to help catch and treat them early or prevent them altogether? Victor Ortega, M.D., Ph.D., associate director for the Mayo Clinic Center for Individualized Medicine in Arizona, explains how science is drawing ever closer to making such personal health forecasts possible.

Previously inconceivable, such personal guides to well-being are becoming increasingly possible because of new and sophisticated genome-wide technologies that capture data spanning entire genomes, Dr. Ortega says. The complex scores are compiled from a combination of data from thousands to hundreds of thousands of a person's DNA sequence variants. This type of large genome-wide data has the potential to predict disease risks, such as heart disease, diabetes, asthma and specific cancers.

"Imagine knowing your genetic predisposition for having a heart attack in your 50s, or if you're in the top 5% of the population for the risk of cancer or diabetes based on data from your whole genome. With this knowledge, you could make informed lifestyle choices and receive enhanced screenings to mitigate that risk," Dr. Ortega says.  

As a pulmonologist and genomic scientist, Dr. Ortega is leading a charge to breathe new life into precision medicine advancements. His mission is rooted in a deep commitment to health equities and inspired by his grandmother. 

"My grandmother died of asthma, and that should not have happened. She was Puerto Rican like me, and Puerto Ricans have the highest severity and frequency of asthma of any ethnic group in the world," Dr. Ortega says. "They also represent less than 1% of people in genetic studies. So, I've made it a life mission to develop cures and diagnostics for people like my grandma, and for all people." 

Each person has millions of genetic variants, each having a small effect. But together, these variants can increase the risk of getting a condition. A polygenic risk score estimates the overall risk someone has of getting a disease by adding up the small effects of variants throughout an individual’s entire genome. 

Polygenic risk scores are not used to diagnose diseases. Some people who don't have a high-risk score for a certain disease still can be at risk of getting the disease or might already have it. Other people with high-risk scores may never get the disease.

People with the same genetic risk can have different outcomes depending on other factors such as lifestyle which determine one’s lifelong environmental exposures, also called the exposome.

Dr. Ortega says that getting to the point where all people know their polygenic risk scores will require a solid foundation of "omics" research and datasets, cutting-edge technologies and further discoveries of gene-disease links — all of which are within his team's expertise and capabilities.

Omics is an emerging multidisciplinary field of biological sciences that encompasses genomics, proteomics, epigenomics, transcriptomics, metabolomics and more.

"It's going to take considerable work and planning, but it really is the way of the future," he says.

In the shorter term, Dr. Ortega plans to transition more omics discoveries from research laboratories to the clinic. Omics data can help identify the molecular culprits driving a person's disease, as well as biomarkers that can lead to the development of targeted treatments and diagnostics.

Recent omics discoveries at Mayo Clinic's Center for Individualized Medicine have enabled scientists to predict antidepressant response in people with depression and discover a potential therapeutic strategy for bone marrow cancer. Scientists have also used omics to pinpoint genetic variations that potentially increase the risk for severe COVID-19, uncover potential clues for preventing and treating gliomas and unravel the genetic mystery of a rare neurodevelopmental disorder.

Drawing from his years of extensive clinical experience in treating patients with severe respiratory illnesses, Dr. Ortega is also working to expand genomic testing to a broader set of diseases. He highlights the center's collaborative Program for Rare and Undiagnosed Diseases as an effective model that he hopes to amplify.

The Program for Rare and Undiagnosed Diseases proactively engages healthcare teams across Mayo's clinical practice to conduct targeted genomic testing for patients with a suspected rare genetic disease. He says expanding this strategy to more diseases will help build collaborations across Mayo and educate more clinicians on genomics. It may also ensure the most effective genomic sequencing tests are given to patients, ultimately improving patient care and outcomes.

Dr. Ortega is leading the development of a polygenic risk score framework for Mayo Clinic, beginning with interstitial lung disease. This condition, marked by progressive scarring of lung tissue, is influenced by both rare gene variants and a collection of more common variants, all of which are captured together in polygenic risk scores.

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About Mayo Clinic 
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and to providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Sharon Theimer, Mayo Clinic Communications, newsbureau@mayo.edu

The post What’s your health forecast? Expert explains science behind personal guides to well-being appeared first on Mayo Clinic News Network.