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ROCHESTER, Minn. — Aug 26, 2013 — An increasing gap between the incidence of thyroid cancer and deaths from the disease suggests that low-risk cancers are being overdiagnosed and overtreated, a study from the
Mayo Clinic Center for the Science of Health Care Delivery finds. The study appears in the current issue of BMJ.
“High tech imaging technologies such as ultrasound, CT and MRI can detect very small thyroid nodules many of which are slow growing papillary thyroid cancers, says the study’s lead author Juan Pablo Brito, M.B.B.S. an endocrine fellow and health care delivery scholar at Mayo Clinic. “This is exposing patients to unnecessary and harmful treatments that are inconsistent with their prognosis.”
Dr. Brito says the surgical removal of all or part of the thyroid gland is a costly procedure and includes a risk of complications such as low calcium levels and nerve injury. Surgical removal procedures in the United States have tripled in the past 30 years — from 3.6 per 100,000 people in 1973 to 11.6 per 100,000 people in 2009.
“Uncertainty about the benefits and harms of immediate treatment for low-risk should spur clinicians to engage patients in shared decision-making to ensure treatment is consistent with the research evidence and patient goals,” Dr. Brito says.
To help provide context for patients, Dr. Brito recommends the development of a new term that connotes a favorable prognosis for low-risk thyroid cancers, such as microPapillary Lesions of Indolent Course (microPLIC). A new term would make it easier for clinicians to offer patients the choice of active surveillance instead of immediate and often intensive treatment. He also calls for research to identify the appropriate care for these patients.
About Mayo Clinic
Recognizing 150 years of serving humanity in 2014, Mayo Clinic is a nonprofit worldwide leader in medical care, research and education for people from all walks of life. For more information, visit 150years.mayoclinic.org, http://www.mayoclinic.org and newsnetwork.mayoclinic.org.
MULTIMEDIA ALERT: For audio and video of Sahra Borges, Ph.D., talking about the study, visit the Mayo Clinic News Network.
JACKSONVILLE, Fla. — A drug used to treat blood cancers may also stop the spread of invasive breast cancer, researchers at Mayo Clinic in Florida have discovered. Their study, published online in Breast Cancer Research, found that in the lab and in animals, the drug decitabine turns on a gene coding for protein kinase D1 (PRKD1) that halts the ability of cancer cells to separate from a tumor and spread to distant organs.
“Treatment with low doses of decitabine in an animal model of breast cancer restored PRKD1 expression, reduced tumor size, and blocked metastasis to the lung,” says the study’s senior investigator, Peter Storz, Ph.D., a biochemist and molecular biologist at Mayo Clinic in Florida.
“The outcome of patients with invasive breast cancer is less than optimal despite many attempts to improve treatment, including advanced chemotherapy and hormonal therapy,” says Dr. Storz. “We hope this study offers a new avenue to prevent breast cancer from becoming aggressive and untreatable.”
The research team, which includes first author Sahra Borges, Ph.D., a postdoctoral researcher in Dr. Storz’s lab, found that the gene coding for PRKD1 was silenced in all but one subtype of invasive breast cancer, including aggressive triple negative breast cancer. That subtype is invasive lobular carcinoma.
Dr. Borges also developed an assay that can be used to measure the amount of PRKD1 that is silenced in patients’ breast tumors.
“Because we found that PRKD1 is increasingly silenced as breast cancer becomes aggressive and spreads, the hope is that this test can be further developed and used to predict which patients are at risk for cancer metastasis, and thus may benefit from decitabine,” Dr. Borges says.
Decitabine, approved by the U.S. Food and Drug Administration for use in some blood cancers, is a demethylating agent, meaning that it can switch on beneficial genes such as PRKD1 that cancer has silenced in order to grow.
Treating genes that are silenced is much easier than trying to restore function of a mutated gene, Dr. Storz says. The normal function of PRKD1, which is expressed in cells of the mammary gland, is to maintain normal function by preventing cells from morphing into a state where they can dislodge and spread, he says.
The researchers hope this study will help them to design a clinical trial in collaboration with Mayo Clinic physicians using decitabine to promote re-expression of PRKD1 and agents that activate PRKD1.
The study’s other key researchers at Mayo include Heike Doeppler, Edith Perez, M.D., Cathy Andorfer, Ph.D., Zhifu Sun, M.D., Panos Anastasiadis, Ph.D., E. Aubrey Thompson, Ph.D., and Xochiquetzal J. Geiger, M.D. The study was supported by the National Institutes of Health (GM086435), the Bankhead-Coley Program of the Florida Department of Health, Mayo Clinic Breast Cancer SPORE, Breast Cancer Foundation, and from the 26.2 with Donna Foundation.
Aug 22, 2013 · Mayo Clinic to Open Stem Cell Laboratory in Phoenix
PHOENIX — Mayo Clinic in Arizona, with one of the most active bone marrow transplant programs in United States, will open its own stem cell laboratory in summer 2014. The laboratory will be initially dedicated to storing and processing stem cells used for bone marrow transplants at Mayo Clinic Hospital and Phoenix Children’s Hospital.
Mayo Clinic is a regional referral center and performs more than 200 adult stem cell transplants each year and approximately 30 pediatric transplants with Phoenix Children’s. The program is accredited by the Foundation for the Accreditation of Cellular Therapy and the National Bone Marrow Donor Program.
Stem cell (blood or marrow) transplant is the infusion or injection of healthy stem cells into the body to replace damaged or diseased stem cells. Although the procedure to replenish the body’s supply of healthy blood-forming cells is generally called a stem cell transplant, it’s also known as a bone marrow transplant, peripheral blood stem cell transplant or an umbilical cord blood transplant, depending on the source of the stem cells. Stem cell transplants can use cells from a person’s own body (autologous stem cell transplant), from a donor (allogeneic stem cell transplant) or from an identical twin (syngeneic transplant).
Mayo Clinic’s Bone Marrow Transplant program provides consultations, evaluations and treatment for patients who would potentially benefit from a stem cell transplant. Patients who are younger than age 18 are cared for through Mayo Clinic’s pediatric program at Phoenix Children’s Hospital.
The new 6,200-square-foot lab will be located on the Phoenix campus of Mayo Clinic in Arizona. Mayo Clinic physicians say the new lab will help increase capacity, improve turnaround times for processing and provide the potential for research-related activities including regenerative medicine.
SCOTTSDALE, Ariz. – Intense Pulsed Light therapy (IPL) is being used at Mayo Clinic in Arizona to treat chronic dry eye, a condition affecting millions of people in the U.S., particularly those in the desert Southwest.
Video Alert::To view a video of Dr. Patel discussing the IPL therapy, visit the <ahref=”https://newsnetwork.mayoclinic.org/”>Mayo Clinic News Network
The standard treatment for chronic dry eye includes medications, daily eye drops and ointments to nourish the surface of the eye. In some cases, patients have been prescribed omega 3 fatty acid supplements and topical steroids. Left untreated, chronic dry eye can lead to impaired vision or scarring of the eye.
The IPL treatment targets patients who have evaporative dry eye, a subset of chronic dry eye. The condition results from ocular rosacea, inflammation of the eyelid skin, which causes the meibomian glands in the eyelids to fail to produce enough natural oil to slow the evaporation of tears. When that happens, patients experience a burning or gritty sensation, blurry vision and redness of the eyes.
The treatment provides relief for patients who have exhausted or failed to tolerate other treatment options such as drops, compresses or doxycycline pills.
IPL uses bursts of light directed at the lower eyelids and upper cheek areas that heat the eyelid glands that are blocked with stagnant secretions. The physician is then able to manually express the stagnant material from the eyelids.
Most patients require four monthly treatments to see full results, but many notice some transient improvement after a single treatment. For patients severely affected with evaporative dry eye, maintenance treatments are recommended every three to six months.
There are 30 centers around the U.S. offering this treatment, and now it is one of several in the arsenal of treatments for chronic dry eye at Mayo Clinic in Arizona.
Another treatment for dry eye at Mayo Clinic is LipiFlow. This system can evaluate the oil tear film thickness on the surface of the eye. If the patient is eligible, depending on the number of blocked meibomian glands, the LipiFlow treatment is used. Drs. Shen and Patel reserve this treatment for less inflamed dry eye patients.
In this treatment, a single-use eyepiece is placed over the eye that provides a controlled application of warmth and massage to the lids. Following the 12-minute massaging, the blocked oil glands are emptied, allowing for production of healthy oils that are critical for a healthy tear film.
“Patients with chronic dry eye experience more than inconvenience,” says Dr. Shen. “The condition can impact their field of vision, can cause pain and can significantly impact their quality of life.
Causes of dry eye include side effects from medication, age, climate and excessive eye strain due to staring at a computer for long periods of time.
Some 5 million Americans are estimated to have chronic dry eye, and many others have been suffering but have not yet been diagnosed.
- For audio and video of Dr. Parker and the Carmichaels talking about the gift and individualized medicine, visit the
JACKSONVILLE, Fla. — You have a serious medical condition, but conventional tests fail to find an answer. You have no diagnosis and no effective treatment. What do you do? Mayo Clinic has always been a destination for patients seeking answers. Now, Mayo is taking that concept to the next level with the public launch of its Individualized Medicine Clinic at its Florida campus.
To help Mayo Clinic physicians and researchers usher in a new age of medicine that uses technologies like whole genome sequencing to find solutions for patients, Amelia Island, Fla., residents and philanthropists Cecilia and Dan Carmichael have donated $5 million to Mayo.
“If our daughter or our granddaughters were to get cancer, hopefully it could be cured immediately and there would not be this thing hanging over them that any time it could come back,” Cecilia Carmichael says.
“It’s really an exciting time,” Dan Carmichael says. “We want to support the Mayo staff that we’ve gotten to know and love in transforming care for our family and others.”
The Mayo Clinic Individualized Medicine Clinic offers two types of consulting: one for cancer patients for whom standard treatments have failed, and one for “diagnostic odyssey” cases — complex or mysterious disorders that are difficult to diagnose, but appear to have a genetic cause.
“We are leveraging innovative genomic technologies so our physicians can understand a patient’s disease at its most fundamental level and use that information to find answers specific to that patient’s needs,” says Alexander Parker, Ph.D., an epidemiologist and Florida-based associate director of the Mayo Clinic Center for Individualized Medicine.
A multidisciplinary team of experts will work closely with patients and their physicians to determine whether a patient is a good candidate for tests to identify genetic alterations that could help guide treatment. The team includes physicians trained in genomics, genomic scientists, genetic counselors, bioinformatics experts, laboratory professionals and bioethics representatives.
“We are very grateful for the Carmichaels’ gift, which is accelerating the translation of genomics to patient care,” Dr. Parker says. “Their generosity is helping us move from talking about the promise of genomic medicine to making it a reality for patients.”
The Carmichaels’ $5 million donation establishes the Cecilia and Dan Carmichael Family Associate Director for the Center of Individualized Medicine in Florida, as well as the Cecilia and Dan Carmichael Family Fund for Individualized Breast Cancer Medicine Honoring Edith Perez, M.D. The donation builds upon the Carmichael’s previous generosity. In 2008, they established the Mayo Clinic Carmichael Family Endowed Fund for Individualized Breast Cancer Medicine and also provided funds for an assistant to Dr. Perez in the Breast Clinic at Mayo Clinic.
ROCHESTER, Minn. — A new population-based study has found that patients with glioblastoma who died in 2010, after the Food and Drug Administration (FDA) approval of bevacizumab, had lived significantly longer than patients who died of the disease in 2008, prior to the conditional approval of the drug for the treatment of the deadly brain cancer. Bevacizumab is used to treat patients with certain cancers whose cancer has spread. The study appears in the journal Cancer.
MULTIMEDIA ALERT: For audio and video resources, please visit the Mayo Clinic News Network.
“There has been a great deal of debate about the effectiveness of bevacizumab in treating patients with glioblastoma,” says lead author Derek Johnson, M.D., a neuro-oncologist at Mayo Clinic Cancer Center. “Our study found that, at the population level, treatment strategies involving bevacizumab prolonged survival in patients with progressive glioblastoma.”
Researchers analyzed data on 5,607 adult patients from the National Cancer Institute (NCI) Surveillance, Epidemiology and End Results (SEER) database before and after the conditional approval of bevacizumab for the treatment of glioblastoma in 2009. The SEER database covers 18 geographic areas of the U.S., which collectively represent 28 percent of the U.S. population.
Researchers studied survival in 1,715 patients with glioblastoma who died in 2006, 1,924 who died in 2008 and 1,968 who died in 2010. “The difference in survival between 2008 and 2010 was highly significant and likely unrelated to any advancements in supportive care,” Dr. Johnson says. “This study provides the strongest evidence to date that bevacizumab therapy improves survival in patients with glioblastoma.”
Glioblastoma, is an aggressive cancer in which tumors grow rapidly and spread rapidly to new sites. It is the most common malignant brain tumor in adults and accounts for about 22 percent of all brain cancers. About 3,000 people develop a glioblastoma each year in the U.S.
Co-authors include Heather Leeper, M.D., and Joon Uhm, M.D. both of Mayo Clinic.
About Mayo Clinic Cancer Center
As a leading institution funded by the National Cancer Institute, Mayo Clinic Cancer Center conducts basic, clinical and population science research, translating discoveries into improved methods for prevention, diagnosis, prognosis and therapy. For information on cancer clinical trials, call
JACKSONVILLE, Flórida — Uma droga aprovada recentemente para o tratamento de mieloma múltiplo está sendo testada para comprovar sua capacidade de combater o linfoma do sistema nervoso central (SNC), um câncer fatal do sistema imunológico, que pode afetar o cérebro, a medula e fluido espinhal e os olhos. O estudo clínico, que está em andamento nas três unidades da Clínica Mayo — na Flórida, Minnesota e Arizona — dá prosseguimento ao teste bem-sucedido da droga, a pomalidomida, em camundongos com linfoma do SNC. Os detalhes sobre o teste pré-clínico estão disponíveis no jornal científico PLOS ONE.
Aproximadamente 5.000 pacientes são diagnosticados com essa doença, todos os anos, nos Estados Unidos.
“Acreditamos que a pomalidomida pode beneficiar pacientes com esse tipo de câncer porque ela faz duas coisas que as demais drogas contra o câncer não fazem”, diz o oncologista da Clínica Mayo de Jacksonville, na Flórida, Han Tun. “A droga tem uma excelente penetração no cérebro, o que é uma necessidade no tratamento de tumores cerebrais. O outro fator interessante é que essa droga, além de atacar diretamente as células do linfoma, também altera o microambiente do tumor”, ele explica.
Han Tun é o principal pesquisador do estudo PLOS ONE e o principal pesquisador do estudo clínico, que está recrutando pacientes.
“Nosso estudo pré-clínico sugere que a pomalidomida é muito promissora. O tratamento com pomalidomida em camundongos contra o linfoma do SNC aumentou significativamente a sobrevivência e o crescimento do tumor”, ele diz. “O estudo clínico de fase I foi desenvolvido com base nesses resultados pré-clínicos”, diz o oncologista da Mayo.
A pomalidomida pertence à classe de drogas chamadas de agentes imunomoduladores. A talidomida foi a primeira droga dessa classe e foi aprovada em 2006 para o tratamento do mieloma múltiplo, um câncer da medula óssea. A pomalidomida foi aprovada para uso em mieloma múltiplo em fevereiro.
Entre os coautores do estudo estão cinco pesquisadores da Celgene, a fabricante da pomalidomida. Outros coautores são Zhimin Li, Ph.D.; Yushi Qiu, M.D.; Peng Huang, M.D., Ph.D.; David Personett; Brandy Edenfield; e John Copland, Ph.D., todos da Clínica Mayo da Flórida.
O oncologista Han Tun recebeu uma verba da Celgene em apoio à pesquisa.
Para mais informações sobre tratamento de mieloma múltiplo, linfoma do sistema nervoso central e outros tipos de câncer na Clínica Mayo de Jacksonville, Flórida, contate o departamento de Serviços Internacionais pelo telefone 904-953-7000 ou envie um email para firstname.lastname@example.org.
JACKSONVILLE, Flórida — Depois de sobreviver a dois transplantes de pulmão, em 2005 e 2008, o músico Larry Rawdon compartilha uma nova forma de cura por música com outros pacientes da Clínica Mayo de Jacksonville, Flórida. Afinal, foi a música que o levou à Clínica Mayo e o ajudou a se recuperar, depois que foi diagnosticado, em 2002, com fibrose pulmonar idiopática.
Antes de chegar à Clínica Mayo, Rawdon tinha poucas esperanças de que sua doença iria melhorar. Mas um encontro casual com o cirurgião cardiotorácico Octavio E. Pajaro, M.D., durante um festival de música, em 2005, mudou seu ponto de vista sobre seu problema e trouxe esperança para Rawdon e sua família.
“Os instrumentos musicais sempre exerceram um impacto significativo em minha vida, que se estende além da própria música”, diz Rawdon. “Foi o que realmente iniciou meu relacionamento com a Clínica Mayo e exerceu um papel importante nas mudanças em minha vida”.
Amante de tudo que se refere à música, Rawdon se sentiu atraído por diversos instrumentos musicais. Sua carreira como violoncelista profissional o levou à Broadway e a experimentar um grande número de instrumentos. Assim, quando sua mulher Katie soube dos benefícios que tocar a gaita trazia para pacientes da medicina pulmonar, ela percebeu que havia encontrado o presente de Natal perfeito para seu marido.
“No Natal de 2007, ganhei duas gaitas de minha mulher e comecei, imediatamente, a me ensinar a tocar esse novo instrumento, observando outros músicos em vídeos no YouTube, conta Rawdon.
Sua paixão por compartilhar a gaita vem de sua experiência de reabilitação com ou sem esse instrumento.
Depois de seu segundo transplante de pulmão em 2008, Rawdon não perdeu tempo e pegou sua gaita para suplementar os exercícios prescritos de reabilitação pulmonar. Ele observou resultados significativamente positivos.
Rawdon notou que quando tocava a gaita por 10 minutos, durante exames de espirômetro de incentivo, as pontuações de capacidade pulmonar eram substancialmente elevadas, depois de tocar o instrumento.
Rawdon relatou seu êxito pessoal ao médico Cesar Keller, do Departamento de Serviços de Transplantes da Flórida.
“Pessoalmente, penso que essa técnica é um acréscimo e um complemento muito bom a todo o processo de recuperação geral de um transplante de pulmão”, diz Cesar Keller. “Ela combina uma terapia respiratória excelente com a diversão e produz um resultado imediato, decorrente da execução do instrumento musical”, ele explica.
O impacto profundo de tocar a gaita levou Rawdon a compartilhar seu amor pelo instrumento e por sua capacidade de reabilitação com outros pacientes no Grupo de Transplante do Coração e do Pulmão de Jacksonville. Em fevereiro, Rawdon começou a dar aulas de gaita aos demais pacientes, como um exercício de reabilitação pulmonar suplementar. As aulas são divertidas, envolventes e, além disso, trazem benefícios para os pacientes em processo de recuperação pulmonar.
“Estou convencido de que a gaita, para os pacientes de transplante de pulmão, pode ser considerado uma parte de um equipamento legítimo de exercício respiratório”, diz Rawdon. “Além de tudo o mais que a gaita passou a representar para mim, é especialmente gratificante ouvir de outros pacientes de transplante que eles também estão se beneficiando o uso da gaita, pelo que estão percebendo”.
Rawdon vem trabalhando diligentemente para ajudar a reunir recursos para desenvolver aulas de música de uma forma regular aos pacientes. Ele fez parceria com Chrys Yates, coordenadora do Centro para Humanidades em Medicina da Flórida, para ajudar a angariar suporte para a equipe da Clínica Mayo.
Ele contatou, por iniciativa própria, a Hohner Inc., uma grande fabricante de gaitas, para ajudar a fornecer o instrumento para os pacientes. Depois que Rawson contou sua história sobre a reabilitação com a ajuda da gaita ao presidente e associado de filantropia, a empresa se ofereceu para doar gaitas ao programa de Humanidades em Medicina, garantindo os instrumentos necessários para as aulas.
“A terapia respiratória é inestimável no processo de recuperação de pacientes de doenças pulmonares”, explica Keller. “Depois de um transplante de pulmão, o caminho para uma recuperação completa depende, em grande medida, de o receptor do órgão conseguir recuperar sua capacidade funcional, após o processo debilitador de uma doença crônica e progressiva do pulmão. Isso é sempre complicado devido ao forte impacto fisiológico de uma grande cirurgia, como a de transplante de pulmão”, ele diz. “Portanto, os papéis da terapia física, os exercícios para recuperar a resistência física e o vigor, bem como os exercícios de respiração para recuperar músculos diafragmáticos e respiratórios são fundamentais no processo de recuperação”.
Para mais informações sobre tratamento da fibrose pulmonar idiopática e outras doenças respiratórias na Clínica Mayo de Jacksonville, Flórida, contate o departamento de Serviços Internacionais pelo telefone 904-953-7000 ou envie um email para email@example.com.