Latest / Morning Medical with Dr. Chow / Global Cancer Rates, Malaria Prevention, and Dietary Insights on Psoriasis

Transcript

Global Cancer Rates, Malaria Prevention, and Dietary Insights on Psoriasis · Morning Medical with Dr. Chow

• 0:00
  Good morning, everyone!
• 0:01
  Welcome to another episode of Morning Medical with Dr.
• 0:04
  Chow.
• 0:04
  I'm Dr.
• 0:05
  Chi-Ming Chow, and I'm here to bring you the latest updates in the world of medical and
• 0:09
  health news.
• 0:11
  Today, we're diving into some pressing issues that have been making headlines, and we're
• 0:16
  starting with a topic that affects millions around the globe: cancer.
• 0:21
  Let's get into it.
• 0:25
  A recent report from The Lancet medical journal has highlighted a concerning trend: by the year
• 0:31
  2050, the number of cancer cases and deaths worldwide is expected to skyrocket.
• 0:38
  Here in Canada, our health-care systems need to brace for this increase, even though
• 0:43
  age-standardized cancer rates are actually declining.
• 0:47
  So, what's driving these projections?
• 0:49
  Well, it primarily comes down to our aging population.
• 0:53
  As more Canadians live longer, the number of people diagnosed with cancer is naturally
• 0:58
  expected to rise.
• 1:01
  In 2023, there were 18.5 million new cancer cases globally, excluding non-melanoma skin
• 1:08
  cancers.
• 1:09
  By 2050, researchers anticipate this number will jump to 30.5 million.
• 1:16
  And it's not just the cases that are increasing; cancer deaths are also projected to
• 1:20
  rise significantly.
• 1:22
  From 10.4 million cancer deaths in 2023, we're looking at an estimated 18.6 million deaths by
• 1:29
  2050.
• 1:30
  That's a staggering 75 percent increase in cancer-related mortality since 2024.
• 1:37
  The study points out that the three most deadly cancers worldwide—those affecting the windpipe
• 1:43
  and lungs, colon and rectum, and the stomach—are expected to see increases by 2050.
• 1:50
  In high-income countries like Canada, this uptick is largely due to the aging and growing
• 1:55
  populations.
• 1:56
  Professor Ali Mokdad from the University of Washington, one of the study's authors,
• 2:02
  emphasizes that we will see more cancer cases simply because Canadians are living longer
• 2:07
  lives.
• 2:09
  Interestingly, when researchers adjusted the data to account for age, they found that the
• 2:14
  likelihood of an individual developing cancer is actually declining in high-income countries.
• 2:21
  From 1990 to 2023, cancer rates decreased by 9 percent per 100,000 people, while cancer deaths
• 2:29
  fell by 29 percent.
• 2:31
  This is a testament to advancements in early diagnosis and treatment.
• 2:37
  Canada's universal health care system plays a crucial role in diagnosing cancer cases earlier
• 2:41
  compared to some other countries.
• 2:44
  However, in low and middle-income countries, the situation is different.
• 2:48
  Factors such as smoking, environmental pollution, and alcohol consumption are
• 2:53
  contributing to rising cancer rates and deaths, even after adjusting for age.
• 2:58
  Tobacco use alone is linked to 21 percent of cancer deaths globally.
• 3:03
  Professor Mokdad warns that even in countries like Canada, where mortality rates are on the
• 3:08
  decline, the absolute number of cancer cases and deaths will continue to rise.
• 3:14
  This means our health-care systems need to ramp up cancer screening and treatment capabilities
• 3:19
  to prevent cancers from being caught too late, which can lead to worse outcomes and higher
• 3:24
  treatment costs.
• 3:26
  Dr.
• 3:27
  Keith Stewart, director of the Princess Margaret Cancer Care Network in Toronto, has
• 3:32
  already noticed the strain on resources due to increasing numbers of cancer patients.
• 3:37
  He highlights the challenges of having enough space and resources for treatments like
• 3:42
  chemotherapy and advanced therapies such as bone marrow transplants.
• 3:47
  Dr.
• 3:48
  Stewart stresses the importance of a multi-faceted approach, including better
• 3:52
  appointment scheduling and increased investment in at-home care, to manage the growing demand.
• 3:59
  Ultimately, the report underscores the need for careful planning and investment in health-care
• 4:03
  infrastructure to accommodate the rising tide of cancer cases.
• 4:07
  As we look towards the future, it's crucial that we prepare not only for the immediate
• 4:11
  needs of cancer patients but also for the long-term support of those who survive cancer.
• 4:18
  Skipping your first breast cancer screening can have significant long-term consequences,
• 4:23
  according to a comprehensive study from Sweden.
• 4:26
  Women who missed their initial screening mammogram faced a 53 percent higher risk of
• 4:31
  developing stage III breast cancer over the next 25 years and an almost fourfold increased
• 4:38
  risk of stage IV breast cancer.
• 4:41
  The mortality rate from breast cancer was also 40 percent higher among those who did not
• 4:48
  participate in the screening.
• 4:50
  Interestingly, the overall incidence of breast cancer was nearly identical between women who
• 4:56
  attended their first screening and those who did not.
• 5:00
  This suggests that the increased risk of later-stage diagnosis and higher mortality
• 5:04
  stems from delayed detection.
• 5:07
  The study highlights the crucial role of attending the first screening in predicting
• 5:11
  long-term outcomes, as early nonparticipation appears to set a trajectory of factors
• 5:16
  negatively influencing breast cancer prognosis.
• 5:20
  The research was conducted by Wei He, Doctor of Philosophy, from the Karolinska Institute in
• 5:26
  Stockholm and Zhejiang University School of Medicine in China, and published in The British
• 5:31
  Medical Journal.
• 5:32
  The authors emphasize that the increased risk is primarily due to later detection, as
• 5:37
  nonparticipants were more likely to have symptom-detected breast cancers, which are
• 5:43
  typically diagnosed at later stages and associated with poorer prognoses.
• 5:48
  Supporting their hypothesis, the study found no evidence of a higher overall breast cancer
• 5:53
  incidence among nonparticipants.
• 5:56
  However, these women were significantly more likely to have advanced-stage tumors at
• 6:00
  diagnosis, which are linked to significantly lower survival rates.
• 6:04
  The findings align with previous research showing a connection between delayed breast
• 6:08
  cancer diagnosis and mortality.
• 6:11
  An editorial accompanying the study noted the compelling evidence that women who skipped
• 6:16
  their initial screening were less likely to participate in future screenings.
• 6:21
  This has important implications for both patients and clinicians.
• 6:26
  For patients, especially those approaching the recommended age for breast cancer screening,
• 6:31
  the message is clear: attending early mammography screenings can be a long-term
• 6:36
  investment in breast health and survival.
• 6:40
  Doctor Zhen-Qiang Ma from the University of Pittsburgh Graduate School of Public Health
• 6:45
  emphasized that this study provides concrete evidence for clinicians.
• 6:50
  It highlights that initial screening reduces mortality, which should encourage healthcare
• 6:55
  providers to focus on the long-term benefits of mammography rather than just short-term cancer
• 7:01
  detection rates.
• 7:03
  Despite advances in breast cancer screening, diagnosis, and treatment, up to 22 percent of
• 7:08
  cases are still diagnosed at stage III or IV.
• 7:13
  Screening mammography remains the most effective method for early detection and has
• 7:18
  been shown to reduce later-stage diagnoses and mortality.
• 7:22
  However, there are gaps in understanding the long-term implications of early screening
• 7:27
  behavior, particularly the impact of first screening participation.
• 7:32
  The study addressed this knowledge gap by analyzing data from the Swedish Mammography
• 7:37
  Screening Register, which includes screening practices since 1989.
• 7:43
  Before 2005, women in Sweden were invited for their first screening at age 50, a starting age
• 7:50
  that was later lowered to 40.
• 7:52
  The researchers identified women who received their first screening invitation from 1991 to
• 7:59
  2020 and excluded those who had a cancer diagnosis before their first invitation.
• 8:06
  The study involved over 432,000 women and more than 4.9 million person-years of follow-up for
• 8:13
  breast cancer diagnosis.
• 8:16
  Among these women, 16,059 new cases of breast cancer were documented.
• 8:22
  Notably, 32.1 percent of the women did not participate in their first screening
• 8:27
  invitation.
• 8:29
  These initial nonparticipants were less likely to attend subsequent screenings and more likely
• 8:34
  to be diagnosed with advanced-stage, symptom-detected breast cancer.
• 8:38
  First-screening nonparticipants had a 53 percent higher odds of being diagnosed with
• 8:45
  stage III breast cancer and a 3.61 times higher odds for stage IV disease compared to those who
• 8:52
  attended their first screening.
• 8:54
  During the follow-up period, 1,603 breast cancer deaths occurred, and nonparticipation
• 9:01
  was associated with a 25-year breast cancer mortality rate of 9.9 per 1,000 compared to 7.0
• 9:10
  per 1,000 for participants.
• 9:13
  The study concludes that first screening nonparticipants represent a large population at
• 9:18
  long-term risk of dying from breast cancer, providing a crucial opportunity for targeted
• 9:23
  interventions to improve adherence to screening and decrease mortality risk.
• 9:30
  Let's shift our focus to a promising development in the fight against malaria,
• 9:35
  particularly in young children.
• 9:37
  A recent randomized trial conducted in Uganda has revealed that using insecticide-treated
• 9:43
  baby wraps can significantly reduce the incidence of malaria in infants.
• 9:49
  This study, led by Doctor Ross Boyce from the University of North Carolina at Chapel Hill,
• 9:55
  highlights a novel approach that could fill a crucial gap in malaria prevention strategies.
• 10:02
  The trial involved 400 pairs of mothers and their young children, all of whom were using
• 10:07
  insecticide-treated bed nets at night.
• 10:10
  The researchers found that infants who were carried in baby wraps treated with the
• 10:14
  insecticide permethrin had a 66 percent lower incidence of clinical malaria compared to those
• 10:20
  in sham-treated wraps.
• 10:22
  Specifically, the rate was 0.73 cases per 100 person-weeks for the permethrin group, versus
• 10:30
  2.14 cases for the control group.
• 10:33
  This significant reduction was observed throughout the 24-week follow-up period.
• 10:39
  Permethrin, a medication commonly used to treat scabies and lice, is also widely used as an
• 10:46
  insecticide on clothing and mosquito nets.
• 10:49
  In this study, it was used to treat cotton cloth wraps, providing an inexpensive and
• 10:55
  accessible method to protect infants from malaria.
• 10:59
  The cost of treating a wrap is estimated to be between 25 to 50 cents, making it a
• 11:05
  cost-effective addition to existing malaria prevention efforts.
• 11:10
  The study's findings suggest that these permethrin-treated wraps could be particularly
• 11:14
  beneficial during the early months of a child's life, before they develop vaccine-induced
• 11:19
  immunity.
• 11:20
  There's often a gap between the waning of maternal antibodies and the administration of
• 11:25
  malaria vaccines at six months.
• 11:28
  By providing these wraps during routine health visits, mothers could protect their children
• 11:33
  during this vulnerable period.
• 11:36
  Doctor Boyce, reflecting on his military experience with permethrin-treated uniforms,
• 11:41
  saw an opportunity to apply this concept in malaria-endemic regions.
• 11:46
  The wraps, used extensively by mothers in sub-Saharan Africa to carry their children,
• 11:52
  offer a practical medium for this intervention.
• 11:55
  The study demonstrated that infants in the treated-wrap group had significantly fewer
• 12:00
  hospitalizations due to malaria compared to the control group.
• 12:05
  While the study showed promising results, it also noted some limitations.
• 12:10
  For instance, the effectiveness of permethrin-treated wraps in different regions
• 12:15
  with varying malaria vectors remains uncertain.
• 12:19
  Additionally, the distinct odor of permethrin could potentially affect the blinding of the
• 12:24
  study, and self-reported behaviors such as bed-net use could introduce recall bias.
• 12:31
  Despite these limitations, the permethrin-treated baby wraps present a simple
• 12:35
  yet innovative solution to reduce malaria incidence in young children.
• 12:41
  By integrating this approach into existing healthcare practices, particularly in
• 12:46
  sub-Saharan Africa, we could see substantial progress in protecting infants from this deadly
• 12:51
  disease.
• 12:53
  A recent report from Ontario's patient ombudsman has shed light on a troubling issue
• 12:59
  that affected palliative and home-care patients in the province last fall: a shortage of
• 13:04
  medical supplies.
• 13:06
  This shortage was primarily triggered by one vendor, but Ontario Health atHome, the agency
• 13:12
  responsible for coordinating home care, was also found to have contributed due to a lack of
• 13:16
  planning and oversight.
• 13:18
  The report highlighted that this supply chain failure had serious consequences for patients.
• 13:25
  One particularly harrowing example involved a person with three types of Stage 4 cancer who
• 13:30
  experienced a delay in receiving essential supplies to manage their end-of-life symptoms.
• 13:36
  These supplies arrived just ten minutes before the patient passed away, leaving the family
• 13:41
  traumatized and the care team morally distressed.
• 13:45
  The investigation, led by ombudsman Craig Thompson, involved interviews with affected
• 13:51
  patients, caregivers, nurses, and Ontario Health atHome staff.
• 13:56
  It revealed several instances where patients did not receive timely deliveries, including a
• 14:02
  patient with a severe arm infection who had to go to the hospital for antibiotics due to
• 14:07
  missed deliveries.
• 14:09
  Another elderly patient experienced delays in receiving catheters, resulting in urinary tract
• 14:14
  infections.
• 14:16
  The report criticized Ontario Health atHome for its "attitude of complacency" and lack of
• 14:21
  proactive measures to mitigate risks associated with the new supply contracts that took effect
• 14:26
  in September.
• 14:27
  Despite concerns about inaccurate forecast data being raised well in advance, the agency went
• 14:33
  ahead with the implementation, leading to significant service disruptions.
• 14:38
  By mid-October, the agency began offering reimbursements to patients and families who had
• 14:43
  to purchase supplies out of pocket due to delivery issues.
• 14:47
  As of February, over nine hundred reimbursement claims had been paid, totaling more than half a
• 14:52
  million dollars.
• 14:54
  However, the ombudsman emphasized that more could have been done to prevent these
• 14:57
  disruptions from occurring in the first place.
• 15:01
  In response to the report, Ontario Health atHome's interim CEO, Anna Greenberg, and board
• 15:07
  chair, Carol Annett, issued an apology to the affected patients, families, and caregivers,
• 15:13
  acknowledging the distress caused by the supply shortages.
• 15:17
  They expressed a commitment to learning from the incident and improving their systems to
• 15:21
  ensure high-quality patient care in the future.
• 15:25
  The ombudsman made four recommendations to improve the situation, including better
• 15:29
  oversight, more time for implementation, and ensuring patients receive advance notice of
• 15:34
  significant service changes.
• 15:36
  Additionally, a 24-7 line for urgent issues and an external clinical advisory group have been
• 15:43
  established to prevent future occurrences.
• 15:46
  Health Minister Sylvia Jones criticized Ontario Health atHome for failing in its "basic
• 15:51
  responsibility" to patients and caregivers.
• 15:55
  She assured that with new leadership and additional mechanisms in place, the agency is
• 16:00
  working to strengthen its delivery of home care services across the province.
• 16:06
  This situation highlights the critical importance of effective planning and oversight
• 16:10
  in healthcare delivery to prevent such distressing scenarios from unfolding.
• 16:17
  A recent study published in JAMA Dermatology has shed new light on the potential benefits of
• 16:23
  the Mediterranean diet for individuals with psoriasis, a chronic inflammatory skin
• 16:28
  condition.
• 16:29
  This small randomized trial, conducted by Álvaro González-Cantero, Doctor of Medicine,
• 16:35
  Doctor of Philosophy, and his team at the Hospital Universitario Ramon y Cajal in Madrid,
• 16:41
  demonstrated significant improvements in psoriasis severity among patients who adhered
• 16:47
  to a Mediterranean diet.
• 16:49
  The trial involved 38 participants with mild to moderate psoriasis, all of whom were on stable
• 16:55
  topical therapy.
• 16:57
  The findings are particularly noteworthy, as the improvements in psoriasis severity occurred
• 17:03
  without significant weight loss, which is often a confounding factor in dietary intervention
• 17:08
  studies.
• 17:10
  The Mediterranean diet, rich in whole foods, healthy fats, and antioxidants, appears to
• 17:16
  exert its beneficial effects through pathways relevant to chronic inflammation.
• 17:21
  The study reported a notable reduction in the Psoriasis Area and Severity Index, or PASI,
• 17:27
  among those following the Mediterranean diet compared to the control group, which did not.
• 17:33
  In fact, nearly half of the patients in the Mediterranean diet group achieved a 75 percent
• 17:38
  reduction in their PASI scores after just 16 weeks, whereas none of the control participants
• 17:45
  reached this level of improvement.
• 17:47
  The researchers highlighted that these effects were independent of any changes in body weight,
• 17:53
  suggesting that the Mediterranean diet's anti-inflammatory properties are the key
• 17:58
  contributors to the observed benefits.
• 18:02
  Additionally, the study found that patients in the Mediterranean diet group were able to
• 18:06
  reduce their reliance on topical psoriasis treatments more significantly than those in the
• 18:12
  control group.
• 18:13
  This further supports the idea that dietary changes can have a meaningful impact on
• 18:18
  psoriasis management, potentially reducing the need for medication over time.
• 18:24
  The study also noted improvements in other health markers for those following the
• 18:28
  Mediterranean diet.
• 18:30
  For instance, there was a significant reduction in estimated marginal mean HbA1c levels, an
• 18:37
  indicator of blood sugar control, compared to the control group.
• 18:41
  This suggests that the Mediterranean diet may also support better glycemic control, adding
• 18:46
  another layer of potential health benefits for individuals with psoriasis.
• 18:51
  Doctor Danilo C.
• 18:52
  Del Campo from the Chicago Skin Clinic emphasized the broader implications of these
• 18:57
  findings, noting that chronic inflammatory conditions often respond well to
• 19:01
  anti-inflammatory strategies, with diet being one of the most practical starting points.
• 19:06
  The Mediterranean diet, with its focus on whole foods and healthy fats, aligns well with these
• 19:12
  strategies and may improve not only skin health but also overall well-being.
• 19:18
  Doctor Del Campo also pointed out the cardiometabolic benefits of the Mediterranean
• 19:23
  diet, which could be particularly advantageous for psoriasis patients who often face
• 19:28
  additional health challenges such as high blood pressure and cholesterol.
• 19:34
  Encouraging patients to adopt this diet provides them with a practical way to improve
• 19:38
  their overall health and potentially reduce long-term risks.
• 19:43
  The trial, conducted from February 2024 to March 2025, involved a structured Mediterranean
• 19:50
  diet program guided by dietitians.
• 19:53
  Participants received nutritional counseling and educational materials, along with extra
• 19:58
  virgin olive oil to incorporate into their daily meals.
• 20:02
  This comprehensive approach ensured that participants were well-supported in making
• 20:06
  dietary changes.
• 20:09
  Beyond improvements in psoriasis severity, participants in the Mediterranean diet group
• 20:14
  also reported enhancements in quality of life, including better sleep, reduced anxiety, and a
• 20:22
  trend towards improved depression symptoms.
• 20:25
  These aspects are crucial, as they directly impact how patients experience their condition
• 20:30
  and adhere to treatment plans.
• 20:33
  Despite the promising results, the authors acknowledged limitations such as the study's
• 20:39
  small sample size and exclusion criteria that may affect the generalizability of the
• 20:44
  findings.
• 20:45
  Nonetheless, this research provides valuable insights into how dietary modifications,
• 20:51
  specifically the Mediterranean diet, could be a beneficial adjunct therapy for managing
• 20:56
  psoriasis and improving patient outcomes.
• 21:01
  In light of recent statements from former U.S.
• 21:03
  President Donald Trump regarding the use of Tylenol during pregnancy, Health Canada has
• 21:08
  issued an advisory to clarify the facts for concerned individuals.
• 21:13
  Trump claimed that taking Tylenol, also known as acetaminophen, during pregnancy could be
• 21:18
  linked to autism in children.
• 21:20
  However, Health Canada has responded by stating there is no conclusive evidence to support
• 21:26
  these claims.
• 21:28
  Health Canada emphasized that acetaminophen remains a recommended treatment for pain or
• 21:33
  fever during pregnancy, provided it is used as directed.
• 21:38
  The advisory pointed out that untreated fever and pain can pose significant risks to an
• 21:43
  unborn child, making effective management crucial.
• 21:47
  Acetaminophen has been used safely by millions of Canadians, including pregnant and
• 21:52
  breastfeeding women, for decades.
• 21:55
  The advisory also cautioned that excessive use of acetaminophen can lead to serious liver
• 22:00
  damage.
• 22:02
  Pregnant or breastfeeding patients with concerns about medication use are encouraged to
• 22:07
  consult their healthcare providers, especially if their pain persists for more than five days
• 22:12
  or if a fever lasts over three days.
• 22:15
  The World Health Organization has also weighed in, noting that extensive research conducted
• 22:20
  over the last decade has not established a consistent link between acetaminophen use
• 22:25
  during pregnancy and autism.
• 22:27
  This aligns with statements from the Society of Obstetricians and Gynaecologists of Canada,
• 22:32
  which reviewed existing evidence and found no causal link between prenatal acetaminophen
• 22:38
  exposure and neurodevelopmental disorders.
• 22:41
  Despite some observational studies suggesting a possible association, these studies cannot
• 22:46
  definitively establish a causal relationship.
• 22:50
  Factors such as genetics and other health conditions, which are known to influence
• 22:54
  neurodevelopment, were not accounted for in these studies.
• 22:58
  The medical community continues to support the judicious use of acetaminophen during pregnancy
• 23:03
  for managing fever and pain.
• 23:06
  As we wrap up today's episode, it's clear that while public figures may make bold claims, it's
• 23:11
  essential to rely on scientific evidence and the guidance of healthcare professionals when
• 23:16
  it comes to making informed decisions about medication use during pregnancy.
• 23:20
  Thank you for joining me on Morning Medical with Dr.
• 23:23
  Chow.
• 23:24
  Stay informed, stay healthy, and I'll see you next time!