Latest / Morning Medical with Dr. Chow / Order of Canada Highlights, Prostate Cancer Advances, and Colorectal Screening Updates

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Order of Canada Highlights, Prostate Cancer Advances, and Colorectal Screening Updates · Morning Medical with Dr. Chow

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Welcome to Morning Medical with Doctor Chow.
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I'm your host, Doctor Chi-Ming Chow.
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Today, we'll explore some fascinating developments in the world of health and
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medicine.
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From groundbreaking achievements in women's health to the latest in cancer research, we've
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got a lot to cover.
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So, let's dive right in with our first story about a remarkable woman who's made a
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significant impact on women's health in Canada.
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Cecilia Benoit, a medical sociologist and professor of sociology at the University of
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Victoria, has been appointed to the Order of Canada, one of the country's highest civilian
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honors.
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Her pioneering work has been instrumental in shedding light on hidden populations and
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driving change in the healthcare system, particularly in the field of midwifery.
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Benoit's journey began in the early 1990s when midwifery was not just excluded from the
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healthcare system in Canada, but it was also illegal in most parts of the country.
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Her research highlighted the crucial role midwives play in supporting women through
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pregnancy, labour, and the postpartum period.
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At the time, midwifery was heavily stigmatized, largely because it was seen as 'women's work'
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and not given the recognition it deserved.
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Her research, particularly in places like Newfoundland and Labrador where midwives were
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still practicing due to a shortage of doctors, was pivotal in changing Canadian laws.
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Today, midwifery is not only legal but also publicly funded across all provinces and
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territories, thanks in large part to her efforts.
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Beyond midwifery, Cecilia Benoit has dedicated her career to advocating for vulnerable
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communities, including sex workers, street-involved youth, and Indigenous women.
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She believes that policy can shift to be more inclusive and understanding of marginalized
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groups, and her work has led to significant positive changes in this regard.
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This week, Benoit's extraordinary contributions were formally recognized with her appointment
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to the Order of Canada.
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Joining her in being honored from British Columbia are other notable figures, including
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Trevor Hurwitz, a neuropsychiatrist, and Christopher Gaze, the founder of the Bard on
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the Beach Shakespeare Festival, among others.
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The Order of Canada is a prestigious recognition, celebrating individuals who have
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made 'extraordinary and sustained contributions' to the nation.
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Since its inception 60 years ago, nearly 8,800 people have been appointed to the order,
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including this year's appointees.
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It’s a testament to the incredible impact that individuals like Cecilia Benoit have had on
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Canadian society.
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Let's move on to some recent developments in the treatment of prostate cancer.
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This year has seen significant advancements, particularly in the management of high-risk
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localized disease and metastatic castration-sensitive prostate cancer.
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A paradigm-changing study has shown that the combination of perioperative apalutamide, also
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known as Erleada, with androgen deprivation therapy significantly reduces the risk of
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metastasis compared to androgen deprivation therapy alone.
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This combination has been shown to increase five-year metastasis-free survival rates from
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seventy-three point five percent to seventy-eight point two percent.
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The phase three PROTEUS study highlights the potential of apalutamide to deepen responses
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and reduce the risk of cancer spreading or progressing, marking a new standard of care for
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high-risk localized prostate cancer.
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In other news, a chemotherapy-free combination therapy for metastatic castration-sensitive
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prostate cancer has shown promise.
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In a large randomized trial, the combination of an androgen pathway receptor inhibitor and a
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PARP inhibitor led to a significant improvement in radiographic progression-free survival for
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patients with DNA mismatch repair alterations.
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The three-year radiographic progression-free survival increased from fifty percent with
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enzalutamide plus placebo to seventy-seven percent with the combination of the androgen
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pathway receptor inhibitor and talazoparib.
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These findings underscore the importance of early molecular testing to identify alterations
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in homologous recombination repair genes.
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Meanwhile, a study utilizing propensity score matching has demonstrated that the combination
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of darolutamide and androgen deprivation therapy offers improved progression-free
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survival compared to androgen deprivation therapy alone in metastatic
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castration-sensitive prostate cancer.
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This innovative approach has the potential to accelerate patient access to emerging therapies
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and enhance clinical trial efficiency.
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The findings from the phase two ARASEC study and the phase three ARANOTE trial have already
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led to the approval of darolutamide plus androgen deprivation therapy as a standard of
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care in the United States.
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In terms of minimizing cognitive effects during hormonal therapy, a comparison of two androgen
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receptor pathway inhibitors, darolutamide and enzalutamide, revealed that darolutamide is
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associated with less cognitive decline.
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Over a twenty-four week period, patients treated with darolutamide experienced a median
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cognitive function decline of fifteen point eight percent, compared to thirty-six point one
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percent with enzalutamide.
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Although these cognitive changes were not indicative of clinical disorders like dementia,
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they provide important information for treatment decisions.
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For men with metastatic castration-resistant prostate cancer harboring specific mutations, a
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combination of abiraterone and the PARP inhibitor olaparib demonstrated an impressive
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thirty to forty-month improvement in overall survival.
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The median overall survival with this combination was sixty-eight months, compared to
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thirty-seven months with abiraterone and prednisone, and twenty-eight months with
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olaparib alone.
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However, it is important to consider these results in the context of the small sample size
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and imbalances in patient characteristics across treatment groups.
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Lastly, a large randomized trial has shown that transdermal estradiol patches are a viable
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alternative to luteinizing hormone-releasing hormone agonists for testosterone suppression
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in locally advanced prostate cancer.
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The three-year metastasis-free survival rates were similar between the two treatments, but
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the patches were associated with fewer vasomotor symptoms like hot flashes.
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While gynecomastia was more common with estradiol, these findings support the use of
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estradiol patches as an effective and potentially more tolerable option for patients.
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Let's shift our focus to an interesting study about coffee and its potential benefits for
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liver health.
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According to a large-scale study published in the journal Clinical Gastroenterology and
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Hepatology, your daily cup of coffee might do more than just wake you up in the morning.
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Researchers have found that drinking coffee can potentially lower your risk for liver disease
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and even liver cancer.
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This is true even for those who consume five or more cups a day.
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The study tracked over three hundred fifty-four thousand participants for more than a decade,
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making it one of the most comprehensive long-term studies on coffee's impact on liver
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health.
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Doctor Hyunseok Kim, a transplant hepatologist at Cedars-Sinai Medical Center in Los Angeles
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and the first author of the study, noted that the liver benefits from coffee seem to be more
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related to its anti-oxidative properties rather than caffeine itself.
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This is because similar benefits were observed in participants who drank decaffeinated coffee.
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The researchers measured liver disease by looking at cases of cirrhosis, which is
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permanent liver scarring and damage.
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Cirrhosis can result from several long-term liver diseases, including fatty liver disease,
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viral hepatitis, and alcohol-related liver disease.
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Globally, cirrhosis affects more than fifty-eight million people and causes nearly
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one and a half million deaths each year.
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The study also measured hepatocellular carcinoma, the most common type of liver
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cancer, which has a significant global impact with nearly six hundred eighty-five thousand
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cases and more than five hundred ninety-seven thousand deaths annually.
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Interestingly, the protective effect of coffee increased with the amount consumed.
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Drinking one to two cups daily was associated with a twenty percent lower risk of cirrhosis,
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a twenty-four percent lower risk of liver cancer, and thirty-one percent lower odds of
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liver-related death.
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For those drinking three to four cups, the risk of cirrhosis and liver cancer dropped by
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thirty-five percent, and the risk of liver-related death decreased by forty-one
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percent.
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Consuming five or more cups was linked to a thirty-two percent lower risk of cirrhosis, a
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forty-seven percent decrease in liver cancer risk, and forty-two percent lower odds of
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liver-related death.
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These statistics are quite compelling for something as ordinary as coffee.
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However, it's important to note that these are associations and not definitive proof of cause
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and effect.
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Lauren Manaker, a registered dietitian nutritionist who was not involved in the study,
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pointed out that while these findings are meaningful, they should be interpreted with
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caution.
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The study also found that the risk reductions were slightly lower for those who sweetened
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their coffee with sugar or substitutes.
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Participants who used sweeteners showed an elevated marker for liver inflammation, which
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can contribute to fatty liver disease.
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It is advisable to be mindful of sugar intake, as recommended by the American Heart
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Association, which suggests limiting added sugar to no more than six percent of daily
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calories.
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The United States Food and Drug Administration advises that healthy adults should limit
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caffeine intake to no more than four hundred milligrams per day, which is about two to three
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twelve-ounce cups of coffee.
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It's also wise to avoid caffeine at least six hours before bedtime to prevent interference
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with sleep.
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In addition to the potential liver benefits, coffee drinkers in the study showed healthier
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liver protein profiles and less liver fat and inflammation, as confirmed by advanced imaging
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techniques.
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Combining these layers of evidence strengthens the findings.
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However, it's important to note some limitations of the study.
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Coffee intake was measured only at the beginning and again when the MRIs were
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conducted, so there is potential for other factors to influence the results over the
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ten-year period.
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Furthermore, the study participants were mostly of European descent and relatively
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health-conscious, which may not fully represent the general population.
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More research is needed to determine if these benefits apply across diverse ethnic groups,
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such as the population in the United States.
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Despite these limitations, the study provides intriguing insights into the potential health
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benefits of coffee, not only for liver health but also for reducing the risk of other chronic
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diseases.
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Our final story today focuses on a significant change in cancer screening protocols in
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Ontario, Canada.
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Ontario has become the second province in the country to lower the routine colorectal cancer
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screening age from fifty to forty-five years.
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This adjustment aims to address the increasing incidence of colorectal cancer among younger
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adults.
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As of July first, Ontarians aged forty-five and older are eligible to receive the at-home fecal
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immunochemical test, commonly known as FIT.
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This test is designed to detect traces of blood in the stool, which can be an early indicator
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of colorectal cancer.
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If the test results are abnormal, individuals can be referred for a colonoscopy for further
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evaluation.
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Prince Edward Island was the first province to implement this change back in March.
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Barry Stein, president of Colorectal Cancer Canada, emphasized the importance of early
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detection, noting that colorectal cancer is increasingly being diagnosed in younger adults.
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He stated that early detection and removal of polyps in the colon or rectum could prevent the
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progression to cancer.
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Both Stein and the Canadian Cancer Society are advocating for other provinces and territories
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to adopt similar screening age reductions, highlighting that such measures could save
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lives and reduce healthcare costs.
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Stein, who was diagnosed with colorectal cancer at the age of forty-one, underscored the need
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for equal preventative opportunities across all regions in Canada.
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According to Cancer Care Ontario, early detection is crucial, as nine out of every ten
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people can be cured when colorectal cancer is caught in its early stages.
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Currently, most provinces recommend FIT screening for individuals between the ages of
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fifty and seventy-four.
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However, those with a higher risk, such as individuals with a family history of colorectal
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cancer, are advised to begin more specialized screenings earlier.
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For instance, people with a first-degree relative who had colorectal cancer before the
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age of sixty, or those with two family members diagnosed at any age, are considered at higher
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risk.
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They are typically recommended to start colonoscopies at age forty or ten years before
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the age their family member was diagnosed, whichever comes first.
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Trish Riley, an Ottawa resident, shared her personal experience with colorectal cancer,
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having been diagnosed at stage three at the age of fifty-one.
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Her story highlights the impact of early detection, as she underwent surgery and
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chemotherapy following her diagnosis.
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Riley emphasized the potential benefits of earlier screening, reflecting on how her cancer
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might have been caught sooner had testing been available at forty-five.
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The Canadian Cancer Society acknowledges that no screening test is one hundred percent
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accurate, but emphasizes that regular stool tests with appropriate follow-up can
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significantly lower the risk of dying from colorectal cancer.
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Elizabeth Holmes, the society's director of health policy, reiterated the importance of
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early detection and the benefits of regular screening.
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As we wrap up today's episode, it's clear that advancements in screening and early detection
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play a vital role in improving health outcomes.
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Whether it's through innovative therapies for prostate cancer or updated screening guidelines
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for colorectal cancer, these developments underscore the importance of proactive
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healthcare.
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Thank you for joining us on Morning Medical with Doctor Chow.
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Stay informed, stay healthy, and we'll see you next time.