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Harvard Medical SchoolControlling your weight is key to lowering stroke riskThere is a lot you can do to lower your chances of having a stroke. Even if you've already had a stroke or TIA ("mini-stroke"), you can take steps to prevent another.Controlling your weight is an important way to lower stroke risk. Excess pounds strain the entire circulatory system and can lead to other health conditions, including high blood pressure, diabetes, high cholesterol, and obstructive sleep apnea. But losing as little as 5% to 10% of your starting weight can lower your blood pressure and other stroke risk factors.Protect your brain: That’s the strategy that Harvard doctors recommend in this report on preventing and treating stroke. Whether you’ve already had a mini-stroke or a major stroke, or have been warned that your high blood pressure might cause a future stroke, Stroke: Diagnosing, treating, and recovering from a "brain attack" provides help and advice.Of course, you'll need to keep the weight off for good, not just while you're on a diet. The tips below can help you shed pounds and keep them off:Move more. Exercise is one obvious way to burn off calories. But another approach is to increase your everyday activity wherever you can — walking, fidgeting, pacing while on the phone, taking stairs instead of the elevator.Skip the sipped calories. Sodas, lattes, sports drinks, energy drinks, and even fruit juices are packed with unnecessary calories. Worse, your body doesn't account for them the way it registers solid calories, so you can keep chugging them before your internal "fullness" mechanism tells you to stop. Instead, try unsweetened coffee or tea, or flavor your own sparkling water with a slice of lemon or lime, a sprig of fresh mint, or a few raspberries.Eat more whole foods. If you eat more unprocessed foods — such as fruits, vegetables, and whole grains — you'll fill yourself up on meals that take a long time to digest. Plus, whole foods are full of vitamins, minerals, and fiber and tend to be lower in salt — which is better for your blood pressure, too.Find healthier snacks. Snack time is many people's downfall — but you don't have to skip it as long as you snack wisely. Try carrot sticks as a sweet, crunchy alternative to crackers or potato chips, or air-popped popcorn (provided you skip the butter and salt and season it with your favorite spices instead). For a satisfying blend of carbs and protein, try a dollop of sunflower seed butter on apple slices.For more information on lifestyle changes you can make to help prevent a stroke, buy Stroke: Diagnosing, treating, and recovering from a "brain attack, " a Special Health Report from Harvard Medical School.Stroke: Know when to act, and act quicklyIdentifying and treating a stroke as quickly as possible can save brain cells, function, and lives. Everyone should know the warning signs of a stroke and when to get help fast.The warning signs of a stroke can begin anywhere from a few minutes to days before a stroke actually occurs. The National Stroke Association has devised the FAST checklist to help determine whether a person is having a stroke.Act FASTIf the answer to any of the questions below is yes, there's a high probability that the person is having a stroke.Face: Ask the person to smile. Does one side of the face droop?Arms: Ask the person to raise both arms. Does one arm drift downward?Speech: Ask the person to repeat a simple sentence. Are the words slurred? Does he or she fail to repeat the sentence correctly?Time: If the answer to any of these questions is yes, time is important! Call the doctor or get to the hospital fast. Brain cells are dying.When stroke symptoms occur, quick action is vital. If you think you or someone with you is having a stroke, call the doctor. Ideally, the person affected should be taken to a hospital emergency room that has expertise and experience in treating stroke as it occurs (called acute stroke). If you or someone you love is at high risk for having a stroke, you should know the name and location of the nearest hospital that specializes in treating acute stroke.The goal of stroke treatment is to restore blood circulation before brain tissue dies. To prevent brain cell death that is significant enough to cause disability, treatment is most effective if it starts within 60 minutes of the onset of symptoms. But it can still be very effective if given within 3 hours of symptom onset.An important goal of ongoing stroke research is to find treatments that can buy time by protecting the person's brain until blood circulation is restored, which can increase the chances of survival and decrease the chances of disability.
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Medical Medium Have you or someone you love been diagnosed with rheumatoid arthritis (RA) or psoriatic arthritis (PA)? Have you been told that the cause is a mystery or that it’s your body attacking itself? The truth is that there’s a real cause behind these illnesses that medical science and research are unaware of. Fortunately, this article and the accompanying radio show explore the information medical science has yet to fully understand or uncover. Once you know the real cause, you can begin to move forward with healing as you will be addressing the root issue. The Autoimmune TheoryMost people are told that their rheumatoid and psoriatic arthritis are caused by an antibody that has been created within the body that attacks the joints. This is a misguided theory that not only has never been proven, but has also sadly become law within the medical community. When this antibody was discovered, science and research did not even know what it did, and they still don’t. This means that all of the treatments and prognoses that have been delivered since this theory was put in place have been precariously balancing on an antibody whose function is still a complete mystery, which makes the true cause of RA and PA just as enigmatic as it was when research on these illnesses first began. Additionally, since the current treatments and medications prescribed for patients are based on this erroneous theory, there are so many people who are still suffering from swelling, stiffness, and pain in the joints, as well as the other symptoms that are associated with these diseases.When people first began suffering from mystery illnesses in the 1950s, research and science was compelled to blame hormones. This is because, like so many other times in medical research, all the money was in hormones. There was such a deluge of research being conducted on hormones at the time that pharmaceutical companies were primed and ready to sell their new hormone drugs they had been itching to promote.However, one doctor was not convinced hormones were to blame, so he got funding for more research and dug further. He eventually stumbled upon an antibody, which, he thought, was the ticket. He created a theory that the antibody was the body’s inexplicable weapon against itself, even though the actual reason for the antibody was still completely unknown. This research was so heavily funded that it would have been unacceptable to emerge and explain that they have no idea what the antibody does. Therefore, some sort of conclusion was necessary, some theory that would stick. The reason researchers eventually concluded the body was attacking itself was because it protected the institution of modern medicine. In this theory, the patient is blamed above all else, which in turn prevents any fingers being pointed at medicine. Currently, most funding is going toward gene research, which always concludes that the patient’s genes are to blame and there is nothing to be done. In this theory, the patient is blamed above all else, which in turn prevents any fingers being pointed at medicine.The Truth about the AntibodyThis antibody that has become the false poster child for autoimmune diseases is actually just one of many antibodies that have yet to be discovered by science and research. The most ironic part about the events of the last half century is that everything medical research claims to be true about this antibody is actually the exact opposite. Rather than attacking the body, this antibody has been created by the body to protect itself from an outside intruder. The antibody, while an indicator of something being attacked, is not the one doing the attacking. It is proof of your body doing everything it can to support and safeguard you. It doesn’t go after tissue; it goes after the pathogen.The True Cause of RA and PAWe are currently living in a virus culture. Our world is rampant with pathogens that are causing the diseases so many are mystified by and calling autoimmune. Medical science and research are unaware that Epstein-Barr Virus (EBV) is the cause of so many illnesses, including fibromyalgia, chronic fatigue syndrome, multiple sclerosis, thyroid disorders, lupus, Lyme disease, tinnitus, vertigo, rheumatoid arthritis, and psoriatic arthritis. There are over 60 varieties of EBV, which may come as a shock to anyone who is only nominally familiar with this virus as well as to those who work in the medical field.Psoriatic arthritis is created by EBV, which feeds on the heavy metal copper in the liver. Toxic varieties of copper are perfect food for the virus that creates PA. When there is an abundant amount of food that EBV likes, such as copper, the virus becomes stronger and more rampant in the body, attacking the joints and tissues. EBV then creates an internal dermatoxin, which is different to the known external dermatoxin, which then surfaces to the skin. This is when a rash, either of the psoriasis and/or eczema variety, occurs, as well as aches, pains, and inflammation, Thyroid Healing. Medical communities are not aware that this is the true cause of PA, or even that viruses feed on specific foods, metals, and toxins. This is one huge reason why people are not able to receive the answers and help they need to truly heal.Copper can be absorbed into the system in many ways. Someone could have lived in an old house with ancient pipes made of copper that turned everything green. Or they could have used copper pans that flaked the metal off into the food. Copper is rife in pesticides, which means living near farmland, even 50 miles away, can be conducive to toxic copper exposure. Copper is in all pesticides, rodenticides, herbicides, and fungicides, which means we should avoid spraying both inside and outside the house. Anytime you purchase new linens or fabrics, such as towels, sheets, clothing, underwear, or socks, it would be prudent to wash them twice before using. New linens and clothing are loaded with fungicides, which are full of copper that can seep into the skin, your largest organ. It’s important to note that this toxic heavy metal copper is different to the helpful trace mineral copper which is found in plants.Rheumatoid arthritis is also caused by Epstein-Barr Virus that’s in a late stage (read more about the stages of EBV in my book Thyroid Healing, ) except this variety of EBV either does not like to feed on copper as much, or there simply is not an excessive amount of toxic copper in the system. The particular variety of EBV that causes RA much prefers the heavy metal mercury as its food. This specific variety of EBV gets into connective tissue, joints, and ligaments in its fourth stage, causing inflammation that’s evidence of your body trying to hold the invader at bay. Swelling of the knuckles, cervical spine, and the like is an indication that the body is reacting to the virus burrowing deeper and causing permanent damage to nerves and tissue. In its milder forms, this may display itself as mystery aches and pains. In its advanced forms, people experience severe joint swelling and a diagnosis of RA. This information is unknown to medical science and research.The Very First StepThe most important step you can take today toward true healing is way beyond diet or avoiding sprays. You must first know in your heart the true cause of your disease. Your body is not attacking itself. It is the biggest mistake to believe your immune system is not supporting you. When you believe your disease is autoimmune, you are preventing true healing from taking place because you are not giving your body the support it needs as it continues the fight against the pathogen in your body. Knowing your body is not fighting itself but rather a pathogen such as a virus ignites your immune system to become stronger, more focused, and work even harder for you. Additionally, when you know you should be fighting a virus, you can learn the practical steps you can take to give your body as much support as you possibly can.How to HealUnknown to medical research and science, the antibody was created to fight Epstein-Barr Virus; however, your body still needs all the support it can get. The following are some steps to take that can help you to begin recovering from rheumatoid and psoriatic arthritis.Remove Heavy MetalsHeavy metals are one of EBV’s favorite foods. And almost all of us unknowingly have toxic heavy metals inside our bodies. These metals make it possible for the virus to continue growing and becoming more prolific. And the more it feeds on metals such as mercury and copper, the more toxic waste matter the virus excretes in the body, which leads to the symptoms of psoriatic and rheumatoid arthritis. To get rid of heavy metals, heavy metal detox foods to include in your diet daily: barley grass juice, cilantro, spirulina, wild blueberries. Foods to AvoidWhen healing from RA and PA, it is essential to avoid eating things that happen to be some of EBV’s favorite foods, such as eggs and dairy. Also, it’s best to avoid pork because it burdens the liver to such a degree that it gives viruses an opportunity to proliferate, grow, and inflame the joints and skin. It’s also important to stay away from gluten as well because unknown to all medical communities it also provides fuel for the virus. If you have taken out eggs, dairy, and gluten, and you are still experiencing symptoms after several months, consider removing all grains from your diet, including oats and rice, while you heal. Some people tolerate grains well but for some, grains have to be removed to allow for deeper healing. It’s also helpful to avoid corn, soy, and canola oil.The Healing Food: FruitWhile many have been told to avoid fruit because of its sugar content, this trend is actually another example of misinformation that is only preventing people from taking advantage of the powerful antiviral properties in bananas, dates, apples, melons, mangoes, and all other kinds of fruit. Fruit is the most antioxidant-rich food in the world. Antioxidant should really be synonymous with longevity, as fruit is the best food to prolong life and fight disease. Wild blueberries, blackberries, and cherries are among the most antioxidant-filled foods. You can focus on whichever fruits are most attractive to you. If you have the luxury of a farmers market near you, make it a weekly habit to do your shopping there and explore the numerous varieties of fruit that are available to you: apples, pears, peaches, persimmons, apricots, watermelons, and dates. Different kinds of citrus are also a wonderful addition to your fruit-filled diet. While some people may think oranges, lemon water, or grapefruit cause flare ups in their RA or PA, it only feels that way because the citrus is detoxifying the poisons and viral byproduct in your system. In addition to fruit, be sure to eat plenty of leafy greens, vegetables, and include celery juice daily.Helpful SupplementsFor healing supplements, consider including the following supplements:Zinc sulfate is one of the most important resources to fight EBV. The body uses up supplies and even deep reserves of zinc at a rapid rate—meaning that it’s very common to become zinc-deficient when you have EBV, if you weren’t already. This supplement gives a major boost to the immune system so that EBV cells can be destroyed and suppressed.L-Lysine inhibits and reduces an EBV viral load and acts as an anti-inflammatory to the entire body.Cat's claw is a powerful anti-inflammatory and anti-viral that can be very helpful for rheumatoid and psoriatic arthritis.Taking a methylfolate supplement that supports methylation issues is very important for those suffering with rheumatoid and psoriatic arthritis.Bringing in the right B-12 supplement that contains adenosylcobalamin and methylcobalamin can be a wonderful addition as well.Glutathione helps to detoxify the liver, which is where the virus and toxins that cause these conditions can be found.Alpha Lipoic Acid (ALA) repairs and fortifies areas of the body that have been damaged by the virus.Mullein leaf’s strong anti-viral abilities make it an important supplement to consider.Additional TherapiesMany people with RA go to an infrared sauna to help with the fatigue and stiffness. This can be a good option for you, just be sure not to have the heat set too high Be conscious about how long you stay in the sauna. Another extremely helpful treatment is gentle massage therapy, one of the oldest modalities since the beginning of time. Healing touch from one person to another can be incredible for RA.Moving ForwardRheumatoid arthritis and psoriatic arthritis are not autoimmune diseases, and this myth is one that needs to rectified immediately so that the millions of people who are suffering can begin to get true answers. When you are given wrong information about your illness, you are essentially given a stop sign. My hope is for you to walk away from this understanding of RA or PA with a renewed hope and green light. Realizing that your body is fighting a virus that is feeding on toxins and metals in your system is the first and most powerful thing you can do. You must let go of the idea that your body is working against you. It is impossible for the body to attack a single cell in our bodies.When you are considering your healing options, it can be overwhelming. Remember to take it slow and at your own pace. Everyone’s path is going to look a little different. Maybe the foods to avoid will take you some time to remove but the supplements will come more easily. Maybe eating fruit will be an easy step but including celery juice is too much for you up front. Do what you can today and keep building on it from here. Never forget that your body is working with you, not against you, and healing is possible.
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Harvard Health LetterBuild a better bladderExercises, lifestyle change, medications, and procedures can alleviate incontinence and give you your life back.Published: February, 2016A leaky bladder or a sudden urge to go to the bathroom is uncomfortable andembarrassing. But you can take steps to alleviate the problem. "Some people tell me they would have sought treatment sooner if they'd known it was this simple, " says Dr. Anurag Das, director of the Center for Neurourology and Continence at Harvard-affiliated Beth Israel Deaconess Medical Center.Lifestyle changesOne of the first lines of defense is pill-free and costs nothing: lifestyle change. For urge incontinence (see "Types of incontinence"), you can try timed voiding (urinating on a schedule) and bladder guarding, which teaches you to cope with triggers that set off the urge to go, such as washing dishes or hearing water. "You squeeze your muscles to hold in urine before a trigger, which sends a message to the brain that this is not the time to go, " says Dr. Das. Other lifestyle changes include watching fluid intake; quitting smoking, to reduce coughing and pressure on the bladder; and minimizing bladder irritants such as caffeine, alcohol, and carbonated drinks.Pelvic floor rehabThe pelvic floor muscles aid control of your bladder and bowels. Strengthening these muscles can be helpful to people with stress incontinence (see "Types of incontinence") as well as those with urge incontinence. This is done with Kegel exercises, which involve squeezing and releasing the muscles you use to hold in urine. A physical therapist can help you learn how to do the exercises properly. "The majority of people with urge incontinence will improve with rehab. It may not make it 100% better, but even 75% may be acceptable to many people, " says Dr. Das.MedicationsWhen pill-free measures aren't enough to curb incontinence, medications may help. The most commonly prescribed drugs for urge incontinence are anticholinergics, such as oxybutynin (Ditropan). Side effects can include dry mouth and eyes, headache, constipation, and confusion.Some drugs relieve stress incontinence, such as tricyclics like imipramine (Tofranil) and alpha-adrenergic agonists like pseudoephedrine (Sudafed), which are often found in cold medicines. However, these, too, are limited by side effects, and their effect declines over time. When an enlarged prostate causes overflow incontinence (see "Types of incontinence"), alpha blockers such as doxazosin (Cardura) may help by relaxing the smooth muscle of the prostate. It may take trial and error to find the best drugs with the fewest side effects.ProceduresInjections of botulinum toxin (Botox), a muscle relaxant, are used to treat urge incontinence. "The downside is a higher incidence of urine retention and risk of bladder infection. Some patients won't be able to urinate and may need to use a catheter, " says Dr. Das. Injections of calcium hydroxylapatite (Coaptite) are used to treat stress incontinence by tightening the urethra.A procedure called sacral neuromodulation can help people with urge incontinence. A small device called Interstim is implanted in the lower back to stimulate the sacral nerve, improving both bladder and bowel problems.Surgery sometimes is used for stress incontinence. This involves creating a sling that wraps around a person's urethra. "You don't have to use artificial mesh materials for the sling; you can use the patient's own fascia (muscle lining) if preferred, " says Dr. Das. There is no surgery for overflow incontinence if the bladder muscle does not work. However, in cases of blockage from the prostate, prostate surgery may help.Types of incontinenceStress incontinence occurs mostly in women, and it's often the result of a weakened or stretched pelvic floor from childbirth. The telltale symptom is leakage with pressure or stress on the bladder, such as when laughing or coughing. Stress incontinence is less common in men unless they've had an injury or had their prostate removed.Urge incontinence (overactive bladder) is characterized by an inability to get to the bathroom in time. It's caused by overactive contractions of the bladder muscle that may be related to an enlarged prostate in men; changes to the bladder lining or bladder muscle in postmenopausal women; or a chronic neurological condition, such as multiple sclerosis.Overflow incontinence occurs when there's no room for additional urine because the bladder is not emptying, either because it is blocked or because it isn't working properly because of a neurological disorder or a medication side effect. Overflow incontinence primarily affects men with enlarged prostates. Symptoms include frequent leakage or a feeling of lower-belly fullness. The condition increases the risk for bladder infections because the urine pools in the bladder for long periods of time
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Differentiation sensitizes stem-like glioblastoma tumor-initiating cells to mechanical inputsSPONSORED BY: Thermo Fisher Scientific/GibcoCONTINUING EDUCATION (CME/CE/CEU) CREDITS: P.A.C.E. CE | Florida CEMechanobiology of Glioblastoma-Initiating CellsGlioblastoma (GBM) is the most aggressive primary brain cancer, with nearly universal recurrence after treatment. GBMs are highly heterogeneous at the cellular level, and there is much evidence that recurrence, chemoresistance, and invasion are driven by a rare and specialized population of tumor initiating cells (TICs) within the tumor. These TICs are thought to share some similarities with stem cells in that they can both self-renew and differentiate to produce a range of cell types found in the bulk tumor. Because glioblastoma is above all a disease of tissue invasion and because invasion involves complex mechanical signaling between the microenvironment and the invading cells, we probed how TICs respond to mechanical cues. We found that in contrast to the majority of other cell types, TICs surprisingly showed very little stiffness-dependent change in cell shape and migration. Furthermore, we found that by increasing cellular force generation we could increase mechanosensitivity and extend survival in a mouse xenograft model. We next asked how the mechanosensitivity of these TICs changes as they are exposed to bone morphogenetic protein 4 (BMP4), which has been previously shown to elicit a differentiation-like effect on GBM TICs and extend survival in a xenograft model. We found that TICs treated with BMP4 showed increased stiffness-dependent changes in cell shape and reduced tissue invasion. We next performed RNA sequencing for a systems-level picture of how differentiation impacts mechanical signaling in TICs. We identified several pathways that showed mechanically-regulated changes impacted by differentiation, particularly those governing cell-extracellular matrix adhesions. These findings demonstrate that manipulation of mechanotransductive signaling can be leveraged to control tumor growth and invasion, and provide insight on alterations in mechanical signaling in stem-like and differentiated tumor initiating cells.
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What is Tourette syndrome? Rani Mukerji plays a patient with rare disorder in HichkiTourette Syndrome, the neurological condition Rani Mukerji’s character has in her forthcoming film Hichki, cannot be cured but it can be controlled. In her forthcoming film Hichki, Rani Mukherjee plays a woman with Tourette Syndrome who wants to be a teacher.Chances are that you may not have heard of the Tourette Syndrome till you saw the just-released trailer of Rani Mukerji’s forthcoming film Hichki. For those who still haven’t seen it, here’s a quick round up.In the film, Rani Mukerji plays Naina Mathur – a woman with Tourette Syndrome who wants to be a teacher. She seems bright, enthusiastic and devoted, but there is just one problem. Her rare disorder comes with an involuntary vocal tic (she frequently makes a loud noise like two hiccups in a row), which would make her a soft target for ridicule especially in a class full of adolescents.But surely that is not all there is to Tourette Syndrome, named after French physician and neurologist Gilles de la Tourette who did pioneering research on the disorder in 1885. Here’s what we know.Happens because…Tourette Syndrome manifests in adolescence (before age 18) and is attributed to genetic and environmental factors.“It is a neurobehavioural disorder that occurs because of dysfunction in the areas of the brain involved in movement and behaviour – basal ganglia, cerebral cortex and the thalamus, ” says Dr Anshu Rohatgi, senior consultant neurologist at Sir Ganga Ram Hospital in Delhi.While the exact cause for Tourette Syndrome is not known, genetics plays a major role. “If someone has Tourette, there is a 50% chance that it may be passed onto to the children, ” says Dr Rohatgi.How to identify…There is no test for Tourette Syndrome. It can be identified only through a clinical diagnosis.The syndrome is characterised by motor tics, which vary from person to person and may manifest as blinking, jerking head, arm or shoulder, clearing of throat, scrunching of face and vocal tics like shouting, grunting. In some cases, the vocal tics can occur as involuntary barking, swearing, or repeating your own words or things spoken by other people, which can be embarrassing.“In addition to the motor and vocal tics, you see a lot of behavioural changes such as hyperactivity, obsession, depression, mood changes, aggression, ” says Dr Rohatgi. “Besides a neurologist, most patients also see a psychiatrist, ” he adds.Appearance of motor and vocal tics are essential to identify a condition as Tourette Syndrome. If a person just suffers from compulsive motor tics (like shrugging shoulders or shaking leg) it could also be due to anxiety, which can be treated with behavioural therapy.“Tourette Syndrome is quite rare, ” says Dr Rachna Sehgal, associate professor, paediatrics and paediatric neurologist at Safdarjung Hospital in Delhi. “In my 20 years of practice as a paediatrician and 8 years as a neurologist, I have seen two children with Tourette, ” she says. Treatable but not curable…Tourette Syndrome cannot be cured, say doctors but it can be controlled. “The motor tics can be treated with medication, ” says Dr Rohatgi, “And there are anti-psychotic medicines to control the behavioural disorders, which are harder to control.”Patients with Tourette have the intelligence and work output of a regular person, says Dr Sehgal, but the stigma their condition invokes affects their day-to-day functioning. “People around them don’t understand they can’t control the tics. Not just the patients, but even their parents become stigmatised, ” she says.“People with Tourette become objects of ridicule in social situations, ” says Dr Rohatgi. “People don’t like to interact with them and tend to avoid them.”Given the stigma and ridicule this difficult condition invites, Naina Mathur’s dream of becoming a teacher may seem like a tall order. It remains to be seen whether the disorder gets a realistic treatment in the film. Let’s wait and watch.Hindustan times
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Breast Cancer in India: Pre-Emptive Testing Can Halt the Disease in its Tracks– Dr. Shefali SabharanjakStrand Life SciencesAbstractHereditary cancer may prove to be a significant chunk of all kinds of cancers in India.Analysis of 1000 breast and ovarian cancer (BOC) cases shows that the prevalence of germline pathogenic mutations in India is as high as 30%.Germline mutations in BRCA1, BRCA2, TP53 and PALB2 genes account for a significant share of hereditary mutations.A combination of the Strand Germline Cancer test and mutation-specific testing can be effectively leveraged to extend the benefits of genetic testing to probands as well as to their extended families.Pre-emptive testing can help to identify carrier individuals, at increased risk for cancer, and enable better medical surveillance for the earliest signs of cancer.Development and adoption of India-specific guidelines for genetic testing is the need of the hour.IntroductionBreast cancer in IndiaBreast cancer is set to become a major healthcare issue in India. The combined effects of factors such as low awareness about breast cancer, lack of periodic surveillance against signs and symptoms of nascent disease, and social inhibitions leading to inadequate access to healthcare, results in a huge burden of breast cancer on the healthcare system. One silent, yet significant, factor that is likely to play a huge role in the breast cancer burden in India is the prevalence of hereditary mutations that lead to development of breast cancer. Strand has published a study on the prevalence of hereditary mutations that can increase a person’s lifetime risk for developing cancer, in a small cohort of the 150 breast and ovarian cancer(BOC) cases (Mannan et al. 2016). An expansion of that cohort to a 1000 BOC cases has led to the reaffirmation of the salient finding that the prevalence of hereditary mutations that predispose towards hereditary breast and ovarian cancer (HBOC), is very high in India (Singh et al. 2018). The prevalence of hereditary mutations that increase the risk of HBOC is 30% in the Indian cohort of BOC cases. Additionally, there are 56 novel mutations found in the Indian cohort that are clearly distinct from other known HBOC mutations. Incidence and distribution of germline mutationsFigure 1: Incidence and distribution of germline mutations in 1000 BOC cases (Ref: Singh et al. 2018)Figure 1: Incidence and distribution of germline mutations in 1000 BOC cases (Ref: Singh et al. 2018)A significant proportion of mutations lie in the BRCA1 and BRCA2 genes. Mutations in TP53 and PALB2 are the second most frequent class of mutations. In contrast, a study conducted with a predominantly European and North American cohort has shown that the prevalence of hereditary mutations is only 12 % amongst all BOC cases (Buys et al. 2017). Interestingly, the cohort size (35, 000 individuals) as well as the size of the gene panel (35 genes) in this study (Buys et al. 2017) are larger than the 1000-case cohort and 19-gene panel germline test, used in the Indian study (Singh et al. 2018). Given that the odds of finding germline mutations are higher in the earlier study, the presence of a surprisingly high number of BRCA1 and BRCA2 mutations in the Indian study, is definitely a red flag.The high prevalence of germline mutations in India is also reflected in the profile of breast cancer in India. The proportion of triple-negative breast cancer cases, an aggressive and early-onset sub-type of breast cancer is quite high in India (31%) as compared to that seen in North America (12%) (Phuah et al. 2012; Sandhu et al. 2016).Incidentally, a comparative analysis of the prevalence of hereditary mutations across three different studies shows that distribution of germline mutations is unique to different population groups. This not only makes the extrapolation of results from one to the other difficult, but also underlines the need for differential, population-specific screening strategies.Inadequate Genetic Testing In IndiaAwareness about genetic testing is slowly picking up pace with more and more doctors opting for this diagnostic criterion, in addition to other clinico-pathological evaluations, in oncology as well as in rare inherited disorders.There have been cases where the index case of early-onset breast cancer was not advised genetic testing. Early germline testing, especially in young women, as well as in cases of male breast cancer, can lead to the identification of pathogenic or likely pathogenic variants in the affected individuals. Strand offers a rapid, custom-designed and convenient, mutation-specific test, that can be extended to the immediate and extended family members of probands, in order to understand their status, vis-à-vis the identified hereditary mutation(s).Pre-emptive Testing Can Increase Surveillance Against CancerConverts are often the most ardent zealots, they say. Nothing illustrates this fact more than a recent mega-case that was analyzed at Strand.Mr. Ramakant Patole*, a progressive agriculturist living near Pune, had been diagnosed with pancreatic cancer at age 56 years and with male breast cancer at the age of 65 years. The incidence of two different primary cancers in the same person is definitely a case for germline testing, as per NCCN guidelines.The Strand Germline Cancer test was used to identify the presence of a ‘likely pathogenic’ variant of the BRCA2 gene in his genome. Subsequently, he convinced his immediate as well as extended family members to undergo pre-emptive genetic testing for the same gene variant. This massive, co-ordinated testing effort laid out a clear picture of their genetic status, before this family. Three other family members, two of them physicians, tested positive for the same BRCA2 mutation. Pedigree chart post genetic testingFigure 2. Pedigree chart post genetic testing of Mr. Patole’s extended familyFigure 2. Pedigree chart post genetic testing of Mr. Patole’s extended family.These people were unaffected at the time of testing (Dec 2017-March 2018) and now have a chance to undergo frequent medical surveillance for the earliest signs of cancer.Dr. Anagha* also has the chance to undergo risk-reduction bilateral salpingo-oophorectomy (RRSO) as well as risk-reduction bilateral mastectomy (RRBM) at a suitable juncture in her life, before cancer is detected.The pre-emptive testing for germline mutations also provided emotional relief to other family members who tested negative for this BRCA2 mutation.This family is representative of the kind of prevalence of HBOC in the Indian population.SummaryHereditary cancer may prove to be a significant chunk of all kinds of cancers in India.Analysis of 1000 BOC cases shows that the prevalence of germline pathogenic mutations in India is as high as 30%.Germline mutations in BRCA1, BRCA2, TP53 and PALB2 genes account for a significant share of hereditary mutations.A combination of the Strand Germline Cancer test and mutation-specific testing can be effectively leveraged to extend the benefits of genetic testing to probands as well as to their extended families.Pre-emptive testing can help to identify carrier individuals, at increases risk for cancer, and enable better medical surveillance for the earliest signs of cancer.Development and adoption of India-specific guidelines for genetic testing is the need of the hour.*– Fictitious names used to protect patient privacyReferencesBuys, Saundra S., John F. Sandbach, Amanda Gammon, Gayle Patel, John Kidd, Krystal L. Brown, Lavania Sharma, Jennifer Saam, Johnathan Lancaster, and Mary B. Daly. 2017. “A Study of over 35, 000 Women with Breast Cancer Tested with a 25-Gene Panel of Hereditary Cancer Genes.” Cancer 123 (10): 1721–30. doi:10.1002/cncr.30498.Mannan, Ashraf U, Jaya Singh, Ravikiran Lakshmikeshava, Nishita Thota, Suhasini Singh, T S Sowmya, Avshesh Mishra, et al. 2016. “Detection of High Frequency of Mutations in a Breast And/or Ovarian Cancer Cohort: Implications of Embracing a Multi-Gene Panel in Molecular Diagnosis in India.” Journal of Human Genetics 61 (6): 515–22. doi:10.1038/jhg.2016.4.Phuah, Sze-Yee, Lai-Meng Looi, Norhashimah Hassan, Anthony Rhodes, Sarah Dean, Nur Aishah Mohd Taib, Cheng-Har Yip, and Soo-Hwang Teo. 2012. “Triple-Negative Breast Cancer and PTEN (Phosphatase and Tensin Homologue) Loss Are Predictors of BRCA1 Germline Mutations in Women with Early-Onset and Familial Breast Cancer, but Not in Women with Isolated Late-Onset Breast Cancer.” Breast Cancer Research : BCR 14 (6). BioMed Central: R142. doi:10.1186/bcr3347.Sandhu, Gurprataap S, Sebhat Erqou, Heidi Patterson, and Aju Mathew. 2016. “Prevalence of Triple-Negative Breast Cancer in India: Systematic Review and Meta-Analysis.” Journal of Global Oncology 2 (6). American Society of Clinical Oncology: 412–21. doi:10.1200/JGO.2016.005397.Singh, Jaya, Nishita Thota, Suhasini Singh, Shila Padhi, Puja Mohan, Shivani Deshwal, Soumit Sur, et al. 2018. “Screening of over 1000 Indian Patients with Breast And/or Ovarian Cancer with a Multi-Gene Panel: Prevalence of BRCA1/2 and Non-BRCA Mutations.” Breast Cancer Research and Treatment, February. doi:10.1007/s10549-018-4726-x.
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Mesothelioma: The Role Of Asbestos And Gene Therapy In IndiaHomeStrand Gene WordMesothelioma: The Role of Asbestos and Gene Therapy in IndiaAsbestos has deep ties in the fabric of Indian industry and construction. Behind China, India is the second largest market for asbestos in the world, importing hundreds of millions of dollars worth of the material annually. The impact asbestos has on community and individual health is as vast as it is severe. As a versatile material favored by the construction and repair industries because of its heat and fire resistant properties, asbestos use saw its peak in the mid-20th century. However, people began noticing its alarming health effects, including mesothelioma, only decades after exposure to the toxin.Some of the effects from exposure include certain forms of cancer. Asbestos fibers often remain in the body for years, leading to irritation and the eventual development of malignant cells. Through further research and the development of clinical trials, aggressive cancers that are difficult to treat may stand a better chance with tumor profile-based targeted therapies and experimental treatments such as gene therapy.Asbestos Use in IndiaBeing the largest global importer of asbestos, much of India’s industry relies on the mineral’s production and use. Asbestos-containing products are manufactured in nearly 200 factories around India. The mineral can be found in a range of products, from cement and roofing to household appliances and automotive parts.Danger - Asbestos - Cancer and Lung Disease HazardMuch of India’s asbestos-related health issues can be attributed to occupational and secondhand exposure. Employees who work with the material in factories and shipyards, like those in Gujarat and Alang, are often the primary victims of diseases derived from asbestos exposure. The fibers produced by disturbed asbestos can stick to a worker’s attire, potentially entering their homes and communities. Those living near factories or construction sites are also at risk of airborne exposure, resulting in health complications that can be just as detrimental. Mesothelioma is one of the most significant byproducts of asbestos exposure. This rare form of cancer takes root in the mesothelium, or lining of the internal organs, and is known for its significantly low survival rate.Patients may not develop symptoms of mesothelioma for upwards of 10-50 years, and these symptoms are typically only discovered in the later stages of the disease. In addition, due to its rarity, mesothelioma can often be misdiagnosed or improperly treated. To fully understand the condition and how it develops, further clinical study and testing needs to be done. Innovative treatment methods and solutions could prove life changing for the majority of patients who do not survive more than a year after diagnosis.Gene Therapy, Targeted Therapy and Mesothelioma Even in its initial stages gene therapy has the potential to hugely benefit cancer patients like those suffering from mesothelioma. At its core, gene therapy works to replace mutated or cancerous cells, leading to correcting the gene completely and deactivating the mutation. In mesothelioma cases, the DNA of a cell is damaged by asbestos fibers, leading to uncontrolled growth and abnormalities.Mesothelioma patients most often receive treatment through some form of surgery, radiation, or chemotherapy. While a combination of these three treatments sees the highest success rates, the condition’s prognosis continues to be poor. Targeted therapy based on the mutation profile of the tumor is starting to become a reality for some patients (eg Erlotinib for tumors that carry an EGFR mutation) with some success in extending survival beyond one year, in some cases even up to five years. Gene therapy on the other hand is still in its experimental stages for mesothelioma, but is available now to patients through clinical trials. So far, much of the results have seen limited success with notable side effects or complications.However, researchers have uncovered the TP53 gene as an effective target in treating tumors through gene therapy. This gene comprises a key protein (p53) that regulates normal cell function within the body and is vital in preventing tumor growth. Almost every form of cancer linked to a poor prognosis has a mutation in this gene, making it an ideal target for therapy. Preclinical studies have focused on the common genetic mutation in mesothelioma which deactivates the p53 pathways. This study has been successful in restoring the pathways that prevent tumor growth, but so far researchers have not been able to use this therapy to greatly reduce tumor size.Mesothelioma in IndiaOn a global scale, the World Health Organization estimates asbestos was linked to an estimated 107, 000 deaths in 2004 alone. Although about 60 countries have banned the use of asbestos due to its threat to human health, India’s asbestos industry is worth billions of dollars and continues to grow. Around 80% of mesothelioma cases in the country involve men who experienced occupational exposure or those living in proximity to production.Yet, mesothelioma is a considerably new condition for India, with the first case being reported as recently as 2015. However, the crux of this cancer is that it will continually be diagnosed for years, even after asbestos has been fully banned. The epidemic of asbestos exposure in India will only come to a halt when the dangers associated with this mineral are fully investigated, and it has been proactively handled or disposed of.Until this time, it is important that evolving forms of cancer treatment, like targeted and gene therapy, are studied and implemented to help save the lives of those afflicted by mesothelioma. Targeted and gene therapy has the potential to greatly impact the way cancer care is approached, especially for patients with late stage diagnoses and where other forms of treatment would be too risky or ineffective. Further study into these treatment options provides hope in the cancer research community, and gives those who may face hazardous asbestos exposure the chance at a more promising future.Editor’s Note: We would like to thank the team at Mesothelioma + Asbestos Awareness Center for their contribution to this article.
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Patient Derived Xenograft/PDX Models Market by Type (Mouse & Rat), Tumor Type (Gastrointestinal, Gynecological, Respiratory), Application (Pre-Clinical Drug Development & Biomarker Analysis), End User (Pharma & Biotech, CRO) - Global Forecast to 2022The growth of the overall Patient Derived Xenograft Models Market can be attributed to the growing demand for personalized medicine, continuous support for cancer research from the public as well as private sectors, and growth in the number of R& D activities in the pharmaceutical industry.In addition, Growth in biomedical research in the US, rising preclinical activities by CROs and pharmaceutical companies, and growing stem cell research in Canada are the major factors expected to drive the growth of the market during the forecast period.The report analyzes the patient derived xenograft models market by type, tumor type, application, end user, and region.Based on application, the PDX models market has been broadly segmented into preclinical drug development & basic cancer research and biomarker analysis. In 2017, the preclinical drug development and basic cancer research segment is expected to account for the largest share of the global patient derived xenograft models market. Growth in this segment is mainly driven by the increasing number of research activities in the field of oncology drug research.The pharmaceutical and biotechnology companies segment is estimated to account for the largest share of the patient derived xenograft models market in 2017. The large share of this segment is due to the increasing expenditure on R& D by companies for drug development.
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Gene Editing for GoodHow CRISPR Could Transform Global DevelopmentBy Bill GatesToday, more people are living healthy, productive lives than ever before. This good news may come as a surprise, but there is plenty of evidence for it. Since the early 1990s, global child mortality has been cut in half. There have been massive reductions in cases of tuberculosis, malaria, and HIV/AIDS. The incidence of polio has decreased by 99 percent, bringing the world to the verge of eradicating a major infectious disease, a feat humanity has accomplished only once before, with smallpox. The proportion of the world’s population in extreme poverty, defined by the World Bank as living on less than $1.90 per day, has fallen from 35 percent to about 11 percent.Continued progress is not inevitable, however, and a great deal of unnecessary suffering and inequity remains. By the end of this year, five million children under the age of five will have died—mostly in poor countries and mostly from preventable causes. Hundreds of millions of other children will continue to suffer needlessly from diseases and malnutrition that can cause lifelong cognitive and physical disabilities. And more than 750 million people—mostly rural farm families in sub-Saharan Africa and South Asia—still live in extreme poverty, according to World Bank estimates. The women and girls among them, in particular, are denied economic opportunity.Some of the remaining suffering can be eased by continuing to fund the development assistance programs and multilateral partnerships that are known to work. These efforts can help sustain progress, especially as the world gets better at using data to help guide the allocation of resources. But ultimately, eliminating the most persistent diseases and causes of poverty will require scientific discovery and technological innovations.That includes CRISPR and other technologies for targeted gene editing. Over the next decade, gene editing could help humanity overcome some of the biggest and most persistent challenges in global health and development. The technology is making it much easier for scientists to discover better diagnostics, treatments, and other tools to fight diseases that still kill and disable millions of people every year, primarily the poor. It is also accelerating research that could help end extreme poverty by enabling millions of farmers in the developing world to grow crops and raise livestock that are more productive, more nutritious, and hardier. New technologies are often met with skepticism. But if the world is to continue the remarkable progress of the past few decades, it is vital that scientists, subject to safety and ethics guidelines, be encouraged to continue taking advantage of such promising tools as CRISPR.FEEDING THE WORLDEarlier this year, I traveled to Scotland, where I met with some extraordinary scientists associated with the Centre for Tropical Livestock Genetics and Health at the University of Edinburgh. I learned about advanced genomic research to help farmers in Africa breed more productive chickens and cows. As the scientists explained, the breeds of dairy cows that can survive in hot, tropical environments tend to produce far less milk than do Holsteins—which fare poorly in hot places but are extremely productive in more moderate climates, thanks in part to naturally occurring mutations that breeders have selected for generations. The scientists in Scotland are collaborating with counterparts in Ethiopia, Kenya, Nigeria, Tanzania, and the United States. They are studying ways to edit the genes of tropical breeds of cattle to give them the same favorable genetic traits that make Holsteins so productive, potentially boosting the tropical breeds’ milk and protein production by as much as 50 percent. Conversely, scientists are also considering editing the genes of Holsteins to produce a sub-breed with a short, sleek coat of hair, which would allow the cattle to tolerate heat.This sort of research is vital, because a cow or a few chickens, goats, or sheep can make a big difference in the lives of the world’s poorest people, three-quarters of whom get their food and income by farming small plots of land. Farmers with livestock can sell eggs or milk to pay for day-to-day expenses. Chickens, in particular, tend to be raised by women, who are more likely than men to use the proceeds to buy household necessities. Livestock help farmers’ families get the nutrition they need, setting children up for healthy growth and success in school.Similarly, improving the productivity of crops is fundamental to ending extreme poverty. Sixty percent of people in sub-Saharan Africa earn their living by working the land. But given the region’s generally low agricultural productivity—yields of basic cereals are five times higher in North America—Africa remains a net importer of food. This gap between supply and demand will only grow as the number of mouths to feed increases. Africa’s population is expected to more than double by 2050, reaching 2.5 billion, and its food production will need to match that growth to feed everyone on the continent. The challenge will become even more difficult as climate change threatens the livelihoods of smallholder farmers in Africa and South Asia.Gene editing to make crops more abundant and resilient could be a lifesaver on a massive scale. The technology is already beginning to show results, attracting public and private investment, and for good reason. Scientists are developing crops with traits that enhance their growth, reduce the need for fertilizers and pesticides, boost their nutritional value, and make the plants hardier during droughts and hot spells. Already, many crops that have been improved by gene editing are being developed and tested in the field, including mushrooms with longer shelf lives, potatoes low in acrylamide (a potential carcinogen), and soybeans that produce healthier oil.Improving the productivity of crops is fundamental to ending extreme poverty.For a decade, the Bill & Melinda Gates Foundation has been backing research into the use of gene editing in agriculture. In one of the first projects we funded, scientists from the University of Oxford are developing improved varieties of rice, including one called C4 rice. Using gene editing and other tools, the Oxford scientists were able to rearrange the cellular structures in rice plant leaves, making C4 rice a remarkable 20 percent more efficient at photosynthesis, the process by which plants convert sunlight into food. The result is a crop that not only produces higher yields but also needs less water. That’s good for food security, farmers’ livelihoods, and the environment, and it will also help smallholder farmers adapt to climate change.Such alterations of the genomes of plants and even animals are not new. Humans have been doing this for thousands of years through selective breeding. Scientists began recombining DNA molecules in the early 1970s, and today, genetic engineering is widely used in agriculture and in medicine, the latter to mass-produce human insulin, hormones, vaccines, and many drugs. Gene editing is different in that it does not produce transgenic plants or animals—meaning it does not involve combining DNA from different organisms. With CRISPR, enzymes are used to target and delete a section of DNA or alter it in other ways that result in favorable or useful traits. Most important, it makes the discovery and development of innovations much faster and more precise.ENDING MALARIA In global health, one of the most promising near-term uses of gene editing involves research on malaria. Although insecticide-treated bed nets and more effective drugs have cut malaria deaths dramatically in recent decades, the parasitic disease still takes a terrible toll. Every year, about 200 million cases of malaria are recorded, and some 450, 000 people die from it, about 70 percent of them children under five. Children who survive often suffer lasting mental and physical impairments. In adults, the high fever, chills, and anemia caused by malaria can keep people from working and trap families in a cycle of illness and poverty. Beyond the human suffering, the economic costs are staggering. In sub-Saharan Africa, which is home to 90 percent of all malaria cases, the direct and indirect costs associated with the disease add up to an estimated 1.3 percent of GDP—a significant drag on countries working to lift themselves out of poverty.With sufficient funding and smart interventions using existing approaches, malaria is largely preventable and treatable—but not completely. Current tools for prevention, such as spraying for insects and their larvae, have only a temporary effect. The standard treatment for malaria today—medicine derived from artemisinin, a compound isolated from an herb used in traditional Chinese medicine—may relieve symptoms, but it may also leave behind in the human body a form of the malaria parasite that can still be spread by mosquitoes. To make matters worse, the malaria parasite has begun to develop resistance to drugs, and mosquitoes are developing resistance to insecticides.Efforts against malaria must continue to make use of existing tools, but moving toward eradication will require scientific and technological advances in multiple areas. For instance, sophisticated geospatial surveillance systems, combined with computational modeling and simulation, will make it possible to tailor antimalarial efforts to unique local conditions. Gene editing can play a big role, too. There are more than 3, 500 known mosquito species worldwide, but just a handful of them are any good at transmitting malaria parasites between people. Only female mosquitoes can spread malaria, and so researchers have used CRISPR to successfully create gene drives—making inheritable edits to their genes—that cause females to become sterile or skew them toward producing mostly male offspring. Scientists are also exploring other ways to use CRISPR to inhibit mosquitoes’ ability to transmit malaria—for example, by introducing genes that could eliminate the parasites as they pass through a mosquito’s gut on their way to its salivary glands, the main path through which infections are transmitted to humans. In comparable ways, the tool also holds promise for fighting other diseases carried by mosquitoes, such as dengue fever and the Zika virus.It will be several years, however, before any genetically edited mosquitoes are released into the wild for field trials. Although many questions about safety and efficacy will have to be answered first, there is reason to be optimistic that creating gene drives in malaria-spreading mosquitoes will not do much, if any, harm to the environment. That’s because the edits would target only the few species that tend to transmit the disease. And although natural selection will eventually produce mosquitoes that are resistant to any gene drives released into the wild, part of the value of CRISPR is that it expedites the development of new approaches—meaning that scientists can stay one step ahead.THE PATH FORWARDLike other new and potentially powerful technologies, gene editing raises legitimate questions and understandable concerns about possible risks and misuse. How, then, should the technology be regulated? Rules developed decades ago for other forms of genetic engineering do not necessarily fit. Noting that gene-edited organisms are not transgenic, the U.S. Department of Agriculture has reasonably concluded that genetically edited plants are like plants with naturally occurring mutations and thus are not subject to special regulations and raise no special safety concerns.The benefits of emerging technologies should not be reserved only for people in developed countries.Gene editing in animals or even humans raises more complicated questions of safety and ethics. In 2014, the World Health Organization issued guidelines for testing genetically modified mosquitoes, including standards for efficacy, biosafety, bioethics, and public participation. In 2016, the National Academy of Sciences built on the WHO’s guidelines with recommendations for responsible conduct in gene-drive research on animals. (The Gates Foundation co-funded this work with the National Institutes of Health, the Foundation for the National Institutes of Health, and the Defense Advanced Research Projects Agency.) These recommendations emphasized the need for thorough research in the lab, including interim evaluations at set points, before scientists move to field trials. They also urged scientists to assess any ecological risks and to actively involve the public, especially in the communities and countries directly affected by the research. Wherever gene-editing research takes place, it should involve all the key stakeholders—scientists, civil society, government leaders, and local communities—from wherever it is likely to be deployed.Part of the challenge in regulating gene editing is that the rules and practices in different countries may differ widely. A more harmonized policy environment would prove more efficient, and it would probably also raise overall standards. International organizations, especially of scientists, could help establish global norms. Meanwhile, funders of gene-editing research must ensure that it is conducted in compliance with standards such as those advanced by the WHO and the National Academy of Sciences, no matter where the research takes place.When it comes to gene-editing research on malaria, the Gates Foundation has joined with others to help universities and other institutions in the regions affected by the disease to conduct risk assessments and advise regional bodies on experiments and future field tests. The goal is to empower affected countries and communities to take the lead in the research, evaluate its costs and benefits, and make informed decisions about whether and when to apply the resulting technology.Finally, it’s important to recognize the costs and risks of failing to explore the use of new tools such as CRISPR for global health and development. The benefits of emerging technologies should not be reserved only for people in developed countries. Nor should decisions about whether to take advantage of them. Used responsibly, gene editing holds the potential to save millions of lives and empower millions of people to lift themselves out of poverty. It would be a tragedy to pass up the opportunity.
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Insight into lung cancer diagnostics Lung Cancer Diagnostics Market size is projected to experience significant growth from 2017 to 2024.Lung cancer diagnostics market size should witness significant growth due to increased prevalence of smoking and exposure to secondhand smoke, influencing the occurrence rate of lung malignancies. Smoking is forestalled to be the major cause of approximately 85 per cent of cancer. The surging dominance of cancer is directly proportional to the business growth, owing to the high demand for diagnosis and early disease screening.Mounting technological advancements such as the development of specific biomarkers facilitates the customized treatment approach of lung malignancies eventually driving the lung cancer diagnostics market during the forecast period. The rising awareness levels amongst the populace and the availability of government as well as private funds for R& D of better tumor diagnostic tools further fuels the industry growth.Evidences show that beta-carotene supplements and arsenic in drinking water intensifies the risk of lung cancer, and accounted for 8.8 million deaths in 2015. An estimated 14 million adults have been diagnosed with the disease worldwide, with its prevalence expected to reach 21.7 million by 2030Increased exposure to radon, asbestos, secondhand smoke, air pollution, or other factors cause lung cancer in nonsmokers. Genetics also play a vital role for disease occurrence in non-smokers. Workplace exposures to diesel exhaust, asbestos and other chemicals increases the chance of cancer. As per WHO, lung cancer accounted for 1.69 million deaths worldwide in 2015.Kirti Juneja
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