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Heart Checks While You Shop: NHS Announces Plan To Have Pharmacies Check Shoppers’ Heart Health In Bid To Cut Deaths

Shoppers will be offered on-the-spot NHS heart checks to detect signs of killer conditions.

High street pharmacies will be overhauled under the national plan to prevent up to 150,000 heart attacks and strokes within a decade.

The country’s most senior doctor said the new approach would be a “game changer,” helping to identify risks far earlier, with advice on lifestyle overhauls as well as targeted medication.

Pilot schemes have seen some types of strokes fall by a quarter.

From October, chemists will begin rolling out the “rapid detection service,” which includes mobile electrocardiograms to spot irregular heartbeats, as well as checks on blood pressure and cholesterol levels.

If successful, the scheme will be rolled out to every pharmacist in the country within three years.

An NHS sign is pictured at St Thomas’ Hospital  Credit: AFP

The plans aim to identify those at risk far earlier, when treatment and lifestyle changes are most likely to be effective.

Pharmacists will be expected to dole out advice on exercise and diet, with results passed directly to GP practices, who can prescribe the right medication.

Professor Stephen Powis, NHS England medical director, said: “Heart disease and strokes dramatically cut short lives, and leave thousands of people disabled every year, so rapid detection of killer conditions through high street heart checks will be a game-changer.”

The plans, launched to coincide with the world’s biggest heart conference, follow proposals to scrap “one size fits all” health MOTs at GP surgeries.  In future, GPs will be expected to increasingly target checks on those thought to be at greatest risk, due to their medical and genetic history, while routine screening tests are offered by pharmacists.

Heart disease is Britain’s biggest killer, with deaths from heart attacks, strokes and circulatory diseases accounting for 160,000 deaths in the UK every year.

More than 7 million people are living with heart and circulatory diseases.

Speaking at the European Society for Cardiology (ESC) conference, in Paris, Professor Bryan Williams, author of its guidelines on disease prevention, said: “This is hugely important. Heart disease and stroke remain the most important cause of premature death and disability and we have the means to prevent the many of them.

“The key is early detection of those at risk and doing this is a way that is convenient for the public, not having to wait for a GP appointment that could be done simply the local pharmacy.”

Chemists will begin rolling out the “rapid detection service,” which includes mobile electrocardiograms to spot irregular heartbeats, as well as checks on blood pressure and cholesterol levels. Credit: Anthony Devlin/PA

Yesterday Dexter Canoy, clinical epidemiologist from the University of Oxford, presented research showing that raised blood pressure at the age of 40 is a clear indicator of the risk of suffering heart attacks and strokes in later life.

He said: “We need to find ways to target the people who aren’t seeing their GP regularly – the middle-aged men who think they are healthy, but haven’t actually been checked.”

“If opening it up to pharmacies and shopping malls means that people are more likely to have their blood pressure checked, that could make a significant difference,” he said, calling for proper evaluation of the measures.

The checks are part of a new £13 billion five year contract for community pharmacists which aims to expand their roles and offer earlier detection of diseases.

More than 100 pharmacies in Cheshire and Merseyside have begun offering blood pressures screening services, under a local initiative, backed by the British Heart Foundation, with plans to recruit more than 200 more chemists to the service as it expands.

Medics said widespread use of the monitors by pharmacies, hospitals and individual patients could cut costs, speed diagnosis and avoid preventable hospital admissions.

Pilot schemes in Lambeth and Southwark in south London identified more than 1,400 patients suffering from atrial fibrillation – an irregular heart rhythm –  who should have been taking blood thinning drugs, but were not. In total, 1,300 of the patients have now been put on the medication, leading to a 25 per cent reduction in the rate of strokes linked to their heart condition.

Keith Ridge, England’s chief pharmaceutical officer, said: “This new contract makes the most of the clinical skills of local pharmacists and establishes pharmacies across England as local health hubs – open in the evenings and at weekends – where people can go for an ever-increasing range of clinical health checks and treatment.”

Simon Gillespie, chief executive of the British Heart Foundation, said: “Millions of people in England are living with conditions such as high blood pressure which, if left untreated, significantly increase the risk of having a potentially deadly heart attack or stroke. Reaching more people and encouraging them to check their blood pressure, working with them to lower it where necessary, will play an absolutely critical role in saving lives in the coming years.”

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Source: Heart checks while you shop: NHS announces plan to have pharmacies check shoppers’ heart health in bid to cut deaths

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Promising Blood Test Could Help to Predict Breast Cancer Recurrence

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Doctors have gotten much better at detecting and treating breast cancer early. Drug and chemotherapy regimens to control tumors have gotten so effective, in fact, that in some cases, surgery is no longer necessary. In up to 30% of cases of early-stage breast cancer treated before surgery, doctors can’t find evidence of cancer cells in postoperative biopsies. The problem, however, is that there is currently no reliable way to tell which cancers have been pushed into remission and which ones have not.

That’s where an easy identifier, like a blood test, could transform the way early stage breast cancer is treated. In a paper published in Science Translational Medicine, researchers led by a team at the Translational Genomics Institute (TGen), an Arizona-based nonprofit, report encouraging results on just such a liquid biopsy. Its test, called Targeted Digital Sequencing (or TARDIS), was up to 100 times more sensitive than other similar liquid-biopsy tests in picking up DNA shed by breast cancer cells into the blood.

Currently available ways of tracking breast cancer cells in the blood are most useful in people with advanced cancer. In those conditions, cancer cells litter the blood with fragments of their DNA as they circulate throughout the body to seed new tumors in other tissues like the bone, liver and brain. But in early-stage breast cancer, these cells are, by definition, scarcer.

To address the problem, the research team, which included scientists at Arizona State University, the City of Hope, Mayo Clinic, and the Cancer Research UK Cambridge Institute, developed a new way to pick up elusive cancer DNA. They genetically sequenced tumor biopsy tissue from 33 women with stage 1, 2, or 3 breast cancer, most of whom received drug or chemotherapy treatment prior to getting surgery to remove their tumors. By comparing the tumor sequence to the sequence from the patients’ normal cells, the scientists isolated potential mutations that distinguished the cancer cells and identified those that were most likely to be so-called “founder mutations”—genetic aberrations present in the original cancer cells and carried into the resulting tumor.

On average, each patient harbored about 66 such founder mutations. For each patient, the scientists combined the founder mutations to form a personalized assay, which could then be used to pick up signs of breast cancer DNA in blood samples. Combining a number of mutations together turned out to be a more sensitive way to detect tumor DNA than trying to pick up a single or a small number of mutations in an already small number of tumor DNA fragments present in the blood.

They combined this approach with a new strategy for amplifying the scarce tumor DNA found in a blood sample by preserving the size of these snippets and attaching unique molecular identifiers to them to make them more easily detectable.

At the start of the study, TARDIS was able to find tumor DNA in the blood samples of all the patients; other liquid biopsies for breast cancer currently in development have reported picking up 50% to 75% of the cancer cases.

After the pre-surgery treatment TARDIS detected circulating tumor DNA in the blood in concentrations as low as 0.003%, or 100-fold more sensitive than other tests being developed.

“This is an important advance,” says Dr. Debu Tripathy, professor and chair of the breast medical oncology department at the University of Texas MD Anderson Cancer Center, who was not involved in the study. “This test can help identify those with early stage breast cancer who may still have residual cancer in their body that may not be detectable with standard scans.”

That could help guide treatment, by, for example, determining which patients require closer monitoring for recurrent growths. Because the sequencing identifies the genetic mutations contributing to the tumor, the test could also help doctors to decide which targeted drug therapies, which are designed to address specific cancer mutations, to prescribe for their patients.

Most importantly, the test could help women whose tumors are effectively eliminated by their pre-surgery treatment to avoid an operation altogether since the blood test would reassure her and her doctor that no residual tumor DNA remained.

“If we could really know with a more accurate degree of certainty that you don’t have residual disease, it would be help in saying that you don’t need any more therapy [including surgery],” says Dorraya El-Ashry, chief scientific officer of the Breast Cancer Research Foundation. ”Conversely, if you still had residual disease, if there is information from the test that can pinpoint the next therapy, that would also be better.”

Muhammed Murtaza, co-director of the center for non-invasive diagnostics at TGen, says TARDIS needs to be tested in a larger group of breast cancer patients before it can be rolled out to doctors’ offices. His team is planning to study the test’s efficacy in about 200 breast cancer patients, in order to clarify exactly what levels of tumor DNA found in the blood are most likely to lead to recurrence. They are also exploring how modified versions of TARDIS could be applied to other cancers, like esophageal, colorectal, pancreatic and prostate.

There’s even encouraging precedent for this sort of a liquid biopsy. Doctors routinely rely on a blood test for chronic myeloid leukemia, for example, to track patients’ response to targeted drugs that treat specific mutations driving the cancer. “Applying this same technology to more common solid cancers like breast cancer is the new frontier,” says Tripathy.

By Alice Park

Source: https://time.com

 

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