How to find hidden cancers? Doctors try glowing dyes

The Free Press WV

It was an ordinary surgery to remove a tumor — until doctors turned off the lights and the patient’s chest started to glow. A spot over his heart shined purplish pink. Another shimmered in a lung.

They were hidden cancers revealed by fluorescent dye, an advance that soon may transform how hundreds of thousands of operations are done each year.

Surgery has long been the best way to cure cancer. If the disease recurs, it’s usually because stray tumor cells were left behind or others lurked undetected. Yet there’s no good way for surgeons to tell what is cancer and what is not. They look and feel for defects, but good and bad tissue often seem the same.

Now, dyes are being tested to make cancer cells light up so doctors can cut them out and give patients a better shot at survival.

With dyes, “it’s almost like we have bionic vision,” said Dr. Sunil Singhal at the University of Pennsylvania. “We can be sure we’re not taking too much or too little.”

The dyes are experimental but advancing quickly. Two are in late-stage studies aimed at winning Food and Drug Administration approval. Johnson & Johnson just invested $40 million in one, and federal grants support some of the work.

“We think this is so important. Patients’ lives will be improved by this,” said Paula Jacobs, an imaging expert at the National Cancer Institute. In five or so years, “there will be a palette of these,” she predicts.



Singhal was inspired a decade ago, while pondering a student who died when her lung cancer recurred soon after he thought he had removed it all. He was lying next to his baby, gazing at fluorescent decals.

“I looked up and saw all these stars on the ceiling and I thought, how cool if we could make cells light up” so people wouldn’t die from unseen tumors, he said.

A dye called ICG had long been used for various medical purposes. Singhal found that when big doses were given by IV a day before surgery, it collected in cancer cells and glowed when exposed to near infrared light. He dubbed it TumorGlow and has been testing it for lung, brain and other tumor types.

He used it on Ryan Ciccozzi, a 45-year-old highway worker and father of four from Deptford, New Jersey, and found hidden cancer near Ciccozzi’s heart and in a lung.

“The tumor was kind of growing into everything in there,” Ciccozzi said. “Without the dye, I don’t think they would have seen anything” besides the baseball-sized mass visible on CT scans ahead of time.

Singhal also is testing a dye for On Target Laboratories, based in the Purdue research park in Indiana, that binds to a protein more common in cancer cells. A late-stage study is underway for ovarian cancer and a mid-stage one for lung cancer.

In one study, the dye highlighted 56 of 59 lung cancers seen on scans before surgery, plus nine more that weren’t visible ahead of time.

Each year, about 80,000 Americans have surgery for suspicious lung spots. If a dye can show that cancer is confined to a small node, surgeons can remove a wedge instead of a whole lobe and preserve more breathing capacity, said On Target chief Marty Low. No price has been set, but dyes are cheap to make and the cost should fit within rates hospitals negotiate with insurers for these operations, he said.



Dyes may hold the most promise for breast cancer, said the American Cancer Society’s Dr. Len Lichtenfeld. Up to one third of women who have a lump removed need a second operation because margins weren’t clear — an edge of the removed tissue later was found to harbor cancer.

“If we drop that down into single digits, the impact is huge,” said Kelly Londy, who heads Lumicell, a suburban Boston company testing a dye paired with a device to scan the lump cavity for stray cancer cells.

A device called MarginProbe is sold now, but it uses different technology to examine the surface of tissue that’s been taken out, so it can’t pinpoint in the breast where residual disease lurks, said Dr. Barbara Smith, a breast surgeon at Massachusetts General Hospital.

She leads a late-stage study of Lumicell’s system in 400 breast cancer patients. In an earlier study of 60 women, it revealed all of the cancers, verified by tissue tests later.

But it also gave false alarms in more than a quarter of cases — “there were some areas where normal tissue lit up a little bit,” Smith said.

Still, she said, “you would rather take a little extra tissue with the first surgery rather than missing something and have to go back.”



Blaze Bioscience is testing Tumor Paint, patented by company co-founder Dr. Jim Olson of Fred Hutchinson Cancer Research Center and Seattle Children’s Hospital. It’s a combo product — a molecule that binds to cancer and a dye to make it glow.

“You can see it down to a few dozen cells or a few hundred cells,” Olson said. “I’ve seen neurosurgeons come out of the operating room with a big smile on their face because they can see the cancer very clearly.”

Early-stage studies have been done for skin, brain and breast cancers in adults, and brain tumors in children.

Avelas Biosciences of San Diego has a similar approach — a dye attached to a molecule to carry it into tumor cells. The company is finishing early studies in breast cancer and plans more for colon, head and neck, ovarian and other types.

Cancer drugs have had a lot of attention while ways to improve surgery have had far less, said company president Carmine Stengone.

“This was just an overlooked area, despite the high medical need.”

The most and least affordable places to buy a home

The Free Press WV

Whether you can afford a home depends — a lot — on the city you want to call home. A modest income can go a long way in Cumberland, Maryland, the metropolitan area with the nation’s most affordable houses. In contrast, the least affordable homes are in the San Jose, California, metropolitan area — the center of Silicon Valley.

In Cumberland, a median-priced house costs less than two years’ median household income. By contrast, the typical home in San Jose costs about 10 years of household income.

NerdWallet calculated affordability for 173 metropolitan areas by comparing the median annual household income and the monthly principal-and-interest payment for a median-priced single-family home. “Median” means half of the values or incomes are higher and half are lower. Those comparisons revealed the five most- and least-affordable markets for buying a home.

The lists were compiled using data from the National Association of Realtors, the Census Bureau and NerdWallet surveys.



Median home price: $84,600

Median household income: $45,808

Principal and interest payment: $326 (equals 8.5 percent of monthly income)

Despite their affordability, houses in the Cumberland metro area don’t sell quickly. In February, single-family home listings had been on the market for a median of 146 days, according to The national median was 84 days.


Median home price: $90,200

Median household income: $44,981

Principal and interest payment: $348 (9.3 percent of monthly income)

Roughly midway between Pittsburgh and Cleveland, Youngstown was once a steel manufacturing powerhouse. Since then, it has embraced its diminished population and opted not to prioritize growth.


Median home price: $120,400

Median household income: $57,090

Principal and interest payment: $464 (9.8 percent of monthly income)

Among the five most-affordable metro areas, Peoria has the highest house prices. But it also has the highest median household income among the five, boosting affordability.


Median home price: $108,900

Median household income: $51,360

Principal and interest payment: $420 (9.8 percent of monthly income)

Nearby Binghamton University is considered one of the top public universities in the country.


Median home price: $100,000

Median household income: $46,198

Principal and interest payment: $386 (10 percent of monthly income)

Decatur is in the heart of corn country, and is home to an Archer Daniels Midland facility that processes hundreds of thousands of bushels of corn a day.



Median home price: $1.27 million

Median household income: $110,040

Principal and interest payment: $4,898 (53.4 percent of monthly income)

This is the only major metro area in this analysis with a six-figure median household income. But it’s also the only metro with a seven-figure median home price.


Median home price: $920,000

Median household income: $96,677

Principal and interest payment: $3,548 (44 percent of monthly income)

With a median home price of almost $1 million, homes in the Bay Area are hard to afford.


Median home price: $760,600

Median household income: $80,513

Principal and interest payment: $2,933 (43.7 percent of monthly income)

Honolulu is one of the hottest housing markets for international buyers, with Canada, Australia, Germany, Japan and the United Kingdom leading the pack.


Median home price: $610,000

Median household income: $70,824

Principal and interest payment: $2,352 (39.9 percent of monthly income)

San Diego is also a top destination for foreign buyers, led by Canada, Mexico, the U.K., Japan and Germany.


Median home price: $546,400

Median household income: $74,615

Principal and interest payment: $2,107 (33.9% of monthly income)

The population of the Boulder metro area grew by almost 24,000 between 2010 and 2016, to 313,961. It’s home to the University of Colorado, where about 30,000 students are enrolled.

Data sources:

— Household income: U.S. Census Bureau’s American Community Survey from 2016 (the most recent available)

— Home prices: National Association of Realtors’ metropolitan median price index for the fourth quarter of 2017

— Mortgage payments: Principal and interest only on a 30-year, fixed-rate mortgage, assuming a 20 percent down payment, at 4.08 percent (the average rate for the fourth quarter in NerdWallet’s daily mortgage rates survey)

CDC Wants to Know What’s Killing Dentists in Virginia

The Free Press WV

A deadly lung disease is killing dentists in Virginia at a notably high rate, and the CDC wants to know why, CNN reports. Friday’s Morbidity and Mortality Weekly Report reveals eight dentists and a dental technician were treated for idiopathic pulmonary fibrosis at a Virginia care center between 2000 and 2015. They make up about 1% of the 894 IPF cases handled by the facility between 1996 and 2017, according to Medscape. But Newsweek notes dentists and dental technicians make up only about 0.038% of the US population. The study published Friday is the first to show a link between IPF and dentistry. The study’s lead author, Dr. Randall Nett, tells CNN the number of IPF cases at the Virginia care center involving dentists and dental technicians “was about 23 times higher than expected.“

Only two of the nine patients—all men with an average age of 64—are still alive. The cause of IPF is unknown, but the study found occupational hazards faced by dentists could play a role. “Dentists and other dental personnel have unique exposures at work,“ Nett says. “These exposures include bacteria, viruses, dusts, gases, radiation, and other respiratory hazards.“ The chief policy officer of the American Academy of Pediatric Dentistry says the report is “not surprising,“ especially because the IPF patients were older and may not have been using modern practices and protections. One of the surviving patients told the CDC he worked as a dentist for 40 years and only wore a surgical mask during the last 20; he said he never wore a certified respirator. The CDC is planning to follow up the study with further research.

Study: Cholesterol drug lowers risk of death, heart attack

The Free Press WV

A newer cholesterol drug, used with older statin medicines, modestly lowered heart risks and deaths in a big study of heart attack survivors that might persuade insurers to cover the pricey treatment more often.

Results on the drug, Praluent (PRALL-yoo-ent), were announced Saturday at an American College of Cardiology conference in Florida. It’s the first time a cholesterol-lowering drug has reduced deaths since statins such as Lipitor and Crestor came out decades ago.

“It’s the ultimate outcome; it’s what matters to patients,” said study leader Dr. Philippe Gabriel Steg of Hospital Bichat in Paris.

But the benefit was small — 167 people would need to use Praluent for nearly three years to prevent a single death.

“That’s a high cost” that may still hinder its use, said one independent expert, Dr. Amit Khera, a preventive cardiologist at UT Southwestern Medical Center in Dallas and a spokesman for the American Heart Association.

The drug’s makers, Sanofi and Regeneron Pharmaceuticals, sponsored the study and said they would work with insurers on pricing to get the medicine to those who need it the most.


Doctors focus on lowering LDL, or bad cholesterol, to prevent heart problems. Statins are the main medicines for this, but some people can’t tolerate or get enough help from them.

Praluent and a similar drug, Amgen’s Repatha, work in a different way and lower cholesterol much more. Patients give themselves shots of the medicine once or twice a month. The drugs have been sold since 2015 but cost more than $14,000 a year, and insurers have balked at paying without proof that they reduce health problems, not just the cholesterol number.

Last year, a study showed Repatha cut heart problems but did not improve survival. The new study tested the rival drug, Praluent, for a longer time and in patients at higher risk — nearly 19,000 people who in the previous year had a heart attack or chest pain serious enough to put them in the hospital.

All had LDL over 70 despite maximum statin use. Half were given Praluent and the rest, dummy shots. Praluent was started at a lower dose and increased if LDL did not drop below 50.

After nearly three years, 9.5 percent of those on Praluent and 11.1 percent of those on dummy medicine had suffered a heart attack, stroke, heart-related death or serious chest pain; 3.5 percent on Praluent and 4.1 percent on dummy medicine died.

That worked out to a 15 percent lower risk with Praluent. Benefits were greater for those whose LDL was 100 or more at the start of the study. The drug had no major safety issues.


“We need to reset our expectations” and realize that benefits for any new drug are going to be fairly small when added to already good treatments such as statins, said Dr. Jeffrey Kuvin, conference leader and cardiology chief at Dartmouth-Hitchcock Medical Center. The new drugs clearly help people at high risk and are not aimed at people at low risk, such as those who have high cholesterol but have never had a heart attack, he said.

“I’ve been unconvinced” of the drugs’ benefits but now may prescribe them for certain very high risk patients, said Duke University cardiologist Dr. Christopher Granger. But preventing fewer than one heart problem a year at the drug’s current price is not cost-effective, he said.


An independent group, the Institute for Clinical and Economic Review, on Saturday released a new range for what Praluent should cost, based on the new results — $2,300 to $3,400 per year for people like those in the study. A price of $4,500 to $8,000 per year would be justified for patients at higher risk, with LDL over 100.

From 300,000 to 400,000 people in the U.S. each year fall in that second category. Praluent’s makers say they will aim for those price ranges for insurers that remove barriers to coverage for people at the highest risk.

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