If you feel as if the pace of medical innovation has speeded up lately, you’re right. In the past year, important medications have been approved for treating multiple sclerosis, diabetes and obesity. What’s more, the time lag between when a discovery is made and when its application appears at a doctor’s office has gotten shorter. For instance, a link between HPV and cervical cancer was first shown in 1983; it took an additional 23 years for a vaccine against the virus to be approved. But just 10 years passed from the finding of aberrations in an enzyme that affects the DNA of breast-cancer tumors to the development of a genetic test that determines the risk that a breast cancer will recur. This faster pace means you may benefit from today’s breakthroughs more quickly now than you would have if they’d come along a decade or two ago.
What kinds of breakthroughs can you expect in the next 15 years? We asked four women on the front lines of health care to share their predictions.
Better prevention and detection of ovarian cancer
The five-year survival rate for ovarian cancer is estimated at 44 percent—much lower than that for other female cancers, such as breast (90 percent) and cervical (69 percent)—but by 2028 that prognosis is likely to improve. Genetic testing that gives women an estimate of their inherited risk of ovarian cancer should become both more comprehensive and more available.
Increased knowledge of genetic patterns will give doctors more ways to test your vulnerability to the disease. “We will be able to say, ‘Here’s your risk, and here are decisions you could make to prevent the cancer,’ ” says Barbara Goff, MD, president of the Society of Gynecologic Oncology. For example, if you’re genetically at high risk, you could choose to have your ovaries and tubes surgically removed. In addition, because of technological developments and a Supreme Court ruling that genes can’t be patented, “the cost of genetic testing is going to come down drastically in 15 years,” Goff predicts.
Substantial work is also being done on tests that can detect ovarian cancer, which is much more treatable in its early stages. Researchers are looking for biological markers—proteins, DNA and other molecules in the blood or urine—that indicate cancer long before symptoms appear. Another possibility is identifying, at an early stage of the disease, abnormal cells that may be shed from a tumor into the vagina. “An accurate screening test could save many lives,” says Goff.
Greater understanding of women’s heart disease
Within 15 years, insurers and mainstream doctors will probably acknowledge the differences in the way heart disease plays out in men and women, says Suzanne Steinbaum, DO, director of women’s heart disease at Lenox Hill Hospital in New York City and author of Dr. Suzanne Steinbaum’s Heart Book.
One difference: Women are prone to experience damage throughout the arteries that supply their heart muscle, while men are more likely to have specific trouble spots, such as clots, in these blood vessels. The frequently used nuclear stress test, which measures blood flow in the heart during exercise, works well for gauging artery blockages (the more common situation with men) but is not necessarily the best test for spotting diseased arteries in women. That practice will change over the next 15 years, Steinbaum speculates, because cardiologists will put a greater emphasis on the now--experimental endothelial--dysfunction test, which is especially useful for detecting early blood vessel trouble in women. This test detects stiffness in artery walls, which precedes the plaque buildup known as atherosclerosis. An office test can assess the health of a woman’s arteries and pinpoint a heart problem at a stage early enough that it can be reversed through lifestyle changes such as regular aerobic exercise.
Extreme weight loss without stomach shrinking
Very obese Americans—those with a BMI over 40—often are not able to sustain sufficient weight loss to significantly reduce their risks of type 2 diabetes and other obesity-related diseases. “For getting to a healthy weight, bariatric surgery has been the most successful option,” says Caroline Apovian, MD, director of the Nutrition and Weight Management Center at Boston Medical Center and author of The Overnight Diet. Procedures such as gastric bypass and gastric band reduce the size of the stomach and dramatically decrease a person’s ability to digest food, typically leading to substantial loss of pounds.
“In the future, there will be less invasive devices that will be almost as effective as bariatric surgery,” says Apovian. These may include AspireAssist, a system that allows a person to remove about a third of her stomach contents after a meal before the calories and nutrients pass farther along the intestinal tract. The partly digested food leaves through a tube that is connected to a valve on the abdomen and gets dumped in a toilet. This system, already available in Europe, is undergoing clinical trials in the U.S.
Another weight-loss device, the Endo-Barrier, is also being used in Europe. It consists of a thin, sleevelike liner that is inserted via the mouth, then attached to the first portion of your small intestine, where it forms a physical barrier that prevents food from being absorbed by this part of your body. This change in the normal digestive process brings down blood sugar and makes you feel full on small meals. Both AspireAssist and EndoBarrier are inserted without risky general anesthesia.
A test for Alzheimer’s disease
Almost two thirds of Americans who suffer from Alzheimer’s are women. The disease is now diagnosed largely through a process of elimination. Using CT scans and MRIs, doctors rule out other likely causes of memory loss and behavior changes, such as a brain tumor. Currently a definitive diagnosis of Alzheimer’s can be made only after a patient has died, through an autopsy of brain tissue that confirms the presence of neurofibrillary tangles, which are twisted protein fibers, and amyloid deposits, which are hard accumulations of protein in the brain.
By 2028 scientists will probably be able to diagnose the disease in people before it causes symptoms. Research centers are trying out tracers that can detect abnormal amyloid deposits in the brain using positron-emission tomography (PET), a type of scan that captures images of brain activity. Amyloid plaque can appear long before Alzheimer’s symptoms do, says Hui Zheng, PhD, professor of molecular and human genetics at Baylor College of Medicine. The radiotracers being tested literally light up amyloid in the brain and will allow drug companies to track the progression of Alzheimer’s to see how medication affects it. The PET scans will also pick up the disease early. “If we can make this kind of test affordable, I have no doubt that 15 years down the road we will be using it for people with memory issues and even for healthy people,” says Zheng.
Earlier detection of Alzheimer’s—say, when the neurofibrillary tangles are just beginning to form—might lead to a drug that would clear away what Zheng calls “the cellular garbage” before damage to neurons occurs.
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