Researchers use AI to detect pancreatic cancer sooner
Dear Doctors: A dear friend was diagnosed with pancreatic cancer. It was so advanced, he died just a month later. I recently saw a discussion on television about using AI to detect pancreatic cancer early, while it is still curable. How would that work?
Dear Reader: With a five-year survival rate of only 9%, pancreatic cancer is among the deadliest of the major cancers. It accounts for just 3% of all cancers diagnosed in the United States, which makes it fairly rare. And yet it is the third-leading cause of cancer-related deaths, behind lung and colorectal cancer.
One of the main factors driving such a high mortality rate is the difficulty of catching this cancer at an early stage. This is due, in large part, to the location of the organ. The pancreas itself is small, just 6 inches long. It is situated deep inside the abdomen, tucked among the liver, spleen, small intestine and stomach. This makes it impossible to see without the benefit of imaging tests. Adding to the challenge is that earlystage pancreatic cancer causes few, if any, symptoms. When symptoms do begin to appear, the cancer is usually quite advanced. At that point, it has often begun to spread to other areas of the body.
In the past year, several medical institutions have reported success in developing AI technology to improve pancreatic cancer outcomes. For those who are not familiar, AI stands for artificial intelligence. It is a form of targeted problem-solving that harnesses the power of computers and computer science to analyze vast amounts of data.
Last fall, the Mayo Clinic announced the development of AI technology to analyze CT scans of patients suspected to have pancreatic cancer. Researchers “trained” their AI model using a data set of 3,000 CT scans of patients with pancreatic tumors. The resulting technology was then tested using CT scans of both healthy and diseased pancreases. The AI model, with an accuracy rate of 87%, detected tumors between three months and three years sooner than the real-world diagnosis had found them.
Researchers from MIT and a Harvard-affiliated hospital approached the problem from a different angle. Their goal was to identify people at high risk of developing pancreatic cancer. That’s important because under current guidelines, only people with first-degree relatives with the disease or a known gene mutation that causes it are routinely screened. Health data show that’s just 10% of the population that goes on to develop this type of cancer.
Turning to AI, the Boston researchers created a neural network trained to identify patients at high risk of developing pancreatic cancer. They did this using anonymous electronic health records from 55 health care organizations in the U.S. The neural network was able to identify patients at risk of developing pancreatic cancer up to 18 months sooner than their real-world diagnosis of the disease.
It will take time for these Ai-based approaches to go into widespread use. However, these results signal a possible turning point in early pancreatic cancer diagnosis.
OPD can develop due to environmental hazards
Dear Doctors: I work in a big shop where we make custom furniture. My wife thinks it puts me at risk of COPD and insists I should use a mask. Is she right? I thought COPD was something that happens to smokers. Plus, wearing a mask isn’t very comfortable.
Dear Reader: COPD is short for chronic obstructive pulmonary disease. It’s an umbrella term for a group of diseases in which damage to the tissues of the lungs, along with inflammation, obstruct the airways and make it difficult to breathe.
Symptoms include shortness of breath, a persistent cough, difficulty taking a deep breath, wheezing, excess mucus and a feeling of tightness in the lungs and chest. Because the airways of someone with COPD are obstructed, they can’t get enough oxygen. This causes an oxygen deficit in tissues throughout the body, which results in weakness, fatigue and a loss of stamina.
The two most common conditions associated with COPD are chronic bronchitis and emphysema. In chronic bronchitis, the lining of the bronchial tubes, which carry air to and from the tiny air sacs of the lungs, become inflamed. This causes excess mucus production and a chronic cough. It also puts the person at increased risk of having repeated respiratory infections. In emphysema, those tiny air sacs, known as alveoli, become permanently damaged. This leads to the oxygen deficit and resulting fatigue and breathing difficulties that we discussed earlier.
You’re correct that smoking is a primary cause of COPD. The condition develops in response to repeated and long-term exposure to irritating gases and fine particulates, both of which smoking delivers in abundance. However, COPD can be an industrial hazard as well. People who work in occupations as varied as construction, mining, agriculture, welding, brick laying, stonemasonry, textiles, painting, and hair and nail care can all be at risk. When workers in these professions are also smokers, their chance of developing COPD goes up.
Occupational health data show that your own work in a carpentry shop, which exposes you to an environment that is not kind to the lungs, does put you at risk of developing COPD. The act of cutting, carving and sanding wood creates fine, airborne particulates that can damage the lungs and impair their ability to function. So can the fumes and gases emitted by the paints, stains, shellacs and solvents typically used in making furniture.
Even in a well-ventilated shop, particulates and gases will remain in the air. Long-term exposure to these can irritate, inflame and even damage delicate lung tissues, which can eventually lead to COPD.
COPD is a progressive disease. That means it gets worse with the passage of time. Although there is no known cure, it can be managed with medications and changes to behavior. Fortunately, you can significantly lower your own risk of developing this condition with one easy step: Always wear a high-quality, well-fitted mask while at work. It may be a bit uncomfortable, but to protect your lungs, it’s a small price to pay.
Research suggests jet lag can be managed with food schedules
Dear Doctors: I’ve noticed that as I get older, jet lag hits me harder. I recently read that timing your meals on the day you fly can make a difference. Do you know if that’s true? I’m also curious about apps like Timeshifter, which my son swears by. Can they help?
Dear Reader: Jet lag is the collection of unpleasant symptoms that occur when a flight takes you across multiple time zones. When you arrive, your body’s inner clock is out of sync with your destination, and that exacts a physical toll.
Symptoms of jet lag include daytime fatigue, low mood, disordered sleep, brain fog and a general feeling of malaise. Some people experience gastric problems, including diarrhea or constipation. Traveling west is easier on the body clock than traveling east, because it prolongs the normal day-night cycle, but the more time zones that are involved, the greater the net effects of jet lag. And as you have discovered, the effects of jet lag can become more pronounced and harder to shake off as we age.
The challenge of jet lag lies in the complexity of our bodies’ circadian rhythms. Also referred to as the body clock, they are synced to our planet’s 24-hour cycle of daylight and darkness. Circadian rhythms trigger the hormonal, neural and other changes in the brain that oversee sleep and wake patterns. They also affect mood and cognition, are influenced by physical activity and control how our bodies process nutrients.
Making things even trickier is newer research that suggests each cell has its own internal clock. Emerging evidence also shows that exposure to as little as five minutes of bright light can cause the circadian system to reset and recalibrate. With so many intricate and interlocking biological systems involved, it’s easy to see how the problem of jet lag remains unsolved.
Resetting the body clock during travel typically takes about one day per time zone crossed. Popular strategies to speed recovery include scheduling exposure to light or dark, taking melatonin to signal sleep and using sleep medications.
In a study published last fall, researchers from Northwestern University explored a possible role for food in managing jet lag. They found that scheduling meals to match the new zone helped to reset the body clock. Someone traveling to Europe from New York on an evening flight, for example, would have a light dinner and avoid eating on the flight. Upon arrival in the morning, they would have a hearty breakfast. That, along with deliberate exposure to bright daylight, was found to cut the typical six-day recovery time by as much as one-third.
Apps like the one your son recommends use each person’s travel information to craft a detailed jet lag recovery schedule. This includes exposure to light and darkness and optimal sleep and wake times, both before the trip and after arrival at the destination. Some include an alarm function synced to gradually awaken the individual during a cycle of light sleep, which can help to minimize grogginess. Although scientific proof of their efficacy is lacking, anecdotal evidence suggests these apps can be helpful.
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet. ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.