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In part one of a two-part series on prostate cancer, the Precision Medicine Podcast addresses critical challenges as well as new advancements in prostate cancer, the second leading cause of cancer-related deaths in men. Host, Karan Cushman, is joined by Dr. William Oh, Director of Precision Medicine at Yale Cancer Center and Chair of the American Cancer Society National Prostate Cancer Roundtable. Together, they shed light on the complexities of prostate cancer and how early screening can address rising incidence rates and persistent disparities, particularly among African American men. Subscribe to get Part 2 delivered straight to your inbox.
Prostate cancer currently affects one in eight men in the US, with African American men facing a one-in-six risk and 70% higher incidence rate than White men. These disparities extend to earlier onset and more aggressive disease presentations. Globally, the disease is the most frequently diagnosed cancer in 112 countries and a leading cause of cancer-related deaths in 48 countries. The incidence of prostate cancer has been rising steadily. There has been a 3% annual increase in cases and a 5% annual rise in advanced prostate cancer diagnoses since 2014. Throughout the series, Dr. Oh discusses the role precision medicine can play in addressing these trends by tailoring prevention, diagnosis and treatment strategies to individual patient profiles.
Karan and Dr. Oh begin the conversation by highlighting critical advances in prostate cancer care, including the development of over a dozen FDA-approved drugs in recent decades. Listeners will learn of the systemic barriers that often prevent men from accessing these treatments, resulting in just half of men with advanced prostate cancer receiving standard-of-care therapiesâa fact that underscores the need to improve access and equity in treatment. Dr. Oh chairs the American Cancer Society National Prostate Cancer Roundtable, which aims to address these gaps by uniting diverse stakeholdersâfrom patient advocacy groups to scientific organizationsâto improve outcomes through collaborative efforts.
The discussion also explores the role of environmental and epigenetic factors in prostate cancer risk. Dr. Oh discusses how stress, socioeconomic disparities, and toxic exposures, such as those experienced by 9/11 first responders, may alter DNA and increase cancer risk. He compares these findings to the higher incidence of prostate cancer among African American men who live in environments that exacerbate health disparities. Dr. Oh emphasizes the importance of identifying and mitigating these risks to improve outcomes.
Screening is a key topic throughout the conversation, and Dr. Oh discusses the challenges of early detection and the controversies surrounding PSA (prostate-specific antigen) screening. While current guidelines recommend baseline PSA testing for most men between the ages of 50 to 55, new evidence supports earlier screening for high-risk populations, particularly African American men who should begin testing between ages 40 and 45. This shift toward earlier detection is critical for addressing aggressive cancers before they progress to advanced stages.
Dr. Oh goes on to explain the importance of genetic testing, which reveals up to 10% of advanced prostate cancer cases involve BRCA or other DNA repair mutations. Recognizing these mutations early can inform targeted treatments like PARP inhibitors, yet Dr. Oh notes that many patients are not tested, underscoring the need for better implementation of precision diagnostics. By linking genetic data to clinical outcomes, precision medicine can help tailor treatments to the unique needs of each patient.
The episode concludes with a call to action for improved education and collaboration. Dr. Oh emphasizes the need for patients to discuss family history and risk factors with their doctors and for primary care physicians to prioritize early conversations about prostate health. He advocates for a comprehensive approach that combines education, technology and multidisciplinary care to close gaps in prostate cancer treatment and ensure that advances in precision medicine benefit all populations, especially those at highest risk.
Stay tuned for Part 2 with Dr. Oh coming out in late December 2024.
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New Legislation Helps Deliver Appropriate Biomarker Testing to More Cancer Patients When and Where They Need It
Currently, there is a significant divide between the promise of precision medicine and how equitably new innovations are applied to each cancer patientâs treatment journey. Our expert guests Hilary Gee Goeckner (Director of State and Local Campaigns for the American Cancer Society's Cancer Action Network), and Kristine Ashcraft (founder and President of YouScript, and member of ACS CAN task force) are actively working to close that gap. They are champions of the ASC CAN effort to pass legislation across the US to expand insurance coverage of evidence-based biomarker testing for cancer patients. In this episode of the Precision Medicine Podcast, they explain why itâs so important.
Because biomarker testing is a complex topic, host Karan Cushman kicks off the episode by asking our guests to define the different types and their respective benefits. Hilary begins by explaining genetic testing and how results offer a view into someoneâs risk for developing cancer. She continues through diagnostic biomarker testing which can help match patients with the right treatments. Kristine then introduces pharmacogenomic/pharmocogenetic testing which looks at the genetic variability of how patients respond to drugs.
It's clear that testing offers a wide range of benefits and having biomarker test results upfront can support clinicians in making more precise treatment decisions as well as modifications to drug selections and dosing based on a patientâs individual profile. But our guests remind us that many underserved patients are less likely to receive guideline-indicated biomarker testing for a variety of reasons. Tune in to the full episode for more!
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Welcome to Part 2 of a two-part colorectal cancer (CRC) awareness series featuring guest Trevor Maxwell, Founder and CEO of Man Up to Cancer, a non-profit that inspires men to connect and avoid isolation during their cancer journeys. Trevor shares what heâs learned since being diagnosed with stage 4 CRC six years ago, the darkness he faced from mental health struggles and how he ultimately decided to Man Up to Cancer himself.
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Precision medicine (i.e. âpersonalizedâ medicine) is predicated on the idea that treating the whole person leads to better outcomes. Trevorâs story is evidence as host Karan Cushman takes listeners through his journey with cancer beginning with the less-than-obvious signs that led to his diagnosis at age 41.
As husband to his wife, Sarah, and father to two young daughters, Sage and Elsie, Trevor now realizes he has a lot to live for, but in the initial months after he was diagnosed he couldnât see beyond the devasting news. He says he felt like an outlierâas if all other men with cancer were somehow shouldering the burden without help while he struggled. He later realized that many, many men felt the same way he did, and they were less likely to be accessing support resources than women. Trevor says, âI just realized that something needed to be done for those guys like me who maybe donât want to participate in a co-ed environment, and maybe if we give them something, maybe if we build something for them where itâs by men going through cancer, for men going through cancer, maybe theyâll open up.â
This realization led Trevor to launch Man Up to Cancer. He says, âPeople who isolate going through cancer have worse medical outcomes, number one, and worse problems with mental health.â He created his non-profit to address those issues head on.
Trevor notes that treating the whole person, not just the cancer, can save lives, but men first need to learn to ask for help. This whole-person approach is very much in line with the idea behind precision medicine today in that understanding ourselves and how we operate can optimize our treatment paths. As Trevor says, âFor me, mental health was just as important as my physical health going through this [colorectal cancer]. For so many others, itâs the same.â
If youâre living with cancer or supporting someone through their journey with cancer, please tune in to Part 2 of our incredibly candid and insightful conversation with Trevor. Not only is he truly inspiring, but he underscores how cancer patients reaching out to their communities and asking for support can sometimes literally be a matter of life or death.
And donât miss the other episodes in our CRC awareness series, which includes Part 1 with Trevor in which he discusses the critical need for better screening for CRC as well as our broader discussion with Dr. Douglas Flora, Executive Medical Director of Oncology Services at St. Elizabeth Healthcare and Editor-in-Chief of AI and Precision Oncology.
Download the full transcript of the episode here (pdf).
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Today, 80% of adults younger than 60 are not being effectively screened for colorectal cancer. They now have a 50% greater chance of being diagnosed than they did in the 90s. Additionally, the rise of early-onset CRCâeven in otherwise healthy young people in their 20s and 30sâis unprecedented.
This marks the 60th episode of the Precision Medicine Podcast as host Karan Cushman begins a two-part series focused on colorectal cancer with Trevor Maxwell, Founder and CEO of Man Up to Cancer. Trevor was diagnosed with CRC at age 41 and attests that it feels like we are back in the early days of breast cancer in terms of building awareness around the criticality of basic screening, yet the statistics are startling.
In this Part 1, Trevor helps us understand the facts and current trends behind the second-leading cause of death for both men and women in America today. Trevor says the numbers are alarming, noting a 1% to 3% increase in the young-onset cohort every year. The big question, he says, is âwhy?â.
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In this episode of the Precision Medicine Podcast, host Karan Cushman does some time traveling with Dr. Douglas Flora through his lifetime journey with cancer. Dr. Flora is the Medical Director of Oncology Services at St. Elizabeth Healthcare and Editor-in-Chief AI in Precision Oncology, a peer-reviewed research journal dedicated to advancing artificial intelligence applications in clinical and precision oncology.
Read the full summary and tune in here.
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In this episode of the Precision Medicine Podcast, hosts Karan Cushman and Clynt Taylor welcome back Dr. Luis Raez, Medical Director and Chief Scientific Officer at Memorial Cancer Institute who is joined by Dr. Pranil Chandra, Chief Genomic Officer at PathGroup.
Together, we discuss the key barriers to performing comprehensive genomic profiling in lung cancer; how collaboration between oncologists and pathologists can enable a more consistent approach; and the improvements that should be made to close the gaps between the available life-extending, targeted therapies on the market today and the lung cancer patients who need them.
To read the full summary, download the transcript and subscribe to receive future episodes straight to your in-box visit Precision Medicine Podcast Episode #58.
Special thanks to our partners at Janssen Biotech for their sponsorship of this episode.
We encourage you to share this episode with others in your community.
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To mark the beginning of Season 5 of the Precision Medicine Podcast, we are honored to welcome Dr. Debra Patt, Executive Vice President of Texas Oncology. As an oncologist and breast cancer specialist at one of the nationâs largest community cancer practices, Dr. Patt is on the frontlines of oncology care every day. She joins us to discuss how Texas Oncology uses clinical decision-support technologies and health economics and health services research (HEOR) to deliver more consistent precision oncology care to patients at over 200 locations across Texas.
Tune in and subscribe to get the latest episode delivered straight to your in-box.
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In this episode, we are joined by Dr. Karen Winkfield, Executive Director of the Meharry-Vanderbilt Alliance, appointee to President Joe Biden's National Cancer Advisory Board, and co-host of the weekly podcast, 3 Black Docs, which is dedicated to educating the community about health and health disparities in an approachable and entertaining way.
Dr. Winkfieldâs commitment to her calling was clear by the fact that she joins us during her vacation to discuss racial disparities in the healthcare system that prevent many Black patients from seeking and receiving appropriate care. She tells us that she didnât discover her calling early and, due to family and cultural barriers of her own, she almost didnât pursue it at all. In fact, it took the support of a dedicated high-school teacher and nine emotional years to finish her undergraduate degree in biochemistry to get her where she is today as a practicing radiation oncologist.
Off the top we ask Dr. Winkfield what can be learned from greater participation of underrepresented groups in clinical trials or greater participation in the healthcare system. She notes that Black people are still dying of cancer at a much higher rate than the rest of the population, and while there are some biologic reasons, much of the cause is under-representation in cancer clinical trials.
We point out her step-by-step plan to address this type of imbalance in the healthcare system, and we are reminded that this is nothing new as she has been working to help address it for decades. She says, "Okay, I laid out a plan, but there's been a plan out for ending cancer disparities for over 20 years." The unequal burden document that was essentially kind of written by the Institutes of Medicine. Congress actually was the one who said, "Hey, we need to kind of understand what's going on with this cancer disparities thing." The whole plan is outlined.
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Part of what the challenge is now is, do we have the will, do we have the will to do what is needed? Yes, I mean, there are those of us who've been kind of yelling from the mountaintops for decades now that we need to do something different because people are dying.â
She goes on to explain that balancing disparity isnât as easy as, say, offering translation services, because institutionalized racism runs so deep that it presents barriers at every step. For instance, she says that if you look at the Cancer Genome Atlas Program, which has over 11,000 primary cancer samples, only 25 of those specimens are from prostate cancers derived from Black men, despite the fact that Black men not only have a much greater risk of developing prostate cancer, probably twice as high as any other racial ethnic group, and they're two-and-a-half times as likely to die of prostate cancer. She says, in America, your wealth directly impacts your health. Your zip code impacts your outcome more than your genetic code.
We naturally asked what role technology can play in eliminating healthcare disparities, and she says that without more representative patient samples, trials and access, precision medicine can never be precise.
In fact, she believes precision medicine can actually deepen the divide if it is not used with precision in terms of the whole person.
Where do they come from? What are barriers to them accessing precision medicine, such as transportation or even paying for parking?
Dr. Winkfield is a strong proponent of navigators who help cancer patients overcome those institutional barriers to ensure that they have equal access to the promise of precision medicine. She says, âThese are the things, the social determinants of health, if we can stop and just see the person in front of us and say, what is it that you need to help you along your cancer journey? That to me is being precise.â
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In episode 55 of the Precision Medicine Podcast, we welcome Dr. Stephen Kingsmore, President and CEO of the Rady Children's Institute for Genomic Medicine. Dr. Kingsmore joins us to discuss the extraordinary role whole genome sequencing is playing in prolonging and improving the life of critically ill newborns.
Read the full summary and tune in here!
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Dr. Christian Rolfo, President of the International Society of Liquid Biopsy and Associate Director for Clinical Research at the Center of Thoracic Oncology at the Tisch Cancer Institute at the Icahn School of Medicine at Mount Sinai in New York City, joins us to explain the unique role liquid biopsies are playing in the diagnosis and treatment of cancer.
Read the full summary, subscribe and tune in here.
Learn more about our lead sponsor Trapelo Health here.
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In this Precision Medicine Podcast episode, we are joined by Dr. Belinda King-Kallimanis, Director of Patient-Focused Research at LUNGevityâan organization that brings together research, education and support services for patients and caregivers in the lung cancer communityâand Nichelle Stigger, LUNGevity board member and lung cancer survivor. They sat down with us to discuss everything from the importance of patient-friendly language in lung cancer to discrepancies in access to biomarker testing and what LUNGevity is doing to improve the status quo. Read the full summary and listen here.
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In celebration of the three-year anniversary of the Precision Medicine Podcast, we take a look back at how far precision diagnostics have come with the help of one of our first guests Hannah Mamuszka, Founder and CEO of Alva10, and her colleague Lena Chaihorsky. Both women are focused on resolving the knowledge gap between payers and diagnostic companies and moving diagnostics to the forefront of the precision medicine conversation.
Read the full summary and tune in here!
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In this episode, in honor of Breast Cancer Awareness Month, we speak with Ali Rogin, author of Beat Breast Cancer Like a Boss and award-winning producer of PBS NewsHour. Ali is what is commonly known as a breast cancer previvor, someone who knows they have a mutation that may lead to cancer and takes preventative steps to avoid a diagnosis. With the growth of genetic testing and precision medicine and the ability to isolate genes that can lead to cancer, more and more people may fall into the category of previvors. For instance, women that have the BRCA 1 or 2 mutation, as Rogin does, have a 70% chance of developing breast cancer by the age of 80. Rogin says progress in precision medicine has given these women options they would never have had before, enabling them to make proactive, informed decisions about their future health.
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For our 50th episode, we welcome Dr. Kashyap Patel, medical oncologist and CEO of Carolina Blood and Cancer Center, current president of the Community Oncology Alliance (COA), and author of the book, Between Life and Death: From Despair to Hope. Dr. Patel explains the social determinants that can impact the quality of care and opportunity for precision medicine that patientsâand specifically oncology patientsâreceive. For him, Covid-19 brought to light the impact that disparities in healthcare can have for all of us. He notes that one in three cancer deaths could be prevented if disparities didn't exist and that disparities result in 230B of excess expense. Read the full summary, listen and subscribe to the Precision Medicine Podcast here.
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In this episode of the Precision Medicine Podcast, Janine Morales, PhD, Chief Scientific Officer at Trapelo Health takes us inside the complex world of evidence-based decision making in oncology.
Specifically, she dives deeps into some of the nuances in the latest targeted therapy approvals and explains how having access to a real-time knowledge-base and a team of experts that curate current clinical evidence can empower physicians to make more appropriate decisions at the point of care. Read the full summary here and subscribe to join us in the advancement of precision medicine.
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Dr. Howard McLeod is Medical Director for Precision Medicine at The Geriatric Oncology Consortium, a fellow of the American Society of Clinical Oncology and has worked on research projects with some of the most notable institutions around the world, including FDA, NIH, and NCI.
We cover a lot of ground with Dr. McLeod in this podcast, including career advice, the advancement of precision medicine technology and the positive impact of COVID on telemedicine and clinical trials. Read the full summary and tune in to the audio here.
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Bill Bonello, president of NeoGenomics Informatics, and Clynt Taylor, president of Trapelo Health, discuss challenges in precision medicine and how evidence-based technologies can help deliver more appropriate, value-based care to more patients.As a subtext to the discussion is the recent acquisition of Trapelo Health, creator of clinical decision-making platform Trapelo, by NeoGenomics Informatics, provider of bioinformatics services. This acquisition is aimed at improving access to precision medicine testing and treatment. Read the full summary and learn more about Trapelo here.
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In this notable episode, Dr. Caroline Carney, Chief Medical Officer at Magellan Health, and Clynt Taylor, CEO at Trapelo Health, join us to discuss how collaborative technologies can help payers more effectively manage the cost of precision oncology while delivering the best outcomes for patients. Read the full summary.
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In this Part 2 podcast featuring Dr. Gabriel A. Bien-Willner, Medical Director of the MolDX programat Palmetto GBA, we dive into the core challenges that payers face in navigating the explosion of precision medicine tests and treatments, and specifically how the prior authorization process can be streamlined by keeping payers updated on changes in coverage policy for new genes or CDx.
Be sure to tune in to Part 1 with Dr. Bien-Willner who speaks about reshaping reimbursement policies for genetic and genomic testing.
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