Written by Dr Tom Nolan for Doctify
What do the experts think will be the big health breakthroughs in 2016? We asked some of our experts what their predictions are for the next year.
In prostate cancer treatment we have, until now, struggled to tell apart low risk prostate tumours from aggressive ones. Combining MRI imaging with molecular signatures will help us find the aggressive tumours that might previously have been deemed low-risk. We will be able to thus deliver refined, precision and stratified therapies, such as surgery, radiotherapy or ablative approaches like HIFU or cryotherapy.
Using the Prostate Specific Antigen (PSA) blood test to screen for prostate cancer is a contentious issue. Expect to hear more about this in the Spring, when a large study evaluating whether PSA screening is effective in the UK will report its first analysis. The ProtecT trial, as it is known, also includes an important study evaluating the effectiveness of three treatments for prostate cancer: active monitoring, surgery and radiotherapy. Finally, the UK PROMIS trial evaluating MRI prostate across ten NHS centres will evaluate whether the NHS can deliver MRI prostate and how accurate that is. 2016 will very exciting and might lead to wholesale changes in prostate cancer diagnosis and treatment.
The way we screen for Down’s syndrome within the NHS may change in 2016. The current standard is to offer invasive testing (such as an amniocentesis or chorionic villous sampling) to women in their first trimester (before 12 weeks) with a risk of 1 in 150 or more. Some NHS Trusts across London are piloting offering Non Invasive Prenatal Testing (NIPT) to these patients. NIPT is more accurate than the standard screening tests that are available. It is also easy to perform, since all we need is a sample of mother’s blood (taken at 11 weeks gestation as confirmed by ultrasound). NIPT is not yet accurate enough to give a definite answer as to whether or not a baby has Down’s syndrome. An invasive test is still necessary to confirm diagnosis following a positive NIPT result.
Until now NIPT testing has been done overseas by companies such as Harmony. However, for the first time this test is being carried out entirely in a UK NHS laboratory thanks to funding from the National Institute of Health Research (NIHR). It is hoped that, in the near future, NIPT can be implemented in the NHS setting – this is currently being consideration by the National Down Syndrome Screening Programme.
Tom Nolan, GP and Doctify Journal Editor
The DNA screening test 23andMe could become more widely used in 2016. The £125 kit checks your genes for inherited conditions such as cystic fibrosis and sickle cell anaemia. It also identifies genetic risk factors for conditions including dementia and diabetes. Knowing about this may help motivate you to live more healthily. It could help you to decide whether or not to take medication, such as a statin, to lower your heart attack and stroke risk. On the other hand, an abnormal result might make you worry more about your health, and if you’re already living healthily there may be nothing you can do about it. My advice is to think carefully before you take the test – once you’ve taken you can’t take it back.
The new biological drugs for psoriasis are very exciting and are being approved on a monthly basis. These are super targeted molecules that switch off the inflammatory pathways that cause psoriasis whilst minimising side effects on the immune system. Already, we are seeing patients with stubborn or difficult to treat diseases, like psoriasis, responding very nicely to some of these new drugs.
I have concerns that the NHS will struggle financially and therefore more and more skin problems will be seen in the private sector. Benign moles, warts and cysts are already mostly treated in the private sector rather than the NHS. I think the most important aspect of private medicine is to offer a very rapid and accurate service that is powered by clinical expertise and excellence. It is vital that patient care remains at the heart of any doctor’s practice and that patients receive the best possible service at all times. Maintaining this level for 100% of patients is the greatest challenge and needs to be met.