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© Arthon Meekodong via Canva.com Breast cancer screening has long been a cornerstone of women's healthcare. With 1 in 8 women diagnosed with breast cancer in their lifetime1, the United States Preventive Services Task Force (USPSTF) has developed screening recommendations to help detect early-stage cancer. Notably in 2023, the USPSTF revised the recommended age for biennial mammogram screenings for women with average risk to start at age 40 instead of 502, estimated to result in 19% more lives being saved3 by starting screening earlier. While initiating screening at an earlier age offers advantages to a wide demographic, concerns about the potential of over-screening prompted research into the feasibility of identifying women with lower breast cancer risk who could safely delay mammograms. While guidelines address high-risk individuals, a notable gap exists in providing recommendations tailored to those at lower risk. To gain insight into a patient's risk level, physicians are able to utilize genetic testing to understand an individual's genetic makeup, providing precise insights into their predisposition to various health conditions, including breast cancer. Armed with this genetic information, healthcare providers could craft tailored screening strategies that align with an individual’s specific risk profile. This genetic risk-based approach underscores the value of genetics in individualizing the onset of screening to help avoid over-screening and its associated costs. Surprisingly, genetic information is not currently being widely utilized to identify women at risk of breast cancer or other diseases in clinical practice, despite its potential to make a significant positive impact for patients. A recent retrospective analysis of 25,591 women from the Healthy Nevada Project4 sheds light on the potential benefits of this genetic risk-based approach. The study classified 2,338 (9.1%) of these women as having a low genetic risk for breast cancer. What's remarkable is that these women exhibited a significantly lower and later onset of breast cancer compared to their average or high-risk counterparts. This finding suggests that it might be safe for low-risk women to delay mammogram screening by 5 to 10 years without compromising their health.

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Renown Health, the region's leading cardiology care provider, is offering a clinical trial for eligible patients struggling to control their high blood pressure. Nearly half of adults (119.9 million) in the United States have hypertension, or blood pressure that is higher than normal. Hypertension can put you at risk of other life-threatening disease, such as a heart attack or stroke. There are methods that cardiologists use to manage high blood pressure, but only 1 in 4 adults with hypertension (27.0 million) have their blood pressure under control.* Some patients with high blood pressure experience resistant hypertension, which does not respond well to multiple antihypertensive medications given at the same time. This means that there are many important opportunities for healthcare professionals to explore new ways to treat hypertension.  At Renown Health, we lead the region in cardiology care with our technological expertise and patient-centered approach. That is why our cardiology team is partnering with the Renown Research Office to offer the RADIANCE Continued Access Protocol (RADIENCE CAP) clinical trial to eligible patients. RADIANCE CAP is a non-randomized study designed to allow for continued access to ultrasound renal denervation therapy via the Paradise System, and to allow for the on-going collection of safety and effectiveness data in patients with uncontrolled hypertension despite the prescription of antihypertensive medications. The body’s complex communication system between the brain, heart and kidneys can sometimes become overactive, increasing your blood pressure through messages in the nervous system. Renal denervation is a minimally-invasive procedure which reduces activity from the nerves in your kidneys to lower blood pressure.  This is the third in a series of renal denervation clinical trials Renown Health has offered to patients with resistant hypertension over the last several years, with over 40 local participants.  “All the participants that I have had the pleasure to work with on these studies are very excited and grateful to have this option for helping control their blood pressure” states Lisa English, Lead Clinical Research Coordinator for Cardiology studies at Renown Health. “I love getting to know each one of them and helping on their healthcare journey. We have an amazing team of providers and staff at Renown that go out of their way to make patients experiences positive and the studies successful.” Dr. Michael Bloch, Cardiologist and Principal Investigator for the RADIANCE CAP study at Renown Health’s Institute for Heart and Vascular Health adds, “Despite lifestyle modifications like diet and exercise and the widespread availability of effective and well-tolerated medications, approximately 50% of all people with hypertension have inadequate blood pressure control putting them at risk for stroke, heart failure and kidney disease. As a one-time durable procedure, renal denervation with the Paradise endovascular system from ReCor Medical, Inc. may help millions of patients improve their blood pressure control without necessarily needing to increase their medications.” Our teams of expert providers and researchers are here to support you on your healthcare journey. Talk to your provider about the RADIANCE CAP clinical trial at your next appointment to see if participation may be right for you.

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In February, we think about hearts not just in honor of Valentine’s Day but because it is American Heart Association Month. This is a great reminder to focus on our personal cardiovascular health. Renown Health helps patients think about their heart health with our world-class providers and cutting-edge treatments through our Cardiovascular Clinical Trials. “Research serves a vital role in the future care of cardiovascular diseases. Being involved in research will help our medical community to further discover new treatment plans in our quest for life preservation and extension,” Dr. Thomas To, Cardiologist and Researcher at Renown Health. For example, let’s talk about atherosclerosis. When our hearts are healthy, they are a strong muscle that pumps our oxygen-rich blood through our coronary arteries. Over time, cholesterol and fats can build up in our arteries. This is a condition known as atherosclerosis. This type of plaque buildup in the arteries can lead to a heart attack or stroke if not properly managed. If you are experiencing chest pain or discomfort, shortness of breath or pain in areas of the upper body, these can be the warning signs of a heart attack, and you should call 911. One contributing factor to atherosclerosis is elevated lipoprotein(a) levels and the accumulation of cholesterol in the arteries, which increases the likelihood of a heart attack or stroke. Lipoprotein(a) is tested separately from the standard panel that is completed for cholesterol management, and while your total cholesterol levels may be in a healthy range, lipoprotein(a) levels can still be elevated. "Increasingly we are realizing that lipoprotein(a) levels can be used as an important assessment in more carefully delineating an individual's risk of future cardiovascular events and treatment targets" said Dr. Michael Bloch, Lipid Specialist and Researcher at Renown Institute for Heart and Vascular Health. While it is clear that elevated lipoprotein(a) contributes to atherosclerosis, there are currently no approved medications for reducing cardiovascular disease risk through reducing lipoprotein(a) levels. This is why Renown Health’s Research Office is proud to offer a phase III clinical trial, called the OCEAN(a) study, to our patients with elevated lipoprotein(a) levels as a care option for management of their heart disease risk. Our teams of expert providers and researchers are here to support you on your healthcare journey. “I am thrilled to be able to be part of this study and bring opportunities like this to our patients. The highlight of my day is getting to hear life stories from my patients during our study visits,” Lisa Preciado, Primary Clinical Research Coordinator for the OCEAN(a) study said. Join us in raising awareness around American Heart Month by talking to your provider about lipoprotein(a) at your next appointment. At Renown Health, our goal is to make it easy for patients to access clinical research as a care opportunity where patients can access a variety of standard care treatment options for their health condition or choose to participate in a clinical trial. For more information about clinical trial opportunities available to you or to ask any questions, contact the Renown Research Office at Renown-CRD@renown.org or 775-982-3646.

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While there used to be three basic treatment options for cancer -- surgery, radiation and chemotherapy, or a combination of the three -- there's a fourth option: clinical trials. Here, a Renown patient shares her successful battle with ovarian cancer, aided by a clinical trial. Shari Flamm's battle with ovarian cancer began in 2011. She was experiencing prolonged bleeding, irregular thyroid levels and anemia and was scheduled to undergo a hysterectomy. Before the surgery, her gynecologist ran routine tests to check for cancer as a precautionary measure. All tests were negative for cancer, expect her CA 125 test. A CA 125 test measures the amount of the protein CA 125 (cancer antigen 125) in the blood. In some cases, a CA 125 test may be used to look for early signs of ovarian cancer in women with a very high risk of the disease. In most laboratories, the normal level is 0 to 35 units/ml. Flamm's CA 125 level was 121. As Flamm can attest, early diagnosis played a key role in her battle with ovarian cancer. September is Gynecologic Cancer and Ovarian Cancer Awareness Month – an important time to learn the signs, symptoms and risk factors of this type of cancer so your doctor can diagnosis the disease as early as possible. Ovarian Cancer: Round One Despite the elevated CA 125 results, her doctor recommended they move forward with the hysterectomy. But when surgery began, doctors discovered a mass. She had stage 4 cancer. The procedure was halted, the mass was biopsied and she was immediately seen by Dr. Peter Lim of the The Center of Hope. Following diagnosis, Flamm underwent surgery with Dr. Lim to remove the cancer, which had spread to part of diaphragm, spleen, colon and other organs. Three months after surgery, Flamm had recovered enough to start six rounds of chemotherapy in her hometown of Carson City. She continued working at a doctor's office during her treatment, and was grateful for Dr. Lim’s ability to co-manage her care so she could stay close to work and family. “To me, chemo was the scariest part because I didn’t like feeling sick,” Flamm says. Thankfully, her body responded well to the treatments and she was back to the things she loved. “I stated working out at the gym, even if it was only for 10 minutes,” she says. She also stayed positive by spending time with her grandchildren, attending a San Jose Sharks hockey game, going for walks and enjoying concerts. Ovarian Cancer: Round Two In November 2014, Flamm had a cancer check-up. That’s when doctors discovered three cancerous tumors. For this round, Flamm choose another treatment option -- clinical trials at Renown Institute for Cancer. Clinical trials are the studies that test whether drugs work, and inform doctors' decisions about how to treat their patients. Flamm participated in a clinical trial that featured oral-targeted therapy stronger than IV chemotherapy. The hope was for the drug to shrink her tumors, however the result was stabilization -- meaning the lumps weren’t growing or spreading. The best part of the clinical trial, Flamm says, was the constant monitoring. Between the CT scans every six weeks, a heart scan every three months and monthly doctor visits, she was confident that if the cancer started growing or spreading, her healthcare team would catch it right away. For Flamm, the benefits of the clinical trial included less hair loss, less fatigue and more time to focus on what’s important in her life -- her family. “I decided I wasn’t going to be that sick grandma on the couch with cancer,” Flamm says. After taking the oral medication for one year, Flamm developed a rash and discontinued treatment due to discomfort. Clinical Trials, Setbacks and Survival In June 2016, two of the three tumors began to grow and had to be surgically removed. Despite the setback, Flamm was determined to maintain a positive outlook. "You have to stay positive because cancer feeds off anger, depression and stress," Flamm says. Flamm was released to go home with clear margins, meaning the tumors were removed and are surrounded by a rim of normal tissue that does not have cancerous cells. Flamm says her outlook on life has changed drastically since her first cancer diagnosis. “Your whole mentality changes when cancer disturbs your life," Flann says. "The things that weren’t important, are now ever so important. I’m a lot calmer now,” Flamm says.

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With more than 29 million adult Americans having high cholesterol, it’s important to know the facts. We asked Jayson Morgan, MD, a cardiologist with Renown Institute for Heart and Vascular Health, explains the numbers, the risk factors and how to maintain healthy levels. What is cholesterol? There are two types: Low-density lipoprotein (LDL) cholesterol, also known as the “bad” variety, because it can eventually build up within the walls of your blood vessels and narrow the passageways. High-density lipoprotein (HDL), also known as the “good” variety, because it helps remove other forms of cholesterol from the bloodstream. In adults, total cholesterol is considered high if it is more than 200 mg/dL. If the total is more than 200 or if high-density lipoprotein (HDL) levels are less than 40, your heart and brain may not be getting as much oxygen-rich blood as they need. This puts you at greater risk of heart attack and stroke. HDL levels greater than 60 mg/dL can actually lower your risk. What are the risk factors for high levels? Diet high in saturated fat Excess body weight Lack of exercise Smoking Family history Age (as people age, they are more prone to high levels) How often should someone get their numbers checked, and what kind of test is done? The American Heart Association recommends all adults age 20 or older have their cholesterol checked every four to six years. Those with cardiovascular disease or who are at higher risk of it may need their levels and other risk factors assessed more often. Your primary care provider can perform the test, along with assessing your other risk factors to help determine a treatment plan if necessary. The test will likely be one you will need to fast for, meaning no food, beverages or medications for around nine to 12 hours. Your healthcare provider will let you know if, and for how long, to fast. A simple blood test is all that’s needed to get your levels. What are some ways to lower “bad” cholesterol and raise “good” cholesterol? To achieve healthier levels, people should: Eat a heart-healthy diet: Choose healthier fats, eliminate trans fats, eat foods rich in omega-3 fatty acids and increase soluble fiber. Increase physical activity: Exercise on most days of the week. Quit smoking: If you smoke, it’s time to stop. Quitting smoking will improve HDL “good” cholesterol levels. Lose weight: Losing as little as five to 10 percent of your weight can improve cholesterol levels. Drink alcohol only in moderation. And finally, if lifestyle changes aren’t enough, your care provider might recommend medication to help lower your numbers. Renown Institute for Heart & Vascular Health For optimal heart health, the American Heart Association encourages you to “Know Your Numbers” which include: blood pressure, body mass index (BMI), cholesterol and fasting blood sugar, by scheduling a visit with your doctor. These numbers are critical in assessing your current risk for heart disease and stroke. Find a Cardiologist

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Head, neck and oral cancers account for just 3 percent of all cancer in the U.S. and can be hard to diagnose. Dr. Abhinand Peddada, radiation oncologist with the Renown Institute for Cancer, explains. While you likely don’t frequently hear about head, neck and oral cancers — they are significantly less common than many kinds of cancer — they can be extremely dangerous. One of the primary reasons: some symptoms mimic the common cold, making them difficult to detect without a medical professional. We asked Abhinand Peddada, M.D., radiation oncologist with the Renown Institute for Cancer, to break down the symptoms and lifestyle risks of these rare cancers. First off, what are some of the signs and symptoms of head, neck and oral cancers? Symptoms can vary based on where the cancer is. For example, throat cancer may show up as a persistent sore throat, while sinus cancer may present as soreness or pressure in the sinuses that doesn’t get better. Some other symptoms to watch may include: Swelling in the throat Painless swelling in the neck Red or white patches in the throat Hoarseness Bloody noses or blood in the mucus or saliva A new and unexplained lump or bump anywhere on the face, neck, mouth or throat Difficulty breathing Difficulty swallowing, chewing or moving the muscles in your face, neck, mouth or throat Bad breath, even with good oral hygiene Loose teeth Dentures or retainers that no longer fit Double vision Who is most at risk for head, neck and oral cancers? Both men and women can develop head, neck and oral cancers, but men are at almost twice the risk of women. People over the age of 40 are also at a higher risk, and these cancers tend to be more common in African Americans. Tobacco use — including cigarettes, cigars, pipes and chewing tobacco — is another risk factor. Tobacco is linked to 85 percent of head and neck cancers. Exposure to fumes and chemicals can increase your risk as well. We’re also seeing more HPV-related head and neck cancers in the U.S., so patients with HPV may want to watch more closely for symptoms. What about screening and prevention? Your dentist already looks for signs and symptoms at your regular dental checkups. Additionally, if you have one of these risk factors and are experiencing signs and symptoms, it’s a good idea to check with your doctor about possible screenings. To help prevent these types of cancers, try to minimize your controllable risk factors. This means quitting tobacco, watching your alcohol consumption and taking care of your oral hygiene by brushing and flossing regularly. We also recommend the HPV vaccination for both boys and girls starting at age 11. By vaccinating at an earlier age, one is less likely to develop oral HPV. What do diagnosis and treatment look like for these cancers? At Renown Institute for Cancer we offer the most advanced diagnostic testing available including fiberoptic photos, CT and PET scans, as well as MRIs. Together, you and your care team will decide which treatment best fits your needs. For these types of cancers, treatment options include radiation, chemotherapy and surgery. Renown Institute for Cancer | 775-982-4000 At the Renown Health Institute for Cancer, our experienced team provides the support and care to maintain the highest quality of life and then achieve the best possible outcome, all in one location that’s close to home. Our dedicated team, clinical expertise and advanced treatment options allow us to tailor care to each patient. Learn about: Our Team Cancers We Treat Screening and Prevention Treatment Options Find a Cancer Doctor

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Maintaining a healthy weight has many benefits: among those is improved heart health. If you’re trying to eat right as well as become healthier, nutrition experts say you might want to consider a plant-based diet. Plants provide air to breathe, beauty in our surroundings — and just may be a viable solution to your weight-loss goals. According to the Centers for Disease Control and Prevention, more Americans than ever are overweight: Today, 7 in 10 Americans are classified as “obese” or “overweight,” and childhood obesity rates are growing rapidly. So experts encourage would-be dieters to look to plants as a source of daily inspiration. “When you slowly and consistently expand your daily food choices to include more plant-based options, you will feel fuller, have more energy and lose weight,” says Lynice Anderson, director of Renown’s Healthy Heart Program. But according to a recent study from the U.S. Centers for Disease Control and Prevention, just 1 in 10 adults eats enough vegetables and only 12 percent get the recommended amount of fruit daily. The same study notes that eating a diet rich in fruits and vegetables daily can help reduce the risk of many leading causes of illness and death, including heart disease, type 2 diabetes, some cancers and obesity. Plant Foods = Foods with Fiber One of the overwhelming health benefits of plant-based foods: fiber. A study published in a recent issue of the Annals of Internal Medicine suggests that something as simple as aiming to eat 30 grams of fiber each day can help you lose weight, lower your blood pressure and improve your body’s response to insulin just as effectively as a more complicated diet. Fiber contains no calories and comes in two forms: soluble, which dissolves in water, and insoluble, which doesn’t dissolve. Both are important for different reasons. The soluble fiber found in oats, fruits and beans forms a gel-like substance and helps to lower blood cholesterol and blood sugar levels. Insoluble fiber found in fruit skins, green beans and cauliflower goes through your intestines relatively intact providing “bulk” and improving bowel-related health problems. “My fiber champion is chickpeas, also known as garbanzo beans,” says Renown Chef Chris Wyatt. “They are high in fiber, low in fat, low sodium and have zero cholesterol. Not only do they not contain any cholesterol, chickpeas work to remove cholesterol from your body. It’s a win-win.” Snacks That Are Part of a Plant-Based Diet Looking for the best sources of fiber from the plants and trees in your life? Here are the best options, according to this CDC fact sheet: Fruits Raspberries, 1 cup: 8.0 grams of fiber Pear, with skin, 1 medium: 5.5 grams of fiber Apple, with skin, 1 medium: 4.4 grams of fiber Strawberries (halved), 1 1⁄4 cup: 3.8 grams of fiber Banana, 1 medium: 3.1 grams of fiber Orange, 1 medium: 3.1 grams of fiber Veggies Artichoke, cooked, 1 medium: 10.3 grams of fiber Peas, cooked, 1 cup: 8.8 grams of fiber Broccoli, boiled, 1 cup: 5.1 grams of fiber Turnip greens, boiled, 1 cup: 5.0 grams of fiber Sweet corn, cooked, 1 cup: 4.2 grams of fiber Brussels sprouts, cooked, 1 cup: 4.1 grams of fiber Potato; with skin, baked, 1 medium: 2.9 grams of fiber Carrot, raw, 1 medium: 1.7 grams of fiber Renown Health Improvement Programs | Appointments: 775-982-5073  Renown Health offers a number of educational and support programs to help people overcome the challenges presented through various health conditions and to aid in creating and adopting a healthy lifestyle. To get an assessment of your dietary needs, schedule a consultation with one of Renown’s registered dietitians, who can help with: Diabetes Programs Medical Weight Management Nutrition Programs Make an Appointment

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