Science
How AI can help researchers make esophageal cancer less deadly
Approximately 600 times a day, the esophagus ferries whatever is in your mouth down to your stomach. It’s usually a one-way route, but sometimes acid escapes the stomach and travels back up. That can damage the cells lining the esophagus, prompting them to grow back with genetic mistakes.
About 22,370 times a year in the United States, those mistakes culminate in cancer.
Esophageal cancer can be cured if it’s discovered and treated before it burrows in deep or spreads to other organs. But that’s rarely the case.
“The way this usually goes is a patient has had reflux symptoms for many years, they’ve taken Tums or something, and then all of a sudden they have difficulty swallowing so they come to the ER,” said Dr. Allon Kahn, a gastroenterologist and associate professor of medicine at the Mayo Clinic in Arizona. That’s when doctors discover a tumor that has grown into the walls of the esophagus, and likely beyond.
“At that point,” Kahn said, “it’s incurable.”
This is why only about 20% of Americans with esophageal cancer are still alive five years after their diagnosis. To improve on that figure, doctors say they don’t necessarily need better medicines. What they need are better ways to find the cancer while it’s still in its earliest, highly treatable stages.
And to do that, they need a breakthrough in screening for the disease.
“The concept of screening is to find dangerous things before they do dangerous things,” said Dr. Daniel Boffa, chief of thoracic surgery at Yale.
It works for diseases like breast, lung and colon cancer. In those cases, there’s a clear progression of steps that leads to cancer — and only to cancer.
But that doesn’t seem to be the case with esophageal cancer.
“We don’t really know who to screen, how often to screen, and what is the thing that we can see that will tell us, ‘This person is going to develop a dangerous cancer,’” Boffa said.
He likened the situation to the difficulty of forecasting a tornado.
“Most tornadoes happen when conditions are favorable for a tornado,” he said. “But most of the time that conditions are favorable for a tornado, there’s not a tornado. And a lot of the time, tornadoes happen outside of those conditions.”
Another complicating factor is that cases of esophageal cancer are rare, accounting for about 1% of all cancers diagnosed in the U.S.
Picture the 100,000 college football fans packed into Michigan Stadium in Ann Arbor on a game day, said Dr. Joel Rubenstein, a research scientist based 3 miles away at the Lt. Col. Charles S. Kettles VA Medical Center and a gastroenterologist at the University of Michigan. Then picture yourself having to figure out which four of those fans will develop esophageal cancer this year.
Screening someone for esophageal cancer is not a trivial procedure.
The standard method involves inserting an endoscope — a flexible tube with a camera on one end — into a patient’s throat and threading it down to the stomach. The camera allows doctors to inspect the esophagus up close and check for abnormal cells that could become cancerous.
The tube also serves as a conduit for tools that can collect tissue samples, which can be sent to a pathology lab for diagnostic analysis. If a doctor sees a growth that looks like early-stage cancer, it can be removed on the spot.
It sounds straightforward, but patients must be sedated for the procedure, which means they lose a day of work. Endoscopy is also expensive, and there’s a shortage of doctors who can do it.
“We’re only catching 7% of cancers through endoscopy,” Kahn said. “We’ve got to find a way to increase that number.”
In the U.S., the most common form of the cancer begins at the base of the esophagus. The cells there aren’t built to withstand exposure to stomach acid, so in people with chronic acid reflux, they sometimes adapt by becoming more like intestinal tissue. That condition is called Barrett’s esophagus, and about 5% of U.S. adults have it.
“If that’s all that was, we’d say, ‘That’s great,’” Kahn said. “But unfortunately, when it makes that change in cell type, there are genetic changes that predispose a patient to cancer.”
About 0.3% of people with Barrett’s esophagus develop esophageal cancer each year, said Dr. Sachin Wani, a gastroenterologist and professor at the University of Colorado School of Medicine. And compared to people without Barrett’s, they are roughly nine times more likely to die of esophageal cancer.
That means screening for Barrett’s is tantamount to screening for esophageal cancer.
Doctors largely agree on a core group of risk factors, including chronic gastroesophageal reflux disease, smoking and carrying extra pounds in the abdomen. Other risk factors include being at least 50 years old, male, white and having a family history of either Barrett’s or esophageal cancer.
There is less agreement about how many risk factors a person must have to justify screening.
Based on recommendations from the American College of Gastroenterology, more than 31 million people are eligible for screening. Guidelines from the American Society for Gastrointestinal Endoscopy raise that figure to 52 million, and the American Gastroenterological Assn.’s advice expands it to 120 million, said Dr. Gary Falk, a gastroenterologist and professor of medicine emeritus at the University of Pennsylvania’s Perelman School of Medicine.
All of these recommendations leave room for improvement. Only 50% to 60% of people who meet screening requirements actually have Barrett’s, said Dr. Prasad Iyer, the chair of gastroenterology at the Mayo Clinic in Arizona.
“The screening criteria are not accurate enough,” he said.
Indeed, at least 90% of people who have risk factors for Barrett’s don’t actually have the condition, Iyer said. That includes the vast majority of people with acid reflux.
So doctors are turning to artificial intelligence to identify additional characteristics that can improve their ability to identify those most likely to have Barrett’s and esophageal cancer.
“Everyone in medicine is looking at AI,” Falk said. “We think it’s going to revolutionize things.”
Iyer and his colleagues are developing an AI tool that scours the electronic medical records of Mayo Clinic patients to find those who should be screened for Barrett’s. The tool considers more than 7,500 distinct data points, including past medical procedures, lab test results, prescriptions and more. (Among the surprises: A patient’s triglycerides and electrolytes had predictive value.)
“This is probably something a human would not be able to do efficiently,” Iyer said.
In tests, the overall accuracy of both tools was 84%. While those are substantial improvements, the team would like to bump that up to 90% before they are rolled out in the clinic, Iyer said.
Rubenstein and his colleagues in Michigan created something similar, using machine learning techniques to analyze the health records of VA patients across the country. Their tool also performed better than the official guidelines of medical societies, with an accuracy of 77%. Now the team is working to refine its threshold for screening by adding cost-effectiveness to the mix.
Once in use, tools like these could lighten the load of overburdened primary care doctors, who aren’t necessarily up to date on the latest screening guidelines and refer fewer than half of their eligible patients for testing.
“It will flag a patient and say, ‘This patient should be screened,’ or, ‘This patient should not be screened,’” Iyer said. “That’s what the future really needs.”
Science
FDA sets limits for lead in many baby foods as California disclosure law takes effect
The U.S. Food and Drug Administration this week set maximum levels for lead in baby foods such as jarred fruits and vegetables, yogurts and dry cereal, part of an effort to cut young kids’ exposure to the toxic metal that causes developmental and neurological problems.
The agency issued final guidance that it estimated could reduce lead exposure from processed baby foods by about 20% to 30%. The limits are voluntary, not mandatory, for food manufacturers, but they allow the FDA to take enforcement action if foods exceed the levels.
It’s part of the FDA’s ongoing effort to “reduce dietary exposure to contaminants, including lead, in foods to as low as possible over time, while maintaining access to nutritious foods,” the agency said in a statement.
Consumer advocates, who have long sought limits on lead in children’s foods, welcomed the guidance first proposed two years ago, but said it didn’t go far enough.
“FDA’s actions today are a step forward and will help protect children,” said Thomas Galligan, a scientist with the Center for Science in the Public Interest. “However, the agency took too long to act and ignored important public input that could have strengthened these standards.”
The new limits on lead for children younger than 2 don’t cover grain-based snacks such as puffs and teething biscuits, which some research has shown contain higher levels of lead. And they don’t limit other metals such as cadmium that have been detected in baby foods.
The FDA’s announcement comes just one week after a new California law took effect that requires baby food makers selling products in California to provide a QR code on their packaging to take consumers to monthly test results for the presence in their product of four heavy metals: lead, mercury, arsenic and cadmium.
The change, required under a law passed by the California Legislature in 2023, will affect consumers nationwide. Because companies are unlikely to create separate packaging for the California market, QR codes are likely to appear on products sold across the country, and consumers everywhere will be able to view the heavy metal concentrations.
Although companies are required to start printing new packaging and publishing test results of products manufactured beginning in January, it may take time for the products to hit grocery shelves.
The law was inspired by a 2021 congressional investigation that found dangerously high levels of heavy metals in packaged foods marketed for babies and toddlers. Baby foods and their ingredients had up to 91 times the arsenic level, up to 177 times the lead level, up to 69 times the cadmium level, and up to five times the mercury level that the U.S. allows to be present in bottled or drinking water, the investigation found.
There’s no safe level of lead exposure for children, according to the U.S. Centers for Disease Control and Prevention. The metal causes “well-documented health effects,” including brain and nervous system damage and slowed growth and development. However, lead occurs naturally in some foods and comes from pollutants in air, water and soil, which can make it impossible to eliminate entirely.
The FDA guidance sets a lead limit of 10 parts per billion for fruits, most vegetables, grain and meat mixtures, yogurts, custards and puddings and single-ingredient meats. It sets a limit of 20 parts per billion for single-ingredient root vegetables and for dry infant cereals. The guidance covers packaged processed foods sold in jars, pouches, tubs or boxes.
Jaclyn Bowen, executive director of the Clean Label Project, an organization that certifies baby foods as having low levels of toxic substances, said consumers can use the new FDA guidance in tandem with the new California law: The FDA, she said, has provided parents a “hard and fast number” to consider a benchmark when looking at the new monthly test results.
But Brian Ronholm, director of food policy for Consumer Reports, called the FDA limits “virtually meaningless because they’re based more on industry feasibility and not on what would best protect public health.” A product with a lead level of 10 parts per billion is “still too high for baby food. What we’ve heard from a lot of these manufacturers is they are testing well below that number.”
The new FDA guidance comes more than a year after lead-tainted pouches of apple cinnamon puree sickened more than 560 children in the U.S. between October 2023 and April 2024, according to the CDC.
The levels of lead detected in those products were more than 2,000 times higher than the FDA’s maximum. Officials stressed that the agency doesn’t need guidance to take action on foods that violate the law.
Aleccia writes for the Associated Press. Gold reports for The Times’ early childhood education initiative, focusing on the learning and development of California children from birth to age 5. For more information about the initiative and its philanthropic funders, go to latimes.com/earlyed.
Science
NASA punts Mars Sample Return decision to the next administration
Anyone hoping for a clear path forward this year for NASA’s imperiled Mars Sample Return mission will have to wait a little longer.
The agency has settled on two potential strategies for the first effort to bring rock and soil from another planet back to Earth for study, NASA Administrator Bill Nelson said Tuesday: It can either leverage existing technology into a simpler, cheaper craft or turn to a commercial partner for a new design.
But the final decision on the mission’s structure — or whether it should proceed at all — “is going to be a function of the new administration,” Nelson said. President-elect Donald Trump will take office Jan. 20.
“I don’t think we want the only [Mars] sample return coming back on a Chinese spacecraft,” Nelson said, referencing a rival mission that Beijing has in the works. “I think that the [Trump] administration will certainly conclude that they want to proceed. So what we wanted to do was to give them the best possible options so that they can go from there.”
The call also contained words of encouragement for NASA’s Jet Propulsion Laboratory in La Cañada Flintridge, which leads the embattled mission’s engineering efforts.
“To put it really bluntly, JPL is our Mars center in NASA science,” said Nicky Fox, associate administrator of the Science Mission Directorate. “They are the people who landed us on Mars, together with our industry partners. So they will be moving forward, regardless of which path, with a key role in the Mars Sample Return.”
In April, after an independent review found “near zero probability” of Mars Sample Return making its proposed 2028 launch date, NASA put out a request for alternative proposals to all of its centers and the private sector. JPL was forced to compete for what had been its own project.
The independent review board determined that the original design would probably cost up to $11 billion and not return samples to Earth until at least 2040.
“That was just simply unacceptable,” said Nelson, who paused the mission in late 2023 to review its chances of success.
Ensuing cuts to the mission’s budget forced a series of layoffs at JPL, which let go of 855 employees and 100 on-site contractors in 2024.
The NASA-led option that Nelson suggested Tuesday includes several elements from the JPL proposal, according to a person who reviewed the documents. This leaner, simpler alternative will cost between $6.6 billion and $7.7 billion, and will return the samples by 2039, he said. A commercial alternative would probably cost $5.8 billion to $7.1 billion.
Nelson, a former Democratic U.S. senator from Florida, will step down as head of the space agency when Trump takes office. Trump has nominated as his successor Jared Isaacman, a tech billionaire who performed the first private space walk, who must be confirmed by the Senate.
NASA has not had any conversations with Trump’s transition team about Mars Sample Return, Nelson said. How the new administration will prioritize the project is not yet clear.
“It’s very uncertain how the new administration will go forward,” said Casey Dreier, chief of space policy for the Planetary Society, a Pasadena nonprofit that promotes space research. “Cancellation is obviously still on the table. … It’s hard to game this out.”
Planetary scientists have identified Mars Sample Return as their field’s highest priority in the last three decadal surveys, reports that the National Academies of Sciences, Engineering, and Medicine prepare every 10 years in order to advise NASA.
Successfully completing the mission is “key for the nation’s leadership in space science,” said Bethany L. Ehlmann, a planetary scientist at Caltech in Pasadena. “I hope the incoming administrator moves forward decisively to select a plan and execute. There are extraordinary engineers at JPL and NASA industry partners eager and able to get to work to make it happen.”
Science
Panama Canal’s Expansion Opened Routes for Fish to Relocate
Night fell as the two scientists got to work, unfurling long nets off the end of their boat. The jungle struck up its evening symphony: the sweet chittering of insects, the distant bellowing of monkeys, the occasional screech of a kite. Crocodiles lounged in the shallows, their eyes glinting when headlamps were shined their way.
Across the water, cargo ships made dark shapes as they slid between the seas.
The Panama Canal has for more than a century connected far-flung peoples and economies, making it an essential artery for global trade — and, in recent weeks, a target of President-elect Donald J. Trump’s expansionist designs.
But of late the canal has been linking something else, too: the immense ecosystems of the Atlantic and the Pacific.
The two oceans have been separated for some three million years, ever since the isthmus of Panama rose out of the water and split them. The canal cut a path through the continent, yet for decades only a handful of marine fish species managed to migrate through the waterway and the freshwater reservoir, Lake Gatún, that feeds its locks.
Then, in 2016, Panama expanded the canal to allow supersize ships, and all that started to change.
In less than a decade, fish from both oceans — snooks, jacks, snappers and more — have almost entirely displaced the freshwater species that were in the canal system before, scientists with the Smithsonian Tropical Research Institute in Panama have found. Fishermen around Lake Gatún who rely on those species, chiefly peacock bass and tilapia, say their catches are growing scarce.
Researchers now worry that more fish could start making their way through from one ocean to the other. And no potential invader causes more concern than the venomous, candy-striped lionfish. They are known to inhabit Panama’s Caribbean coast, but not the eastern Pacific. If they made it there through the canal, they could ravage the defenseless local fish, just as they’ve done in the Gulf of Mexico and the Caribbean.
Already, marine species are more than occasional visitors in Lake Gatún, said Phillip Sanchez, a fisheries ecologist with the Smithsonian. They’re “becoming the dominant community,” he said. They’re “pushing everything else out.”
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