Presbyphonia: Dealing with an ageing voice
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What is presbyphonia and why does it affect some older people but not others?
Hello and welcome to The Health Report with me, Norman Swan. Today, a cheap new medication to help you quit smoking. We'll use a couple of well-known RN broadcasters to illustrate a common voice issue and let you know what can be done about it, good news about living longer, and a story going around the world this week from a presentation at a major conference in the US and a paper in the New England Journal of Medicine. It seems that it's now possible to identify women with breast cancer which hasn't spread to lymph nodes who can get away without chemotherapy. For many years, chemo has been a mainstay of treatment following surgery to remove the cancer and is credited, along with radiotherapy, with a very significant improvement in survival.
But now the game has changed thanks to a trial using gene testing. On the line from the Mater Hospital in Sydney is Professor Fran Boyle, a cancer specialist and researcher with an interest in breast cancer. She's here to explain. Welcome back to The Health Report, Fran.
Hello, Norman. It's a very exciting day.
Well, it is. I mean, what proportion of women can now, with this kind of, we'll come to what the kind of breast cancer is in a minute, can escape chemotherapy?
Well, I think chemotherapy is fantastic if you need it, and it's fantastic if it's going to work for you. But if it isn't, then it's absolutely something to be avoided. And we think that the group that we're looking at here are people with what we call an intermediate risk cancer. not a really high-risk cancer, not a really low-risk cancer, but that sort of grey zone or the ones where you sit on the fence and ponder, And what's fantastic is that additional information can help you work out who really is going to benefit.
So let's just talk about because breast cancer has changed enormously and it's turned really breast cancer into a chronic disease rather than a fatal one for many, many women. But it's become, you know, you do all these tests on women. So just describe the sort of breast cancer these women had in this trial before you get onto the test itself.
So these would be women who've had surgery to remove a lump or a mastectomy. They've had some lymph nodes sampled under the arm. And they've had some standard pathology tests that we do all around the country. So they've got hormonal breast cancer, which you can tell from staining the slides. Meaning
that it's positive. They've got receptors locking key mechanisms for estrogen and progesterone.
That's exactly right. So that some of the growth of the cancer is being driven by estrogen. And we know that hormone blocking drugs are very helpful for that group of women. So that's a standard test we would do here. It also is the kind of cancer that doesn't need Herceptin because it doesn't have that extra lock and key of the HER2 and it isn't in the lymph nodes. So this is actually a pretty common kind of breast cancer we would pick up, particularly in older women who are in the screening age groups and are having breast screened so their cancers are picked up at that earlier stage.
So what is this test?
So what the test does is it takes a piece of that pathology sample and in our case, sends it to America. And additional genes are looked at, which are not the inherited breast cancer genes, so not the ones that tell you whether you got it from your granny and your auntie, but the ones that are actually mutated in the cancer that are associated with growth and spread. And the test can come back with more or less three kinds of answers. One, low risk, don't worry about it. I'm going to
say low risk, low risk of recurrence or spread.
That's right. Number two can come back with, yes, up to a 30% risk of recurrence and spread. So we call that a high risk. And then there's the sort of fuzzy zone in the middle of the intermediate risk. And that's the group of people who were involved in this clinical trial called the Taylor X trial.
How can gene‑testing (Oncotype DX) determine whether older breast‑cancer patients need chemotherapy?
So the practice up till now has been if you come back on this 21 gene test, low risk, you haven't been given chemotherapy.
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Chapters
8 chapters
1
What is presbyphonia and why does it affect some older people but not others?
0:00–3:46
2
How can gene‑testing (Oncotype DX) determine whether older breast‑cancer patients need chemotherapy?
3:46–7:28
3
What did the trial reveal about the benefit of chemotherapy for intermediate‑risk breast cancer?
7:28–11:08
4
How does the plant‑derived drug cytosine work as a smoking‑cessation aid and what is its trial status in Australia?
11:08–15:09
5
What are the key findings of the US study on why some seniors experience bothersome presbyphonia?
15:09–19:08
6
What treatment options exist for pathological presbyphonia, including voice therapy and vocal‑fold augmentation?
19:08–22:16
7
How much longer are Australians living and what are the main drivers behind the decline in middle‑age mortality?
22:16–25:46
8
What public‑health actions are recommended to improve healthy lifespan and reduce dementia and disability in older adults?
25:46–28:19
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