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A major trial suggests tailoring screening to individual risk is safe and might reduce unnecessary tests

• A large U.S. clinical trial found that risk-based breast cancer screening where screening frequency is tailored to each womans individual risk is just as safe as yearly mammograms for catching advanced cancers.

• Women were grouped using genetics, lifestyle, and clinical factors; those at highest risk got more intensive screening, while lower-risk women had less frequent imaging.

• Most women preferred risk-based screening when given the choice, and the approach led to fewer mammograms overall without increasing dangerous late-stage cancers.

For decades, routine breast cancer screening in the U.S. has largely meant annual mammograms starting in middle age a one-size-fits-all approach based mostly on age.

But what if screening could be smarter?

Thats exactly what researchers set out to test in the WISDOM trial, a large study coordinated by the University of California, San Francisco (UCSF) that asked a simple question: Can we use individual risk profiles to decide who needs what kind of screening?

Published in JAMA and presented at a major cancer symposium, the trial enrolled tens of thousands of women ages 4074 and compared traditional yearly mammograms with a personalized plan driven by each womans unique risk factors including genetics, breast density, lifestyle, and other health details.

These findings should transform clinical guidelines for breast cancer screening and alter clinical practice, Laura J. Esserman, M.D., MBA, director of the UCSF Breast Care Center, said in a news release. The personalized approach begins with risk assessment, incorporating genetic, biological, and lifestyle factors, which can then guide effective prevention strategies.

How the study worked

Instead of automatically giving everyone a mammogram every year, researchers built risk scores that placed participants into different screening pathways.

Women in the highest risk group based on things like genetic predisposition or very high calculated risk were advised to get imaging every six months, switching between mammograms and MRI.

Those with elevated risk still got annual mammograms plus counseling on ways to lower their risk. Most women fell into the average risk category and were recommended to have mammograms every two years. At the lowest end, women with especially low estimated risk were told they could safely delay screening until later often up to age 50 unless their calculated risk rose.

This design also offered tools for personalized risk reduction, like diet and exercise guidance or conversations about medications that may lower cancer risk. Women who chose not to be assigned randomly could pick their own screening approach in an observational group and most picked the risk-based route.

What the results showed

After about five years of following more than 28,000 women, the core finding was that the risk-based screening plan was as safe as traditional annual mammography.

Researchers looked especially at the number of advanced cancers (stage IIB or higher) detected and found that the risk-based group did not have more of these serious cases in fact, the rate was slightly lower across the study period, meeting the trials main goal of noninferiority.

Interestingly, women in the risk-based strategy had fewer mammograms overall but similar rates of biopsies and cancer detection meaning the personalized approach didnt miss cancers or lead to more invasive follow-ups even with less frequent imaging for many.

Whats more, when given the choice, a large majority of participants opted for the risk-based strategy, showing that many people appreciate tailoring screening to their specific profile.

A new study explains how the sweetener travels from the gut to the liver

• Sorbitol, a common sugar alcohol used in zero-calorie foods and found naturally in some fruits, isnt just a passive sweetener it can be converted inside the body into compounds that stress the liver.

• In experiments with zebrafish, sorbitol formed in the gut moves to the liver and becomes a fructose derivative, which fuels fat buildup linked to liver disease.

• Friendly gut bacteria normally break down sorbitol, but high levels or an imbalance of microbes may allow more sorbitol to reach the liver.

Sorbitol has long been marketed and often enjoyed as a healthier option for people trying to cut calories or manage blood sugar. Its a sugar alcohol that adds sweetness without the glycemic spike of table sugar, popping up in sugar-free candies, gums, and many diet goodies.

But recent research out of Washington University in St. Louis is prompting scientists and consumers alike to rethink that assumption.

The work suggests that sorbitol may not be quite as biologically innocent as its packaging implies especially when it comes to how the liver handles it.

The study

To understand how sorbitol behaves inside the body, the research team used zebrafish a species scientists often study because many of its metabolic processes work in ways similar to humans. The goal was to follow sorbitol step by step and see where it goes after its produced or consumed.

The researchers focused on the gut and the liver, two organs that play major roles in processing sugars. Using advanced lab tools that let them track tiny molecules, they discovered that cells in the intestine can actually turn glucose into sorbitol. That means sorbitol isnt just something we eat it can also be made inside the body.

In simple terms, the study followed sorbitols journey through the body and found that whether it stays in the gut or reaches the liver may depend heavily on the health of the gut microbiome.

What the results mean and dont mean

The researchers discovered that when sorbitol remains in the gut, certain bacteria can break it down before it causes problems. But when those helpful microbes are reduced or overwhelmed, more sorbitol is able to travel from the intestine to the liver.

Once it reaches the liver, sorbitol doesnt just pass through harmlessly. The liver converts it into a compound related to fructose. Unlike glucose, which the body uses widely for energy, fructose is processed almost entirely in the liver. That process can trigger the production of fat inside liver cells.

In the zebrafish studied, this chain reaction sorbitol moving from the gut to the liver and then being converted was linked to fat buildup in the liver, a hallmark of steatotic liver disease.

The findings suggest that sorbitol may contribute to liver fat accumulation under certain conditions, particularly when the gut microbiome isnt able to effectively break it down first.

While the study was conducted in zebrafish and more research is needed to understand how this translates to humans, the results highlight how a sweetener often considered a safer alternative can still have meaningful effects inside the body.

The agency points out the compounded drugs are not the same as FDA-approved drugs

By Mark Huffman of ConsumerAffairs

• The FDA has issued 30 warning letters to telehealth companies over misleading claims about compounded GLP-1 drugs.

• Regulators say some companies implied their compounded products were equivalent to FDA-approved medications or obscured where the drugs were made.

• The action is part of a broader crackdown on misleading direct-to-consumer pharmaceutical advertising launched last September.

The U.S. Food and Drug Administration (FDA) has issued warning letters to 30 telehealth companies for making false or misleading claims about compounded GLP-1 drugs promoted on their websites.

The agency said the companies marketed compounded versions of GLP-1 medications in ways that suggested the products were the same as FDA-approved drugs or failed to clearly disclose where the medications were produced.

Its a new era. We are paying close attention to misleading claims being made by telehealth and pharma companies across all media platformsand taking swift action, said FDA Commissioner Dr. Marty Makary.

Dr. Makary said compounded drugs can play an important role in addressing shortages or meeting specific patient needs, but warned that compounders should not attempt to bypass the FDAs drug approval process.

Second wave of actions

The warning letters mark the second wave of enforcement actions targeting telehealth companies since the FDA launched a broader effort last September to police misleading direct-to-consumer pharmaceutical advertising.

Over the past six months, the agency said it has sent thousands of warning letters to pharmaceutical and telehealth companies directing them to remove misleading advertisements more than were sent during the entire previous decade.

According to the FDA, the most common violations involved claims that compounded GLP-1 products were the same as FDA-approved medications. Other companies promoted drugs using their own brand names or trademarks without clarifying that a separate pharmacy actually compounded the medications.

The FDA emphasized that compounded drugs are not FDA-approved, meaning the agency does not review them for safety, effectiveness,or quality before they are sold. The agency also noted that compounded drugs are not equivalent to generic drugs, which must undergo FDA review and approval.

The warning letters require the companies to correct the violations and remove misleading claims from their marketing materials. Failure to comply could result in further regulatory action, the agency said.

Midwest and Gulf Coast states are feeling the most impact

By Mark Huffman of ConsumerAffairs

• U.S. gasoline prices have jumped more than 20 cents per gallon since the conflict with Iran began, pushing the national average to about $3.19 a gallon, according to AAA.

• Drivers in West Coast states are paying the most, with California averaging nearly $4.74 per gallon about $1.50 above the national average.

• Southern and Midwestern states still have the lowest prices, but many have seen some of the fastest daily increases as oil markets react to the war.

Gasoline prices across the United States are climbing quickly after the outbreak of the war involving Iran, as fears of disruptions to global oil supplies ripple through energy markets.

AAA reports the national average price for regular gasoline reached about $3.19 per gallon on March 4, up sharply from roughly $3.00 just days earlier.

The spike follows escalating military strikes and retaliatory attacks in the Middle East, raising concerns that tanker traffic or oil production could be disrupted in the Strait of Hormuz, a narrow shipping lane that carries roughly one-fifth of the worlds oil supply.

Oil prices jumped more than 5% after the fighting intensified, pushing U.S. crude toward $75 a barrel and driving wholesale gasoline prices higher.

Because gasoline prices are tied to global crude markets, analysts say geopolitical shocks can quickly show up at the pump even though the United States produces much of its own oil.

Some states feeling the surge faster

While prices have increased nationwide, the impact varies widely by region.

West Coast states continue to have the highest gasoline prices due to higher taxes, stricter fuel blends, and supply constraints. The latest AAA data show:

• California: $4.736/gallon

• Washington: $4.409/gallon

• Hawaii: $4.418/gallon

• Oregon: $3.990/gallon

• Nevada: $3.829/gallon

Meanwhile, several Midwestern states where prices often react quickly to wholesale changes are also seeing noticeable jumps.

Average prices include:

• Illinois: $3.318/gallon

• Michigan: $3.243/gallon

• Indiana: $3.145/gallon

• Ohio: $3.095/gallon

• Wisconsin: $2.936/gallon

Southern states still cheapest for now

Drivers in the South continue to pay the lowest prices in the country, though increases have accelerated in recent days.

AAA lists several of the lowest statewide averages as:

• Mississippi: $2.739/gallon

• Oklahoma: $2.735/gallon

• Texas: $2.817/gallon

• Arkansas: $2.836/gallon

• Louisiana: $2.835/gallon

Even in these states, prices are rising quickly. In Texas, gasoline jumped about 12 cents in a single day as crude oil markets reacted to the conflict.

Mid-Atlantic and Northeast prices

In the Mid-Atlantic and Northeast regions heavily dependent on refined fuel shipments prices are hovering close to the national average.

Examples include:

• Virginia: $3.032/gallon

• Maryland: $3.115/gallon

• Pennsylvania: $3.297/gallon

• New Jersey: $3.083/gallon

• New York: $3.105/gallon

• Massachusetts: $3.047/gallon

• Connecticut: $3.043/gallon

AAA says crude oil accounts for 5060% of the price of gasoline, meaning any shock to global supply can quickly translate into higher pump prices.

What drivers can expect next

Energy analysts warn that prices could rise further if the conflict continues or if shipping through the Persian Gulf is disrupted.

Some forecasts suggest crude oil could approach $100 per barrel if the war escalates, which would likely push gasoline prices significantly higher nationwide.

Seasonal factors may also add pressure. Gas prices typically rise in spring as refineries transition to summer fuel blends and travel demand increases.

For now, experts say the biggest factor affecting what drivers pay will be the course of the conflict itself.