FORT WORTH, Texas (MCT) — Spurred by emerging health threats such as avian flu and bioterrorism, new research tools and a revolutionary understanding of basic human biology (thanks to the Human Genome Project), scientists and doctors say we are on the brink of transforming medical treatment in the 21st century.

“Imagine a world where we will be able to tell each patient whether they need to take action to pre-empt altogether the development of costly and painful diseases. Imagine telling them that they do not need to take expensive medications for life, because they are not at risk of disease,” said Dr. Elias Zerhouni, director of the National Institutes of Health, during his 2007 budget request to Congress last spring. “Our hope is to usher in an era where medicine will be predictive, personalized and pre-emptive.”

With life expectancy in the United States at an unprecedented 78 years, being able to predict and prevent illness will be more important in the future.

Cancer

The first vaccine developed to prevent cancer was approved by the U.S. Food and Drug Administration last summer. Gardasil, the new vaccine, proved 100 percent effective in preventing cervical cancer in a two-year test of more than 10,000 girls and women. The disease is caused almost exclusively by a highly common sexually transmitted virus called the human papilloma virus, or HPV. There are about 500,000 new cases of cervical cancer each year worldwide, and 300,000 deaths, including 3,700 in the United States. In addition, a new study found the vaccine effective in preventing HPV-related vaginal and vulvar cancer.

Other vaccines to prevent virus-related cancers are under development. Some vaccines that prime the immune system to better recognize and get rid of cancer cells are now in clinical trial. Known as “immune therapy,” the vaccines grown from a patient’s own malignant cells are being tested against melanoma, leukemia, lymphoma and myeloma as well as malignant tumors in the brain, breast, lung, kidney, ovary, prostate, pancreas, colon and rectum.

Other important advances in the detection and treatment of cancer include several new “smart drugs” — targeted therapies that improve survival and response rates for hard-to-treat cancers, including ones for high-risk kidney cancer, advanced breast cancer and the first new treatment for head-and-neck cancer in 45 years, according to the American Society of Clinical Oncology.

There also have been significant advances in genetic tests that predict the outcomes of people with lung cancer. Such tests help determine how aggressive treatment should be.

Diabetes

In September, the National Institute of Allergy and Infectious Diseases announced its findings in the first international, multicenter trial of the Edmonton Protocol — a standardized approach to transplanting insulin-producing islet cells.

The clinical trial, involving 36 adult volunteers, found that the approach could dramatically benefit patients with severe complications of type I diabetes mellitus.

Five to 10 percent of the estimated 21 million Americans with diabetes have type I, an autoimmune disease in which the body destroys its own islets, the cells that make insulin (the hormone required to use glucose for energy). With the more common type II diabetes, the body produces insulin but has a reduced ability to use it properly. With either, high levels of glucose can accumulate in the blood, causing injury to nerves and blood vessels.

The Edmonton Protocol trial was designed to gauge how well the transplanted islets would function in regulating blood sugar levels. A year after final treatment, 44 percent of the transplant recipients no longer needed any insulin injections, and an additional 28 percent had enough islet function to avoid hypoglycemic unawareness, a severe complication of diabetes in which people can no longer recognize symptoms of low blood sugar.

Also, an inhaler that delivers measured doses of aerosolized insulin was cleared for use by both type I and type II diabetics in 2006 and could replace some of the pumps, pens and needles diabetics use.

Wound care

Some of the biggest medical advances for wound care in recent years have been developed on the battlefields in Iraq.

One bandage, developed by the American Red Cross with the U.S. Army, contains fibrinogen and thrombin, natural clotting proteins that stem the flow of blood in about a minute. When the biodegradable bandages come into contact with a bleeding wound, the fibrinogen and thrombin melt into it and give clotting factors already present in the blood a boost to stop bleeding.

The U.S. Navy has also developed a bandage that uses algae fibers to seal wounds and give the body time to form its own blood clots to stop bleeding.

Another development for wound care is a pain-reducing wound dressing. London’s Royal College of Physicians and a Danish medical-device manufacturer developed the wound dressing with built-in ibuprofen to deliver pain relief directly into the wound. Besides relieving pain, the dressing absorbs and evaporates away any excess fluid that builds up in the wound.

Cardiovascular care

Stem cells to repair damaged heart muscle and improve cardiac function were the big breakthroughs in heart disease in 2006. Researchers are finding ways to replace dead and malfunctioning cells so the weakened heart muscle can regain its pumping power.

Specialized heart stem cells are also being used to establish new blood vessels to supply oxygen to the heart, according to the National Institutes of Health.

In the United States, congestive heart failure — ineffective pumping of the heart caused by loss of heart muscle cells because of heart attacks, hypertension and coronary artery disease — afflicts 4.8 million people, with 400,000 new cases each year, according to the NIH.

A simple new blood test is telling doctors when to adjust drug treatment for congestive heart failure. It measures a protein identified as proBNP, which is released when the heart is in trouble and is used to diagnose the disease and to tell physicians when patients are getting worse, so that they are not over- or under-treated.

Women’s health

A dramatic decrease in breast cancer rates was announced at the annual San Antonio Breast Cancer Symposium in December.

An analysis of federal cancer statistics found that about 14,000 fewer women had breast cancer diagnosed in 2003, the year after millions of women quit taking estrogen and other hormones to help deal with the symptoms of menopause. Because the steepest declines occurred in women ages 50 to 69 with estrogen-receptor-positive breast cancer, the most likely explanation is the decrease in hormone replacement therapy, said Dr. Peter Ravdin, research professor in the Department of Biostatistics at M.D. Anderson Cancer Center in Houston. However, additional data are needed to prove the cause-and-effect relationship.

In addition, the morning-after pill went over-the-counter, and women got their own knee-replacement implants that address the thinner, narrower shape of a woman’s knee. More than two-thirds of the 400,000 patients who get knee replacements each year are women, primarily older women who have suffered years of degenerative arthritis.

What’s next?

HIV test: This month, Duke University Medical Center researchers said they have developed a highly sensitive test to identify which drug-resistant strains of HIV are developing in a patient’s bloodstream. The test, which detects genetic changes in HIV, may help guide treatment by predicting whether a patient is likely to become resistant to a particular HIV drug and help scientists understand how the constantly evolving virus develops drug resistance.

Good genes: Top Australian scientists say that within 10 years, people will be able to find out how good their genes are at fighting disease, which environmental risks they are susceptible to, and steps they should take to prevent the onset of bad health. Someday, it will be possible to have a bad combination of genes repaired to avoid disease, according to the report released in October by Research Australia.

Diagnosis chip: The National Institute of Allergy and Infectious Diseases reported in December that new “GreeneChip” technology developed by an international group of researchers will soon be used to quickly and accurately diagnose infectious diseases. GreeneChip is a glass slide with 30,000 pieces of genetic material taken from thousands of viruses, bacteria, fungi and parasites. When human fluid and tissue samples are applied to the chip, the microscopic genetic probes stick to any closely related genetic material in the sample being tested, so that a correct diagnosis can be made.

Bird flu: The fear of a bird flu pandemic has spurred researchers and vaccine manufacturers to step up efforts to develop a vaccine. The hope is to have a vaccine specifically for the pandemic strain, if or when the ever-changing avian virus mutates into a form that can easily infect and spread disease among humans. Even a strain that is not a perfect match could prevent people from dying, according to researchers at Stanford University Medical Center who are at the forefront of the effort. They are now testing a new flu vaccine made in cell cultures in a laboratory rather than the traditional chicken eggs. This is because cell cultures, which may someday be used for all vaccines, permit better control and are more efficient. Stanford researchers say there is a good chance that an avian flu vaccine will be licensed for human use in the United States by the end of 2007.