Rodrigo Arrangoiz MS, MD, FACS, FSSO

03/12/2026

What was your doctor doing 36 years ago?
Training at Nick Bolletierri Tennis Academy in Bradenton Florida

03/11/2026

03/11/2026

Key Genetic Mutations in Primary Hyperparathyroidism

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03/06/2026

Board Review Q&A (2025): De-escalating Axillary Surgery in Breast Cancer

What was the pivotal shift from ALND to SLNB? Randomized trials: Milan / Veronesi, NSABP B-32, ALMANAC This trials showed that SLNB achieves equivalent survival and regional control compared with A…

03/05/2026

Margins of Resection in Head and Neck Squamous Cell Carcinoma

Surgical margin status: Remains one of the most powerful and actionable prognostic factors in oral tongue / oral cavity SCC Classically, Scholl and colleagues: Reviewed 268 patients with squamous c…

03/04/2026

Patients with HER2-positive early breast cancer and residual invasive disease after neoadjuvant therapy are at high risk for recurrence.  
 
Postneoadjuvant trastuzumab emtansine (T-DM1), the current standard treatment, has been shown to improve outcomes; however, whether postneoadjuvant trastuzumab deruxtecan (T-DXd; a HER2-directed antibody–drug conjugate) can result in better outcomes than those with T-DM1 is unknown.
 
In the phase 3 DESTINY-Breast05 trial, adults with HER2-positive early breast cancer and residual invasive disease were assigned to receive either T-DXd or T-DM1 as postneoadjuvant therapy. The primary end point was invasive disease–free survival. Safety, including the incidence of interstitial lung disease, a known adverse event associated with T-DXd treatment, was also assessed.
 
Among patients with high-risk, residual invasive HER2-positive early breast cancer, postneoadjuvant T-DXd resulted in a significantly higher likelihood of invasive disease–free survival than T-DM1. Interstitial lung disease was an important identified risk.
 
Read the full DESTINY-Breast05 trial results and Research Summary: https://nej.md/4an3Az2

03/04/2026

Partially true — but often oversimplified.

Lifestyle changes do not change your DNA sequence, but they can influence how genes behave, partly through effects on telomeres and epigenetic mechanisms.

1. What Telomeres Are

Telomeres are repetitive DNA sequences at the ends of chromosomes that protect genetic material during cell division.

Key points:
• Each time a cell divides, telomeres shorten slightly.
• When telomeres become too short, the cell ages, stops dividing, or dies.
• The enzyme telomerase can rebuild telomeres in certain cells (e.g., stem cells, germ cells, cancer cells).

2. Lifestyle Can Influence Telomere Length

Research shows that several lifestyle factors are associated with longer or shorter telomeres:

Associated with longer telomeres
• Regular physical activity
• Mediterranean-type diet
• Adequate sleep
• Stress reduction / mindfulness
• Not smoking

Associated with shorter telomeres
• Chronic psychological stress
• Smoking
• Obesity
• Sedentary lifestyle
• Poor diet

A famous study by Dean Ornish and Elizabeth Blackburn (Nobel Prize 2009 for telomeres) showed that intensive lifestyle intervention could increase telomerase activity, suggesting possible telomere maintenance.

3. The Key Scientific Nuance

Lifestyle changes:

✔ Can influence telomere length and gene expression
✔ Can affect aging and disease risk

But they do NOT change your genes themselves.

Instead they influence:
• Epigenetics (DNA methylation, histone modification)
• Telomere maintenance
• Inflammation and oxidative stress

4. Bottom Line

The statement:

“Lifestyle changes alter genes based on telomeres.”

Verdict: Partially true but imprecise.

A more accurate version:

Lifestyle factors can influence telomere length and gene expression, which affects aging and disease risk, without changing the DNA sequence itself.

02/28/2026

A Paradigm Shift in Early HER2+ Breast Cancer: The Rise of Trastuzumab Deruxtecan (T-DXd)

The treatment landscape for HER2-positive early breast cancer (EBC) is evolving rapidly — and trastuzumab deruxtecan (T-DXd) is emerging as a potential new standard in both the neoadjuvant and adju…