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VA News podcast delivers the latest updates from the Department of Veterans Affairs, focusing on essential resources, benefits, and news that matter the most to veterans. Stay informed on the support and opportunities available to you.
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Dr Jason Vassy rodecaster mixdown for PP 1
[VA Podcast Host ]
Welcome back to another episode of VA News Podcast. Today, we're diving into one of the most forward-leaning areas of VA research. How genetics is transforming the future of veteran health care.
We're joined by Dr. Jason Vassi, a primary care physician and the leader of the Genomes to Veterans Research Program. His team is working to bring genomic medicine out of the lab and into everyday clinical care, giving providers new tools to match veterans with the right treatments, identify health risk earlier, and personalize care in ways that were impossible just a decade ago. We'll talk about how these advances are already improving outcomes for veterans with depression, how the Million Veteran Program is reshaping what we know about disease risk, and what the new progress study can mean for prostate cancer screening across the VA.
This is an important conversation about where medicine is headed and how veterans are helping lead the way. Let's get into it. I think the first question that I want to ask you is, can you give like an overview of the Genomes to Veterans Research Project?
[Dr. Jason Vassy]
So, thank you for the opportunity to be able to share this work with your audience. So, I lead a research program called the Genomes to Veterans Research Program.
And as the name kind of suggests, what we are interested in is how can we use a veteran's, a patient's genetic makeup to help improve their health care? So, we've heard a lot about the genetic or genomic revolution. In the last 20 years, we've learned a lot about the human genome and what it means for people's health and disease.
But a lot of that information hasn't yet quite trickled down to where the rubber meets the road. And when you see your primary care doctor, when you see some of your other health care providers, they're probably not on the typical encounter using your genetic information to help make decisions about maybe diseases you're at risk for, treatments you should get. And in most cases, that's appropriate.
You know, not everything is genetic and a lot of the decisions that doctors and patients make together needs to have genetic testing, but some does. And a lot of primary care doctors that are in practice today, that wasn't necessarily a part of their medical school training. And they may not be up to date on the most cutting edge genetic technologies that might actually improve the way they take care of patients.
So, my research group does a lot of what we call implementation science, which is in the areas where we know that perhaps doctors should be using genetic testing to help improve the health care of veterans. And I can go into a few examples of that. How do we make it easier for them?
How do we make it easier for them to learn about those technologies, to order the technologies, to know how to use it in medical decision making, how to talk to their patients about that information? And the majority of my research is based in the VA. So, I, myself, am a practicing primary care doctor here at the Boston VA.
So, I know what it's like to be a busy frontline primary care provider. I know we don't have a lot of time. Our patients are looking to us to make sure that we help guide them through their health journeys.
And we, and, you know, if a kind of an outside researcher says, hey, I've got this new technology that you really should be using on your patients, we kind of say, well, prove it to me. Prove that it's actually going to improve the way I take care of patients and improve their health and their health outcomes. So, in general, the research we do all kind of is focused on that theme of getting genomic medicine into the hands of doctors, specifically doctors who take care of veterans to help improve their outcomes.
Awesome.
[VA Podcast Host ]
Can you let us know how long this program has been going on, like from the very beginning? And can you give us any kind of success stories that you've seen so far in your time?
[Dr. Jason Vassy]
Jay Haynes Yeah. Yeah, there's quite a few success stories. So, I've been here at VA Boston for about 12, 13 years now.
So, we started as a small program and we have now grown. So, we encompassed several different studies that we're working on. Let me give you maybe two big examples.
So, one, we participated in a randomized trial across a few different VA sites, not just at the Boston VA, looking at pharmacogenetics for depression. So, that's the idea that your genetic makeup in some small way helps determine if you have depression, whether certain antidepressants work for you or don't work for you, or whether you might have side effects from them and the person who has a different genetic makeup might not have those same side effects. So, we actually now know a lot about the different genes that impact how your body would respond to a certain antidepressant if you're being treated for depression.
So, I was a part of a study that showed that compared to a group of patients with depression who didn't get pharmacogenetic testing before their mental health provider prescribed antidepressant, the patients that got that kind of testing were more likely to have a drug, they were more likely to be prescribed a medication that was a better match for their DNA, and six months down the road had lower rates of depressive symptoms.
Presumably because that medication worked better for them or had a better safety profile, they had fewer side effects from it, which is huge. We know what a significant health condition, health concern depression is, not just for veterans, but for all Americans. It's just a very common condition.
And a lot of patients don't have success with the first antidepressant they try and maybe using genetics to help pick the right choice, the right medication right from day one might help people have better outcomes. So, that was a big win that was published a few years ago that we participated in. Another example, your audience might be familiar with the Million Veteran Program.
This is a tremendous accomplishment from the VA. So, in November of 2023, just a year and a half ago, the VA enrolled its one millionth volunteer. Veterans continue to give service for sure, even well into their 60s and 70s as an MVP participant.
But a million volunteers, now more than a million, voluntarily gave a DNA sample and gave permission for researchers to use their VA health records for research. So, we now have a biobank of more than a million people, their health information, their DNA information. And so, researchers can really do some cutting edge association studies to look at genetic patterns that might be associated with certain diseases or certain health conditions and the way they respond to certain medications.
Our group has led a project where in the course of doing those analyses, we've actually identified some veterans who had genetic markers indicating that they had a very high risk of having very high cholesterol that would lead to early heart attacks and strokes. So, I led a project where we actually reached back out to those MVP participants and said, we know you just participated in this study just to volunteer your data and your DNA, but we've actually found something important for you and your family. Would you like to hear more about it?
We think this is medically important. And we were able to reach back out to 120 individuals that we had found in the biobank and get them connected to clinical genetic testing to confirm the result, increased surveillance to predict their cardiovascular disease, increased treatment. And all of their first degree family members also have a 50-50 chance of carrying this genetic condition.
So, they were able to tell their family members, hey, you need to talk to your doctor about this and, you know, because I'm at risk, you're at risk. And so, it created this cascade effect of helping people identify this genetic risk for a disease they didn't know they had. And there are several other examples I can share with you, but, you know, those are the first that come to mind.
[VA Podcast Host ]
Yeah. And, you know, I think those are very important. When you talk about depression and medicines that Veterans take, there's a little bit of hesitance to go and try it, right?
Because you maybe have heard bad experiences, but to have this type of information ready to go, I think that can, you know, persuade a lot of Veterans to give it a shot just because you have that backing. That's exactly right.
[Dr. Jason Vassy]
This really is, it really, you know, a lot of people do have bad experiences or side effects or they just don't think it's working. And that can be for a few different reasons, but one of those reasons could be it's not a great match for your DNA. So, now that's something we now can put into the equation when we're selecting a first medication.
And we know that if someone doesn't have a good experience with the first medication, the chances of them sticking around and engaged in care to try out a second medication or a third medication, the chances of that happening just go down. So, in many ways, we kind of have that one shot to help find the right medication right at the beginning to really kind of change the trajectory of their mental health.
[VA Podcast Host ]
You know, I'm also a Veteran that goes to my VA clinic. So, how accessible are these genetic tests and what do I have to do to actually get one of those?
[Dr. Jason Vassy]
Yeah, it is. So, you know, when in doubt, always talk to your provider about this. Now, I will tell you, as a primary care provider, the average PCP is not great at genetics, you know, and that just is what it is.
And because we're all kind of trained in an era where we thought genetic diseases were so rare that, you know, when our plates are full, when we've got a lot we have to learn about and stay on top of, genetic diseases are just not, they don't kind of fall into that sweet spot for primary care doctors, which is things that are common, things that we have a good idea of how to manage blood pressure, diabetes, weight, mental health, smoking cessation.
These are kind of cancer screenings. These are kind of the bread and butter of primary care. We're now learning that more people carry genetic diseases than we used to think.
But we still kind of our training and the resources at our disposal haven't quite caught up yet. But, I mean, like with anything, if there's something you're concerned about, you know, hey, I'm concerned about my cholesterol. I'm concerned about my family history because there's a lot of cancer in my family and, you know, people getting cancer in their 40s, what's that about?
I'm worried. Is there something genetic? Or, you know, my brother was just told he had this condition.
What does that mean for my health? All of these are questions that kind of fall into the area of genetics. Primary care, I don't mean to kind of belittle our skill set when it comes to genetics.
What we're experts at is identifying kind of, hmm, there's something going on here that's out of the ordinary. I'm not sure what it is, but I've got specialists at my disposal that can help me answer these questions. So, if you're getting care at the VA, there are medical geneticists and there are genetic counselors in the VA.
Different facilities have different referral patterns. So, some refer to community care for geneticists or genetic counselors in the community. Some stations have geneticists or genetic counselors there on site.
Others participate in telehealth programs. So, you actually could have a telegenetic counseling appointment with a genetic counselor several states over, but can review your medical record and help you decide is a genetic test right for you. For medications, there's a national program called the National Pharmacogenomics Program.
So, actually, the kind of test I was describing that can help you decide, you know, if you have depression, what's the right antidepressant for you? That's now available at well over a hundred VA facilities. And so, that actually is something that is rolling out.
And so, chances are, if you get care at a VA, your provider has access to ordering that test specifically. So, it kind of depends. It kind of depends, but it starts with asking the right question in the first place.
[VA Podcast Host ]
Mike Granato You know, the first thing that came to mind was my audience might want to kind of go over the cost of this, how much it's going to cost the VA. But the way that I thought about it right away was, you know, if you get the right medicine at the first time, you might save some money. So, can genetic testing significantly reduce healthcare costs for the VA?
[Dr. Jason Vassy]
Dr. John Bolton Yeah. So, the answer to the question is, in some cases, it actually can reduce costs. So, the pharmacogenetic example is a good one.
You're, as you said, things like adverse drug reactions or medications that just don't work, those are a waste of money. And so, having a test that can avoid those things, modeling studies have actually shown that if you use a pharmacogenetic test to help guide medication selection, it actually can reduce costs, primarily because it can prevent some of the bad outcomes. Having a serious adverse drug reaction that could cause someone to be hospitalized, if you could avoid that, for example, because upfront, you knew someone's genetic makeup and prevent that, that does reduce costs.
Some of the other examples don't necessarily reduce costs, but the costs of genetic testing overall are decreasing. And so, when you look at overall healthcare expenditures, genetic testing is not a huge driver of healthcare costs for the VA. If anything, because of the VA's size, we have the ability to negotiate for national contracts with genetic testing companies, and so, can get a pretty good rate on those genetic tests, because we're doing it for a population.
Sometimes we do those contracts at the national level, sometimes at the regional level, but in any case, it's that kind of economy of scale that allows us to get these in as cost-effective manner as we can, which is important if we really think these are important tests for veterans to have.
[VA Podcast Host ]
But how does the VA ensure that the privacy and security of the veteran's genetic information is going to be secure?
[Dr. Jason Vassy]
Yeah, this is so important. This is so important. So, first, I guess it's important to make the distinction between two different kinds of data.
So, one is your healthcare data, if you're a patient in the VA, and one is research data, if you decide to volunteer to be in a research study at the VA. They're important for different reasons, but in both examples, the VA takes data privacy supremely important. So, these are data that are essentially password-protected, encrypted, only people with a right to access it.
Inside the VA, they're very controlled access and multiple lines of defense between hackers or data leaks. If you got a genetic test as a part of your healthcare, those are subject to the same privacy and security regulations as all of your medical data. The average person does not have access to your healthcare data, only people that have a right to do that, the doctors, nurses, other healthcare professionals that are taking care of you and yourself.
Genetic data is similar in that regard. It is just like your list of health conditions and your list of prescriptions and your office notes. It's in that same bucket.
So, this is a constant concern. It's the right question to ask, how do I know my data are safe? And it's something we absolutely take seriously.
[VA Podcast Host ]
Yeah. I was looking at some of your background and some of the notes that I got from you. There's a progress study that is highlighted.
And I think once I saw that it's for prostate cancer, I knew that that was a question that I wanted to really touch on and have you give us an overview, a breakdown of what that is. Because I know that it's, I read that it's the second leading cancer death for men, right? So, can you just break that down?
[Dr. Jason Vassy]
Yeah. I'm really excited about the progress study. And so, this is another place first, where I should kind of make the distinction between a clinical test, genetic test your doctor could order today versus a research study.
So, progress is currently a research clinical trial. But what we hope is that if the trial is successful, it'll become a part of clinical care, but we'll have to wait a few years to see. But in general, progress is a clinical trial that's asking the question, could my genetic information help me and my doctor make better decisions about prostate cancer screening?
So, this is a study for men. And as you mentioned, prostate cancer is the most common cancer in men. And it is the second biggest cancer killer in men, the second leading cause of cancer death in men.
And yet, we don't have a great screening test currently for it. So, you might have heard that there is a blood test called the PSA test, the prostate specific antigen test. Many men starting at age 50 or 55, their doctor, their primary care doctors will start to talk to them about this test.
If you get a value of a PSA that's higher than normal, that could mean you have prostate cancer. But it could also mean a lot of other things. It could be a false positive, it could be higher for other reasons.
And also, if the test is normal, that doesn't necessarily mean you don't have prostate cancer. So, this test by itself is not great. In the meantime, a lot of discovery has been made about the genetics of prostate cancer.
And we've learned more about which men, just based on their genetic makeup, are more predisposed genetically to getting prostate cancer compared to those that don't. And we've now been able to, in fact, in large part because of the Million Veteran Program, we've been able to create genetic models to identify who is more likely or who's less likely to get prostate cancer. And so, now in progress, what we're doing is we're enrolling men across the VA who are 55 to 70.
So, because that's typically the age where we start having conversations about prostate cancer screening. And we invite them to be a part of this clinical trial. It's a randomized clinical trial.
So, the way that works is kind of at a flip of a coin. You're either in the, what we call the control group, which is, all right, you and your doctor should keep talking about prostate cancer screening as you're already doing. Or you're in the half of the group that gets genetic testing, where we then can give you the results.
Are you at high, average, or low genetic risk for prostate cancer? And if you're in the really high group, then we recommend absolutely that you get screening. Perhaps you get it every six months or every year.
You know, do it more frequently to really keep an eye on the risk of developing prostate cancer. And if you have a PSA that's even slightly abnormal, you and your doctors are probably more likely to take that seriously. On the other end of the spectrum, if you're told you're a very low genetic risk, maybe for you it's safe to skip a PSA every now and then or to, you know, if one comes back a little bit high, maybe just repeat it instead of jumping right to a biopsy, which is something that you'd want to avoid if you don't need it.
You know, actually putting a needle in the prostate, we'd like to avoid those if it turns out you don't really have cancer. So, we're hoping that this kind of tailored risk information that actually is more personalized will help people make better decisions so we can really focus on the men that are high risk for prostate cancer and identify them. And if they have cancer, identify it early so they can get treated earlier.
And for the low risk men, we might be able to safely say, you know what, you could probably put prostate cancer screening on the back burner this year. Let's talk about it again next year or let's kind of put it off. So, that trial is ongoing right now.
We've already enrolled a thousand men have already gotten their genetic results back. So, we're ultimately going to enroll 5,000 across the VA and follow them for about five years to see who goes on to get prostate cancer and who doesn't. And can we show that the use of this test in their clinical care actually improved the outcomes that they had?
You know, and this is super important.
[VA Podcast Host ]
You mentioned five years. Is there a specific outcome or progress that you're looking for in those next five years?
[Dr. Jason Vassy]
Yeah. Well, we want to make sure, first of all, we want to make sure that by adding this new risk information, we don't decrease screening and actually find fewer cases of cancer. So, it's a little bit technical, but the way we've set up the statistics of the trial, we want to make sure that we're at least detecting the same amount of clinically important prostate cancer.
We don't want that to go down in the group that gets the genetic information. But what we do want to go down in the group that gets the genetic information is those negative biopsies. So, a man actually goes through the trouble and pain of having a prostate biopsy, which is 12 needles in the prostate, and it turns out there was not cancer there.
So, we think overall for this population, if we can still detect the same, if not maybe even a little bit more, but earlier, clinically important cancer that we should identify and treat, and overall at the whole population, decrease the number of those negative biopsies. So, men who didn't need to get a biopsy, but got it, then overall, that's a win. So, we're kind of looking at both sides of the coin, the benefits of screening, identifying the cancers, but also the risks of screening, which is a test you didn't need to have, like a minor procedure and intervention that you didn't need to have.
[VA Podcast Host ]
How soon do you think the genetic testing is for disease prevention is going to become like a standard? So, when you go in, you know, I go in at least once a year to do my checkup. Do you foresee this to be something that will the next 10 years be kind of a norm for all the veterans?
[Dr. Jason Vassy]
I do think so. You know, I don't speak for the VA or policy about kind of whether this will be a part of the future of VA healthcare specifically, but when I just look at the trends in healthcare overall, and also knowing that the costs of genetic testing are decreasing, and our understanding of what genetic information means, like we're just better now at analyzing DNA and interpreting it, what it means for health and disease, all of those trends are moving towards this idea that, yes, this is going to become a more common part of healthcare. You know, a lot of people would say, well, why don't you just get some kind of genome sequencing the day you're born?
And then it's got kind of like the story of your life already laid out. There's some research studies, not at the VA, but in other places that are looking at that. What if you sequence all babies?
And then that can help inform just the course of their health. You could make the same argument maybe when you're a young adult. So, before you've gone on to get colorectal cancer or prostate cancer, maybe when you're 18 to 25, that's the time to get a test like this that can then kind of help you develop a customized kind of prevention plan for your adulthood.
So, exactly where, what shape this is going to take and where it's going to be, in most cases, it's not a test you would need every year. Your genetic makeup doesn't change. But although the technologies that we have might get better, so it might be a reason to get if there are new developments in the technology.
But the short answer to your question, that was long-winded, but the short answer is yes, this is a part of the future of healthcare. And it's just a question of how exactly it takes shape, I think.
[VA Podcast Host ]
If the audience does want to just do their own research and kind of dive into more information about VA genetic testing and all this stuff that we're doing, I know that there's an MVP program, but where could they go?
[Dr. Jason Vassy]
Yeah, it's a great question. Let me give you a few resources. So, one, if they're interested specifically in the progress study, which is, you know, our clinical trial of prostate cancer screening based on genotype, they can go to progress-study.org and they'll see that, I'm sorry, progress-study.org, right? And that's where they can learn about the study and actually enroll directly on that website. They don't have to come into their local VA to do that. We actually can, they can fill out all their surveys and the consent form from home and we can email or we can ship them a saliva kit.
Then they can provide a DNA sample that way from their own home. It doesn't have to be a blood draw. Oh yeah, this is a VA-funded research study.
So, again, progress-study.org. And there's information there including, so you can call a phone number to confirm this is a legitimate VA website approved by the VA IRB. And yes, totally free, totally free for veterans to participate.
In fact, you have to be a veteran to participate, a man 55 to 70, and you just cannot have previously had prostate cancer. But otherwise, that's where we're actively enrolling and would love to have your listeners join. Other sites that are worth knowing about, include the Million Veteran Program, as you mentioned, which lists a lot of the accomplishments that the MVP program has had to date.
And then the, let me, I'll provide to you after the fact, some websites that I think are worth knowing about. One is the National Pharmacogenomics Program. So, that's the national VA program I mentioned, where you can get a pharmacogenetic test.
That's the one that helps you match medications with your genetic makeup. And then for any patients who already have cancer, the National Precision Oncology Program is also really groundbreaking in this country in terms of making sure that tens of thousands of veterans who've had cancer, not only get genetic testing of their own kind of genetic makeup, but also the genetic makeup of their cancer. And sometimes that can help us really target the right chemotherapy or other kind of treatment specifically for the kind of tumor that they have.
So, we haven't had a chance to talk a lot about that, but that has really become the standard of care for oncology in the VA, is that genetic testing to really help guide treatment for veterans with cancer. So, I'll provide some resources, some links for you for those two resources too.
[VA Podcast Host ]
Darrell Bock And for my audience, there's going to be an article online as well on newsva.gov that's going to accompany this episode, and I'm going to make sure to provide all the links from Dr. Vassie. So, this is a great conversation, great information. I think a lot of the audience are really going to enjoy it and they're going to find this information very useful.
Is there something that maybe we didn't cover? I know you mentioned right now that specific area about how it's genetic testing that's being used right now for oncology and stuff like that, but maybe is there something that we didn't talk about that you feel like, hey, before I go, I just want to mention this to the audience?
[Dr. Jason Vassy]
Jay Haynes Yeah. I guess maybe the kind of important thing is, yes, this is a groundbreaking technology, but at the end of the day, it's actually not that different from what we do every day in healthcare, which is if you have a concern, and that concern could be, hey, I've got this funny spot on my arm, or I've got this family history, like, I don't know, there seems to be a lot of cancer in my family. Like, bring those questions to your healthcare provider and they're the ones that help kind of figure out, all right, what are the next steps?
What could this be? So, in that sense, genetics and genomics is just another tool in the toolbox for how to manage a concern that you bring. And my second point would be the importance actually of family history.
So, for many patients, knowing a good family history of your, especially of what we call your first-degree relatives, parents, siblings, kids, knowing about any cancers or early diseases that they had, and sharing that information with your healthcare provider, for a lot of people, that uncovers kind of what seems to be kind of a concerning pattern that would be that first step towards getting the right genetic test to figure out if something's going on.
That, it turns out, a lot of people have a family history that should warrant genetic testing. And it just, we don't have a great way of collecting that information. Oftentimes, it's hard.
You know, you don't necessarily know what kind of cancer your grandmother might have had or your aunt, but if you can get some of that information, that's helpful to share with your providers and they could take it from there. And sometimes, that next step would be talking to a genetic counselor. Awesome.
[VA Podcast Host ]
Well, I've been very, very fortunate to like listen to all this and kind of understand a little bit more about what we're doing at the VA. I do want to thank you for taking time from your busy schedule coming on here. You know, as far as my audience, like I said, there's going to be an article that's going to accompany this episode.
And like always, you know, I encourage you, if you're a veteran, if your family members are veterans or you know a veteran, please encourage them to come to the VA. You know, there's a lot of resources and benefits that are available to them through their military service. But Jason, thank you so much.
It was a pleasure having you on.
[Dr. Jason Vassy]
Yeah, likewise. Thanks for the opportunity. And looking forward to continuing the conversation.
This really is a privilege to be able to do this work. It's so exciting. And to be able to do this with veterans in partnership with them is just even more rewarding.
So, thank you for letting me share this with you.