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This Week in JAMA
June 25, 2003

This Week in JAMA

JAMA. 2003;289(24):3207. doi:10.1001/jama.289.24.3207
Hormone Therapy and Breast Cancer Risk

The Women's Health Initiative (WHI) trial of estrogen plus progestin in postmenopausal women was terminated early when overall health risks, including invasive breast cancer, exceeded benefits. In this updated analysis of breast cancer risk over a mean of 5.6 years of follow-up, Chlebowski and colleaguesArticle reporting for the WHI Investigators found that the incidence of total and invasive breast cancer was significantly increased in the estrogen plus progestin group compared with the placebo group. The invasive breast cancers in the 2 study groups were similar in histology and grade but were larger and at more advanced stages in the estrogen plus progestin group. Li and colleaguesArticle, in a population-based case-control study of women aged 65 to 79 years, found that risks of invasive lobular carcinoma and invasive ductal carcinoma were significantly increased among women who used combined estrogen plus progestin therapy (with continuous or sequential progestin use) but not among women who used estrogen therapy alone. In an editorial, Gann and MorrowArticle note that breast cancers associated with estrogen plus progestin use in the WHI trial did not have the favorable prognostic characteristics reported in prior observational studies and also occurred earlier than expected.

Outcomes of Low Birth Weight and Very Preterm Birth

During the 1990s, survival of extremely low birth weight (ELBW) and very preterm children increased significantly. In this evaluation of children born in 1991 and 1992, Anderson and colleagues found that at age 8 years, ELBW and very preterm children performed significantly below normal birth weight children on measures of cognitive ability and educational progress and had more behavioral impairments.

Article
Characteristics of Renal Insufficiency in Type 2 Diabetes

Classic type 1 diabetic glomerulosclerosis, which is associated with albuminuria and retinopathy, may not be the underlying etiology of renal insufficiency in patients with type 2 diabetes. In this analysis of data from adults aged 40 years or older with type 2 diabetes who participated in the Third National Health and Nutrition Examination Survey, Kramer and colleagues found that both diabetic retinopathy and albuminuria (microalbuminuria or macroalbuminuria) were absent in 30% of participants with type 2 diabetes and chronic renal insufficiency.

Article
New Research on Smallpox Vaccination

Four studies in this issue of THE JOURNAL provide insights into issues of safety and efficacy that were raised following reintroduction of smallpox vaccination to prepare against the use of smallpox as a biological weapon. Grabenstein and WinkenwerderArticle report that in the US military smallpox vaccination program from December 13, 2002, through May 28, 2003, adverse event rates were very low—below historical rates, and no cases of eczema vaccinatum, progressive vaccinia, or vaccinia-attributed deaths occurred. Halsell and colleaguesArticle describe 18 cases of probable myopericarditis following smallpox vaccination among US military personnel who were primary vaccinees. Talbot and colleaguesArticle characterize a newly recognized cutaneous complication of smallpox vaccination, postvaccination folliculitis, observed during a randomized trial investigating the efficacy of various dilutions of smallpox vaccine in a civilian population. Also in a civilian population, Frey and colleaguesArticle found that previously vaccinated persons can be successfully revaccinated with diluted (≤1:10) smallpox vaccine.

Article
A Piece of My Mind

"I suppose there are those who practice the art of medicine who become accustomed to the routine of death, those who practice the specialties of oncology or geriatrics, but in pediatrics such events are thankfully rare." From "Eventide."

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Medical News & Perspectives

Recent evidence indicates that companies that receive accelerated approval for drugs to treat life-threatening illnesses are slow to perform the required phase 4 studies to confirm efficacy and safety.

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CLINICIAN'S CORNER

Clinical presentation, diagnostic evaluation, and treatment of sarcoidosis.

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JAMA Patient Page

For your patients: Information about diabetes and kidney failure.

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