The leading cause of death in long-term survivors of Hodgkin disease
(HD) is second malignant neoplasms. In this case-control study of breast cancer
in a cohort of female 1-year survivors of HD diagnosed at age 30 years or
younger, Travis and colleaguesArticle found that treatment
with radiation alone at doses of 4 Gy or more delivered to the breast was
associated with a 3.2-fold increased risk of breast cancer compared with patients
who received lower doses of radiation and no alkylating agents. Treatment
with combined radiotherapy and alkylating agents was associated with a 1.4-fold
increased risk, whereas treatment with alkylating agents alone was associated
with a reduced risk of breast cancer. Ovarian damage by either radiation or
chemotherapy was associated with decreased risk. In an editorial, YahalomArticle
suggests that brief chemotherapy and reduced radiation
may provide the safest cure for HD.
In the Alpha-Tocopherol, Beta-Carotene Cancer (ATBC) Prevention Study,
a 6-year randomized placebo-controlled trial among male smokers aged 50 to
69 years, lung cancer risk and total mortality were increased among participants
who received beta-carotene, whereas prostate cancer incidence was decreased
among participants who received α-tocopherol supplementation. In this
postintervention follow-up study reported by the ATBC study group, incidence
of lung and prostate cancer in the 6-year posttrial period was not significantly
different between supplement recipients and nonrecipients. The excess risk
of death among beta-carotene recipients was no longer evident 4 to 6 years
after ending the intervention.
Postprandial hyperglycemia may be an independent risk factor for cardiovascular
disease (CVD). In this analysis of data from patients with impaired glucose
tolerance (IGT) in the STOP-Noninsulin-Dependent Diabetes Mellitus (NIDDM)
trial, a placebo-controlled trial of the α-glucosidase inhibitor acarbose,
Chiasson and colleagues found that risk of major cardiovascular events and
incidence of hypertension during a mean follow-up of 3.3 years were significantly
lower in the acarbose group than in the placebo group.
Failure to publish the results of large clinical trials can lead to
bias in the literature and may contribute to inappropriate clinical decisions.
Krzyzanowska and colleagues identified abstracts of large phase 3 clinical
trials in the proceedings of the annual American Society of Clinical Oncology
meetings from 1989 through 1998 and found that the probability of full publication
by 5 years was significantly greater for trials with significant results than
for trials with nonsignificant results. Trials with oral or plenary presentation
were published sooner than those not presented, and trials with pharmaceutical
sponsorship were published sooner than cooperative group trials or those for
which sponsorship was not specified.
Dietary interventions generally result in smaller cholesterol reductions
than does treatment with statins. In this 4-week preliminary investigation,
Jenkins and colleaguesArticlecompared cholesterol
reduction among adults with hyperlipidemia randomly assigned to 1 of 3 interventions:
a very low–saturated fat diet (control), the same diet plus lovastatin,
or a diet high in plant sterols, soy protein, viscous fibers, and almonds
(dietary portfolio). Reductions in low-density lipoprotein cholesterol and
C-reactive protein levels in the statin and dietary portfolio groups were
significantly greater than in the control group, and there were no significant
differences in efficacy between the statin and dietary portfolio groups. In
an editorial, AndersonArticlesuggests that for most
patients, dietary interventions should be the first line of therapy for hyperlipidemia
before initiating pharmacotherapy.
Scientists in Scotland plan to create human embryos for stem cell research
via parthenogenesis, a technique that activates oocytes and allows them to
develop without sperm.
A review of West Nile virus (WNV)Article discusses
the epidemiology, clinical features, treatment, and prevention of WNV
infection. In a related article, Sejvar and colleaguesArticle describe the acute neurologic
manifestations of WNV infection and neurologic outcomes observed in a prospective case
Dickersin and Rennie call for a comprehensive register of all initiated
For your patients: Information about West Nile virus.
This Week in JAMA . JAMA. 2003;290(4):435. doi:10.1001/jama.290.4.435