Mammography screening in the United States differs from that in the
United Kingdom in a variety of ways, including clinical setting, ages of women
screened, interval between screening examinations, and follow-up of suspicious
findings. Smith-Bindman and colleagues compared outcomes of screening mammography
in the 2 countries and found that rates of recall for further diagnostic evaluation
and rates of open surgical biopsy that did not result in a breast cancer diagnosis
were approximately twice as high in the United States as in the United Kingdom,
but breast cancer detection rates were similar.
Evidence on the association between psychosocial factors and risk of
hypertension has been inconsistent. Yan and colleaguesArticle analyzed
data from the Coronary Artery Risk Development in Young Adults study, a population-based,
prospective study of adults aged 18 to 30 years, to examine the role of 5
psychosocial factors—hostility, time urgency/impatience, achievement
striving/competitiveness, depression, and anxiety—on long-term risk
of hypertension. Of these factors, time urgency/impatience and hostility were
associated with increased 15-year risk of hypertension. In an editorial, Williams and coauthorsArticle discuss biobehavioral mechanisms and
gene-environment interactions that mediate the influence of psychosocial factors
on the development and course of cardiovascular disease.
Gefitinib is an oral drug that inhibits the epidermal growth factor
receptor (EGFR), a cell-signaling mediator involved in cancer cell growth,
proliferation, and metastasis, by blocking EGFR tyrosine kinase. Kris and
colleagues conducted a randomized trial to compare 250-mg and 500-mg daily
doses of gefitinib among patients with stage IIIB or IV non–small cell
lung cancer persisting after at least 2 regimens of chemotherapy. Rates of
disease-related symptom improvement, radiographic tumor regression, and projected
1-year survival were not significantly different in the 2 dosage groups.
In the Diabetes Control and Complications Trial (DCCT), a randomized
trial comparing intensive treatment of type 1 diabetes with conventional treatment,
participants in the intensive treatment group were exposed to lower glycemic
levels over an average of 6.5 years than were participants who received conventional
treatment. At the end of the DCCT, participants were followed up in the Epidemiology
of Diabetes Interventions and Complications (EDIC) Study, and all participants
were encouraged to use intensive treatment. Although glycemic levels during
the EDIC study no longer differed substantially between the 2 original treatment
groups, the Writing Team for the DCCT/EDIC Research Group report that significantly
fewer participants in the previous intensively treated group developed microalbuminuria,
clinical albuminuria, or hypertension during the 7 to 8 years of the EDIC
Flum and colleagues analyzed data from Medicare claims to determine
the population-level risk of death after common bile duct injury during cholecystectomy.
Mortality risk during the 9.2-year follow-up was significantly higher among
patients with a common bile duct injury than among patients without a common
bile duct injury. Survival after common bile duct injury improved when the
bile duct repair was performed by a different, more experienced surgeon than
the one who performed the cholecystectomy.
Virtual reality technology is finding a niche in medicine for the treatment
of patients with phobias and other conditions and for physician training.
Analysis of data from 4 large clinical trials indicates that the Killip
classification, which stratifies risk according to the presence and severity
of heart failure in patients with acute myocardial infarction, is a powerful
independent predictor of all-cause mortality in patients with non–ST-elevation
acute coronary syndromes.
Mrs B, a 60-year-old woman with persistent atrial fibrillation, is considering
undergoing elective cardioversion followed by antiarrhythmic therapy. Singer
discusses the epidemiology and natural history of atrial fibrillation and
risks and benefits of anticoagulation therapy and cardioversion.
For your patients: Information about type 1 diabetes.
This Week in JAMA. JAMA. 2003;290(16):2095. doi:10.1001/jama.290.16.2095