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This Week in JAMA
April 12, 2006

This Week in JAMA

JAMA. 2006;295(14):1619. doi:10.1001/jama.295.14.1619
Estrogen Effects on Breast Cancer and Mammography

Initial results of the Women's Health Initiative trial comparing treatment with conjugated equine estrogens (CEE) vs placebo in postmenopausal women with prior hysterectomy suggested a possible reduction in breast cancer associated with CEE treatment. In further analyses of the trial data, Stefanick and colleagues found that compared with placebo, treatment with CEE alone for 7.1 years did not increase breast cancer incidence in this group of women. Exploratory analyses suggested reduction in breast cancers with localized disease and ductal carcinomas in women randomly assigned to CEE vs placebo. Treatment with CEE vs placebo was associated with an increased frequency of mammography screening requiring short interval follow-up.

Estrogen-Receptor (ER) Status and Chemotherapy

To predict patients most likely to benefit from advances in adjuvant chemotherapy for node-positive breast cancer, Berry and colleagues analyzed data from 3 sequential randomized clinical trials of intensive chemotherapy, which varied by drug regimen, dose, and cycle. They assessed disease-free and overall survival and found that recent advances in chemotherapy had greater benefits for patients with ER-negative vs patients with ER-positive breast tumors and were associated with improved prognoses for women with ER-negative, node-positive breast tumors.

Invasive Pneumococcal Disease in Young Infants

A heptavalent pneumococcal conjugate vaccine (PCV7) was approved and recommended for children aged 2 to 23 months in 2000. Since then rates of invasive pneumococcal disease (IPD) have declined in this and older age groups. Whether younger infants benefit when children 2 to 23 months receive PCV7 is not known. Poehling and colleagues conducted a population-based study of infants 0 to 90 days of age to assess rates of IPD in young infants before and after the vaccine was added to the childhood immunization schedule. The authors found that rates of IPD among infants 0 to 90 days of age decreased significantly after PCV7 introduction.

Bias in Review of Meeting Abstracts

In an analysis of open vs blinded peer review of abstracts submitted for presentation at the annual scientific sessions of the American Heart Association, Ross and colleagues found that open review was associated with bias favoring the selection of abstracts by authors from the United States, English-speaking countries outside the United States, and prestigious academic institutions. Blinded review partially reduced this bias.

Acute Glucose Fluctuations and Oxidative Stress

Oxidative stress from hyperglycemia is hypothesized to play a role in diabetic complications. In a study of patients with type 2 diabetes, Monnier and colleaguesArticle compared the effect of acute glucose fluctuations vs sustained chronic hyperglycemia on 24-hour urinary excretion of free 8-iso-prostaglandin F (8-iso PGF), a marker of oxidative stress. They found that compared with chronic sustained hyperglycemia, postprandial and other acute glucose fluctuations were related to higher excretion of 8-iso PGF. In an editorial, Brownlee and HirschArticle discuss the implications of these findings for the care of patients with diabetes.

A Piece of My Mind

“While last words are forever, the opportunities to speak them or hear them are fleeting, and usually unrecognized.” From “Last Words.”

Medical News & Perspectives

Researchers are exploring innovative ways to improve stroke treatment.

Clinician's corner

Optimal use of patient self-monitoring of blood glucose and hemoglobin A1cdeterminations in diabetes management.

TV Ads and Food Intake

A study in the Archives of Pediatrics & Adolescent Medicine confirms the relationship of television viewing with increased caloric intake—particularly calories from foods commonly advertised on television—and highlights the potent influence of television advertisements on dietary choices.

Pandemic Influenza

Ethical and legal foundations of public health strategies to control pandemic influenza.

Hypertension Trials

Outcomes of recent long-term trials of antihypertensive agents may have been influenced by aspects of trial design such as disease exclusions and comparator agents.

JAMA Patient Page

For your patients: Information about pneumococcal diseases.