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This Week in JAMA
February 21, 2001

This Week in JAMA

JAMA. 2001;285(7):845. doi:10.1001/jama.285.7.845

Age, Comorbidities, and Breast Cancer Therapy

Sixty-six percent of new cases of breast cancer and 77% of deaths due to breast cancer occur among postmenopausal women aged 55 years and older. Using data from National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) registries, Yancik and colleagues studied the burden of age-related health problems among postmenopausal women with breast cancer and its relationship with age on treatment and early mortality. Older patients with early-stage breast cancer were less likely to undergo an axillary lymph node dissection for prognostic evaluation and less likely to receive therapy consistent with National Institutes of Health consensus statement treatment recommendations. The number of comorbidities increased with increasing age, and patients with certain comorbid conditions were also less likely to undergo axillary lymph node dissection. Among patients aged 75 years and older, comorbid health problems and other cancers accounted for a greater proportion of deaths than breast cancer during the 30-month postdiagnosis period.

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Alcohol Use and Bicycling Injury

Elevated blood alcohol levels have been reported in about one third of fatally injured bicyclists aged 15 years or older. In this case-control study, Li and colleagues found that a blood alcohol concentration ≥0.02 g/dL was detected in 12.9% of bicyclists aged 15 years or older who were seriously or fatally injured while bicycling compared with 2.9% of control bicyclists. The risk of serious or fatal bicycling injury increased with increases in blood alcohol concentration.

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Transportation Changes, Air Quality, and Asthma

During the 1996 Summer Olympic Games, an alternative transportation strategy was implemented in Atlanta, Ga, to minimize road traffic congestion. Friedman and colleagues assessed changes in traffic density during the Olympic Games and concomitant changes in air quality and asthma acute care events among children aged 1 to 16 years. Compared with the summertime baseline period (4 weeks before and 4 weeks after the Olympic Games), traffic density decreased during the Olympic Games, levels of ozone and other air pollutants were reduced, and rates of asthma acute care events among children decreased.

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Prothrombotic Mutations, HRT, and Risk of MI

Genetic variants associated with risk of venous thrombosis may modify the risk of myocardial infarction (MI) associated with use of hormone replacement therapy (HRT) among postmenopausal women. In this case-control study, Psaty and colleagues found that among premenopausal women with hypertension, the prothrombin 20210 G→A variant was associated with a significantly increased risk of first MI. Compared with hypertensive women who had the wild-type genotype for prothrombin and who were not current users of HRT, hypertensive women who had the prothrombin variant and were current users of HRT had a significant increase in the risk of MI.

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Accuracy of PET for Evaluation of Pulmonary Lesions

Positron emission tomography with 18-fluorodeoxyglucose (FDG-PET) is a functional imaging technique used to localize malignant lesions by detecting increased cellular metabolic activity. Gould and colleaguesArticle performed a meta-analysis of 40 studies that examined FDG-PET to estimate the diagnostic accuracy of this imaging test for evaluation of focal pulmonary lesions. Study methodological quality was fair—only 14 studies satisfied 70% to 80% of the quality criteria. For all focal pulmonary lesions, the mean sensitivity for detecting malignancy was 96.0% and the mean specificity was 73.5%. In an editorial, Balk and LauArticle emphasize the importance of conducting methodologically rigorous clinical studies to assess new technologies.

A Piece of My Mind

"After this night of tragedy, I began to wonder if this was what the practice of medicine was to be like, or if there was another more comfortable way to make a living." From "I Remember."

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Medical News & Perspectives

Kenneth W. Kizer, MD, MPH, head of the National Quality Forum, answers questions about how the organization charged with improving the quality of US health care plans to meet its challenge.

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Available Services for End-of-Life Care

The case story of a 47-year-old man with advanced colon carcinoma illustrates limitations in the current system of care for patients at the end of life.

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Conflicts of Interest in Biomedical Research

Proposal for a new model to minimize potential conflicts of interest among investigators and academic institutions conducting industry-sponsored biomedical research.

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In a recent judicial settlement, the US Department of Agriculture (USDA) agreed to initiate and complete rulemaking to amend the regulation that excludes laboratory rats, mice, and birds from coverage under the Animal Welfare Act. FishbeinArticle asserts that the documentation requirements of the USDA regulation would impede biomedical research and not improve the care of laboratory animals. GlickmanArticle describes the rulemaking procedure, noting that it would include consideration of input from the research community.

JAMA Patient Page

For your patients: Information about the goals and services of hospice care.

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