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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.
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.
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.
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.
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."
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.
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.
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
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
This Week in JAMA. JAMA. 2001;285(7):845. doi:10.1001/jama.285.7.845
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