The Women's Health Initiative (WHI) trial of estrogen plus progestin
in postmenopausal women was terminated early when overall health risks, including
invasive breast cancer, exceeded benefits. In this updated analysis of breast
cancer risk over a mean of 5.6 years of follow-up, Chlebowski and colleaguesArticle reporting for the WHI Investigators found that the
incidence of total and invasive breast cancer was significantly increased
in the estrogen plus progestin group compared with the placebo group. The
invasive breast cancers in the 2 study groups were similar in histology and
grade but were larger and at more advanced stages in the estrogen plus progestin
group. Li and colleaguesArticle, in a population-based
case-control study of women aged 65 to 79 years, found that risks of invasive
lobular carcinoma and invasive ductal carcinoma were significantly increased
among women who used combined estrogen plus progestin therapy (with continuous
or sequential progestin use) but not among women who used estrogen therapy
alone. In an editorial, Gann and MorrowArticle note
that breast cancers associated with estrogen plus progestin use in the WHI
trial did not have the favorable prognostic characteristics reported in prior
observational studies and also occurred earlier than expected.
During the 1990s, survival of extremely low birth weight (ELBW) and
very preterm children increased significantly. In this evaluation of children
born in 1991 and 1992, Anderson and colleagues found that at age 8 years,
ELBW and very preterm children performed significantly below normal birth
weight children on measures of cognitive ability and educational progress
and had more behavioral impairments.
Classic type 1 diabetic glomerulosclerosis, which is associated with
albuminuria and retinopathy, may not be the underlying etiology of renal insufficiency
in patients with type 2 diabetes. In this analysis of data from adults aged
40 years or older with type 2 diabetes who participated in the Third National
Health and Nutrition Examination Survey, Kramer and colleagues found that
both diabetic retinopathy and albuminuria (microalbuminuria or macroalbuminuria)
were absent in 30% of participants with type 2 diabetes and chronic renal
Four studies in this issue of THE JOURNAL provide insights into issues
of safety and efficacy that were raised following reintroduction of smallpox
vaccination to prepare against the use of smallpox as a biological weapon.
Grabenstein and WinkenwerderArticle report that in
the US military smallpox vaccination program from December 13, 2002, through
May 28, 2003, adverse event rates were very low—below historical rates,
and no cases of eczema vaccinatum, progressive vaccinia, or vaccinia-attributed
deaths occurred. Halsell and colleaguesArticle describe
18 cases of probable myopericarditis following smallpox vaccination among
US military personnel who were primary vaccinees. Talbot and colleaguesArticle characterize a newly recognized cutaneous complication
of smallpox vaccination, postvaccination folliculitis, observed during a randomized
trial investigating the efficacy of various dilutions of smallpox vaccine
in a civilian population. Also in a civilian population, Frey and colleaguesArticle found that previously vaccinated persons can be successfully
revaccinated with diluted (≤1:10) smallpox vaccine.
"I suppose there are those who practice the art of medicine who become
accustomed to the routine of death, those who practice the specialties of
oncology or geriatrics, but in pediatrics such events are thankfully rare."
Recent evidence indicates that companies that receive accelerated approval
for drugs to treat life-threatening illnesses are slow to perform the required
phase 4 studies to confirm efficacy and safety.
Clinical presentation, diagnostic evaluation, and treatment of sarcoidosis.
For your patients: Information about diabetes and kidney failure.
This Week in JAMA . JAMA. 2003;289(24):3207. doi:10.1001/jama.289.24.3207