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This Week in JAMA
July 23/30, 2003

This Week in JAMA

JAMA. 2003;290(4):435. doi:10.1001/jama.290.4.435

Long-term Risk of Breast Cancer in Hodgkin Disease

The leading cause of death in long-term survivors of Hodgkin disease (HD) is second malignant neoplasms. In this case-control study of breast cancer in a cohort of female 1-year survivors of HD diagnosed at age 30 years or younger, Travis and colleaguesArticle found that treatment with radiation alone at doses of 4 Gy or more delivered to the breast was associated with a 3.2-fold increased risk of breast cancer compared with patients who received lower doses of radiation and no alkylating agents. Treatment with combined radiotherapy and alkylating agents was associated with a 1.4-fold increased risk, whereas treatment with alkylating agents alone was associated with a reduced risk of breast cancer. Ovarian damage by either radiation or chemotherapy was associated with decreased risk. In an editorial, YahalomArticle suggests that brief chemotherapy and reduced radiation may provide the safest cure for HD.

Cancer, Mortality Risk With Antioxidant Supplements

In the Alpha-Tocopherol, Beta-Carotene Cancer (ATBC) Prevention Study, a 6-year randomized placebo-controlled trial among male smokers aged 50 to 69 years, lung cancer risk and total mortality were increased among participants who received beta-carotene, whereas prostate cancer incidence was decreased among participants who received α-tocopherol supplementation. In this postintervention follow-up study reported by the ATBC study group, incidence of lung and prostate cancer in the 6-year posttrial period was not significantly different between supplement recipients and nonrecipients. The excess risk of death among beta-carotene recipients was no longer evident 4 to 6 years after ending the intervention.


Acarbose Therapy and CVD Risk in Patients With IGT

Postprandial hyperglycemia may be an independent risk factor for cardiovascular disease (CVD). In this analysis of data from patients with impaired glucose tolerance (IGT) in the STOP-Noninsulin-Dependent Diabetes Mellitus (NIDDM) trial, a placebo-controlled trial of the α-glucosidase inhibitor acarbose, Chiasson and colleagues found that risk of major cardiovascular events and incidence of hypertension during a mean follow-up of 3.3 years were significantly lower in the acarbose group than in the placebo group.


Failure to Publish Large Randomized Trials

Failure to publish the results of large clinical trials can lead to bias in the literature and may contribute to inappropriate clinical decisions. Krzyzanowska and colleagues identified abstracts of large phase 3 clinical trials in the proceedings of the annual American Society of Clinical Oncology meetings from 1989 through 1998 and found that the probability of full publication by 5 years was significantly greater for trials with significant results than for trials with nonsignificant results. Trials with oral or plenary presentation were published sooner than those not presented, and trials with pharmaceutical sponsorship were published sooner than cooperative group trials or those for which sponsorship was not specified.


Effect of Cholesterol-Lowering Foods vs Statins

Dietary interventions generally result in smaller cholesterol reductions than does treatment with statins. In this 4-week preliminary investigation, Jenkins and colleaguesArticlecompared cholesterol reduction among adults with hyperlipidemia randomly assigned to 1 of 3 interventions: a very low–saturated fat diet (control), the same diet plus lovastatin, or a diet high in plant sterols, soy protein, viscous fibers, and almonds (dietary portfolio). Reductions in low-density lipoprotein cholesterol and C-reactive protein levels in the statin and dietary portfolio groups were significantly greater than in the control group, and there were no significant differences in efficacy between the statin and dietary portfolio groups. In an editorial, AndersonArticlesuggests that for most patients, dietary interventions should be the first line of therapy for hyperlipidemia before initiating pharmacotherapy.

Medical News & Perspectives

Scientists in Scotland plan to create human embryos for stem cell research via parthenogenesis, a technique that activates oocytes and allows them to develop without sperm.


Clinician's corner

A review of West Nile virus (WNV)Article discusses the epidemiology, clinical features, treatment, and prevention of WNV infection. In a related article, Sejvar and colleaguesArticle describe the acute neurologic manifestations of WNV infection and neurologic outcomes observed in a prospective case series.

The Case for Registering Clinical Trials

Dickersin and Rennie call for a comprehensive register of all initiated clinical trials.


JAMA Patient Page

For your patients: Information about West Nile virus.