Women still face cancer risk 25 years after treatment
(Risk of invasive cancer after treatment for cervical intraepithelial neoplasia grade 3: population based cohort study)
(Cervical intraepithelial neoplasia and higher long term risk of cancer)
http://www.bmj.com/onlinefirst_date.dtl
Cancer experts are now calling for cytological smears to be offered at regular intervals for at least 25 years after a woman has had severe dysplasia/CIS (carcinoma in situ).
CIS is not cancer but close to it as some cells look cancerous but are superficially in the mucosa (the soft skin-like layer that lines many body cavities such as the nasal and genital passages) and not in any tissue.
Researchers in Sweden studied data from the National Swedish Cancer Register, which included information recorded between 1958 and 2002 on 132,493 women who had a diagnosis of severe dysplasia/CIS.
They found that 881 women had developed cervical cancer and 111 women had vaginal cancer more than one year after the CIS diagnosis.
Women with such a diagnosis are more than twice as likely to develop cancer as the general female population.
They also found that there was an increasing risk of cervical cancer if the woman was older at the time of diagnosis, with a much higher risk for women aged over 50.
The risk also grew as the decades went by as the researchers found that women were twice as likely to develop invasive cervical cancer after diagnosis of CIS if that diagnosis was made in the period 1991-2000 as in the period 1958-1970. This could be due to changes in the forms of treatment in different decades.
The observed number of cases of women who developed vaginal cancer was almost seven times higher than expected
The authors say: "Although most women with high-grade dysplasia have been protected from invasive cancer it must be considered a failure of the medical service when women participate in screening, their pre-cancerous lesions are found and they subject themselves to treatment of those lesions, presumably participate in follow-up programmes and still develop invasive cancer."
They conclude that follow-up care has, so far, been insufficient and women should be offered cytological smears at regular intervals for at least 25 years after treatment. Long term follow up should not stop for women when they reach the age of 60 if they were older than 35-40 at the time of treatment for CIS.
This view is reiterated in accompanying BMJ editorial, which suggests that women treated for CIN3 should have long term screening, even if beyond the normal age limit of regular screening.
Contact:
Bjorn Strander, Senior Consultant, Department of Obstetrics and Gynecology, Sahlgren's Academy, University of Gothenburg, Sweden
Email: bjorn.strander@oc.gu.se
Saturday, October 27, 2007
Thursday, October 25, 2007
2 dose Measles Vaccine Protects up to 10yrs
Second Dose of Measles Vaccine in Childhood Protects for Up to 10 Years
News Author: Laurie Barclay, MD
CME Author: Penny Murata, MD
March 12, 2007 — Children in a rural area had low susceptibility rates to measles for as long as 10 years after a second dose of the measles vaccine, according to the results of a prospective study reported in the March issue of Archives of Pediatrics & Adolescent Medicine.
"Measles was declared eliminated from the United States in 2000, an achievement attributed to effective implementation of a routine 2-dose vaccination policy," write Charles W. LeBaron, MD, from the Centers for Disease Control and Prevention in Atlanta, Georgia, and colleagues
News Author: Laurie Barclay, MD
CME Author: Penny Murata, MD
March 12, 2007 — Children in a rural area had low susceptibility rates to measles for as long as 10 years after a second dose of the measles vaccine, according to the results of a prospective study reported in the March issue of Archives of Pediatrics & Adolescent Medicine.
"Measles was declared eliminated from the United States in 2000, an achievement attributed to effective implementation of a routine 2-dose vaccination policy," write Charles W. LeBaron, MD, from the Centers for Disease Control and Prevention in Atlanta, Georgia, and colleagues
Stop Gaining Excess Weight - Simple Measures
Simple Measures Help Prevent Excess Weight Gain in Kids
Physician's First Watch for October 25, 2007
Small changes in activity and diet help overweight children limit their weight gain, a Pediatrics study reports.
Researchers randomized nearly 200 families with at least one child who was overweight (or at risk) either to a program that advocated taking an additional 2000 steps daily and reducing calories by 100 kcal or to a control group that simply self-monitored steps taken. (The study sponsor was the manufacturer of a noncaloric sweetener provided to the intervention group.)
After 6 months, both groups showed significant decreases in BMI for age, but the between-group differences were not significant. More children in the intervention group maintained or reduced their BMI for age; fewer in that group showed an increase.
The authors comment that the result still left most of the subjects in the overweight category, but, they say, "it is better than continuing to gain excessive weight."
Physician's First Watch for October 25, 2007
Small changes in activity and diet help overweight children limit their weight gain, a Pediatrics study reports.
Researchers randomized nearly 200 families with at least one child who was overweight (or at risk) either to a program that advocated taking an additional 2000 steps daily and reducing calories by 100 kcal or to a control group that simply self-monitored steps taken. (The study sponsor was the manufacturer of a noncaloric sweetener provided to the intervention group.)
After 6 months, both groups showed significant decreases in BMI for age, but the between-group differences were not significant. More children in the intervention group maintained or reduced their BMI for age; fewer in that group showed an increase.
The authors comment that the result still left most of the subjects in the overweight category, but, they say, "it is better than continuing to gain excessive weight."
Minor Stroke Treated Early Reduces Recurrence
Urgent Treatment of TIA or Minor Stroke Cuts Risk for Early Recurrence
Physician's First Watch for October 19, 2007
Urgent treatment after a TIA or minor stroke can reduce the 90-day risk for stroke by 80%, Lancet reports.
A study examining stroke outcomes was divided into two phases. In the first, 310 patients presenting to primary care with a TIA or minor stroke were referred to a neurovascular clinic, where patients were assessed and treatment recommendations were faxed to the primary care clinician. In phase 2, about 280 patients were sent directly to the neurovascular clinic, where they received appropriate treatment.
The median delay to clinic assessment dropped from 3 days in phase 1 to less than a day in phase 2. Likewise, the median delay to treatment fell from 20 days to 1 day. The incidence of stroke within 90 days also fell significantly — from 10% to 2%.
Editorialists conclude that patients with TIA or minor stroke "should receive the same urgent attention as is provided for those with acute coronary syndromes."
Physician's First Watch for October 19, 2007
Urgent treatment after a TIA or minor stroke can reduce the 90-day risk for stroke by 80%, Lancet reports.
A study examining stroke outcomes was divided into two phases. In the first, 310 patients presenting to primary care with a TIA or minor stroke were referred to a neurovascular clinic, where patients were assessed and treatment recommendations were faxed to the primary care clinician. In phase 2, about 280 patients were sent directly to the neurovascular clinic, where they received appropriate treatment.
The median delay to clinic assessment dropped from 3 days in phase 1 to less than a day in phase 2. Likewise, the median delay to treatment fell from 20 days to 1 day. The incidence of stroke within 90 days also fell significantly — from 10% to 2%.
Editorialists conclude that patients with TIA or minor stroke "should receive the same urgent attention as is provided for those with acute coronary syndromes."
Hepatitis A Post Exposure Prophylaxis
Vaccine as Effective as Immune Globulin for Hepatitis A Postexposure Prophylaxis — ACIP Changes Guidance
For postexposure prophylaxis, hepatitis A vaccine is as effective as immune globulin in preventing transmission, according to reports in NEJM and MMWR.
Researchers randomized 1090 susceptible household or day-care contacts of patients in Kazakhstan to prophylaxis with either hepatitis A vaccine or immune globulin within 2 weeks of exposure. They hypothesized that the effect of the vaccine would be similar to immune globulin. That criterion was met — between 2 and 8 weeks after exposure, vaccine recipients showed a 1.35 relative risk for developing symptomatic infection as compared with those receiving immune globulin. (The confidence interval for the apparent increased risk ranged from 0.70 to 2.67, which an editorialist comments "could signal a true difference between the interventions.)
Consequently, the CDC's Advisory Committee on Immunization Practices has changed its guidelines for postexposure prophylaxis, recommending vaccine for healthy individuals between the ages of 1 and 40. All others should receive immune globulin, if possible.
Physician's First Watch for October 19, 2007
For postexposure prophylaxis, hepatitis A vaccine is as effective as immune globulin in preventing transmission, according to reports in NEJM and MMWR.
Researchers randomized 1090 susceptible household or day-care contacts of patients in Kazakhstan to prophylaxis with either hepatitis A vaccine or immune globulin within 2 weeks of exposure. They hypothesized that the effect of the vaccine would be similar to immune globulin. That criterion was met — between 2 and 8 weeks after exposure, vaccine recipients showed a 1.35 relative risk for developing symptomatic infection as compared with those receiving immune globulin. (The confidence interval for the apparent increased risk ranged from 0.70 to 2.67, which an editorialist comments "could signal a true difference between the interventions.)
Consequently, the CDC's Advisory Committee on Immunization Practices has changed its guidelines for postexposure prophylaxis, recommending vaccine for healthy individuals between the ages of 1 and 40. All others should receive immune globulin, if possible.
Physician's First Watch for October 19, 2007
Updated Adult Immunisation Schedule 2008
ACIP Releases Adult Vaccine Schedule
The Advisory Committee on Immunization Practices (US) has approved an updated Adult Immunization Schedule for October 2007 to September 2008.
MMWR reports changes from the previous schedule, which include:
Varicella vaccine is recommended for all adults without evidence of immunity.
Zoster vaccine is advised for adults aged 60 or older.
Recommendations for HIV-infected individuals are organized according to CD4 cell count.
Healthcare workers have the option of either trivalent inactivated flu vaccine or live, attenuated vaccine.
Physician's First Watch for October 19, 2007
David G. Fairchild, MD, MPH, Editor-in-Chief
The Advisory Committee on Immunization Practices (US) has approved an updated Adult Immunization Schedule for October 2007 to September 2008.
MMWR reports changes from the previous schedule, which include:
Varicella vaccine is recommended for all adults without evidence of immunity.
Zoster vaccine is advised for adults aged 60 or older.
Recommendations for HIV-infected individuals are organized according to CD4 cell count.
Healthcare workers have the option of either trivalent inactivated flu vaccine or live, attenuated vaccine.
Physician's First Watch for October 19, 2007
David G. Fairchild, MD, MPH, Editor-in-Chief
Monday, October 15, 2007
Infant Cough and Cold Medicines
Infant Cough and Cold Medicines Pulled From the Market
Given concerns that accidental misuse can lead to overdose, many manufacturers of over-the-counter infant cough and cold medicines are voluntarily pulling their products off the market, reports the New York Times. The withdrawal comes 2 weeks after the industry’s trade group, the Consumer Healthcare Products Association, advised that the oral products not be used in children younger than 2 years. The group says that between 1969 and 2006, at least 45 children died after using decongestants, and 69 after antihistamines. An FDA advisory panel will meet next week to discuss the medicines' safety. Not only may the medications be unsafe, but there is scant evidence that they're effective in young children, according to the Times story. Withdrawn medicines include Dimetapp Decongestant Infant Drops, Pediacare Infant Drops Decongestant, and Tylenol Concentrated Infant Drops Plus Cold and Cough.
New York Times story (Free)
Physician's First Watch coverage of hydrocodone in pediatric cough suppressants (Free)Sunday, October 7, 2007
pregnant women should eat more seafood
New Seafood Recommendations for Pregnant Women
Physician's First Watch for October 5, 2007 David G. Fairchild, MD, MPH, Editor-in-Chief
The National Healthy Mothers, Healthy Babies Coalition has recommended that pregnant, breast-feeding, and postpartum women consume at least 12 ounces of seafood weekly, especially oily ocean fish like salmon and sardines. Six of the twelve ounces may come from albacore tuna.
The coalition, which comprises groups such as the American Academy of Pediatrics and the CDC, says that "recent studies indicate the nutritional benefits of fish consumption during pregnancy greatly outweigh potential risks from trace methyl mercury consumption."
The recommendation contrasts with that previously issued by the FDA and the Environmental Protection Agency. In 2004, these groups advised that women who are pregnant, breast-feeding, or planning a pregnancy consume up to 12 ounces of lower-mercury seafood (e.g., shrimp, canned light tuna) weekly, with albacore limited to 6 ounces. They also recommend that such women avoid high-mercury fish (e.g., shark, swordfish).
The FDA plans to review this information but is not ready to change its current stance, reports the Washington Post.
National Healthy Mothers, Healthy Babies Coalition seafood recommendations (Free)
FDA and EPA 2004 seafood recommendations (Free)
Washington Post story (Free)
Physician's First Watch for October 5, 2007 David G. Fairchild, MD, MPH, Editor-in-Chief
The National Healthy Mothers, Healthy Babies Coalition has recommended that pregnant, breast-feeding, and postpartum women consume at least 12 ounces of seafood weekly, especially oily ocean fish like salmon and sardines. Six of the twelve ounces may come from albacore tuna.
The coalition, which comprises groups such as the American Academy of Pediatrics and the CDC, says that "recent studies indicate the nutritional benefits of fish consumption during pregnancy greatly outweigh potential risks from trace methyl mercury consumption."
The recommendation contrasts with that previously issued by the FDA and the Environmental Protection Agency. In 2004, these groups advised that women who are pregnant, breast-feeding, or planning a pregnancy consume up to 12 ounces of lower-mercury seafood (e.g., shrimp, canned light tuna) weekly, with albacore limited to 6 ounces. They also recommend that such women avoid high-mercury fish (e.g., shark, swordfish).
The FDA plans to review this information but is not ready to change its current stance, reports the Washington Post.
National Healthy Mothers, Healthy Babies Coalition seafood recommendations (Free)
FDA and EPA 2004 seafood recommendations (Free)
Washington Post story (Free)
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