EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, September 27, 2004
To contact Timothy Gilligan, M.D., call William Schaller at 617/632-5357. To contact editorialist M. Suzanne Stratton, Ph.D., call Donna Breckenridge at 520/626-2277.

ELDERLY AFRICAN AMERICAN MEN LESS LIKELY TO UNDERGO PROSTATE CANCER SCREENING

CHICAGO—- Elderly African American men are less likely to get tested for prostate cancer than elderly white men, according to an article in the September 27 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.

According to the article, major racial differences exist in prostate cancer incidence and death rates in the United States. African American men are 60 percent more likely to be diagnosed with prostate cancer than white men and twice as likely to die from it, the article states. Low screening rates among African American men may contribute to these disparities, but few data exists on racial differences in prostate cancer screening.

Timothy Gilligan, M.D., of the Dana-Farber Cancer Institute, Boston, and colleagues studied differences in prostate cancer screening rates using the prostate-specific antigen test (PSA test, a blood test) among African Americans and white men aged 65 years and older who participated in the Medicare and/or Medicaid program in New Jersey.

The researchers looked at the medical records of 33,463 men who underwent routine prostate cancer screening between January 1, 1994 and December 31, 1996. These men were matched to 33,782 control patients of the same age who did not undergo prostate cancer screening. Among the patients studied, 5.7 percent were black and 87.6 percent were white.

The researchers found that black men were only half as likely to be tested for prostate cancer as white men. Men classified as living in poverty or near poverty were 67 percent and 31 percent less likely to undergo prostate cancer screening, respectively.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, September 27, 2004
To contact Carmen L. Lewis, M.D., M.P.H., call David Williamson at 919/962-8596.

SMALL PROPORTION OF WOMEN APPEAR TO BE ELIGIBLE FOR TAKING MEDICATION FOR BREAST CANCER PREVENTION

CHICAGO—A survey conducted in primary care practices showed that a small proportion of women are eligible for discussions about use of tamoxifen to prevent cancer, and of those women, the proportion of breast cancers that would be prevented is also small, according to an article in the September 27 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.

Despite the importance of screening mammography and breast examination in breast cancer control, randomized trials show modest effect of screening on breast cancer deaths, according to background information in the article. A national breast cancer prevention trial showed a 49 percent reduction in breast cancer incidence in high-risk individuals who received tamoxifen. However, according to the article, the same study also showed that the drug increased the risk of endometrial (uterus) cancer, pulmonary embolism (sudden blockage of an artery in the lung), blood clots in the deep veins, and stroke.

Carmen L. Lewis, M.D., M.P.H., from The University of North Carolina at Chapel Hill, and colleagues surveyed 605 women aged 40 to 69 years in ten general internal medicine practices in North Carolina in 2000. The survey was designed to determine each woman's breast cancer risk and then to assess eligibility for chemoprevention (using tamoxifen to prevent breast cancer). The researchers determined the women's five-year breast cancer risk based on age, ethnicity, number of first-degree relatives with breast cancer, age at first menstruation, age at first live birth, number of breast biopsies, and presence of atypical hyperplasia (abnormal cells that may be indicative of cancer) in a biopsy specimen. Women with an estimated five-year breast cancer risk of at least 1.66 percent were defined as having an increased breast cancer risk. To determine the possible risks of taking tamoxifen, the women were questioned about their medical history; specifically, whether their physicians had told them they had high blood pressure, diabetes mellitus, blood clots in the legs, or blood clots in the lungs.

The researchers found that among white women, nine percent in their 40s, 24 percent in their 50s, and 53.4 percent in their 60s had a five-year estimated breast cancer risk of 1.66 percent or greater. Among black women, 2.9 percent in their 40s, 7.1 percent in their 50s, and 13 percent in their 60s had a similar risk. When the possible side effects of tamoxifen were considered in white women, ten percent or fewer in all age groups were judged to be potentially appropriate for chemoprevention using tamoxifen. In women identified as at an increased risk for breast cancer, the maximum proportion of breast cancers that would be prevented was 6 to 8.3 percent, according to the researchers' calculations.

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To contact corresponding author Drue H. Barrett, Ph.D., call Jill Smith at 404/498-0070.

VIETNAM VETERANS HAD HIGHER DEATH RATES AFTER DISCHARGE THAN OTHER VETERANS

CHICAGO—Vietnam veterans had higher death rates in the first five years after discharge than veterans who did not serve in Vietnam, according to a 30-year follow-up study published in the September 27 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.

During the 1980s, the Centers for Disease Control and Prevention conducted the Vietnam Experience Study (VES) to look at the long-term health effects of military service in Vietnam. Serving in Vietnam exposed servicemen to several possible health factors, including exposure to psychological stress associated with war, infectious diseases prevalent in Vietnam, pesticides and herbicides, and drug and alcohol abuse. The original VES followed 18,313 US Army veterans from their date of discharge from active duty (1965-1977) through December 31, 1983. This study was somewhat limited by the young age of the participants (average age, 36.1 years) and the small number of deaths (446), the article states.

Tegan K. Catlin Boehmer, M.P.H., of the National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Ga., and colleagues followed up participants of the VES through 2000, for an average of 30 years of follow-up, and compared outcomes for Vietnam veterans (n=9,324) with veterans who served during the same period, but not in Vietnam (n=8,989).

Over 30 years of follow up, the researchers found that Vietnam veterans had a 7 percent higher death rate (838 deaths, 3.01 deaths per 1,000 person-years) compared to other veterans (746 deaths, 2.79 deaths per 1,000 person-years). This excess mortality among Vietnam veterans was limited to the first five years after discharge from active duty and resulted from an increase in external causes of death, including motor vehicle collision-related deaths, suicides, and homicides. Additionally, Vietnam veterans experienced higher mortality from unintentional poisoning deaths, and from drug-related deaths over the 30-year study period.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, September 27, 2004
To contact Meena Kumari, Ph.D., e-mail: M.Kumari{at}ucl.ac.uk.

BRITISH CIVIL SERVANTS WITH LOWER EMPLOYMENT GRADE AND LOWER SOCIAL POSITION HAVE INCREASED RISK OF DIABETES

CHICAGO—- London civil servants at the lower end of the employment scale and with lower social position were more likely to develop type 2 diabetes than those at higher employment levels, according to an article in the September 27 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.

According to the article, recent studies have described a significant inverse relationship between impaired glucose tolerance (an indication of diabetes) and grade of employment in the civil service. Also, American adults with type 2 diabetes have less education and lower income than those without the disease. Psychosocial factors, such as having little control at work, low social support, depression and effort-reward imbalance (when high effort at work produces little reward or benefit), are established risk factors for coronary heart disease (CHD), which shares several common features with type 2 diabetes.

Meena Kumari, Ph.D., of University College London, and colleagues examined the relationship between social position and incidence of type 2 diabetes and whether psychosocial risk factors for CHD are associated with the onset of type 2 diabetes.

The researchers studied 10,308 civil servants aged 35 to 55 years during phase 1 of the Whitehall II Study (1985-1988). The Whitehall II study was established to examine relationships between social position, health, and death. Questionnaires were used to determine diabetes status at the beginning of the study and at phase 2 (1989), phase 3 (1992-1993), phase 4 (1995), and phase 5 (1997-1999), and glucose tolerance tests were administered at phase 3 and 4.

Employment grade was divided into three categories: administrative (the seven highest paying grades), executive (including senior executive officers, higher executive officers, executive officers and other professional and technical staff receiving similar salaries), and clerical (including clerical and office support grades). Participants also answered questions regarding family history of diabetes, coronary risk factors (including smoking, alcohol consumption, exercise habits and diet), and psychosocial questions regarding work, social support, depression, and relationships.

The researchers found that over an average follow-up time of 10.5 years, 4 percent of the participants (242 men and 119 women) developed diabetes. Men working in lower employment grades had almost three times the risk of developing diabetes, and women had a 70 percent higher risk of developing diabetes than participants in higher employment grades. Participants whose body mass index (BMI) indicated overweight (BMI, 25.0-29.9) or obesity (BMI, 30 or greater) were at increased risk of diabetes. Among the psychosocial risk factors examined, only effort-reward imbalance was associated with diabetes, and only in men, who had a 70 percent greater chance of developing diabetes if they reported experiencing effort-reward imbalance.