CHICAGO—In women with breast lesions that are suspicious for cancer, based on clinical examination or mammography, performing a breast MRI has high sensitivity but only moderate specificity for detecting breast cancer, but does not necessarily eliminate the need for tissue sampling, according to a study in the December 8 issue of JAMA.

Mammography is the primary imaging modality used to detect clinically occult breast cancer, according to background information in the article. However, mammography has limitations in both sensitivity and specificity that have led to exploration of other imaging techniques. Magnetic resonance imaging (MRI) has been evaluated for breast imaging because of its value for assessing soft tissues of the body. Previous research has indicated that additional lesions seen by MRI that are not visible on the mammogram have been reported to be present in between 27 percent and 37 percent of patients. The use of MRI to evaluate women with mammographically or clinically suspicious breast lesions who are undergoing biopsy has shown high potential.

David A. Bluemke, M.D., Ph.D., of Johns Hopkins University School of Medicine, Baltimore, and colleagues conducted a study to determine the accuracy of breast MRI in conjunction with mammography for the detection of breast cancer in patients with suspicious mammographic or clinical findings. The International Breast MR Consortium was conducted at 14 university hospitals in the United States and Europe from June 2, 1998, through October 31, 2001. The study included 821 patients referred for breast biopsy based on suspicious mammographic, clinical or ultrasound findings. Patients had MRI examinations performed prior to breast biopsy; MRI results were interpreted at each site, with MRI investigators blinded to pathological results.

The researchers found that MRI correctly detected cancer in 356 of 404 cancer cases (ductal carcinoma in situ [DCIS] or invasive cancer), resulting in a sensitivity of 88.1 percent, and correctly identified as negative for cancer 281 of 417 cases without cancer, resulting in a specificity of 67.7 percent. MRI performance was not significantly affected by mammographic breast density, tumor histology, or menopausal status.

CHICAGO—Men and women who were overweight or obese in young adulthood and middle age have significantly higher Medicare costs in older age, compared to their nonoverweight peers, according to a study in the December 8 issue of JAMA.

According to background information, obesity is associated with increased risk of high blood pressure, diabetes, and certain cancers, and has been identified as a major risk factor for coronary heart disease (CHD). Approximately 130 million U.S. adults are currently overweight or obese, defined as having a body mass index (BMI: weight in kilograms divided by height in meters squared) of 25 - 29.9, or 30 and greater, respectively. The proportion of U.S. adults aged 65 years and older is estimated to increase from 12 percent currently to 20 percent by 2050. Obesity and this rising number of older persons in the U.S. is a concern to health care professionals, policy makers, and the U.S. public. However, little is known about the relation of overweight or obesity in young adults to long-term medical care expenditures.

Martha L. Daviglus, M.D., Ph.D., from the Feinberg School of Medicine, Northwestern University, Chicago, and colleagues examined the relationship between BMI in young adulthood and middle age to Medicare spending at ages 65 years and older. Between 1967 and 1973, BMIs and overall health were measured in 9,978 men (average age, 46 years) and 7,623 women (average age, 48 years) participating in the Chicago Heart Association Detection Project in Industry (CHA). Individuals were classified as being nonoverweight (BMI, 18.5 - 24.9), overweight (25 - 29.9), obese (30.0 - 34.9), or severely obese (35 and greater). The participants were free of coronary heart disease, diabetes, and major electrocardiographic abnormalities and were not underweight (BMI less than 18.5). Researchers then examined Medicare claims data for these participants from 1984 through 2002.

The researchers found that annual average Medicare charges for severely obese men were $6,192 more (84 percent higher) than for nonoverweight men. For severely obese women, annual average charges were $5,618 more (88 percent higher) than for nonoverweight women. The total average annual Medicare charges for nonoverweight, overweight, obese, and severely obese men were, respectively, $7,205, $8,390, $10,128, and $13,674. The total average annual charges for nonoverweight, overweight, obese, and severely obese women were, respectively, $6,224, $7,653, $9,612, and $12,342.

CHICAGO—Accumulated exposure to lead may be an important but unrecognized risk for developing cataracts in men, according to a study in the December 8 issue of JAMA.

Lead continues to pose a significant public health problem in spite of substantial reductions in lead exposure in the United States in the recent past, according to background information in the article. Exposure has not been totally eliminated and most adults continue to have substantial levels of lead in their body. Previous evidence has indicated that low-level lead exposure may increase the risk for a number of chronic age-related diseases.

Debra A. Schaumberg, Sc.D., M.P.H., of Brigham and Women's Hospital, Boston, and colleagues investigated whether bone lead levels measured in both the tibia and patella were associated with age-related cataract, the leading cause of blindness and visual impairment worldwide. Bone lead levels were measured between 1991 and 1999 in a subset of participants in the Normative Aging Study (NAS), a Boston-based longitudinal study of aging in men. Among the first 795 NAS participants to have bone lead levels measured, researchers reviewed eye examination data (collected routinely every 3 - 5 years) for the period after the bone lead measurements were taken. The study included men aged 60 years and older who had sufficient eye examination information available (n = 642). Blood lead levels were also measured.

The average age of the study participants was 69 years and cataract was identified in 122 men. The researchers found that men in the highest quintile of tibia lead level had a 2.7 times increased likelihood for cataract compared to men in the lowest quintile. Further adjustment for cigarette smoking, diabetes, blood lead levels, and intake of vitamin C, vitamin E, and carotenoids indicated a 3.2 times increased likelihood of having cataract among men in the highest quintile of tibia lead. For patella lead level, there was a 1.9 times increased likelihood of cataract in the highest vs. lowest quintile, but the trend was not significant. Blood lead levels, more indicative of short-term exposure levels, were not significantly associated with cataract.

"...generalized low lead exposure along with pockets of higher exposure remain commonplace, including in the United States where more than 80 percent of homes built before 1980 are contaminated by lead-based paint and/or leaded water pipes. Results of the present study suggest that cumulative lead exposure is a risk factor for cataract, which accounts for more than 40 percent of all cases of blindness worldwide," the authors write. They add that expenditures for cataract surgery comprise the largest single line item in the Medicare budget.

MEDICARE EXPENDITURES 80% HIGHER FOR PEOPLE WHO WERE SEVERELY OBESE IN YOUNG ADULTHOOD OR MIDDLE AGE