JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENT
JAMA NEWS RELEASES
(Embargoed for Release: 3 p.m. CT, Tuesday, May 24, 2005)
JAMA NEWS RELEASES
MULTISLICE COMPUTED TOMOGRAPHY HAS POTENTIAL TO OFFER ACCURATE, SAFER METHOD FOR DETECTING CORONARY ARTERY DISEASE
PHYSICAL ACTIVITY ASSOCIATED WITH IMPROVED SURVIVAL FOR WOMEN WITH BREAST CANCER
LITTLE CHANGE IN SUICIDAL THOUGHTS, PLANS OR ATTEMPTS IN U.S.
INTERNATIONAL ADOPTEES HAVE FEWER BEHAVIOR PROBLEMS THAN DOMESTIC ADOPTEES
NO STRONG EVIDENCE OF AN INCREASED RISK OF CANCER AMONG PERSONAL HAIR DYE USERS
JAMA REPORT (VIDEO NEWS RELEASE AND SCRIPT)
VIDEO: Windows Media | Quicktime
IN BREAST CANCER PATIENTS, WALKING 3-5 HOURS PER WEEK MAY REDUCE RISK OF DEATH FROM BREAST CANCER BY UP TO 50 %
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
TV Note: This week's JAMA video news release is on physical activity and survival after breast cancer diagnosis. The release will be fed Tuesday, May 24, from 9:00 - 9:30 a.m. ET on Intelsat America 6 (formerly Telstar 6), Transponder 11 (C-Band) and from 2:00 - 2:30 p.m. ET on Intelsat America 6, Transponder 11 (C-Band). For more information, call 312/464-JAMA (5262).
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Embargoed for Release: 3 p.m. CT, TUESDAY, May 24, 2005
Media Advisory: To contact Martin H. K. Hoffmann, M.D., email: martin.hoffmann{at}medizin.uni-ulm.de. To contact editorialist Mario J. Garcia, M.D., call Lisa Murphy at 216-444-7935.
MULTISLICE COMPUTED TOMOGRAPHY HAS POTENTIAL TO OFFER ACCURATE, SAFER METHOD FOR DETECTING CORONARY ARTERY DISEASE
CHICAGO—Multislice computed tomography appears to provide high accuracy for detecting coronary artery disease and may represent a useful complement to conventional coronary angiography, according to a study in the May 25 issue of JAMA.
Conventional invasive coronary angiography is currently the diagnostic standard for clinical evaluation of known or suspected coronary artery disease (CAD), according to background information in the article. The risk of adverse events is small, but serious and potentially life-threatening events may occur, including arrhythmia, stroke, coronary artery dissection, and access site bleeding (total complication rate, 1.8 percent; death rate, 0.1 percent). Furthermore, angiography catheterization induces some discomfort and mandates routine follow-up care. Guidelines recommend that conventional invasive diagnostic angiography be restricted to stringent clinical indications.
A recently developed procedure that may potentially complement invasive coronary angiography is multislice computed tomography (MSCT), which may achieve a high level of reliability and accuracy in the visualization of the coronary arteries. MSCT is a sophisticated x-ray imaging technique, in which a CT tube and multiple layered detector rows rotate around the patient, taking numerous images of the body in seconds. A computer processes this information into three-dimensional images composing volumetric representations of anatomy. The coronary arteries can be extracted from these images and are presented in arbitrarily oriented sectional cuts. This procedure eliminates much of the risk and discomfort associated with invasive coronary artery catheterization, although it retains the risks inherent in radiation exposure and use of contrast agents.
Martin H. K. Hoffmann, M.D., of University Hospital, Ulm, Germany and colleagues assessed the diagnostic accuracy of 16-slice MSCT scanning vs. invasive coronary angiography in a large group of patients with known or suspected CAD. The study, which included 103 patients (average age, 61.5 years), was conducted from November 2003-August 2004. The patients underwent both invasive coronary angiography and MSCT using a scanner with 16 detector rows.
The researchers found that compared with invasive coronary angiography for detection of significant lesions (greater than 50 percent stenosis [narrowing]), segment-based sensitivity, specificity, and positive and negative predictive values of MSCT were 95 percent, 98 percent, 87 percent, and 99 percent, respectively. Quantitative comparison of MSCT and invasive coronary angiography showed good correlation, with MSCT systematically measuring greater-percentage stenoses. Per-patient based analysis indicated high discriminative power to identify patients who might be candidates for revascularization.
"In conclusion, we found that MSCT shows reasonably high accuracy for detecting significant obstructive CAD when assessed at a patient level. At its current stage of development, it may therefore be used to substantially reduce likelihood of clinically important CAD in patients with suspected disease. The appeal of MSCT compared with conventional coronary angiography is that it is noninvasive, avoiding most catheter-associated risks and discomforts with the exception of exposure to iodinated contrast agents and radiation. With rapidly improving technology, MSCT may well evolve from a useful complement to invasive angiography to a clinically viable alternative," the authors write.
(JAMA. 2005;293:2471-2478. Available post-embargo at jama.com)
Editor's Note: This study was funded by the State Government of Baden-Wuerttemberg, Germany. The computed tomography equipment was partially provided by Philips Medical Systems, Best, the Netherlands, on the basis of a beta-site contract.
EDITORIAL: NONINVASIVE CORONARY ANGIOGRAPHY — HYPE OR NEW PARADIGM?
In an accompanying editorial, Mario J. Garcia, M.D., of the Cleveland Clinic Foundation, comments on the findings by Hoffmann et al.
"Despite these promising results, several important limitations of MSCT must be considered. First, MSCT requires ionizing radiation," Dr. Garcia writes. "This dose [in this study] is equivalent to 2 to 3 times the dose typically administered during a diagnostic invasive angiogram. Although the long-term risks associated with this level of radiation exposure are relatively low, it raises a concern about repetitive use or use in younger individuals and women of childbearing age."
"Second, the extent and severity of coronary calcifications in the population studied by Hoffmann et al is not known definitively."
"Despite [these and other limitations], there is an important segment of the population at risk for heart disease in whom MSCT angiography could provide coronary anatomic information with sufficient diagnostic quality. Indeed, MSCT may offer another advantage over conventional angiography, which is the potential ability to detect and quantify atherosclerotic plaques in the coronary vessel walls. Nevertheless, in the absence of outcome and cost analysis studies, it is not yet clear how MSCT coronary angiography should be integrated in the clinical practice. Should it be used as a first test for the evaluation of chest pain or as a complementary test in patients with equivocal stress test results? In either case, adequate patient selection will be critically important."
"...the growing enthusiasm for MSCT in the community must be matched with adequate training, proper credentialing and, above all, appropriate utilization," Dr. Garcia concludes.
(JAMA. 2005;293:2531-2533. Available post-embargo at jama.com)
Editor's Note: Dr. Garcia receives institutional research funding from Philips Medical Systems.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3 p.m. CT, TUESDAY, May 24, 2005
Media Advisory: To contact Michelle D. Holmes, M.D., Dr.P.H., call Melanie Franco at 617-534-1605.
PHYSICAL ACTIVITY ASSOCIATED WITH IMPROVED SURVIVAL FOR WOMEN WITH BREAST CANCER
CHICAGO—Women with breast cancer who engaged in an amount of physical activity equivalent to walking 1 or more hours per week had better survival compared with those who exercised less than that or not at all, according to a study in the May 25 issue of JAMA.
There is reason to believe that physical activity might extend survival in women with breast cancer, according to background information in the article. Physical activity has been linked to lower levels of circulating ovarian hormones, which may explain the relationship between physical activity and breast cancer. Lower estrogen levels among physically active women with breast cancer could potentially improve survival, although few data exist to support this hypothesis.
Michelle D. Holmes, M.D., Dr.P.H., of Brigham and Women's Hospital and Harvard Medical School, Boston, and colleagues conducted a study to examine whether higher levels of physical activity after a breast cancer diagnosis would be associated with longer survival. The study was based on responses from 2,987 female registered nurses in the Nurses' Health Study who were diagnosed with stage I, II, or III breast cancer between 1984 and 1998 and who were followed up until death or June 2002, whichever came first. Physical activity was measured as metabolic equivalent task (MET) hours. Three MET-hours is equivalent to walking at average pace of 2 to 2.9 mph for 1 hour.
The researchers found that compared with women who engaged in less than 3 MET-hours per week of physical activity, the adjusted relative risk of death from breast cancer was 20 percent lower for 3 to 8.9 MET-hours per week; 50 percent lower for 9 to 14.9 MET-hours per week; 44 percent lower for 15 to 23.9 MET-hours per week; and 40 percent lower for 24 or more MET-hours per week. The benefit of physical activity was particularly apparent among women with hormone-responsive tumors. The risk of breast cancer death was 50 percent lower for women with hormone-responsive tumors who engaged in 9 or more MET-hours per week of activity compared with women with hormone-responsive tumors who engaged in less than 9 MET-hours per week. Compared with women who engaged in less than 3 MET-hours per week of activity, the absolute unadjusted risk of death reduction was 6 percent at 10 years for women who engaged in 9 or more MET-hours per week.
"It has been estimated that women decrease their levels of physical activity by 2 hours per week after a breast cancer diagnosis, with greater decreases among obese women, and that less than one third of breast cancer survivors participate in levels of activity recommended by government agencies. Women with breast cancer who follow the Centers for Disease Control and Prevention recommendations for all individuals in the United States to exercise at moderate intensity for 30 or more minutes per day for 5 or more days per week may survive longer," the authors conclude.
(JAMA. 2005;293:2479-2486. Available post-embargo at jama.com)
Editor's Note: The research for this article was funded by a grant from the National Institutes of Health.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3 p.m. CT, TUESDAY, May 24, 2005
Media Advisory: To contact Ronald C. Kessler, Ph.D., call John Lacey at 617-432-0442.
LITTLE CHANGE IN SUICIDAL THOUGHTS, PLANS OR ATTEMPTS IN U.S.
CHICAGO—Despite a substantial increase in treatment for suicide attempts, no significant decrease occurred in the number of persons reporting suicide-related behaviors in the U.S. in the 1990s, according to a study in the May 25 issue of JAMA.
Suicide is one of the leading causes of death worldwide, according to background information in the article. As a result, the World Health Organization and the U.S. surgeon general have highlighted the need for more comprehensive data on the occurrence of suicidal thoughts and attempts, with the assumption that such data would be useful for planning national health care policy, as well as for evaluating efforts to reduce suicide and suicide-related behaviors.
Ronald C. Kessler, Ph.D., of Harvard Medical School, Boston, and colleagues examined nationally representative general-population trend data on the 12-month prevalence and treatment of suicide-related behaviors. Data came from the 1990-1992 National Comorbidity Survey and the 2001-2003 National Comorbidity Survey Replication. These surveys asked identical questions to 9,708 people aged 18 to 54 years about the past year's occurrence of suicidal ideation, plans, gestures, attempts, and treatment. Face-to-face interviews were administered in the homes of respondents.
The researchers found that no significant changes occurred between 1990-1992 and 2001-2003 in suicidal ideation (2.8 percent vs. 3.3 percent), plans (0.7 percent vs. 1.0 percent), gestures (0.3 percent vs. 0.2 percent), or attempts (0.4 percent-0.6 percent). Treatment increased dramatically among ideators who made a gesture (40.3 percent vs. 92.8 percent) and among ideators who made an attempt (49.6 percent vs. 79.0 percent). The authors add that "... we found that risk of suicide-related behaviors is consistently elevated in several vulnerable subgroups, including the young, women, individuals with low education, and individuals lacking stable relationships or employment."
Previous studies have reported a 6 percent decrease in actual suicides among people in this age range (18-54 years) from 14.8 per 100,000 per year in 1990-1992 to 13.9 per 100,000 per year in 2000-2002.
"Efforts are needed to identify optimal interventions for primary and secondary prevention of suicidality," the authors write. "Substantial barriers to uptake of effective interventions continue to exist, including competing clinical demands and distorted incentives for treating mental disorders and symptoms. Failure to disseminate evidence-based treatments widely may, in fact, help explain why suicidality did not decline in response to the treatment increases during the 1990s. This means that expansion of disease management programs, treatment quality-assurance programs, and 'report cards' to improve the quality of care for suicidal patients may all be needed to reduce the burden of suicidality."
(JAMA. 2005;293:2487-2495. Available post-embargo at jama.com)
Editor's Note: For funding/support and financial disclosure information, please see the JAMA article.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3 p.m. CT, TUESDAY, May 24, 2005
Media Advisory: To contact Femmie Juffer, Ph.D., email: juffer{at}fsw.leidenuniv.nl.
To contact editorial author Laurie C. Miller, M.D., call Melissa McPherson at 617-636-0200.
INTERNATIONAL ADOPTEES HAVE FEWER BEHAVIOR PROBLEMS THAN DOMESTIC ADOPTEES
CHICAGO—Most international children who are adopted are well-adjusted and have fewer behavioral problems than children who are adopted domestically, according to an article in the May 25 issue of JAMA.
"International adoption is an increasing phenomenon involving more than 40,000 children a year moving between more than 100 countries," according to background information provided by the authors. "Before adoption, international adoptees often experience insufficient medical care, malnutrition, maternal separation, and neglect and abuse in orphanages."
Femmie Juffer, Ph.D., and Marinus H. van IJzendoorn, Ph.D., from Leiden University, Leiden, the Netherlands, conducted a search of the medical literature from 1950 to January 2005 to estimate the effects of international adoption on behavioral problems and mental health referrals. The authors' meta-analyses compared the international adoptees to children who had not been adopted (controls) and to children who had been adopted within their own countries (domestic adoptees).
"In sum, our series of meta-analyses showed that the majority of international adoptees are well-adjusted although more adoptees are referred to mental health services compared with nonadopted controls," the authors write. "Contrary to common opinion, international adoptees present fewer behavior problems than domestic adoptees, and they have lower rates of mental health referral. Unexpectedly, age at adoption does not appear to be important for the development of behavioral problems." The authors add, "Clinicians should be aware of higher risks for problem behaviors in domestic adoptees and in international adoptees who experienced neglect or maltreatment in the preadoptive period."
(JAMA. 2005;293:2501-2515. Available post-embargo at jama.com)
Editor's Note: The Adoption Meta-Analysis Project (ADOPTION MAP) is supported by grants from Stichting VSBfonds, Stichting Fonds 1818, Nationaal Fonds Geestelijke Volksgezondheid, and Stichting Kinderpostzegels in cooperation with the Adoptie Driehoek Onderzoeks Centrum. Dr. van IJzendoorn is supported by the NWO/Spinoza prize of the Netherlands Organization for Scientific Research.
EDITORIAL: INTERNATIONAL ADOPTION, BEHAVIOR, AND MENTAL HEALTH
In an accompanying editorial, Laurie C. Miller, M.D., from Tufts-New England Medical Center, Boston, writes "the authors convincingly demonstrate that international adoptees have more behavioral problems than nonadopted controls, although the effect sizes were small. On the other hand, when compared with domestic adoptees, international adoptees had fewer total, externalizing, and internalizing behavioral problems and fewer mental health referrals."
"Clearly, this report represents an important step toward the goals of reducing behavioral problems and promoting positive mental health outcomes for this vulnerable group of children," the author concludes.
(JAMA. 2005;293:2533-2535. Available post-embargo at jama.com)
Editor's Note: Dr. Miller is supported in part by the Jaqueline Munroe Noonan Foundation and by a grant from the National Institutes of Health (National Institute on Drug Abuse).
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3 p.m. CT, TUESDAY, May 24, 2005
Media Advisory: To contact Bahi Takkouche, M.D., Ph.D., email: mrbahi{at}usc.es.
NO STRONG EVIDENCE OF AN INCREASED RISK OF CANCER AMONG PERSONAL HAIR DYE USERS
CHICAGO—A meta-analysis of the scientific evidence looking at the association between cancer and hair dye use has found no strong evidence of increased risk, according to an article published in the May 25 issue of JAMA.
According to background information in the article, "there is growing concern worldwide about a possible increase in the risk of cancer among users of hair dyes." The authors add, "An association between hair dyes and cancer would be an important public health concern since about one-third of women in Europe and North America, along with 10 percent of men older than 40 years, use some type of hair dye. Permanent dyes, the most aggressive type, represent 70 percent of the market share - even more in Asia."
Bahi Takkouche, M.D., Ph.D., from the University of Santiago de Compostela, Spain, and colleagues analyzed data found in a medical literature search identifying 79 studies from 11 countries to examine the association between personal use of hair dyes and relative risk of cancer.
"Our results indicate that, globally, there is no effect of personal hair dye use on the risk of breast and bladder cancer," the authors report. "There is a borderline effect for hematopoietic cancers (for example, leukemia and multiple myeloma). However, the evidence of a causal effect is too weak to represent a major public health concern."
"Some aspects related to hematopoietic cancer and other cancers that have shown evidence of increased risk in one or two studies should be investigated further," the authors write in conclusion. "Efforts should be targeted toward the assessment of the risk of cancer in occupational settings where exposure to hair dyes is more prolonged and has a higher concentration and frequency than personal exposure."
(JAMA. 2005;293:2516-2525. Available post-embargo at jama.com)
Editor's Note: Co-author Dr. Etminan is supported by a Canadian Institutes of Health Research postdoctoral fellowship award.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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JAMA REPORTS
VIDEO: Windows Media | Quicktime
IN BREAST CANCER PATIENTS, WALKING 3-5 HOURS PER WEEK MAY REDUCE RISK OF DEATH FROM BREAST CANCER BY UP TO 50 %
INTRO:
Past studies have shown that exercise can reduce a woman’s risk of getting breast cancer. Researchers wanted to know if exercise could also help women who already have breast cancer, by reducing the risk of the disease being fatal. They found that exercise can help, and that women don’t have to run marathons to reap the reward. Mavis Prall explains in this week’s JAMA Report.
VIDEO:
B-ROLL
Susan walking/exercising outside
AUDIO:
IN MANY WAYS, SUSAN de VRIES (du-VREEZ,), A 43-YEAR-OLD MOTHER OF THREE, IS IN GREAT PHYSICAL SHAPE, ESPECIALLY CONSIDERING THAT FOUR YEARS AGO, SHE WAS DIAGNOSED WITH BREAST CANCER.
VIDEO:
SOT/FULL
@ :10
Super: Susan de Vries
Breast cancer patient
Runs :15
AUDIO:
“After my mastectomies, got right out there and started walking pretty much right away. I mean, I remember one week after my surgery, walking, I was staying at my parents’, walking down my parents’ driveway, very proud of myself that I made it that far.”
VIDEO:
B-ROLL
Susan on bike at gym
GFX/JAMA COVER
AUDIO:
NOW SHE EXERCISES ABOUT FOUR HOURS A WEEK, WHICH A NEW STUDY SAYS COULD CUT HER RISK OF DYING FROM BREAST CANCER IN HALF. THE STUDY APPEARS IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
VIDEO:
SOT/FULL
@ :37
Super: Michelle Holmes, M.D., Dr. P.H.
Brigham and Women’s Hospital
Runs :09
AUDIO:
“Women with breast cancer who walked 3 to 5 hours per week were 50% less likely to die from breast cancer compared to inactive women with breast cancer.”
VIDEO:
B-ROLL
Dr. Holmes and colleague going over data
Colleague looking at mammograms on light board
AUDIO:
DR. MICHELLE HOLMES AND COLLEAGUES AT BRIGHAM AND WOMEN’S HOSPITAL IN BOSTON STUDIED ABOUT 3-THOUSAND BREAST CANCER PATIENTS, TRACKING THEIR HEALTH AND EXERCISE HABITS FOR UP TO EIGHTEEN YEARS.
VIDEO:
SOT/FULL
Michelle Holmes, M.D., Dr. P.H.
Brigham and Women’s Hospital
Runs :08
AUDIO:
“Compared to the most inactive women, just about any amount of physical activity was linked with a lower risk of death of breast cancer.”
VIDEO:
B-ROLL
Susan on climber
AUDIO:
BUT THAT DOESN’T MEAN BREAST CANCER PATIENTS HAVE TO BECOME SERIOUS ATHLETES.
VIDEO:
SOT/FULL
Michelle Holmes, M.D., Dr. P.H.
Brigham and Women’s Hospital
Runs :13
AUDIO:
“Women do not have to run marathons to gain the maximum benefit. We found that women who performed activity at the level of walking 3 to 5 hours per week gained the most benefit.”
VIDEO:
B-ROLL
Susan walking on treadmill
AUDIO:
DR. HOLMES SAYS THE LIKELY REASON THAT EXERCISE HELPS IS THAT IT REDUCES THE BODY’S HORMONE PRODUCTION. HIGH HORMONES CAN CAUSE MOST BREAST CANCERS TO GROW. WHATEVER THE REASON, SUSAN SAYS EXERCISE MAKES HER FEEL MUCH BETTER.
VIDEO:
SOT/FULL
Susan de Vries
Breast cancer patient
Runs :07
AUDIO:
“It’s such an uplifting part of my life, that I think the day I can no longer exercise will be a sad one.”
VIDEO:
B-ROLL
Picture of Susan and husband
Picture of Susan with child
Picture of daughter and son
AUDIO:
SHE CONTINUES TO BATTLE CANCER, AND IT’S A FIGHT SHE’S DETERMINED TO WIN, FOR HERSELF AND HER FAMILY. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
TAG:
Dr. Holmes stresses that all the women in the study received standard treatment for breast cancer, so exercise is not a substitute for such treatment. She also says that federal government health recommendations are that ALL adults should be physically active 3 to 5 hours a week, so her recommendations for breast cancer patients match that government recommendation for all of us. For more information, visit www.jama.com.
