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, August 9, 2005)
JAMA NEWS RELEASES
INCIDENCE OF NONMELANOMA SKIN CANCER ON THE RISE AMONG YOUNG ADULTS
CERTAIN GENE VARIATION ASSOCIATED WITH BETTER MOBILITY FOR OLDER INDIVIDUALS WHO EXERCISE
LARGE STUDY FINDS NO LINK BETWEEN MULTIPLE CHILDHOOD VACCINATIONS AND SUBSEQUENT HOSPITALIZATION FOR NONTARGETED DISEASES
FOLLOWING CLINICAL PRACTICE GUIDELINES FOR OLDER ADULTS WITH SEVERAL ILLNESSES COULD HAVE UNDESIRABLE EFFECTS
JAMA REPORT (VIDEO NEWS RELEASE SCRIPT)
VIDEO: Windows Media | Quicktime
SKIN CANCER INCREASING AMONG PEOPLE UNDER AGE 40 – MOST DRAMATIC INCREASE IN WOMEN
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 the trend in rates of skin cancer for adults under age 40. The release will be fed Tuesday, August 9, 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, August 9, 2005
Media Advisory: To contact Leslie J. Christenson, M.D., call Elizabeth Zimmerman at 507-266-0810.
INCIDENCE OF NONMELANOMA SKIN CANCER ON THE RISE AMONG YOUNG ADULTS
CHICAGO—A new study from Minnesota finds the incidence of nonmelanoma skin cancer increasing among men and women under the age of 40, according to an article in the August 10 issue of JAMA.
The overall incidence of nonmelanoma skin cancer, consisting of squamous cell carcinoma (SCC) and basal cell carcinoma (BCC), is increasing, according to background information in the article. This increasing incidence is most likely due to a combination of factors, including increased exposure to UV light, ozone depletion, and increased surveillance. Long-term exposure to the sun resulting in photodamage is perhaps the biggest risk factor for nonmelanoma skin cancer. In the United States, approximately 800,000 new cases of BCC and 200,000 new cases of SCC were diagnosed in 2000. Nonmelanoma skin cancer generally occurs in persons older than 50 years, and in this age group, its incidence is increasing rapidly. However, little is known about its incidence in persons younger than 40 years.
Leslie J. Christenson, M.D., of Mayo Clinic, Rochester, Minn., and colleagues conducted a study to estimate the sex- and age-specific incidence of BCC and SCC in Olmsted County, Minnesota, in a young population (less than 40 years old) from the beginning of 1976 through 2003. The patients in this study have comprehensive medical records captured through the Rochester Epidemiology Project.
During the study period, 451 incident basal cell carcinomas were diagnosed in 417 patients, and 70 incident squamous cell carcinomas were diagnosed in 68 patients. Overall, the age-adjusted incidence of basal cell carcinoma per 100,000 persons was 25.9 for women and 20.9 for men. The incidence of basal cell carcinoma increased significantly during the study period among women but not among men. Nodular basal cell carcinoma was the most common histologic subtype; 43.0 percent of tumors were solely nodular basal cell carcinoma and 11.0 percent had a mixed composition, including the nodular subtype. The incidence of squamous cell carcinoma was similar in men and women, with an average age- and sex-adjusted incidence of 3.9 per 100,000 persons; the incidence of squamous cell carcinoma increased significantly over the study period among both women and men.
Comparing the change in incidence rates for basal cell carcinoma, per 100,000 persons the rate for 1976-1979 for women was 13.4; for men, 22.9, and for both sexes, 18.2. For 2000-2003, the rate for women was 31.6; for men, 26.7; and for both sexes, 29.1.
For squamous cell carcinoma, per 100,000 persons the rate for 1976-1979 for women was 0.6; for men, 1.3, and for both sexes, 0.9. For 2000-2003, the rate for women was 4.1; for men, 4.2; and for both sexes, 4.1.
"This increase [in nonmelanoma skin cancer in young adults] may lead to an exponential increase in the overall occurrence of nonmelanoma skin cancer over time as the population ages. This may mean even greater demands for health care related to nonmelanoma skin cancer. Our results also emphasize the need to focus on the prevention of skin cancer in the very young so that the increasing incidence of a potentially preventable cancer can be halted," the authors conclude.
(JAMA. 2005;294:681-690. Available pre-embargo to the media at www.jamamedia.org)
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, August 9, 2005
Media Advisory: To contact Stephen B. Kritchevsky, Ph.D., call Karen Richardson at 336-716-4587.
CERTAIN GENE VARIATION ASSOCIATED WITH BETTER MOBILITY FOR OLDER INDIVIDUALS WHO EXERCISE
CHICAGO—Older individuals with a certain gene variation who exercise are less likely to develop mobility limitations than individuals without the gene variation, according to a study in the August 10 issue of JAMA.
Mobility limitation (i.e., difficulty walking and climbing steps) is common and is strongly related to major health outcomes, and may represent a stage in the disablement process amenable to intervention, according to background information in the article. Approximately 34 percent of the U.S. population 70 years and older report walking limitations, i.e., difficulty walking a quarter mile. Those reporting such difficulty are at nearly 4 times the risk of nursing home placement and 3 times the risk of death over 2 years compared with those reporting no difficulty. In older adults, more physical activity is consistently associated with less functional decline.
Despite exercise's general benefit, individual responses to exercise vary. The basis for this is unclear, but there appears to be a strong genetic component. A certain gene variation (an insertion [I]/deletion [D] polymorphism in intron 16 of the angiotensin-converting enzyme [ACE]) gene has been identified as a potential marker for differential response to exercise in younger adults.
Stephen B. Kritchevsky, Ph.D., of the Wake Forest University School of Medicine, Winston-Salem, N.C., and colleagues examined the interrelationship between ACE I/D genotype, high levels of physical activity, and functional decline, defined as the incidence of mobility limitation. The Health Aging and Body Composition (Health ABC) Cohort Study, conducted in the metropolitan areas of Memphis, Tenn., and Pittsburgh, Pa., included 3,075 well-functioning community-dwelling adults aged 70 through 79 years. The participants were enrolled from 1997 to 1998 and had an average follow-up of 4.1 years. Mobility limitation, which 1,204 participants developed, was defined as difficulty walking a quarter of a mile or walking up 10 steps, as reported on 2 consecutive semi-annual interviews.
"In this cohort of older well-functioning men and women, a high level of physical activity was associated with the preservation of physical function. Although physical activity was associated with less mobility limitation for all ACE I/D genotypes, the improved risk benefit was significantly greater for those possessing the ID or DD genotypes compared with the II genotype. The physiological basis for these findings is uncertain. However, among the physically active participants, the II genotype was also associated with higher levels of total adiposity [body fat] and intermuscular thigh fat," the authors write.
"...the magnitude of the effect is not so strong as to imply that those possessing the II genotype do not benefit from exercise. Further study is required to confirm these associations and understand their physiological basis," the authors conclude.
(JAMA. 2005;294:691-698. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This work was supported by contracts and grants from the National Institute on Aging and the Claude D. Pepper Older Americans Independence Center.
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, August 9, 2005
Media Advisory: To contact Anders Hviid, M.Sc., email: aii{at}ssi.dk.
LARGE STUDY FINDS NO LINK BETWEEN MULTIPLE CHILDHOOD VACCINATIONS AND SUBSEQUENT HOSPITALIZATION FOR NONTARGETED DISEASES
CHICAGO—New research does not support a belief that children receiving multiple vaccines increase their risk of hospitalization for a nontargeted infectious disease, according to a study in the August 10 issue of JAMA.
During the last 2 decades, more vaccinations have become available and routine vaccination schedules have become increasingly complex, according to background information in the article. This has led to concern among some that multiple antigen vaccines, such as the measles-mumps-rubella vaccine, or aggregated vaccine exposure could lead to immune dysfunction, resulting in infectious diseases not targeted by vaccination, occurring as a result of an "overload" mechanism. In a 2002 safety review of multiple immunizations and immune dysfunction, the U.S. Institute of Medicine concluded that there was strong evidence for the existence of biological mechanisms by which multiple vaccinations could influence the risk of nontargeted infectious diseases. However, epidemiological and clinical support for the effect has been lacking, and some studies have even favored a beneficial effect on nontargeted infectious diseases.
Anders Hviid, M.Sc., of the Statens Serum Institut, Copenhagen, Denmark, and colleagues evaluated the relationship between routinely administered childhood vaccines (Haemophilus influenzae type b; diphtheria-tetanus-inactivated poliovirus; diphtheria-tetanus-acellular pertussis-inactivated poliovirus; whole-cell pertussis; measles-mumps-rubella; oral poliovirus) and hospitalization for nontargeted infectious diseases. The population-based study included all children born in Denmark from 1990 through 2001 (n = 805,206). Information was collected on type and number of vaccine doses received and hospitalization with infectious diseases, specifically acute upper respiratory tract infection, viral and bacterial pneumonia, septicemia (an infection of the blood stream), viral central nervous system infection, bacterial meningitis, and diarrhea.
The researchers found that of 42 possible associations (6 vaccines and 7 infectious disease categories), the only adverse association was for Haemophilus influenzae type b vaccine and acute upper respiratory tract infection. This one adverse association was within the limits of what would be expected by chance alone and the effect was not temporal or dose-response.
"Conversely, the 15 observed protective associations suggest that vaccination may have nontargeted protective effects. When considering aggregated vaccine exposure, we found no adverse associations between an increasing number of vaccinations and nontargeted infectious disease hospitalizations," the authors write.
"In conclusion, our results do not support the hypothesis of increased risk of nontargeted infectious disease hospitalization after childhood vaccination," the researchers write.
(JAMA. 2005;294:699-705. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported by grants from the Danish National Research Foundation and the Danish Medical Research Council.
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, August 9, 2005
Media Advisory: To contact Cynthia M. Boyd, M.D., M.P.H., call John Lazarou at 410-502-8902. To contact editorial author Patrick J. O'Connor, M.D., M.P.H., call Ashley Burt at 952-963-5304.
FOLLOWING CLINICAL PRACTICE GUIDELINES FOR OLDER ADULTS WITH SEVERAL ILLNESSES COULD HAVE UNDESIRABLE EFFECTS
CHICAGO—Current clinical practice guidelines are not written with older adults with multiple illnesses in mind, according to a study in the August 10 issue of JAMA.
The aging of the population and the increasing prevalence of chronic diseases pose challenges to the development and application of clinical practice guidelines (CPGs), according to background information in the article. In 1999, 48 percent of Medicare beneficiaries aged 65 years or older had at least 3 chronic medical conditions and 21 percent had 5 or more.
Clinical practice guidelines are based on clinical evidence and expert consensus to help decision making about treating specific diseases. Most CPGs address single diseases in accordance with modern medicine's focus on disease and pathophysiology. However, physicians who care for older adults with multiple diseases must strike a balance between following CPGs and adjusting recommendations for individual patients' circumstances. Difficulties escalate with the number of diseases the patient has. The limitations of current single-disease CPGs may be highlighted by the growth of pay-for-performance initiatives, which reward practitioners for providing specific elements of care. Because the specific elements of care may be based on single-disease CPGs, pay-for-performance may create incentives for ignoring the complexity of multiple comorbid (related illnesses) chronic diseases and dissuade clinicians from providing optimal care for individuals with multiple comorbid diseases.
Cynthia M. Boyd, M.D., M.P.H., from the Center on Aging and Health, Johns Hopkins University, Baltimore, and colleagues examined how CPGs address comorbidity in older patients and explored what happens when multiple single-disease CPGs are applied to a hypothetical 79-year-old woman with 5 common chronic diseases. Selection of these diseases were based on data from the National Health Interview Survey and a nationally representative sample of Medicare beneficiaries (to identify the most prevalent chronic diseases in this population). The National Guideline Clearinghouse was used to locate evidence-based CPGs for each chronic disease. Of the 15 most common chronic diseases, the researchers focused on CPGs for hypertension, chronic heart failure, stable angina, atrial fibrillation, hypercholesterolemia, diabetes mellitus, osteoarthritis, chronic obstructive pulmonary disease, and osteoporosis.
Two investigators independently assessed whether each CPG addressed older patients with comorbidities, goals of treatment, interactions between recommendations, burden to patients and caregivers, patient preferences, life expectancy, and quality of life. For a hypothetical 79-year-old woman with chronic obstructive pulmonary disease, type 2 diabetes, osteoporosis, hypertension, and osteoarthritis, the authors aggregated the recommendations from the relevant CPGs.
The researchers found that most CPGs did not modify or discuss the applicability of their recommendations for older patients with multiple comorbidities. Most also did not comment on burden, short- and long-term goals, and the quality of the underlying scientific evidence, nor give guidance for incorporating patient preferences into treatment plans. If the relevant CPGs were followed, the hypothetical patient would be prescribed 12 medications (costing her $406 per month) and a complicated nonpharmacological regimen. Adverse interactions between drugs and diseases could result.
"For the present, widely used CPGs offer little guidance to clinicians caring for older patients with several chronic diseases. The use of CPGs as the basis for pay-for-performance initiatives that focus on specific treatments for single diseases may be particularly unsuited to the care of older individuals with multiple chronic diseases. Quality improvement and pay-for-performance initiatives within the Medicare system should be designed to improve the quality of care for older patients with multiple chronic diseases; a critical first step is research to define measures of the quality of care needed by this population, including care coordination, education, empowerment for self-management, and shared decision making based on the individual circumstances of older patients," the authors conclude.
(JAMA. 2005;294:716-724. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: For funding/support information, please see the JAMA article.
EDITORIAL: ADDING VALUE TO EVIDENCE-BASED CLINICAL GUIDELINES
In an accompanying editorial, Patrick J. O'Connor, M.D., M.P.H., of the HealthPartners Research Foundation, Minneapolis, comments on the study by Boyd et al.
"Despite their limitations, evidence-based CPGs remain an important and necessary tool in the effort to improve health care quality. Strategies to address the limitations of current CPGs need to be developed and implemented, including providing recommendations based on level of evidence for particular patient groups and considering the potential economic and personal burden on the patient and caregiver as well as potential interactions with comorbid conditions. Future CPGs could be improved by including explicit information such as the number needed to treat to obtain a specified benefit, and should also be crafted more systematically to consider the influence of patient-specific factors such as age, life expectancy, and comorbidity on anticipated benefits of interventions. In addition, CPGs could include information on cost of various potential therapies, which may influence patient preferences and patient adherence to therapeutic regimens. Such modifications will increase the value of CPGs to clinicians and patients at the point of care, especially when physicians have too much to do [in a given office visit]."
"Encouraging customization of care in complex clinical scenarios respects the individuality of patients and the professional judgment of highly skilled physicians and minimizes the problem of overtreating patients most susceptible to drug interactions, drug adverse effects, and medical error. Boyd and colleagues have presented these important 'in the trenches' issues in a clear and compelling way. Physicians and designers of CPGs owe it to themselves and their patients to consider these issues carefully and to craft CPGs and pay-for-performance accountability measures that will reinforce excellent clinical care while being mindful of resource use and being respectful of patient preferences and priorities," Dr. O'Connor concludes.
(JAMA. 2005;294:741-743. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: For funding/support information, please see the JAMA editorial.
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
SKIN CANCER INCREASING AMONG PEOPLE UNDER AGE 40 – MOST DRAMATIC INCREASE IN WOMEN
VIDEO:
Dr. Christenson pulling down band aid to reveal Lynette’s removal site
Close-up of Lynette’s removal site on her chest
AUDIO:
33-YEAR OLD LYNETTE LACEY RECENTLY HAD A CANCEROUS GROWTH, CALLED A BASAL CELL CARCINOMA, REMOVED FROM HER SKIN. AND IT WASN’T HER FIRST.
VIDEO:
SOT/FULL
@ :09
Super: Lynette Lacey Has skin cancer
Runs :10
AUDIO:
"It started when I was 19, and at that time I only had 3. Within the last 3 years that has increased to 26 basal cell carcinoma removals."
VIDEO:
B-ROLL
Lynette being examined by Dr. Christenson
GFX/JAMA COVER
AUDIO:
LYNETTE IS PART OF AN ALARMING TREND, ACCORDING TO A NEW STUDY IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
VIDEO:
SOT/FULL
@ :28
Super: Leslie Christenson, M.D.
Mayo Clinic
Runs :14
AUDIO:
"The most frightening finding in our study is that three times as many women under the age of 40 are developing basal cell carcinoma than developed it less than 25 years ago."
VIDEO:
B-ROLL
Dr. Christenson looking at slides of cancer cells in lab with colleagues
Basal cell carcinoma still image
Squamous cell carcinoma still image
Dr. Christenson examining cancer cells
AUDIO:
DR. LESLIE CHRISTENSON AND COLLEAGUES AT THE MAYO CLINIC STUDIED NON-MELANOMA SKIN CANCERS… BASAL CELL CARCINOMA AND SQUAMOUS CELL CARCINOMA. THEY EXAMINED HEALTH RECORDS OF THE ENTIRE POPULATION OF OLMSTEAD COUNTY, MINNESOTA… COMPARING SKIN CANCER RATES OVER THE YEARS.
VIDEO:
SOT/FULL
Leslie Christenson, M.D.
Mayo Clinic
Runs :07
AUDIO:
"The overall incidence of non-melanoma skin cancer has been increasing in the young from 1976 to 2003."
VIDEO:
FULL SCREEN GRAPHIC
Title: Basal Cell skin cancers in women under age 40
| 1976-79 |
2000-2003 |
| 13.4 per 100,000 |
31.6 per 100,000 |
AUDIO:
THE BIGGEST INCREASE WAS IN WOMEN. IN THE LATE 1970’S, ABOUT 13 PER HUNDRED THOUSAND WOMEN UNDER AGE 40 HAD BASAL CELL SKIN CANCER. TWENTY FIVE YEARS LATER, THAT FIGURE ROSE TO ABOUT 32 PER HUNDRED THOUSAND WOMEN.
VIDEO:
SOT/FULL
Leslie Christenson, M.D.
Mayo Clinic
Runs :09
AUDIO:
"The incidence of basal cell carcinoma did not increase in men. However, the incidence of squamous cell carcinoma did increase in men and women over that time frame."
VIDEO:
B-ROLL
Teen girl tanning sitting on beach
Wide shot of crowded beach
Young woman tanning on beach
AUDIO:
DR. CHRISTENSON SAYS TANNING IN THE SUN AND TANNING BEDS ARE THE MAJOR CAUSES OF THESE CANCERS.
VIDEO:
SOT/FULL
Leslie Christenson, M.D.
Mayo Clinic
Runs :13
AUDIO:
"Tan is still accepted as a sign of health and a sign of beauty and so changing that message is going to be important to accept fair skin as very healthy and beautiful."
VIDEO:
B-ROLL
Lynette sitting outside in the shade
AUDIO:
LYNETTE USED TO TAN. NOT ANYMORE.
VIDEO:
SOT/FULL
Lynette Lacey
Has skin cancer
Runs :10
AUDIO:
"I do not go outdoors without sunscreen on and the lowest sunscreen I wear full body now is at least a 15."
VIDEO:
B-ROLL
Dad putting sunscreen on mom, mom putting sunscreen on baby
AUDIO:
GOOD ADVICE FOR ALL OF US WHO WANT HEALTHY SKIN. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
