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: 3:00 p.m. CT, Tuesday, November 22, 2005)
JAMA NEWS RELEASES
OLDER WOMEN WHO RECEIVE PELVIC IRRADIATION FOR CANCER TREATMENT HAVE INCREASED RISK FOR PELVIC FRACTURE
TWO ANTICOAGULANT THERAPIES FOR TREATING ACUTE CORONARY SYNDROMES SHOW SIMILAR OUTCOMES AT ONE YEAR
INCREASED DURATION OF BREASTFEEDING ASSOCIATED WITH DECREASED RISK OF DIABETES
JAMA REPORT (VIDEO NEWS RELEASE SCRIPT)
VIDEO: Windows Media | Quicktime
BREASTFEEDING MAY REDUCE WOMEN’S FUTURE RISK OF DIABETES
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TV Note: This week's JAMA video news release is on duration of breastfeeding and incidence of diabetes. The release will be fed Tuesday, November 22, 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: 3:00 p.m. CT, Tuesday, November 22, 2005
Media Advisory: To contact Nancy Baxter, M.D., Ph.D., call Sarah Buss at 612-624-2449. To contact editorial co-author William Small, Jr., M.D., call Elizabeth Crown at 312-503-8928.
OLDER WOMEN WHO RECEIVE PELVIC IRRADIATION FOR CANCER TREATMENT HAVE INCREASED RISK FOR PELVIC FRACTURE
CHICAGO—Older women who received radiation therapy for cervical, rectal or anal cancer have a substantially increased risk for pelvic fractures, according to a study in the November 23/30 issue of JAMA.
Pelvic fractures, including hip fractures, are common in older people and are a major source of illness and death, particularly in women, according to background information in the article. The lifetime risk of a hip fracture after 50 years of age for white women is estimated at 17 percent. Within the first year after a hip fracture, 10 percent to 20 percent more women die than expected for age. The number of deaths due to hip fractures is comparable with the number of deaths due to pancreatic cancer and is only slightly lower than the number of deaths due to breast cancer. It is well recognized that therapeutic radiation can result in bone damage and may increase fracture risks. However, the risks have not been well studied. Because of the high baseline incidence of fractures in older people and the significant illness and death associated with fractures, even a small increase in the fracture rate would be an important finding.
Nancy Baxter, M.D., Ph.D., of the University of Minnesota, Minneapolis, and colleagues conducted a study to determine if women who undergo pelvic irradiation for pelvic malignancies (anal, cervical, or rectal cancers) have a higher rate of pelvic fracture than women with pelvic malignancies who do not undergo irradiation. The researchers used Surveillance, Epidemiology, and End Results (SEER) cancer registry data linked to Medicare claims data. A total of 6,428 women aged 65 years and older diagnosed with pelvic malignancies from 1986 through 1999 were included.
The researchers found that the cumulative incidence of pelvic fractures was greater in the irradiated group than in the nonirradiated group for all 3 types of cancer diagnoses. Within the first 5 years of the study period, the incidence of pelvic fractures was: for women with anal cancer, 14.0 percent in the irradiated group vs. 7.5 percent in the nonirradiated group; for women with cervical cancer, 8.2 percent in the irradiated group vs. 5.9 percent in the nonirradiated group; and for women with rectal cancer, 11.2 percent in the irradiated group vs. 8.7 percent in the nonirradiated group. The incidence of arm or spine fractures was similar in both groups.
"The observed hazard ratio for radiation therapy in women with anal cancer was 3.16. This value can be interpreted as a 3-fold increase in pelvic fracture risk for women with anal cancer who underwent radiation therapy (vs. women who did not) at any given time. The observed hazard ratio for radiation therapy in women with cervical cancer was 1.66; in women with rectal cancer, 1.65. These values indicate a lesser effect, but are still consistent with a substantial increase in fracture risk," the researchers write.
"Given the high baseline rate of fractures in women aged 65 years or older, the hazard ratio of 1.65 that we found in our study may represent an increased lifetime incidence of fractures from the baseline rate of 17 percent to 27 percent – a substantial and clinically significant absolute increase."
"The high risk of pelvic fracture after radiation therapy for anal cancer may reflect the radiation therapy technique used to treat this disease. In the treatment of anal cancer, it is usually appropriate to treat the inguinal [pertaining to the groin] nodes because of the risk of disease at this site. Because of the location of these nodes with respect to the femoral head and neck, it has been difficult to treat these nodes well without concomitant irradiation of the femur, and thus the femoral heads are exposed to a relatively high irradiation dose in the treatment of anal cancer patients," the authors write.
The researchers add that it is important to note that the study population (older, predominantly white women) was already at high risk for pelvic fractures. "Therefore, our results cannot be generalized to other populations (e.g., men, younger age groups). The risk of pelvic fractures after irradiation in other populations should be the focus of future studies."
"In conclusion, older women undergoing irradiation therapy for anal, cervical, or rectal cancer should be counseled with respect to fracture risks from irradiation. Potentially, these women could be targeted for preventive strategies, such as bone mineral densitometry screening, medical regimens aimed at preventing osteoporosis, and fall prevention. Such strategies should be evaluated in prospective studies. In addition, changes in irradiation techniques for high-risk individuals to minimize the irradiation dose received by bone should be investigated."
(JAMA. 2005;294:2587-2593. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This research was supported by a Veterans of Foreign Wars Surgical Oncology research grant and by the University of Minnesota Comprehensive Cancer Center. Dr. Baxter is supported by a University of Minnesota Cancer Center Clinical Scholars Award and by an American Society of Clinical Oncology Career Development Award.
EDITORIAL: POSTRADIOTHERAPY PELVIC FRACTURES - CAUSE FOR CONCERN OR OPPORTUNITY FOR FUTURE RESEARCH?
In an accompanying editorial, William Small, Jr., M.D., of Northwestern University, Chicago, and Lisa Kachnic, M.D., of Boston University Medical Center, Boston, comment of the findings by Baxter and colleagues.
"How should clinicians use the knowledge of an increased risk of pelvic fractures associated with radiotherapy? This potential morbidity should be discussed with the patient at the time of radiation oncology consultation and factored into informed decision making and informed consent regarding the use of radiotherapy. More important, patients who have received prior pelvic radiation must receive long-term follow-up examinations, and must be carefully assessed when pelvic pain appears."
The authors add that besides improved targeting of radiotherapy, there may warrant consideration of agents that reduce toxicity or improve the osseous [of bone-like consistency or structure] environment after radiotherapy.
"In conclusion, Baxter et al have provided compelling evidence for a significant increase in pelvic fracture risk with the use of pelvic radiotherapy as a component of definitive cancer management. The morbidity associated with pelvic fractures and the widespread use of pelvic radiotherapy make research into reducing such osseous effects a high priority," the authors conclude.
(JAMA. 2005;294:2635-2637. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Dr. Small is on the speakers bureau for MedImmune, the company that manufactures amifostine.
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: 3:00 p.m. CT, Tuesday, November 22, 2005
Media Advisory: To contact Kenneth W. Mahaffey, M.D., call Richard Merritt at 919-660-1309.
TWO ANTICOAGULANT THERAPIES FOR TREATING ACUTE CORONARY SYNDROMES SHOW SIMILAR OUTCOMES AT ONE YEAR
CHICAGO—High-risk patients with acute coronary syndromes (ACS) treated with an early revascularization strategy and enoxaparin or unfractionated heparin at the time of hospitalization for ACS had similar outcomes at one year, including remaining at substantial risk for adverse cardiovascular events, according to a study in the November 23/30 issue of JAMA.
Patients with non–ST-segment elevation (NSTE - a certain pattern on an electrocardiogram) acute coronary syndromes (ACS) comprise a spectrum of risk for adverse cardiac events, according to background information in the article. In the Superior Yield of the New Strategy of Enoxaparin, Revascularization, and Glycoprotein IIb/IIIa Inhibitors (SYNERGY) trial, patients at high risk for recurrent ischemic cardiac events were randomly assigned to receive the anticoagulants low-molecular-weight heparin (enoxaparin) or unfractionated heparin. The primary results at 30 days showed that enoxaparin was at least as effective as unfractionated heparin in reducing death or nonfatal myocardial infarction (MI – heart attack). The current study examines the results at six months and one year. "We believe this to be valuable, given the high-risk clinical characteristics of the patient population in SYNERGY and the need to understand the long-term outcomes in patients managed with an early aggressive invasive treatment strategy," the researchers write.
Kenneth W. Mahaffey, M.D., of Duke Clinical Research Institute, Durham, N.C., and colleagues analyzed follow-up data at 6 months and one year from the SYNERGY trial, which included 9,978 patients who were randomized from August 2001 through December 2003 in 487 hospitals in 12 countries. At six months, 541 patients (5.4 percent) had died, and 739 (7.4 percent) had died at one year. The researchers found that death or nonfatal MI at six months occurred in 872 patients receiving enoxaparin (17.6 percent) vs. 884 receiving unfractionated (not separated) heparin (17.8 percent). Rehospitalization within 180 days occurred in 858 patients receiving enoxaparin (17.9 percent) and 911 receiving unfractionated heparin (19.0 percent). One-year all-cause death rates were similar in the two treatment groups.
"The SYNERGY trial studied a high-risk cohort of patients with NSTE ACS. The 30-day, 6-month, and 1-year data show that this cohort of patients remains at substantial risk for recurrent cardiovascular events and coronary revascularization procedures: nearly 20 percent of patients died or experienced reinfarction by six months. Overall, the rates of death and nonfatal MI were similar at 6 months between treatment groups. The reduction in death or nonfatal MI at 30 days seen in the subgroup of patients treated with consistent therapy during the initial study drug assignment was sustained through 6 months, but mortality at 1 year was similar. Despite aggressive revascularization strategies and high use of evidence-based therapies, patients with high-risk ACS features remain at risk for continued adverse cardiac morbidity and mortality," the authors conclude.
(JAMA. 2005;294:2594-2600. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was funded by Aventis Pharmaceuticals, a member of the Sanofi-Aventis Group, Bridgewater, N.J. For the financial disclosures of the authors, 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: 3:00 p.m. CT, Tuesday, November 22, 2005
Media Advisory: To contact corresponding author Karin B. Michels, Sc.D., Ph.D., call Lori Shanks at 617-534-1604.
INCREASED DURATION OF BREASTFEEDING ASSOCIATED WITH DECREASED RISK OF DIABETES
CHICAGO—Women who breastfeed longer have a lower risk of developing type 2 diabetes, according to a study in the November 23/30 issue of JAMA.
Type 2 diabetes mellitus affects about 9 million adult women in the United States, according to background information in the article. The disease and its complications impose a considerable burden on the health care system, absorbing $1 of every $10 spent on health care. Multiple lifestyle factors, including diet, exercise, and obesity, are associated with risk of diabetes.
Previous studies have demonstrated improved insulin sensitivity and glucose tolerance during lactation compared with nonlactating mothers. Although these and other findings have suggested that maternal lactation may reduce future risk of type 2 diabetes, no study has directly examined this association.
Alison M. Stuebe, M.D., of Brigham and Women’s Hospital and Harvard Medical School, Boston, and colleagues studied the association between lactation duration and development of type 2 diabetes. The researchers analyzed data on 83,585 parous (having given birth) women who were part of the Nurses’ Health Study (NHS) and 73,418 parous women who were in the Nurses’ Health Study II (NHS II).
In the NHS, 5,145 cases of type 2 diabetes were diagnosed between 1986 and 2002, and in the NHS II, 1,132 cases were diagnosed between 1989 and 2001. In analyses restricted to women who reported a birth in the past 15 years and controlling for current body mass index and other relevant risk factors for type 2 diabetes, there was a 15 percent reduced risk of diabetes in the NHS and 14 percent reduced risk in the NHS II per additional year of breastfeeding. Among women who reported their last birth more than 15 years ago, there was no association between duration of lactation and type 2 diabetes in the NHS II and a substantially reduced association in the NHS.
"In conclusion, increased duration of breastfeeding was associated with reduced risk of type 2 diabetes in 2 large cohorts of women. Together with clinical evidence of improved glucose homeostasis [equilibrium] in lactating women, these data suggest that lactation may reduce the risk of type 2 diabetes in young and middle-aged women. Further clinical studies are needed to confirm this finding and to elucidate the physiologic mechanisms for an inverse association between duration of breastfeeding and risk of type 2 diabetes," the authors write.
(JAMA. 2005;294:2601-2610. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: The Nurses’ Health Study and the Nurses’ Health Study II are supported by Public Health Service research grants from the National Cancer Institute, National Institutes of Health, Department of Health and Human Services.
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
BREASTFEEDING MAY REDUCE WOMEN’S FUTURE RISK OF DIABETES
VIDEO:
B-ROLL
Alison breastfeeding Charlotte
AUDIO:
ALISON CAPE HAS NURSED HER BABY CHARLOTTE SINCE SHE WAS BORN NINE WEEKS AGO
VIDEO:
SOT/FULL
@:05
Super: Alison Cape
Breastfeeds her baby
Runs :11
AUDIO:
"I’m planning on breastfeeding until I can’t do it any longer, which, I’m hoping to go for a full year, but as I work, you know, I’ll go for as long as I can."
VIDEO:
B-ROLL
Alison breastfeeding Charlotte
AUDIO:
IF SHE DOES BREASTFEED FOR A FULL YEAR, SHE COULD DRAMATICALLY REDUCE HER OWN RISK OF DEVELOPING DIABETES IN THE FUTURE.
VIDEO:
SOT/FULL
@: 21
Super: Alison Stuebe, M.D.
Brigham and Women’s Hospital
Runs :09
AUDIO:
"We looked specifically at women in the 15 years after they had their last baby, and we found that each year a woman breastfeeds reduced her risk of diabetes by 15%."
VIDEO:
B-ROLL
Bite runs long
Exterior of hospital
Dr. Stuebe discussing data with colleague
GFX/JAMA COVER
AUDIO:
DR. ALISON STUEBE (stew-bee) AND HER COLLEAGUES AT BRIGHAM AND WOMEN’S HOSPITAL IN BOSTON TRACKED THE HEALTH AND BREASTFEEDING PRACTICES OF MORE THAN ONE-HUNDRED-FIFTY-THOUSAND WOMEN. THEIR FINDINGS APPEAR IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
VIDEO:
SOT/FULL
Alison Stuebe, M.D.
Brigham and Women’s Hospital
Runs :09
AUDIO:
"Suppose that women do what pediatricians recommend, which is to breastfeed the child for a year. A woman has two children, she breastfeeds for two years. Our data suggest that she may reduce her risk of diabetes by nearly a third."
VIDEO:
B-ROLL
Alison breastfeeding Charlotte
AUDIO:
AND WOMEN WHO EXCLUSIVELY BREASTFED, MEANING THEIR BABY GOT NOTHING BUT BREASTMILK, SAW A GREATER HEALTH BENEFIT THAN THOSE WHO GAVE THEIR BABIES BREASTMILK AND FORMULA OR FOOD. SO WHY WOULD BREASTFEEDING AFFECT DIABETES RISK? IT COULD BE BECAUSE IT CAN HELP PREVENT WEIGHT GAIN.
VIDEO:
SOT/FULL
Alison Stuebe, M.D.
Brigham and Women’s Hospital
Runs :09
AUDIO:
"A breastfeeding woman uses up about 500 calories a day making milk for her baby. That’s the equivalent of running about 4 to 5 miles a day. That’s a lot of energy."
VIDEO:
SOT/FULL
Alison Cape
Breastfeeds her baby
Runs :07
AUDIO:
"It’s just another incentive for people to keep breastfeeding and it certainly makes me, reinforces my decision to do so."
VIDEO:
B-ROLL
B-ROLL Alison holding Charlotte on her lap (backtime into nats)
AUDIO:
A DECISION THAT BENEFITS HER AND HER BABY.
VIDEO:
NAT SOT UP FULL FOR :04
Alison holding Charlotte on her lap
AUDIO:
"Hi baby girl."
Baby burps
"Ooh, good burp."
VIDEO:
B-ROLL
Tight on Charlotte yawning
AUDIO:
THIS IS MAVIS PRALL WITH THE JAMA REPORT.
