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 of 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 CONTENTS
ARCHIVES OF SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, October 16, 2006)
OLDER BREAST CANCER PATIENTS MAY BE UNDER-DIAGNOSED AND UNDER-TREATED
SMALL BUT SUBSTANTIAL PROPORTION OF SURGEONS INTERESTED IN PART-TIME TRAINING
ARCHIVES OF DERMATOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, October 16, 2006)
MOST BEACHGOERS ACCURATELY REPORT THEIR SUN HABITS
ARCHIVES OF OTOLARYNGOLOGY—HEAD & NECK SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, October 16, 2006)
RISK FACTORS FOR DEVELOPING COMPLICATIONS FROM SLEEP APNEA SURGERY
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 16, 2006
Media Advisory: To contact David A. Litvak, M.D., call Michelle Ponte at 510-267-5354.
OLDER BREAST CANCER PATIENTS MAY BE UNDER-DIAGNOSED AND UNDER-TREATED
CHICAGO—Elderly patients with breast cancer who received care in a community hospital setting may have been under-diagnosed, under-staged and under-treated, according to a report in the October issue of Archives of Surgery, one of the JAMA/Archives journals.
The number of older breast cancer patients has increased along with overall elderly population, according to background information in the article. About half of breast cancer patients are older than 65 years and 35 percent are older than 70; 77 percent of breast cancer deaths occur in women older than 55. Choosing the appropriate treatment for older patients is a challenge, because many have other serious illnesses in addition to their cancer that may threaten their health and shorten their lives. Questions remain about the best screening protocols for elderly women, as well. Some current guidelines suggest that women stop having mammograms at age 70, while others provide no upper limit.
David A. Litvak, M.D., then of Michigan State University, Lansing, and now at Kaiser Permanente Medical Center, Orange County, Calif., and Rajeev Arora, M.D., used a tumor registry database to identify 354 women age 70 or older who were diagnosed with breast cancer between 1992 and 2002 at a community hospital. The researchers studied the group of women as a whole and also divided them into three age groups for analysis: ages 70 to 74 (136 patients), 75 to 79 (115 patients) and 80 or older (103 patients).
Overall, 46 percent of the patients came to their physician with breast cancer that could be felt during a physical examination. Although 72 percent of all the women and 60 percent of those age 80 and older had mammograms, they were mainly used to verify the results of the physical exam—mammograms uncovered previously undetected breast cancer in only 54 percent of the patients, including 38 percent of those 80 years or older. More than 70 percent of patients were in the early stages of cancer, stages I and II, at diagnosis, but evaluation of the lymph nodes to thoroughly assess the cancer’s progression was omitted in 36 percent of the cases (56 percent of those in women 80 or older).
About half of the women received breast-conserving surgery; however, rates of chemotherapy, radiation and hormonal therapy were lower than would be expected and were lowest among the oldest women. For example, 12 percent of all patients, 19 percent of those age 70 to 74 and 5 percent of those older than 80 underwent chemotherapy. “We also noted omissions of treatment in patients with indications for adjuvant [combination] treatment,” including those whose cancer had spread to the their lymph nodes or who had estrogen receptor-positive tumors, the authors write. “All together, 70 patients (20 percent) had positive lymph nodes. Of these patients, 29 percent received chemotherapy. Moreover, only 17 percent of patients age 80 years or older received chemotherapy in the presence of lymph node disease, significantly less than the 70- to 74-year age group.”
Although the results of this study do not confirm that these diagnosis and treatment patterns in older women lead to worse health, other evidence suggests this is the case, they continue. “Contrary to many physicians’ beliefs, the data suggest that fit older patients derive the same benefits from treatment as do their younger counterparts,” the authors conclude. “The cornerstone of treatment of older breast cancer patients is an adequate geriatric assessment that helps estimate life expectancy and predict tolerance of treatment. Treatment strategies then ought to be individualized based on this assessment.” Screening guidelines should also be customized to the patient; those who expect to live more than five additional years should continue having mammograms, they write.
(Arch Surg. 2006;141:985-990. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 16, 2006
Media Advisory: To contact corresponding author Hilary A. Sanfey, M.B., B.Ch., call Mary Jane Gore at 434-924-9241.
SMALL BUT SUBSTANTIAL PROPORTION OF SURGEONS INTERESTED IN PART-TIME TRAINING
CHICAGO—Medical students expressed increased interest in a career in surgery if part-time training options were available, and some residents, fellows and practicing surgeons would be interested in flexible training options as well, according to the results of a web-based survey published in the October issue of Archives of Surgery, one of the JAMA/Archives journals.
Current surgical residencies are a minimum of five years long; new regulations limit workweeks to 80 hours. As many as one-fifth of surgical residents leave their programs before finishing, most often citing lifestyle concerns, according to background information in the article. “Many of today’s medical students have more diverse interests and, when they apply for postgraduate training, may prefer specialties in which a more flexible approach to training (i.e., part-time, reduced hours or extended periods of time off) is an option to allow them to integrate other professional and family interests,” the authors write. Because about half of medical school graduates are now women, who comprise only 24 percent of general surgery residents, the field must devise methods to attract and retain female surgeons.
Alison R. Saalwachter, M.D., of the University of Virginia Health System, Charlottesville, and colleagues assessed interest in part-time training options among 482 medical students, 789 surgical residents, 179 surgical fellows and 2,858 fully trained surgeons using a web-based survey. The respondents were asked to rate, on a scale of one to five, how interested they would be in a general surgery training program that lasted longer but featured shorter workweeks (between 40 and 80 hours).
Of the 4,308 physicians and students who responded to the survey, 76 percent were male, and 20 to 30 percent would accept a residency that lasted longer than five years in exchange for the opportunity to train part-time (although few would accept an extension to more than seven years). Thirty-six percent of female and 24 percent of male medical students indicated that the availability of a more flexible approach to training would positively affect the decision to choose a career in surgery. At all levels of training, women were more likely than men to express interest in a program longer than five years and were also more likely to accept a reduction in salary during those years.
Of the survey respondents who were physicians, 9.1 percent had taken time off from their residency for reasons other than doing medical research. The authors suggest that even though not all residents would be interested in part-time training options, such programs could greatly benefit those who desire flexibility for personal, financial or health reasons. “Flexible options should be available for those who need it who might otherwise feel unable to pursue or continue in a surgical career,” they write. “For example, the availability of protected time off could permit a surgeon in training to tend to a personal crisis or a family emergency, whereas, without this option, he or she may have to resign from a program with no guarantee of being able to finish training.”
Although women were more likely than men to express interest in flexible options, lifestyle issues are not solely woman- or family-related, the authors continue. “In light of recent concerns about decreasing applications to general surgery training programs and a need to appeal to students with greater interest in controllable lifestyle careers, a more flexible approach to surgical training could boost interest and improve applicant caliber,” they write. “Because the upcoming generation is less willing than previous ones to sacrifice quality of life, academic medicine will lose both women and men if greater work balance is not achievable.”
(Arch Surg. 2006;141:977-982. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 16, 2006
Media Advisory: To contact David L. O’Riordan, Ph.D., call Sharon Shigemasa, R.N., M.S., at 808-586-3011.
MOST BEACHGOERS ACCURATELY REPORT THEIR SUN HABITS
CHICAGO—Adult beachgoers participating in a research study accurately report their sun habits, including sunscreen use and clothing worn on the beach, according to a report in the October issue of Archives of Dermatology, one of the JAMA/Archives journals.
The skin cancer cutaneous melanoma has become much more common and deadly in the United States over the past few decades, according to background information in the article. To reduce the risk of developing skin cancer, physicians recommend limiting the amount of time spent in the sun; seeking shade, especially during the hours at which ultraviolet rays are strongest; applying sunscreen with a sun protection factor (SPF) of 15 or higher; and wearing protective clothing, such as a hat, shirt, pants and sunglasses. Research on skin cancer prevention generally depends on the honesty of study participants reporting their behaviors.
David L. O’Riordan, Ph.D., and colleagues at the University of Hawaii, Honolulu, surveyed and assessed the behavior of 88 adults (51 percent men, average age 40) who visited a beach in Honolulu on one of three days in February or March 2004. The participants answered questions about sun habits when they arrived at the beach and again when they left; their arms, legs and face were swabbed to detect the presence of sunscreen; and an observer took notes on their clothing and whether they appeared to have a sunburn. Twenty-five of the study participants were given fluorescent wristbands; these participants were located by an observer who took additional notes about clothing worn during their stay at the beach.
Overall, most participants’ reports were consistent with what the observers recorded regarding time spent outside, sunscreen use and clothing worn. Thirty-eight (44 percent) of participants reported spending two to three hours at the beach, 18 (21 percent) one to two hours, 17 (18 percent) three to four hours, 10 (11 percent) four to five hours and five (6 percent) zero to one hour, which was consistent with what the researchers recorded. Most of the beachgoers, including those who were observed during the day, accurately reported what they wore on their upper body, lower body and head, but were less likely to wear sunglasses than reported. There was moderate to substantial agreement between participants who reported wearing sunscreen and those whose skin swabs indicated they had applied sunscreen either at the beach or before they arrived.
“This study contributes to the paucity of existing research describing the validity of self-report sun habits and has demonstrated that multiple strategies can be effectively adopted to achieve this goal,” the authors write. “The moderate to substantial agreement obtained for many self-report measures when compared with objective procedures confirms that self-report is a suitable approach to assess sun habits of beachgoers.”
The sunscreen-swabbing procedure, previously used only in indoor, controlled environments, proved effective in real-world conditions as well, the authors continue. “When used as an adjunct to other assessment instruments, this innovative procedure could be a useful addition to interventions aimed at improving the sun protection practices of individuals,” they write.
(Arch Dermatol. 2006;142:1304-1311. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by Friends of the Cancer Research Center of Hawaii. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 16, 2006
Media Advisory: To contact corresponding author Edward M. Weaver, M.D., M.P.H., call Clare Hagerty at 206-685-1323..
RISK FACTORS FOR DEVELOPING COMPLICATIONS FROM SLEEP APNEA SURGERY
CHICAGO—Patients undergoing surgery to correct sleep apnea are more likely to have complications if their condition is severe, they have a high body mass index, they have other medical problems or they are undergoing certain other surgical procedures at the same time, according to a report in the October issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.
Individuals with sleep apnea repeatedly stop breathing during the night due to upper airway obstruction, according to background information in the article. Sleep apnea contributes to an increased risk of cardiovascular disease, poor quality of life and death. A procedure known as uvulopalatopharyngoplasty (UPPP), during which surgeons remove the uvula and other soft tissues at the back of the throat to help clear the airway, is the most common operation performed to alleviate sleep apnea. About 1.6 percent of all patients undergoing such procedures have serious complications, including .2 percent who die within 30 days. Previous reports about the risk factors for complications have been conflicting.
Eric J. Kezirian, M.D., M.P.H., University of California, San Francisco, and colleagues studied 3,130 consecutive adults (97 percent men, average age 50) in patients who underwent UPPP between 1991 and 2001 at the United States Veterans Affairs medical centers. The researchers gathered data about participants’ surgeries and characteristics from medical records. Data on body mass index (BMI), other illnesses and the severity of sleep apnea was collected from medical charts for a smaller group of patients, including all 51 (1.6 percent) of the original group who had serious complications and 212 others who did not have serious complications but were the same sex and age, had the same number of procedures performed at the same time and had surgery the same year as those who did.
In the larger group of 3,130 patients, those who had more severe sleep apnea, who had additional non-nasal surgeries at the same time and had other medical conditions were more likely to have serious complications following surgery. For each additional illness besides sleep apnea that a patient had, his or her risk for complications almost doubled. In the smaller group of patients, more severe sleep apnea, higher body mass index and the presence of other illnesses were associated with a higher risk for complications when they were all considered together. However, based on the small number of participants with complications, the researchers could not determine if each was an risk factor on its own. Having retrolingual surgery (certain procedures involving the tongue, epiglottis or jaw) at the same time as UPPP was independently associated with having complications following the operation. Lowest oxygen saturation, a measure of how much oxygen red blood cells are carrying, also was not associated with complications.
“Apnea-hypopnea index [a measure of sleep apnea severity], body mass index and medical comorbidity [other illness] were each associated with serious complication; however, the low complication rate precluded demonstration of associations independent of each other,” the authors conclude. “Concurrent retrolingual procedures were also associated with serious complication, but the cumulative risk of separate retrolingual procedures is unknown.”
(Arch Otolaryngol Head Neck Surg. 2006;132:1091-1098. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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