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, May 23, 2006)
JAMA NEWS RELEASES
BENEFITS OF SCREENING COLONOSCOPY IN VERY ELDERLY MAY BE LIMITED
LIVING IN POVERTY ASSOCIATED WITH INCREASED RISK FOR TEENS TO BE OVERWEIGHT
USE OF BREAST MRI CAN BE COST-EFFECTIVE FOR SOME WOMEN AT HIGH-RISK OF BREAST CANCER
JAMA REPORT (VIDEO NEWS RELEASE SCRIPT)
VIDEO: Windows Media | Quicktime
TEENS LIVING IN POVERTY MORE LIKELY TO BE OVERWEIGHT THAN TEENS NOT LIVING IN POVERTY; BREAKFAST-SKIPPING CITED AS ONE REASON
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
Please Note: Because JAMA does not publish on the 5th Wednesday of a month, there will be no JAMA or news releases for May 31.
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TV Note: This week's JAMA video news release is on the trends associated with poverty and being overweight among adolescents. The release will be fed Tuesday, May 23, 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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Go to www.jamamedia.org for more information and to apply for access.
Embargoed for Release: 3:00 p.m. CT, Tuesday, May 23, 2006
Media Advisory: To contact Otto S. Lin, M.D., M.Sc., call Kim Davis at 206-583-6451. To contact Harminder Singh, M.D., call Chris Rutkowski at 204-474-9514. To contact editorial author Timothy R. Church, Ph.D., call Liz Bryan at 612-624-5680.
BENEFITS OF SCREENING COLONOSCOPY IN VERY ELDERLY MAY BE LIMITED
CHICAGO—Even though the prevalence of colon tumors increases with age, screening colonoscopy in patients over 80 years of age results in smaller gains in life expectancy, compared to younger patients, according to a study in the May 24/31 issue of JAMA.
Current guidelines recommend colorectal cancer (CRC) screening for all patients 50 years or older, but do not specify an age limit above which screening is not recommended. The number of screening colonoscopies in elderly U.S. patients has increased dramatically since Medicare coverage was approved in 2001, according to background information in the article. However, some clinicians may have concerns with regard to screening extremely elderly patients, especially when an invasive procedure such as colonoscopy is used. Colonoscopy in very elderly patients is associated with lower procedural completion rates and higher complication rates. In addition, very elderly patients have shorter life expectancies, potentially limiting the benefits of screening procedures. Decisions concerning undergoing a colonoscopy are being based on limited data regarding its impact on life expectancy.
Otto S. Lin, M.D., M.Sc., of Virginia Mason Medical Center, Seattle, and colleagues conducted a study to estimate the average extension in life expectancy in very elderly vs. younger patients undergoing screening colonoscopy. The study included 1,244 asymptomatic individuals in 3 age groups (50 to 54 years, n = 1,034; 75 to 79 years, n = 149; and 80 years and older, n = 63) who underwent screening colonoscopy.
The researchers found that the prevalence of colon neoplasia increased with age. Participants aged 80 years or older had a significantly higher prevalence of advanced neoplasia than the 50- to 54-year-old group (14 percent vs. 3.2 percent). Baseline average life expectancy was lower in the 2 older age groups vs. the 50- to 54-year-old group. Because of this, despite the higher prevalence of advanced neoplasia in elderly patients, the average extension of life expectancy was lower in the 2 elderly groups. The group aged 80 years or older had a average extension of life expectancy of only 0.13 years, compared with 0.85 years for the 50- to 54-year-old group, a 6.5-fold difference. The number of colonoscopies per life-year saved was much lower for the 50- to 54-year-old group than for the 2 older groups (1.18 vs. 5.77 and 7.95, respectively).
“The results reported here show that even though the prevalence of colonic neoplasia increases with age, screening colonoscopy in very elderly patients results in only 15 percent of the expected gain in life expectancy achieved in younger patients,” the authors write. “These data suggest that the benefit of screening colonoscopy in very elderly patients may be smaller than what is commonly believed. This should help individual patients and clinicians decide whether screening colonoscopy should be performed and help avoid its use in patients who are unlikely to benefit substantively.”
(JAMA. 2006;295:2357-2365. Available pre-embargo to the media at www.jamamedia.org)
STUDY PROVIDES EVIDENCE SUPPORTING RECOMMENDED 10 YEAR INTERVAL FOR COLONOSCOPIES FOR MOST PATIENTS
Patients with a negative colonoscopy examination have a reduced risk of developing colorectal cancer for more than 10 years, compared to the general population, according to a study in the May 24/31 issue of JAMA.
Colorectal cancer is the third most commonly diagnosed cancer and the second leading cause of cancer deaths in North America. Screening for CRC and its precursor lesions has become an increasingly prevalent practice. Colonoscopy has been recommended as the preferred initial screening test by several medical organizations and is being widely performed in the United States for screening among average-risk individuals. Colonoscopy allows for removal of most precancerous polyps at the time of detection. A screening interval of 10 years after a normal colonoscopy has been adopted based on the estimate of the time it takes for an adenomatous (benign tumor) polyp to transform into carcinoma. However, the duration over which the risk of CRC remains decreased following the performance of a normal colonoscopy has been unknown.
Harminder Singh, M.D., of the University of Manitoba, Canada, and colleagues analyzed data from individuals who underwent a colonoscopic evaluation that did not result in the diagnosis of colorectal neoplasia to determine the magnitude and duration of their lowered risk of developing CRC. The patients (n = 35,975), who had been evaluated between April 1989 and December 2003, were identified using Manitoba Health’s physician billing claims database. Standardized incidence ratios (SIRs) were calculated to compare colorectal cancer incidence in this group with colorectal cancer incidence in the provincial population. The patients were followed up from the time of the colonoscopy until diagnosis of colorectal cancer, death, moving from Manitoba, or end of the study period on December 31, 2003.
The researchers found that a negative colonoscopy was associated with SIRs of 0.69 (31 percent lower incidence of CRC compared to general population) at 6 months, 0.66 (34 percent lower incidence) at 1 year, 0.59 (41 percent lower incidence) at 2 years, 0.55 (45 percent lower incidence) at 5 years, and 0.28 (72 percent lower incidence) at 10 years. The proportion of colorectal cancer located in the right side of the colon was significantly higher in the colonoscopy group than the rate in the Manitoba population (47 percent vs. 28 percent).
“This study demonstrates that following a negative result from a colonoscopy performed in the usual clinical practice, the risk of developing CRC is at most 60 percent to 70 percent of the risk of developing CRC in the general population and the duration of the interval of decreased CRC risk persists for more than 10 years. Furthermore, if an individual undergoes a single negative colonoscopy, excepting any follow-up endoscopies at which CRC is diagnosed, the risk of developing CRC is even lower and the duration of the interval of decreased risk again exceeds the 10-year interval currently recommended between screening colonoscopies. Our findings suggest that screening colonoscopies do not need to be performed at intervals shorter than 10 years,” the authors conclude.
(JAMA. 2006;295:2366-2373. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: For funding/support information, please see the JAMA article.
EDITORIAL: SCREENING FOR COLORECTAL CANCER BY COLONOSCOPY — ADDING TO THE EVIDENCE
In an accompanying editorial, Timothy R. Church, Ph.D., of the University of Minnesota School of Public Health, Minneapolis, comments on the studies in this week’s JAMA on colorectal cancer screening.
“The authors of these 2 studies address 2 important questions. Because the population average age is steadily increasing and decisions about screening elderly patients have been made inconsistently and with little reference to data, the attempt to bring a careful analysis to bear is crucial. As colonoscopy becomes more widely used as the primary screening method, it is important to reevaluate the performance of the recommended 10-year screening interval, not only for its effect on clinical outcomes but also on the cost-effectiveness of the screening effort. These 2 analyses are solid attempts to address these unanswered questions. Efforts to get at better answers will no doubt continue.”
(JAMA. 2006;295:2411-2412. 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: 3:00 p.m. CT, Tuesday, May 23, 2006
Media Advisory: To contact Richard A. Miech, Ph.D., M.P.H., call Kenna Lowe at 410-614-6029.
LIVING IN POVERTY ASSOCIATED WITH INCREASED RISK FOR TEENS TO BE OVERWEIGHT
CHICAGO—Adolescents aged 15-17 years who live in poverty are more likely to be overweight than those not living in poverty, according to a study in the May 24/31 issue of JAMA.
The number of adolescents in the U.S. who are overweight has more than doubled during the past 3 decades. As the prevalence of adolescent overweight continues to increase, so too will its associated consequences, including type 2 diabetes mellitus, hypertension, obstructive sleep apnea, poor quality of life, and increased illness and risk of death in adulthood, according to background information in the article. Whether the increasing prevalence of adolescent overweight is characterized by larger, smaller, or unchanged disparities in overweight status across socioeconomic strata is not known.
Richard A. Miech, Ph.D., M.P.H., of Johns Hopkins University, Baltimore, and colleagues examined trends in the prevalence of overweight among adolescents aged 12 to 17 years by family poverty status. The researchers used data from four cross-sectional, nationally representative surveys (U.S. National Health and Nutrition Examination Surveys [NHANES] of 1971-1974, 1976-1980, 1988-1994, and 1999-2004).
The authors found that trends in the association of adolescent overweight with family poverty differed by age groups. There was a widening disparity among 15- to 17-year-old adolescents from poor families. This trend was similar among male, female, non-Hispanic white, and non-Hispanic black adolescents, resulting in an overall prevalence of overweight in 1999-2004 more than 50 percent higher among adolescents in poor vs. nonpoor families (23.3 percent vs. 14.4 percent, respectively). In contrast, for 12- to 14-year-old adolescents, prevalence did not significantly differ by family poverty status in any of the surveys; although among non-Hispanic black adolescents, overweight prevalence increased faster in nonpoor vs. poor families.
Additional analyses suggest that physical inactivity, sweetened beverage consumption, and skipping breakfast may contribute to these disparities. The researchers found that among respondents aged 15 to 17 years, the increase in the proportion of calories from sweetened beverages across the last 2 NHANES surveys (1988-1994 and 1999-2002) was significantly larger in poor families (from 9.2 percent to 15.4 percent) compared with nonpoor families (from 11.1 percent to 12.6 percent). Among older adolescents aged 15 to 17 years, the absolute difference in the disparity across poverty status in the prevalence of breakfast skipping increased from 1.1 percent to 16.2 percent across the last 2 NHANES surveys.
“The observed differences across older vs. younger adolescents are consistent with the greater autonomy that comes with increasing age. Adolescents aged 15 to 17 years vs. those aged 12 to 14 years have more opportunities to purchase their own food and determine their own leisure time pursuits and also have more discretionary income with which to act on their preferences,” the authors write.
“These results suggest that efforts to reduce health disparities in the United States require monitoring of population health, so that emergent disparities and their underlying causes can be detected and addressed at early stages of their development.”
(JAMA. 2006;295:2385-2393. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: For funding/support 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: 3:00 p.m. CT, Tuesday, May 23, 2006
Media Advisory: To contact Sylvia K. Plevritis, Ph.D., call Ruthann Richter at 650-725-8047.
USE OF BREAST MRI CAN BE COST-EFFECTIVE FOR SOME WOMEN AT HIGH-RISK OF BREAST CANCER
CHICAGO—A computer model simulation suggests that adding breast MRI screening may be cost-effective for women of certain ages who carry the BRCA1 and BRCA2 gene mutations, according to a study in the May 24/31 issue of JAMA.
Women who inherit mutations in the BRCA1 or BRCA2 cancer susceptibility genes have a 45 percent to 65 percent lifetime risk of developing breast cancer, according to background information in the article. The risk can be reduced by prophylactic mastectomy but many BRCA1/2 mutation carriers choose instead to seek effective screening strategies that detect breast cancer early. Screening with contrast-enhanced breast magnetic resonance imaging (MRI) has been shown to detect disease earlier than mammography in high-risk women; cancers detected by MRI are often axillary (near the armpit) lymph-node negative and stage I. Although breast MRI screening is highly sensitive, it increases the rate of false-positive test results, and it has not been shown to reduce the death rate from breast cancer. Additionally, breast MRI screening is at least 10 times more expensive than mammographic screening and generates higher diagnostic costs. Because cost may be the greatest barrier to broader evaluation and dissemination of breast MRI screening, its cost-effectiveness is a critical consideration.
Sylvia K. Plevritis, Ph.D., of Stanford University School of Medicine, Stanford, Calif., and colleagues evaluated the cost-effectiveness of adding breast MRI screening in BRCA1/2 mutation carriers. A computer model was used that simulates the life histories of individual BRCA1/2 mutation carriers, incorporating the effects of mammographic and MRI screening. The accuracy of mammography and breast MRI was estimated from published data in high-risk women. Breast cancer survival in the absence of screening was based on the Surveillance, Epidemiology and End Results database of breast cancer patients diagnosed in the prescreening period (1975-1981), adjusted for the current use of supplemental therapy. Utilization rates and costs of diagnostic and treatment interventions were based on a combination of published literature and Medicare payments for 2005.
“At a cost-effectiveness threshold of $100,000 per quality-adjusted life-year gained, adding annual MRI from ages 35 to 54 years is cost-effective among all BRCA1 mutation carriers and among BRCA2 mutation carriers for whom mammography is insensitive. Magnetic resonance imaging has a larger role in screening BRCA1 mutation carriers because they are at greater risk for developing breast cancer and their cancers are more aggressive than those that develop in BRCA2 mutation carriers,” the authors write.
The researchers add that screening with MRI becomes more cost-effective as the breast cancer risk increases, mammography performance worsens, greater quality of life gains accrue from MRI and the cost of MRI decreases.
“With substantial declines in its cost, breast MRI screening is likely to represent an acceptable value for a broader group of women.”
(JAMA. 2006;295:2374-2384. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was funded by National Institutes of Health grants and by a California Breast Cancer Research Program 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
TEENS LIVING IN POVERTY MORE LIKELY TO BE OVERWEIGHT THAN TEENS NOT LIVING IN POVERTY; BREAKFAST-SKIPPING CITED AS ONE REASON
VIDEO:
B-ROLL
Overweight teen
Backtime Dr. Scheimann from her name
AUDIO:
OVERWEIGHT TEENS LIKE THIS COME TO PEDIATRIC WEIGHT SPECIALIST DR. ANN SCHEIMANN (SHY-man).
VIDEO:
SOT/FULL
@ :05
Super: Ann Scheimann, M.D.
Pediatric weight specialist
Runs :05
AUDIO:
“So we’re seeing high cholesterol, hypertension, patients developing heart failure in their teens.”
VIDEO:
B-ROLL
Overweight boy
GFX/JAMA Cover
Run-down homes
Overweight girl
AUDIO:
THE MANY HEALTH EFFECTS OF OVERWEIGHT ARE PLAGUING TEENS, ESPECIALLY THOSE LIVING IN POVERTY. A NEW STUDY IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, FINDS TEENS LIVING IN POVERTY ARE MUCH MORE LIKELY TO BE OVERWEIGHT. RESEARCHERS DON’T CLASSIFY CHILDREN AS OBESE… ONLY AS OVERWEIGHT, BUT THEY MEAN KIDS WHOSE WEIGHT IS NEGATIVELY AFFECTING THEIR HEALTH.
VIDEO:
SOT/FULL
@ :30
Super: Richard Miech, Ph.D., M.P.H.
Johns Hopkins University
Runs :09
AUDIO:
“Among the older adolescents of high school age, age 15 to 17, those who are poor are about 50 percent more likely to be overweight in comparison to those who are not poor.”
VIDEO:
B-ROLL
Dr. Miech walking outside
File of overweight teens and pre-teens
Group of older teens walking away
Sweetened beverages on stores shelves (brands turned away)
AUDIO:
DR. RICHARD MIECH (m-YACK) OF JOHNS HOPKINS UNIVERSITY IS ONE OF THE STUDY AUTHORS. HE SAYS THAT A MAJOR DIFFERENCE IN OVERWEIGHT AMONG TEENS ABOVE, VERSUS BELOW THE POVERTY LINE, DIDN’T PREVIOUSLY EXIST. IT STILL DOESN’T AMONG YOUNGER TEENS, AGES TWELVE TO FOURTEEN. SO WHY THE DIFFERENCE IN OLDER TEENS? FOR ONE THING, THEY HAVE MORE FREEDOM TO CHOOSE WHAT THEY DO. AND THE STUDY SHOWS SOME OF THEIR CHOICES ARE RELATED TO WEIGHT GAIN.
VIDEO:
SOT/FULL
Richard Miech, Ph.D., M.P.H.
Johns Hopkins University
Runs :06
AUDIO:
“Drinking sweetened beverages like soda, pop or sweetened fruit juices, physical inactivity and skipping breakfast.”
VIDEO:
B-ROLL
Run-down homes
High-fiber cereals on stores shelves
AUDIO:
TEENS WHO LIVE IN POVERTY OFTEN DON’T HAVE SAFE PLACES TO GET OUTSIDE AND EXERCISE. BUT WHY WOULD SKIPPING BREAKFAST BE A FACTOR?
VIDEO:
SOT/FULL
Richard Miech, Ph.D., M.P.H.
Johns Hopkins University
Runs :13
AUDIO:
“It could be there’s a case of rebound eating here where people who skip breakfast overcompensate in terms of calories later in the day, or it could just be that people who are overweight are skipping breakfast as a dieting strategy, perhaps an ineffective one.”
VIDEO:
SOT/FULL
Ann Scheimann , M.D.
Pediatric weight specialist
Runs :05
AUDIO:
“Among the kids that come to our obesity clinic, about 70% of the kids skip breakfast.”
VIDEO:
B-ROLL
Overweight teens
High-fiber cereals on stores shelves
Teen sipping soda
AUDIO:
DR. SCHEIMANN SAYS HER PATIENTS TELL HER THEY SKIP BREAKFAST TO SAVE TIME. BUT SHE SAYS EATING A HEALTHY BREAKFAST CAN HELP CUT DOWN ON UNHEALTHY SNACKING LATER IN THE DAY. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
