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 INTERNAL MEDICINE NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, March 26, 2007)
LONG-TERM ASPIRIN USE ASSOCIATED WITH REDUCED RISK OF DYING IN WOMEN
MAMMOGRAM RATES MAY IMPROVE WITH WEB-BASED REMINDER SYSTEM
PREVENTIVE HEALTH EXAMS MAY PROVIDE OPPORTUNITIES FOR CANCER SCREENING
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, March 26, 2007
Media Advisory: To contact Andrew T. Chan, M.D., M.P.H., call Sue McGreevey at 617-724-2764. To contact editorialist John A. Baron, M.D., please call Hali Wickner at 603-650-1520.
LONG-TERM ASPIRIN USE ASSOCIATED WITH REDUCED RISK OF DYING IN WOMEN
CHICAGO—Women who take low to moderate doses of aspirin have a reduced risk of death from any cause, and especially heart disease–related deaths, according to a report in the March 26 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Some studies have provided evidence that aspirin may reduce the risk of heart disease and some types of cancer, the two leading causes of death in U.S. women, according to background information in the article. However, it is unclear whether aspirin reduces the risk of death overall for women.
Andrew T. Chan, M.D., M.P.H., Massachusetts General Hospital and Harvard Medical School, Boston, and colleagues examined the association between aspirin use and death in 79,439 women enrolled in the Nurses’ Health Study, a large group of female nurses who have been followed since 1976. Beginning in 1980 and again every two years through 2004, the women were asked if they used aspirin regularly and if so, how many tablets they typically took per week. At the beginning of the study, the women had no history of cardiovascular disease or cancer.
A total of 45,305 women did not use aspirin; 29,132 took low to moderate doses (one to 14 standard 325-milligram tablets of aspirin per week); and 5,002 took more than 14 tablets per week. By June 1, 2004, 9,477 of the women had died, 1,991 of heart disease and 4,469 of cancer. Women who reported using aspirin currently had a 25 percent lower risk of death from any cause than women who never used aspirin regularly. The association was stronger for death from cardiovascular disease (women who used aspirin had a 38 percent lower risk) than for death from cancer (women who used aspirin had a 12 percent lower risk).
“Use of aspirin for one to five years was associated with significant reductions in cardiovascular mortality,” the authors write. “In contrast, a significant reduction in risk of cancer deaths was not observed until after 10 years of aspirin use. The benefit associated with aspirin was confined to low and moderate doses and was significantly greater in older participants and those with more cardiac risk factors.”
There are several mechanisms by which aspirin could reduce the risk of death, the authors note. “Aspirin therapy may influence cardiovascular disease and cancer through its effect on common pathogenic pathways such as inflammation, insulin resistance, oxidative stress [damage to the cells caused by oxygen exposure] and cyclooxygenase (COX) enzyme activity,” also linked to inflammation, they write.
Because the study looked at women who made the decision themselves whether or not to take aspirin, as opposed to a clinical trial where women are randomly assigned to aspirin or a placebo, the results do not suggest that all women should take aspirin. “Nevertheless, these data support a need for continued investigation of the use of aspirin for chronic disease prevention,” the authors conclude.
(Arch Intern Med. 2007;167:562-572. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by grants from the National Institutes of Health. Dr. Chan is the recipient of a career development award from the National Cancer Institute, an American Gastroenterological Association/Foundation for Digestive Health and Nutrition Research Scholar Award, and a GlaxoSmithKline Institute for Digestive Health Research Award. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: SORTING THROUGH THE EVIDENCE ABOUT ASPIRIN’S BENEFITS FOR WOMEN
These findings differ from the results of other studies regarding the benefits of aspirin use in healthy women, leaving confusion about aspirin’s role, writes John A. Baron, M.D., Dartmouth Medical School, Lebanon, N.H., in an accompanying editorial.
Dr. Baron points out that in the Women’s Health Study, researchers followed almost 40,000 women for 11 years and did not find any reduced risk of cardiovascular or other death associated with aspirin therapy, in contrast to the dramatic risk reduction seen in the Nurses’ Health Study. “Is aspirin really that good or is there some other explanation for the findings that differ so much from those of the WHS and other primary prevention trials?” he writes.
“The difference between the NHS and the aggregated data from the WHS and other trials is too large to be explained by potential weaknesses in the randomized studies,” Dr. Baron writes. “At the same time, one has to consider that the observational NHS may not have been able to deal with the differences between aspirin users and non-users.”
“Therefore, these new findings by Chan et al cannot overcome the accumulated evidence that aspirin is not particularly effective for the primary prevention of death from cardiovascular disease in women,” he concludes.
(Arch Intern Med. 2007;167:535-536. 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, March 26, 2007
Media Advisory: To contact Rajeev Chaudhry, M.B.B.S., M.P.H., call Elizabeth Zimmermann at 507- 284-5005
MAMMOGRAM RATES MAY IMPROVE WITH WEB-BASED REMINDER SYSTEM
CHICAGO—An administrative database that helps appointment secretaries remind women to have mammograms increased the breast cancer screening rate at one large group practice, according to a report in the March 26 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
The U.S. Preventive Services Task Force recommends that women age 40 and older have a screening mammogram every one to two years, according to background information in the article. However, a large number of women do not undergo this cancer-detecting test. “A recent study reported that only 47 percent of eligible Medicare patients underwent screening mammography in the preceding two years, and other studies have reported similar poor performance for this preventive service,” the authors write.
Rajeev Chaudhry, M.B.B.S., M.P.H, and colleagues at the Mayo Clinic, Rochester, Minn., implemented a Web-based system known as PREventive Care REminder System (PRECARES) to help appointment secretaries manage proactive breast cancer screening for their group practice. Using this system, the secretaries retrieve a list each month of patients due to undergo mammography in the next three months. Women who have not already made appointments are sent letters asking them to call and schedule mammograms. Those who do not call receive another letter one month later, and then a phone call after an additional month.
For the study, conducted between Oct. 1, 2003, and Oct. 31, 2004, 3,326 women were assigned to the intervention group (using the PRECARES program) and 3,339 received normal care, which did not involve any regular reminder system. A subgroup of 399 women employees of the Mayo Clinic were selected to receive the intervention group reminders via e-mail and were compared with 448 women employees who received reminders via U.S. mail.
The mammography rate was 64.3 percent among women assigned to the intervention group, compared with 55.3 percent in the control group. “For the employee subgroup, the screening rate was 57.5 percent for the control group, 68.1 percent for the U.S. mail group and 72.2 percent for the e-mail group,” although the difference between the mail and e-mail groups was not statistically significant, the authors write. Rates for other adult preventive screening services did not vary between the intervention and control groups.
“In 2005, after our study was completed, we implemented the proactive system of scheduling for mammography in our entire patient population, which includes 11,119 women between the ages of 40 and 75 years,” the authors write. “The current mammography rate for this population has increased further to 71 percent.”
Such a system could be effective for other screening procedures as well, they conclude. “Many preventive screening services can be delivered without involvement of physicians or physician visits, and office staff can manage the preventive service needs of patients, which should also decrease the costs incurred by practices, patients and insurers.”
(Arch Intern Med. 2007;167:606-611. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was funded by the Mayo Foundation. 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, March 26, 2007
Media Advisory: To contact Joshua J. Fenton, M.D., M.P.H., call Claudia Morain at 916-734-9023.
PREVENTIVE HEALTH EXAMS MAY PROVIDE OPPORTUNITIES FOR CANCER SCREENING
CHICAGO—Health plan members who receive preventive health examinations, as opposed to going to a physician only when they are sick, appear more likely to undergo testing for colorectal, breast and prostate cancers, according to a report in the March 26 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Preventive or periodic health examinations—also called well visits, health maintenance visits or general medical examinations—have been part of medical practice since at least the middle of the 19th century, according to background information in the article. These examinations generally include a medical history and a physical examination and may also include screening, counseling or immunizations. “The preventive health examination may be an auspicious time to promote cancer screening,” the authors write. “The preventive health examination may afford primary care physicians the opportunity to discuss and recommend cancer screening when indicated, and physicians’ recommendations have been consistently associated with timely cancer screening.”
Joshua J. Fenton, M.D., M.P.H., University of California, Davis, Sacramento, and colleagues assessed the association between preventive health examinations and screening for colorectal, breast or prostate cancer in 64,288 enrollees of a Washington State health plan in 2002 to 2003. This included 39,475 patients eligible for colorectal cancer screening, 31,379 women eligible for breast cancer screening and 28,483 men eligible for prostate cancer screening. The patients were between the ages of 52 and 78, and all visited their primary care physician at least once during the study period.
More than half (52.4 percent) of the patients received a preventive health examination in 2002 or 2003. After the researchers controlled for other factors influencing cancer screening rates, including patient demographic characteristics and historical use of medical care, eligible patients who received preventive health examinations were significantly more likely than those who did not receive them to undergo testing for colorectal cancer (57.2 percent vs. 17.2 percent), breast cancer screening mammography (74.1 percent vs. 55.9 percent) and prostate cancer PSA testing (58.8 percent vs. 21.1 percent). “The associations were particularly strong for colorectal cancer and prostate cancer, for which the health plan provides no centralized screening program,” as it does for mammography, the authors write.
“In similar populations, the preventive health examination may serve as a clinically important forum for the promotion of evidence-based colorectal cancer and breast cancer screening and of prostate cancer screening, which is not universally recommended,” they conclude. “Experimental studies could confirm the efficacy of the preventive health examination in health promotion, elucidate the ideal content of preventive health examinations and guide the development of interventions to help physicians make the most of preventive health examinations.”
(Arch Intern Med. 2007;167:580-585. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by grants from the National Cancer Institute and the American Cancer Society. 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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