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, July 17, 2007)
JAMA NEWS RELEASES
DIET VERY HIGH IN FRUIT, VEGETABLES AND FIBER AND LOW IN FAT DOES NOT APPEAR TO REDUCE RISK OF BREAST CANCER RECURRENCE MORE THAN THE ‘5-A-DAY’ DIET
HIGH NONFASTING TRIGLYCERIDE LEVELS ASSOCIATED WITH INCREASED RISK FOR CARDIOVASCULAR EVENTS
STUDY ESTIMATES CANCER RISK FROM RADIATION EXPOSURE DURING CARDIAC CT SCANS
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
INCREASED FRUITS AND VEGETABLES NO BETTER THAN 'FIVE A DAY' AT IMPROVING SURVIVAL FOR BREAST CANCER PATIENTS
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TV Note: This week's JAMA Report video is on whether a diet very high in fruit, vegetables and fiber and low in fat reduces the risk of breast cancer recurrence. The report will be fed Tuesday, July 17, from 9:00 - 9:30 a.m. ET and 2:00 - 2:30 p.m. ET, on Galaxy 26 (formerly Intelsat America 6) C-Band, Transponder 09, downlink frequency: 3880 vertical, audio 6.2/6.8. For more information, call 312/464-JAMA.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, July 17, 2007
Media Advisory: To contact John P. Pierce, Ph.D., call Debra Kain at 619-543-6163. To contact editorial co-author Susan M. Gapstur, Ph.D., call Marla Paul at 312-503-8928.
DIET VERY HIGH IN FRUIT, VEGETABLES AND FIBER AND LOW IN FAT DOES NOT APPEAR TO REDUCE RISK OF BREAST CANCER RECURRENCE MORE THAN THE ‘5-A-DAY’ DIET
CHICAGO—Women with early stage breast cancer who adopted a diet very high in vegetables, fruit and fiber and low in fat did not have a lower risk of breast cancer recurrence compared to women who followed a diet of five or more servings a day of fruit and vegetables (the "5-A-Day" diet), according to a study in the July 18 issue of JAMA.
"Considerable evidence from preclinical studies indicates that plant-derived foods contain anticarcinogens. A comprehensive review of the literature found that a diet high in vegetables and fruit probably decreases breast cancer risk and that a diet high in total fat possibly increases risk. However, evidence of an association between a diet high in vegetables and fruit and low in total fat and prevention of cancer progression has been mixed in epidemiological studies," the authors write.
John P. Pierce, Ph.D., of the University of California, San Diego, La Jolla, Calif., and colleagues conducted the Women’s Healthy Eating and Living (WHEL) Study to assess whether a dietary pattern very high in vegetables, fruit, and fiber and low in fat reduces the risks of recurrent and new primary breast cancer and all-cause death among women with previously treated early stage breast cancer. The randomized controlled trial included 3,088 women who were previously treated for early stage breast cancer (18 to 70 years old at diagnosis). Women were enrolled between 1995 and 2000 and followed up through June 2006.
The intervention group (n = 1,537) was randomly assigned to receive a telephone counseling program supplemented with cooking classes and newsletters that promoted daily targets of five vegetable servings plus 16 oz. of vegetable juice; three fruit servings; 30 grams of fiber; and 15 percent to 20 percent of energy intake from fat. The comparison group (n = 1,551) was provided with print materials describing the "5-A-Day" dietary guidelines (five or more servings of fruit and vegetables a day).
From comparable dietary patterns at baseline, the intervention group achieved and maintained the following statistically significant differences vs. the comparison group through four years: servings of vegetables, +65 percent; fruit, +25 percent; fiber, +30 percent, and energy intake from fat, −13 percent. Throughout the study, women in both groups received similar clinical care.
During the study, 518 participants had a breast cancer event, including 256 participants (16.7 percent) in the intervention group and 262 participants (16.9 percent) in the comparison group. There were 315 deaths reported within the study period, with 155 (10.1 percent) in the intervention group and 160 (10.3 percent) in the comparison group. More than 80 percent of all deaths were due to breast cancer. No significant benefit in preventing breast cancer recurrence was observed overall among population subgroups characterized by demographic characteristics, baseline diet, or type of initial tumor or breast cancer treatment.
"In conclusion, during [an average] 7.3-year follow-up, we found no evidence that adoption of a dietary pattern very high in vegetables, fruit, and fiber and low in fat vs. a 5-a-day fruit and vegetable diet prevents breast cancer recurrence or death among women with previously treated early stage breast cancer," the authors write.
(JAMA. 2007;298(3):289-298. Available pre-embargo to the media 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.
EDITORIAL: FAT, FRUITS, VEGETABLES, AND BREAST CANCER SURVIVORSHIP
In an accompanying editorial, Susan M. Gapstur, Ph.D., and Seema Khan, M.D., of the Feinberg School of Medicine, Northwestern University, Chicago, write that there are a number of questions that need to be examined regarding diet and cancer risk.
"Several issues remain to be addressed regarding the effects of dietary interventions on breast cancer prognosis. It is becoming increasingly clear that evaluating dietary effects is complex and requires careful monitoring to ensure adherence to the intervention goals so that any hypothesized effect can be detected. In addition, studies assessing whether breast cancer prognosis would be improved with interventions that focus on the complex components of energy balance (i.e., physical activity and energy intake) appear warranted. Unfortunately, available data do not support best practice dietary recommendations to improve long-term prognosis for early stage breast cancer survivors."
(JAMA. 2007;298(3):335-336. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including financial disclosures, funding and support, etc.
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, July 17, 2007
Media Advisory: To contact Børge G. Nordestgaard, M.D., D.M.Sc., email: brno{at}heh.regionh.dk or call 011-45-30-287-263. To contact the corresponding author of the 2nd study, Paul M. Ridker, M.D., M.P.H., call Kevin Myron at 617-534-1605. To contact editorial author Patrick E. McBride, M.D., M.P.H., call Aaron Conklin at 608-263-5561.
HIGH NONFASTING TRIGLYCERIDE LEVELS ASSOCIATED WITH INCREASED RISK FOR CARDIOVASCULAR EVENTS
CHICAGO—Results from two studies indicate that elevated nonfasting triglyceride levels are associated with cardiovascular events such as a heart attack, with one study finding that triglyceride levels measured after fasting does not show this association, according to studies in the July 18 issue of JAMA.
Triglyceride levels are usually measured in the fasting state, which could exclude certain types of lipoprotein particles ("remnant" lipoproteins), a possible risk factor for atherosclerosis, according to background information in the article. However, except for the first hours in the early morning, most individuals are in the nonfasting state most of the time. "Atherosclerosis may be a postprandial [occurring after a meal] phenomenon in which remnant lipoproteins play a dominant role. If this is true, increased levels of nonfasting triglycerides, reflecting increased levels of remnant lipoproteins, may predict risk of myocardial infarction (MI; heart attack), ischemic heart disease (IHD), and death," the authors write.
Børge G. Nordestgaard, M.D., D.M.Sc., of Herlev University Hospital, Herlev, Denmark, and colleagues tested the hypothesis that very high levels of nonfasting triglycerides are associated with an increased risk of heart attack, IHD, and death in the general population. The study included 7,587 women and 6,394 men from the general population of Copenhagen, age 20 to 93 years, who were followed up from baseline (1976-1978) until 2004 (average follow-up 26 years).
The researchers found that with increasing levels of nonfasting triglycerides, levels of remnant lipoprotein cholesterol increased. During the follow-up, 1,793 participants experienced a heart attack, 3,479 developed IHD, and 7,818 died. In men and women, the cumulative incidence of heart attack, IHD, and death increased with increasing levels of nonfasting triglyceride levels.
Among women, the adjusted risk for heart attack increased for each higher category of triglyceride levels (from 1-mmol/L to greater than 5-mmol/L), with the increase in risk (adjusted for other factors) ranging from 1.7 times to 5.4 times, compared to those with triglyceride levels of less than 1-mmol/L. For men, the increased adjusted risk for heart attack for each higher category of triglyceride levels ranged from 1.4 to 2.4. Risk of IHD and death also generally increased with higher triglyceride levels.
"We found that nonfasting triglyceride levels independently predict MI, IHD, and death, particularly in women. These findings may reflect the effects of remnant lipoproteins and therefore may be of considerable interest when designing future trials of agents aimed at reducing triglyceride levels or attenuating atherogenic metabolic abnormalities. If our findings are confirmed, clinical care might be simplified by using nonfasting lipid profiles for atherosclerosis risk prediction," the researchers conclude.
(JAMA. 2007;298(3):299-308. Available pre-embargo to the media 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.
MEASUREMENT OF NON-FASTING TRIGLYCERIDE LEVELS APPEARS TO PREDICT RISK OF CARDIOVASCULAR EVENTS AMONG WOMEN
In a related study of over 25,000 initially healthy women, higher triglyceride levels measured after not fasting is associated with an increased risk for cardiovascular events, but his association was not found for triglyceride levels measured after fasting, according to a study in the July 18 issue of JAMA.
Sandeep Bansal, M.D., of Brigham and Women’s Hospital and the Harvard School of Public Health, Boston, and colleagues conducted a study to determine the association of triglyceride levels (fasting vs. nonfasting) and risk of future cardiovascular events. The study included 26,509 initially healthy U.S. women (20,118 fasting and 6,391 nonfasting) participating in the Women’s Health Study, enrolled between November 1992 and July 1995. Triglyceride levels were measured in blood samples obtained at time of enrollment.
During a median (midpoint) follow-up of 11.4 years, 1,001 participants experienced a new cardiovascular event (including 276 nonfatal heart attacks, 265 ischemic strokes, 628 coronary revascularizations, and 163 cardiovascular deaths).
"In this large-scale, prospective cohort of initially healthy U.S. women, we observed that higher nonfasting triglyceride levels were strongly associated with an increased risk of future cardiovascular events, independent of baseline cardiac risk factors, levels of other lipids, and markers of insulin resistance. In contrast, fasting triglyceride levels showed little independent association with cardiovascular events. Associations were particularly strong among individuals who had their blood drawn 2 to 4 hours after a meal, and this relationship weakened as more time elapsed postprandially," the authors write.
"Our observations may have implications for the design and conduct of clinical trials evaluating triglyceride-lowering medications. To date, almost all clinical trials of pharmaceutical agents targeting triglyceride levels have relied on fasting levels as inclusion criteria. However, if levels measured in the fasting state are not the best marker for the atherogenicity associated with hypertriglyceridemia, then it is possible that these trials might have targeted the wrong patient populations. By contrast, previous studies have demonstrated the benefits of several classes of drugs on postprandial elevations in triglyceride levels. Thus, based on the data presented here, future end point reduction trials of triglyceride-lowering agents might consider participant inclusion on the basis of nonfasting rather than fasting triglyceride levels."
(JAMA. 2007;298(3):309-316. Available pre-embargo to the media 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.
EDITORIAL: TRIGLYCERIDES AND RISK FOR CORONARY HEART DISEASE
In an accompanying editorial, Patrick E. McBride, M.D., M.P.H., of the University of Wisconsin School of Medicine and Public Health, Madison, comments on the two studies in this week’s JAMA regarding triglyceride levels and risk of cardiovascular events.
"In the end, is it the triglyceride levels or the associated changes in metabolism that explains the high risk associated with postprandial triglyceride levels? This question is important scientifically, but in clinical practice the argument may be as academic as the debate about which came first, the chicken or the egg. For clinicians, it is important to recognize that when triglyceride levels are between 150 and 1000 mg/dL, the risk for atherosclerosis-related events is significantly increased. Therefore, it is important to aggressively and comprehensively treat patients with dyslipidemias that include high levels of triglycerides, low levels of HDL-C, and the presence of small LDL-C particles, using both lifestyle change and medications if necessary."
(JAMA. 2007;298(3):336-338. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including financial disclosures, funding and support, etc.
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, July 17, 2007
Media Advisory: To contact Andrew Einstein, M.D., Ph.D., call Craig LeMoult at 212-305-0820.
STUDY ESTIMATES CANCER RISK FROM RADIATION EXPOSURE DURING CARDIAC CT SCANS
CHICAGO—An analysis based on computerized simulation models suggests that the lifetime risk of cancer associated with radiation exposure from a computed tomography (CT scan) coronary angiography varies widely, with the risk greater for women and younger patients, according to a study in the July 18 issue of JAMA.
Coronary artery disease (CAD) is the leading cause of death in men and women in the United States, accounting for 1 in 5 deaths, and a major cause of health care expenditures, with annual costs estimated at $142 billion, according to background information in the article. Attempts to improve the diagnosis of this disease has led to the development of noninvasive methods for CAD diagnosis, including the 64-slice computed tomography coronary angiography (CTCA; combines multiple X-ray images with the aid of a computer to produce cross-sectional views of the heart and coronary arteries). It has been predicted that CTCA may emerge as the diagnostic test of choice for patients with intermediate pretest probability of disease, yet there are little data on its associated cancer risk from exposure to radiation.
Andrew J. Einstein, M.D., Ph.D., of the Columbia University College of Physicians and Surgeons, New York, and colleagues conducted a study to estimate the lifetime attributable risk (LAR) of cancer incidence associated with radiation exposure from a 64-slice CTCA, and to determine how this risk is influenced by patient age, sex, and scan protocol. The recent Biological Effects of Ionizing Radiation (BEIR) VII Phase 2 report provides a framework for estimating LAR of cancer incidence associated with radiation exposure from a CTCA by using a computational model and integrating the most current data available on health effects of radiation.
Lifetime cancer risk estimates for standard cardiac scans varied from 1 in 143 for a 20-year-old woman to 1 in 3,261 for an 80-year-old man. Use of simulated electrocardiographically controlled tube current modulation (ECTCM; a dose reduction strategy that reduces radiation during part of the cardiac cycle) decreased these risk estimates to 1 in 219 and 1 in 5,017, respectively. Estimated cancer risks using ECTCM for a 60-year-old woman and a 60-year-old man were 1 in 715 and 1 in 1,911, respectively. A combined scan of the heart and aorta had higher LARs, up to 1 in 114 for a 20-year-old woman. The highest organ LARs were for lung cancer and, in younger women, breast cancer.
"In this study, we observed a marked variation by age, sex, and scan protocol for cancer risk associated with radiation exposure from CTCA," the authors write. "The results of this study suggest that CTCA should be used particularly cautiously in the evaluation of young individuals, especially women, for whom alternative diagnostic modalities that do not involve the use of ionizing radiation should be considered, such as stress electrocardiography, echocardiography, or magnetic resonance imaging. If CTCA is considered as an alternative to invasive coronary angiography, the risks and benefits of each test require consideration."
(JAMA. 2007;298(3):317-323. Available pre-embargo to the media 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 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
INCREASED FRUITS AND VEGETABLES NO BETTER THAN 'FIVE A DAY' AT IMPROVING SURVIVAL FOR BREAST CANCER PATIENTS
INTRO:
Some breast cancer experts believe that regular exercise and eating five servings of fruits and vegetables a day may help reduce the risk of the cancer coming back. So researchers wondered if more of a good thing - eating more fruits and vegetables - is better. But they found that "five a day" is as good as it gets. Mavis Prall explains in this week’s JAMA Report.
VIDEO:
NAT SOT UP FULL FOR: 06
Dr. Pierce tossing salad with two study participants in kitchen, c/u salad
AUDIO:
"What we've got here is a good example of the bold colors and the strong flavors that we've emphasized in the study."
VIDEO:
B-ROLL
Cutaway to fruit
Veggies
Breast cancer survivors preparing food
Pan of veggies
AUDIO:
FIVE SERVINGS OF FRUITS AND VEGGIES A DAY, AND GETTING NO MORE THAN THIRTY PERCENT OF ENERGY FROM FAT, MAY HELP BREAST CANCER PATIENTS PREVENT FUTURE CANCER. SO WOULD MORE FIBER AND LESS FAT BE EVEN MORE EFFECTIVE?
VIDEO:
SOT/FULL
@ :17
Super: John Pierce, Ph.D.Moores UCSD Cancer Center
Runs :15
AUDIO:
"The study dramatically increased vegetables up to about 8 vegetable servings, part of that was done with vegetable juice. We got 3 fruit servings and we took energy from fat down to about 24%."
VIDEO:
B-ROLL
Leave up bite through name
Exterior of building
Breast cancer survivors preparing food
GFX/JAMA COVER
AUDIO:
DR. JOHN PIERCE OF MOORES UNIVERSITY OF CALIFORNIA SAN DIEGO CANCER CENTER WAS PART OF THE STUDY OF MORE THAN THREE-THOUSAND BREAST CANCER SURVIVORS. FOR ABOUT SIX YEARS, HALF ATE THE FIVE-A-DAY DIET, AND HALF ATE THE HIGHER-FIBER, LOWER-FAT DIET. THE RESULTS APPEAR IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
VIDEO:
SOT/FULL
John Pierce, Ph.D.
Moores UCSD Cancer Center
Runs :09
AUDIO:
"This major increase in vegetables and fruit and decrease in energy from fat did not prevent additional breast cancers and did not prolong life."
VIDEO:
B-ROLL
Dr. Pierce looking at graph on computer showing no difference between groups
2:02:54
Breast cancer survivors eating food
AUDIO:
THERE WAS NO DIFFERENCE BETWEEN THE TWO GROUPS IN EITHER ADDITIONAL BREAST CANCERS OR SURVIVAL.
VIDEO:
SOT/FULL
John Pierce, Ph.D.
Moores UCSD Cancer Center
Runs :08
AUDIO:
"What this study shows is they don't need to go further than that. You don't need to go 10 a day in vegetables and fruits. Five a day is enough."
VIDEO:
B-ROLL
Karen drinking from a glass
AUDIO:
STUDY PARTICIPANT KAREN GEORGENS (GEORGE-ens) WON’T MISS ALL THAT EXTRA CARROT AND TOMATO JUICE.
VIDEO:
SOT/FULL
@ 1:17
Super: Karen Georgens
Breast cancer survivor
Runs :09
AUDIO:
"I am relieved that I don't have to drink 16 ounces. Eight is really good, but not 16."
VIDEO:
B-ROLL
Joy drinking
AUDIO:
STUDY PARTICIPANT JOY SCHUMACHER (shoe-maker) IS ALSO RELIEVED, BUT...
VIDEO:
SOT/FULL
@ 1:29
Super: Joy Schumacher
Breast cancer survivor
Runs :09
AUDIO:
"I'm also disappointed because as a cancer survivor I'm looking for that miracle, that help that's going to get me going farther."
VIDEO:
B-ROLL
More shots of veggies, women preparing food
More of them eating food
AUDIO:
THERE'S NO MIRACLE YET, BUT THE FIVE-A-DAY, LOW-FAT DIET AND EXERCISE MAY HELP BREAST CANCER SURVIVORS, AND JUST ABOUT EVERYONE ELSE, IMPROVE OVERALL HEALTH. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
TAG:
In the study, about seventeen percent of the women in both diet groups had an additional breast cancer over the ten years after the study started. For more information, visit www.jama.com.
