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, August 14, 2007)
JAMA NEWS RELEASES
HPV VACCINE DOES NOT APPEAR TO BE EFFECTIVE FOR TREATING PRE-EXISTING HPV INFECTION
DIET HIGH IN MEAT, FAT AND REFINED GRAINS ASSOCIATED WITH INCREASED RISK FOR COLON CANCER RECURRENCE AND DEATH
DIABETES APPEARS TO INCREASE RISK OF DEATH FOR PATIENTS WITH ACUTE CORONARY SYNDROMES
USE OF CERTAIN LIPID MEASURES NOT MORE EFFECTIVE IN PREDICTING CORONARY HEART DISEASE
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
’WESTERN PATTERN DIET’ LINKED TO INCREASED RISK OF RECURRENT COLON CANCER OR DEATH IN STAGE III COLON CANCER PATIENTS
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Embargoed for Release: 3:00 p.m. CT, Tuesday, August 14, 2007
Media Advisory: To contact Allan Hildesheim, Ph.D., call Brooke Hardison-Wang at 301-496-6641. To contact editorial author Lauri E. Markowitz, M.D., call Curtis Allen at 404-639-3286.
HPV VACCINE DOES NOT APPEAR TO BE EFFECTIVE FOR TREATING PRE-EXISTING HPV INFECTION
CHICAGO—For women with human papillomavirus (HPV) infection, use of the HPV-16/18 vaccine will not accelerate reduction of the virus and should not be used to treat the infection, according to a study in the August 15 issue of JAMA.
HPV vaccines were designed to prevent HPV infection and the development of cervical precancers and cancer. Some research has suggested that HPV vaccines could help clear the virus in women already infected, according to background information in the article.
Allan Hildesheim, Ph.D., of the National Cancer Institute, Bethesda, Md., and colleagues conducted a study to address the question of whether women positive for HPV DNA should be encouraged to receive HPV-16/18 vaccination to induce or accelerate clearance of their infections. The trial was conducted in two provinces of Costa Rica and included 2,189 women age 18 to 25 years who were positive for HPV DNA. Participants were randomly assigned to receive three doses of HPV-16/18 vaccine (n = 1,088) or a control hepatitis A vaccine (n = 1,101) over 6 months.
There was no evidence that HPV vaccination significantly altered rates of viral clearance. At the 6-month visit, rates of clearance were 33.4 percent vs. 31.6 percent for HPV-16/18 among participants who received the HPV vaccine and the control vaccine, respectively. At the 12-month visit, rates of clearance among participants in the HPV group and the control group, respectively, were 48.8 percent vs. 49.8 percent for HPV-16/18.
There was no evidence of vaccine effects with further analysis on selected study entry characteristics reflective of disease extent, including HPV-16/18 antibody results, cytologic results, and HPV viral load. Similarly, no evidence of vaccine effects was observed in analyses stratified by other study entry parameters thought to potentially influence clearance rates and efficacy of the vaccine, including time since sexual initiation, oral contraceptive use, cigarette smoking, and concomitant infection with Chlamydia trachomatis or Neisseria gonorrhoeae.
“These findings have important clinical implications. For example, in countries where HPV DNA testing is incorporated in cervical cancer screening and prevention efforts, adult women who have abnormal Papanicolaou test results induced by HPV infection and/or who test positive for an oncogenic HPV type using the clinically available HC2 test might be interested in receiving the HPV vaccine to treat their existent infection,” the authors write. “...our results demonstrate that in women positive for HPV DNA, HPV-16/18 vaccination does not accelerate clearance of the virus and should not be used for purposes of treating prevalent infections.”
(JAMA. 2007;298(7):743-753. 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: HPV VACCINES — PROPHYLACTIC, NOT THERAPEUTIC
In an accompanying editorial, Lauri E. Markowitz, M.D., of the Centers for Disease Control and Prevention, Atlanta, comments on the findings of Hildesheim and colleagues.
“What are the implications of these data and how do they bear on recommendations? The lack of therapeutic efficacy of the quadrivalent HPV vaccine was considered in deliberations by the Advisory Committee on Immunization Practices (ACIP). These data, along with data demonstrating the high likelihood of acquiring HPV infection soon after onset of sexual activity and data on sexual behavior in the United States, all contributed to recommendations for routine immunization at 11 to 12 years of age. Because the vaccine has no therapeutic efficacy, the greatest effect will be realized if the vaccine is administered before sexual debut, prior to exposure to HPV.”
“In making the recommendation for this age group, the ACIP also considered safety and immunogenicity data and programmatic issues. While there are safety and immunogenicity data in this age group through 18 months, as well as studies indicating good protection through 5 years after vaccination among older women, as for other new vaccines, data on long-term efficacy are limited. Data on longer-term efficacy will be important, particularly when targeting vaccination of 11- to 12-year-olds. Postlicensure safety monitoring, as done for all vaccines, will also be important.”
(JAMA. 2007;298(7):805-806. 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, August 14, 2007
Media Advisory: To contact Jeffrey A. Meyerhardt, M.D., M.P.H., call Abby Tomlinson at 617-632-5379.
DIET HIGH IN MEAT, FAT AND REFINED GRAINS ASSOCIATED WITH INCREASED RISK FOR COLON CANCER RECURRENCE AND DEATH
CHICAGO—Patients treated for colon cancer who had a diet high in meat, refined grains, fat and desserts had an increased risk of cancer recurrence and death compared with patients who had a diet high in fruits and vegetables, poultry and fish, according to a study in the August 15 issue of JAMA.
Previous research has indicated that diet and other lifestyle factors have a significant influence on the risk of developing colon cancer. However, few studies have assessed the influence of diet on colon cancer recurrence and survival, according to background information in the article.
Jeffrey A. Meyerhardt, M.D., M.P.H., of the Dana-Farber Cancer Institute, Boston, and colleagues examined the influence of two distinct dietary patterns on cancer recurrence and survival in a group of 1,009 stage III colon cancer patients (cancer present in the colon and lymph nodes) enrolled in a clinical trial of postoperative chemotherapy in addition to other treatment. Patients reported dietary intake using a food frequency questionnaire during and six months after supplemental chemotherapy. Two major dietary patterns were identified, prudent and Western. The prudent pattern was characterized by high intakes of fruits and vegetables, poultry, and fish; the Western pattern was characterized by high intakes of meat, fat, refined grains, and dessert.
Patients were followed up for cancer recurrence or death. During a median (midpoint) follow-up of 5.3 years, 324 patients had cancer recurrence, 223 patients died with cancer recurrence, and 28 died without documented cancer recurrence.
The researchers found that a higher intake of a Western dietary pattern after cancer diagnosis was associated with a significant increase in the risk of cancer recurrence or death. Compared with patients in the lowest Western dietary pattern quintile (bottom 20 percent), those in the highest quintile (top 20 percent) experienced a 3.3 times higher risk for cancer recurrence or death. Patients in the highest quintile of Western dietary pattern were 2.9 times more likely to have cancer recur than those in the lowest quintile. Similarly, a significantly higher overall risk of death with increasing Western dietary pattern was observed. In contrast, the prudent dietary pattern was not significantly associated with cancer recurrence or death.
“Studies have shown an improved disease-free survival among patients who receive adjuvant chemotherapy following the surgical resection of stage III colon cancer. This is the first study, to our knowledge, in a potentially cured population of colon cancer survivors to address the effect of diet. Because this was an observational study, causality cannot and should not be drawn from these data. Nonetheless, the data suggest that a diet characterized by higher intakes of red and processed meats, sweets and desserts, french fries, and refined grains increases the risk of cancer recurrence and decreases survival. Further analyses are under way to better delineate specific nutrients or food groupings that may have the strongest association,” the authors write.
(JAMA. 2007;298(7):754-764. 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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Embargoed for Release: 3:00 p.m. CT, Tuesday, August 14, 2007
Media Advisory: To contact corresponding author Elliott M. Antman, M.D., call Kevin Myron at 617-534-1605.
DIABETES APPEARS TO INCREASE RISK OF DEATH FOR PATIENTS WITH ACUTE CORONARY SYNDROMES
CHICAGO—Individuals with diabetes and acute coronary syndromes (ACS) such as a heart attack or unstable angina have an increased risk of death at 30 days and one year after ACS, compared with ACS patients without diabetes, according to a study in the August 15 issue of JAMA.
“The presence of elevated blood glucose levels, diabetes mellitus, or both contributes to more than 3 million cardiovascular deaths worldwide each year. With the increase in obesity, insulin resistance, and the metabolic syndrome, the worldwide prevalence of diabetes is expected to double by the year 2030,” the authors write. They add that more than 1.5 million adults in the U.S. were newly diagnosed with diabetes in 2005, and nearly 65 percent of individuals with diabetes die from cardiovascular disease in the U.S., establishing it as the leading cause of death among this growing segment of the population. The effect of diabetes on the risk of death following ACS is uncertain.
Sean M. Donahoe, M.D., of Brigham and Women’s Hospital and Harvard Medical School, Boston, and colleagues evaluated the independent effect of diabetes on risk of death following ACS at 30 days and 1 year using a large clinical trial database that included ACS. The study consisted of an analysis of patients with diabetes enrolled in randomized controlled trials that evaluated ACS therapies. Patients with ACS in 11 independent Thrombolysis in Myocardial Infarction (TIMI) Study Group clinical trials from 1997 to 2006 were pooled, including 62,036 patients (46,577 with ST-segment elevation myocardial infarction [STEMI; a certain pattern on an electrocardiogram following a heart attack] and 15,459 with unstable angina/non–STEMI [UA/NSTEMI]), of whom 10,613 (17.1 percent) had diabetes.
The researchers found that the rate of death was significantly higher among patients with diabetes than among patients without diabetes at 30 days following either UA/NSTEMI (2.1 percent vs. 1.1 percent) or STEMI (8.5 percent vs. 5.4 percent). After adjusting for baseline characteristics and features and management of the ACS event, diabetes was independently associated with a nearly 80 percent increased risk of death at 30-days after UA/NSTEMI, and 40 percent increased risk of death at 30-days after STEMI.
At 1 year, diabetes remained a significant independent factor associated with all-cause death for patients presenting with UA/NSTEMI (65 percent increased risk of death) or STEMI (22 percent increased risk of death). By 1 year following ACS, patients with diabetes presenting with UA/NSTEMI had a risk of death that approached patients without diabetes presenting with STEMI (7.2 percent vs. 8.1 percent).
“Despite modern therapies for ACS, diabetes conferred a significant independent excess mortality risk at 30 days and 1 year following ACS. Current strategies are insufficient to ameliorate the adverse impact of diabetes. Given the increasing burden of cardiovascular disease attributable to diabetes worldwide, our study highlights the need for a major research effort to identify aggressive new strategies to manage unstable ischemic heart disease among this high-risk population,” the authors conclude.
(JAMA. 2007;298(7):765-775. 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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Embargoed for Release: 3:00 p.m. CT, Tuesday, August 14, 2007
Media Advisory: To contact corresponding author Ramachandran S. Vasan, M.D., call Esta Shindler at 508-935-3434.
USE OF CERTAIN LIPID MEASURES NOT MORE EFFECTIVE IN PREDICTING CORONARY HEART DISEASE
CHICAGO—The lipid measure apolipoprotein (apo) B: apo A-I ratio is not a better predictor of coronary heart disease risk than traditional lipid ratios that include total cholesterol and HDL-C, according to a study in the August 15 issue of JAMA.
Current risk-prediction instruments and guidelines for coronary heart disease (CHD) prevention emphasize the use of low-density lipoprotein cholesterol (LDL-C), total cholesterol, or both for CHD risk assessment. But in recent years, some evidence has suggested that higher apo B (the primary protein component of LDL) and lower apo A-I (the primary protein component of high-density lipoprotein [HDL]) levels play a role in the development of CHD, and that these measures might be superior to traditional lipid measures for CHD risk prediction, according to background information in the article.
Erik Ingelsson, M.D., Ph.D., of the Framingham Study, Boston University School of Medicine, Framingham, Mass., and colleagues evaluated whether apolipoproteins (the protein component of serum lipoproteins) could be used instead of traditional lipid measures for CHD risk prediction in a large group of men and women who were part of the Framingham Offspring Study. The researchers evaluated serum total cholesterol, HDL cholesterol (HDL-C), LDL-C, non–HDL-C, apo A-I and apo B, and three lipid ratios (total cholesterol:HDL-C, LDL-C:HDL-C, and apo B:apo A-I) in 3,322 middle-aged white participants who were examined between 1987-1991 and were without cardiovascular disease. Fifty-three percent of the participants were women. After a median (midpoint) follow-up of 15.0 years, 291 participants, 198 of whom were men, developed CHD.
“Our principal findings are 3-fold. First, even though the apo B:apo A-I ratio performed well overall in terms of CHD risk prediction and model performance measures in both sexes, the differences compared with other lipid variables were small and statistically nonsignificant. Non-HDL-C performed relatively less well compared with the lipid ratios. Second, when CHD risk reclassification was evaluated, the differences in net reclassification improvement offered by the total cholesterol:HDL-C ratio vs. the apo B:apo A-I ratio were small and statistically nonsignificant in both sexes. Third, the apo B:apo A-I ratio was not significantly associated with CHD incidence in either sex when added to a model that incorporated components of the Framingham risk score, including total cholesterol:HDL-C. This observation suggests that apo B:apo A-I ratio does not provide incremental predictive utility over established CHD risk factors including traditional lipid measures,” the authors write.
“Given overall equal performance of various lipids ratios, other factors will be critical in guiding the choice of lipid measures that should be used for CHD risk prediction. These factors include the costs and availability of assays, educational needs for health care professionals and the public for interpreting apolipoprotein measures, the possibility of obtaining valid measurements for risk prediction in nonfasting samples or in patients receiving lipid-lowering treatment, and the availability of appropriate therapeutic cutpoints and clinical evidence of benefits accruing from lowering levels (based on randomized, controlled clinical trials). However, with regard to test performance characteristics, our data do not support the need for measuring apo B or apo A-I in clinical practice when traditional lipid measurements are obtained routinely,” the researchers conclude.
(JAMA. 2007;298(7):776-785. 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
’WESTERN PATTERN DIET’ LINKED TO INCREASED RISK OF RECURRENT COLON CANCER OR DEATH IN STAGE III COLON CANCER PATIENTS
INTRO:
More than thirty–thousand Americans will be diagnosed with stage three colon cancer this year. Stage three means the cancer is present in the colon and lymph nodes. Obviously patients who undergo treatment don’t want the cancer to come back. A new study says diet could play a role in recurrent cancer and survival. Mavis Prall explains in this week’s JAMA Report.
VIDEO:
B-ROLL
John riding his bicycle
John rides out of shot
AUDIO:
FIFTY-FIVE YEAR OLD JOHN COUGHLIN (KOFF-lin) HAS ALWAYS BEEN STRONG AND FIT. THAT STRENGTH CAME IN HANDY IN 2003, WHEN A REGULAR COLONOSCOPY REVEALED HE HAD STAGE THREE COLON CANCER.
VIDEO:
SOT/FULL
@ :13
Super: John Coughlin
Stage III colon cancer survivor
Runs :14
AUDIO:
“I went through six weeks of concurrent radiation and chemotherapy. In December of that year I had major surgery to remove the lower part of my colon and that was followed by six months of weekly chemotherapy.”
VIDEO:
B-ROLL
John putting food on the grill
Close up fish on grill
AUDIO:
AS YOU’D IMAGINE, AFTER THAT, JOHN WOULD DO A LOT TO STAY HEALTHY. TURNS OUT WHAT HE EATS, OR DOESN’T EAT, COULD REALLY HELP.
VIDEO:
SOT/FULL
@ :34
Super: Jeffrey Meyerhardt, M.D., M.P.H.
Dana-Farber Cancer Institute
Runs :15
AUDIO:
“It’s not really increasing the amount of fruits and vegetables but really trying to reduce the amount of red meat intake and fatty foods and sugary, ‘desserty’ foods, that seems to be protective for colon cancer recurrences and survival.”
VIDEO:
B-ROLL
Red meat on grill
Person cutting steak
Fast food sandwich being prepared, with fries
Dr. Meyerhardt and colleague looking at colon cancer images on light board
GFX/JAMA COVER
AUDIO:
THAT HIGHER FAT DIET DR. JEFFERY MEYERHARDT (MY-er-hart) DESCRIBES IS CALLED A WESTERN PATTERN DIET. HE AND COLLEAGUES AT DANA-FARBER CANCER INSTITUTE STUDIED THAT PATTERN IN COLON CANCER PATIENTS. THEIR FINDINGS APPEAR IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
VIDEO:
SOT/FULL
Jeffrey Meyerhardt, M.D., M.P.H.
Dana-Farber Cancer Institute
Runs :07
AUDIO:
“The biggest surprise is actually the impact that a western pattern diet seems to have.”
VIDEO:
B-ROLL
More “western pattern” fast food meals
Red meat on grill
AUDIO:
STAGE THREE COLON CANCER PATIENTS WHO ATE HIGH AMOUNTS OF A WESTERN PATTERN DIET WERE ABOUT THREE TIMES MORE LIKELY TO HAVE RECURRENT CANCER, OR TO DIE, COMPARED TO PATIENTS WHO ATE LESS OF THOSE TYPES OF FOODS.
VIDEO:
SOT/FULL
Jeffrey Meyerhardt, M.D., M.P.H.
Dana-Farber Cancer Institute
Runs :14
AUDIO:
“People who have a higher western pattern diet have an increased risk for recurrence but that doesn’t mean people who have very little of a western pattern diet have no chance for recurrence, it’s just relatively, it’s an additional thing to improve people with colon cancer’s outcomes.”
VIDEO:
B-ROLL
Sequence of John eating fish with his wife
Brown rice
AUDIO:
THE STUDY SAYS IMPROVED OUTCOMES ARE MORE LIKELY IF STAGE THREE COLON CANCER PATIENTS EAT THE WAY JOHN DOES… LOTS OF FISH, CHICKEN, BROWN RICE, AND LESS WESTERN PATTERN FOODS, LIKE RED MEAT.
VIDEO:
SOT/FULL
John Coughlin
Stage III colon cancer survivor
Runs :05
AUDIO:
“To cut down from one steak a week to one steak a month is not a big deal.”
VIDEO:
B-ROLL
John eating with his wife
AUDIO:
IN FACT, COMPARED TO WHAT HE WENT THROUGH TO SURVIVE COLON CANCER, IT’S NOTHING AT ALL. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
TAG:
The researchers studied eating patterns, cancer recurrence and survival among about a thousand stage three colon cancer patients who were undergoing treatment such as chemotherapy. For more information, visit www.jama.com.
