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, December 25, 2007)
JAMA NEWS RELEASES
STUDY FINDS VARYING PREVALENCE AMONG DIFFERENT ETHNIC GROUPS OF GENE MUTATION THAT INCREASES RISK OF BREAST AND OVARIAN CANCER
SOME TYPES OF TEMPORARY NEUROLOGICAL PROBLEMS ASSOCIATED WITH INCREASED RISK FOR STROKE, DEMENTIA
HEALTH IMPROVES FOR PREVIOUSLY UNINSURED ADULTS AFTER RECEIVING MEDICARE COVERAGE
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
STUDY MEASURES PREVALENCE OF CANCER-CAUSING GENE MUTATION IN HISPANICS, AFRICAN AMERICANS AND ASIAN AMERICANS
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Embargoed for Release: 3:00 p.m. CT, Tuesday, December 25, 2007
Media Advisory: To contact Esther M. John, Ph.D., call Rachael Vander Martin at 510-608-5160. To contact editorial co-author Olufunmilayo I. Olopade, M.D., call Scot Roskelley at 773-702-6241.
STUDY FINDS VARYING PREVALENCE AMONG DIFFERENT ETHNIC GROUPS OF GENE MUTATION THAT INCREASES RISK OF BREAST AND OVARIAN CANCER
CHICAGO—Among several U.S. racial/ethnic groups examined, Hispanic women were found to have the highest prevalence of the cancer-associated gene mutation BRCA1 at 3.5 percent, with Asian Americans having the lowest prevalence (0.5 percent), according to a study in the December 26 issue of JAMA.
Mutations in the tumor suppressor gene BRCA1 confer high risks of breast and ovarian cancer. Average cumulative risk by age 70 years has been estimated at 65 percent for breast cancer and 39 percent for ovarian cancer, according to background information in the article. Although mutations in BRCA1 are rare, they are more frequently present in individuals with multiple relatives having breast or ovarian cancer, early-onset breast cancer, or of Ashkenazi Jewish ancestry. Information on the prevalence of BRCA1 mutation carriers in racial/ethnic minority populations is limited.
Esther M. John, Ph.D., of the Northern California Cancer Center, Fremont, Calif., and colleagues examined the prevalence of BRCA1 mutations in Hispanic, African American and Asian American female breast cancer patients compared with non-Hispanic white patients with and without Ashkenazi Jewish ancestry. The patients, younger than 65 years at diagnosis, were enrolled at the Northern California site of the Breast Cancer Family Registry (n = 3,181) during the period 1996-2005.
In patients without reported Ashkenazi Jewish ancestry, estimated mutation prevalence was highest in Hispanic patients (3.5 percent), followed by non-Hispanic white patients (2.2 percent), African American patients (1.3 percent), and Asian American patients (0.5 percent). Those with Ashkenazi Jewish ancestry had a prevalence of 8.3 percent. Within each racial/ethnic group, prevalence estimates decreased with age at diagnosis and were higher in patients who reported a family history of breast or ovarian cancer than in those who did not.
The prevalence of BRCA1 mutations was particularly high in African American patients diagnosed before age 35 years (16.7 percent), compared with young Hispanics (8.9 percent), non-white Hispanics without Ashkenazi Jewish ancestry (7.2 percent), and Asian Americans (2.4 percent).
“The present study included multiple racial/ethnic groups, therefore allowing direct comparison of carrier prevalence estimates. Since certain mutations may be unique to specific populations, the full spectrum of mutations needs to be determined. Such information may facilitate mutation screening in a clinical setting and is needed to guide resource allocation for genetic testing, genetic counseling, and planning of preventive interventions in all population subgroups,” the authors conclude.
(JAMA. 2007;298(24):2869-2876. 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: GENETIC TESTING IN DIVERSE POPULATIONS — ARE RESEARCHERS DOING ENOUGH TO GET OUT THE CORRECT MESSAGE?
In an accompanying editorial, Dezheng Huo, M.D., Ph.D., and Olufunmilayo I. Olopade, M.D., of the University of Chicago, comment on the findings regarding genetic testing for BRCA1.
“As documented by John et al, more than half of BRCA1 mutation carriers would be detected in female patients with breast cancer whose cancers are likely to be hereditary based on age at diagnosis and family history. The differences in BRCA1 mutation prevalence across populations should be used to more accurately calculate the pretest probability of having a mutation, rather than as evidence against genetic testing in minority populations. While there has been great debate about the role of race/ethnicity in health research, clinicians interested in providing patients with personalized assessment of cancer risk must understand the contributions of BRCA1 and BRCA2 mutations in diverse populations, because potential modifying factors particular to patients’ race/ethnicity, family history, ancestral country of origin, and environmental factors may work in concert to influence outcomes.”
(JAMA. 2007;298(24):2910-2911. 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, December 25, 2007
Media Advisory: To contact corresponding author Monique M. B. Breteler, M.D., Ph.D., email: m.breteler{at}erasmusmc.nl. To contact editorial author S. Claiborne Johnston, M.D., Ph.D., call Lauren Hammit at 415-476-2557.
SOME TYPES OF TEMPORARY NEUROLOGICAL PROBLEMS ASSOCIATED WITH INCREASED RISK FOR STROKE, DEMENTIA
CHICAGO—Patients who experience symptoms described as transient neurological attacks, such as temporary amnesia or confusion, may have a higher risk for stroke and dementia, according to a study in the December 26 issue of JAMA.
Transient neurological attacks (TNAs) are episodes involving temporary (less than 24 hours) neurological symptoms. These symptoms can be nonfocal (that can include nonlocalizing cerebral symptoms), focal (known as transient ischemic attacks [TIAs], similar to ischemic stroke, except for duration [commonly 2-15 minutes, maximum 24 hours]), or a mixture of both focal and nonfocal. Although it has been well-documented that patients with TIA are at high risk of major vascular disease, few studies have examined whether nonfocal TNAs are a serious health threat, according to background information in the article.
Michiel J. Bos, M.D., M.Sc., of Erasmus Medical Center, Rotterdam, the Netherlands, and colleagues studied the incidence and prognosis of focal, nonfocal and mixed TNAs. The study included 6,062 participants who were age 55 years or older and free from stroke, heart attack, and dementia when they entered the study (1990-1993), and were followed-up until January 2005.
During the study a TNA occurred in 548 participants; 282 of these were classified as focal, 228 as nonfocal, and 38 as mixed. In both men and women, the incidence rates for nonfocal TNAs were almost as frequent as focal TNAs, and for both types of events the incidence rates strongly increased with increasing age. Mixed TNAs were less frequent.
During follow-up, there were 619 cases of stroke, 848 cases of ischemic heart disease, 662 vascular deaths (also classified as having stroke [192] or ischemic heart disease [430]) and 609 cases of dementia. Compared with participants without TNA, participants with focal TNA had more than twice the risk of stroke and 2.6 times the risk of ischemic stroke; the risk of stroke within 90 days after focal TNA (TIA) was 3.5 percent. Patients with nonfocal TNA had a 56 percent higher risk of stroke and 59 percent higher risk of dementia, than participants without TNA.
Patients with mixed TNA were at increased risk of stroke, especially ischemic stroke; ischemic heart disease, especially heart attack; and vascular death and dementia, compared with participants without TNA.
“Our findings challenge the strong but unfounded conviction that nonfocal TNAs are harmless.
On the contrary, our findings suggest that nonfocal TNAs are not only a risk factor for stroke, but also for dementia,” the authors write.
(JAMA. 2007;298(24):2877-2885. 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.
TRANSIENT NEUROLOGICAL ATTACK — A USEFUL CONCEPT?
In an accompanying editorial, S. Claiborne Johnston, M.D., Ph.D., of the University of California, San Francisco, writes that this study reports important new information.
“...this is the first large-scale study of TNAs, and the findings are intriguing for several reasons. Most patients with nonfocal TNAs are currently treated as though the condition were benign. For some etiologies, such as transient global amnesia, the evidence supports this, but for most of these events, there is no consistent evaluation, no guidelines for treatment, and no information on prognosis. This study argues that, whatever is causing these events, the prognosis justifies greater attention. More needs to be done to identify the TNA patients at greatest risk, to complete evaluations, to rule out important underlying disease, and to continue to study this heterogeneous group.”
(JAMA. 2007;298(24):2912-2913. 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, December 25, 2007
Media Advisory: To contact corresponding author John Z. Ayanian, M.D., M.P.P., call David Cameron at 617-432-0441.
HEALTH IMPROVES FOR PREVIOUSLY UNINSURED ADULTS AFTER RECEIVING MEDICARE COVERAGE
CHICAGO—Previously uninsured adults who received Medicare coverage reported improvements in health, especially those with cardiovascular disease or diabetes, according to a study in the December 26 issue of JAMA.
“Uninsured near-elderly adults, particularly those with cardiovascular disease or diabetes, experience worse health outcomes and use more health services as Medicare beneficiaries after age 65 years than insured near-elderly adults. Because chronic diseases are prevalent and insurance coverage is often unaffordable for older uninsured adults, the impact of near-universal Medicare coverage at age 65 years on the health of previously uninsured adults may be substantial,” the authors write.
J. Michael McWilliams, M.D., of Brigham and Women’s Hospital and Harvard Medical School, Boston, and colleagues assessed the association of acquiring Medicare coverage at age 65 years with trends in self-reported health outcomes from ages 55 through 72 years for previously uninsured adults, especially those with cardiovascular disease or diabetes. The researchers analyzed survey data, collected from 1992 through 2004, from the nationally representative Health and Retirement Study, which included 5,006 adults who were continuously insured and 2,227 adults who were persistently or intermittently uninsured from ages 55 to 64. Changes in health trends were compared for previously uninsured and insured adults after they acquired Medicare coverage at age 65 years. The areas of health surveyed included general health, change in general health, mobility, agility, pain, depressive symptoms, and a summary measure of these, along with adverse cardiovascular outcomes.
The researchers found that before age 65 years, summary health scores worsened at a greater rate for uninsured adults than for insured adults and were significantly worse at age 65 years. Compared with previously insured adults, previously uninsured adults reported significantly improved health trends after age 65 years for the summary measure and several component measures. Relative to previously insured adults with cardiovascular disease or diabetes, previously uninsured adults with these conditions reported significantly improved trends in summary health, change in general health, mobility, agility, and adverse cardiovascular outcomes but not in depressive symptoms. Previously uninsured adults without these conditions reported improvement in depressive symptoms but not in summary health or any other measure. By age 70 years, the expected difference in summary health between previously uninsured and insured adults with cardiovascular disease or diabetes was reduced by 50 percent.
“Our findings have important policy implications. Proposals to extend insurance coverage to uninsured near-elderly adults have been introduced in the U.S. Congress and endorsed by the American College of Physicians. Providing earlier health insurance coverage for uninsured adults, particularly those with cardiovascular disease or diabetes, may have considerable social and economic value for the United States by improving health outcomes,” the authors conclude.
(JAMA. 2007;298(24):2886-2894. 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
STUDY MEASURES PREVALENCE OF CANCER-CAUSING GENE MUTATION IN HISPANICS, AFRICAN AMERICANS AND ASIAN AMERICANS
INTRO:
Researchers know that women who have a harmful mutation in a gene called B-R-C-A-One are more likely to get breast or ovarian cancer. A new study is the first to compare the prevalence of this mutation in women of different racial/ethnic backgrounds. The study shows that Hispanic women are more likely to have the mutation than African Americans, Asian Americans and most non-Hispanic whites. Mavis Prall explains in this week’s JAMA Report.
VIDEO:
B-ROLL
Close up Elaine
Elaine with other woman at conference table
AUDIO:
ELAINE BACA (bah-cah) KNOWS A LOT ABOUT CANCER. SHE WORKS AT THE NORTHERN CALIFORNIA CANCER CENTER, AND...
VIDEO:
SOT/FULL
@ :08
Super: Elaine Baca
Has family history of cancer
Runs :10
AUDIO:
“I do have a family history of breast cancer. My mother was diagnosed at age 36. She was a survivor for about 30 years.”
VIDEO:
B-ROLL
More wide Elaine at conference table
Cutaways to colleagues of different races
GFX/JAMA COVER
AUDIO:
FAMILY HISTORY CAN MEAN GENETICS PLAY A ROLE. AND SINCE ELAINE IS HISPANIC, HER RISK OF HAVING A CANCER-CAUSING MUTATION IN THE B-R-C-A-ONE GENE IS HIGHER THAN WOMEN OF SOME OTHER ETHNICITIES, ACCORDING TO A NEW STUDY IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
VIDEO:
SOT/FULL
@ :33
Super: Esther John, Ph.D.
Northern California Cancer Center
Runs :09
AUDIO:
“We explored this topic because women who have a harmful mutation in BRCA1 have a high risk of developing breast cancer or ovarian cancer.”
VIDEO:
B-ROLL
Hold bite up through her name
Office exterior/sign
Dr. John and colleague at desk
Full screen graphic
100 Hispanic breast cancer patients – 3.5 had BRCA1 mutation
100 Non-Hispanic white patients – 2.2
100 African American patients – 1.3
100 Asian American patients – 0.5
100 Ashkenazi Jewish patients – 8.3
AUDIO:
DR. ESTHER JOHN IS A RESEARCHER AT THE NORTHERN CALIFORNIA CANCER CENTER. SHE AND HER COLLEAGUES ESTIMATE THAT OUT OF A HUNDRED HISPANIC BREAST CANCER PATIENTS, JUST OVER THREE OF THEM WOULD HAVE THE MUTATION, COMPARED TO ABOUT TWO WHITE PATIENTS, ABOUT ONE AFRICAN-AMERICAN PATIENT, AND LESS THAN ONE ASIAN-AMERICAN PATIENT. ASHKENAZI JEWS HAD THE HIGHEST PREVALENCE, BUT THAT IS NOT A NEW FINDING.
VIDEO:
SOT/FULL
Esther John, Ph.D.
Northern California Cancer Center
Runs :15
AUDIO:
“We also found that BRCA1 mutations were most common in young breast cancer patients, patients that were diagnosed before the age of 35, and this was true in all racial-ethnic groups.”
VIDEO:
B-ROLL
Young African American woman walking outside
Another young African American woman
Hispanic woman
Different Hispanic woman having mammogram
Backtime Elaine into bite
AUDIO:
BUT ESPECIALLY TRUE FOR YOUNG AFRICAN AMERICAN WOMEN. DR. JOHN SAYS THIS INFORMATION CAN HELP DOCTORS AND WOMEN DECIDE WHO SHOULD CONSIDER GENETIC TESTING, BUT ALL WOMEN SHOULD BE VIGILANT ABOUT MAMMOGRAMS AND OTHER WAYS OF DETECTING CANCER, BECAUSE EARLY DETECTION GREATLY IMPROVES SURVIVAL. ELAINE HAS ALWAYS TAKEN HER CANCER RISK SERIOUSLY.
VIDEO:
SOT/FULL
Elaine Baca
Has family history of cancer
Runs :14
AUDIO:
“Since age 25 I’ve been getting mammograms regularly once a year. I do self exams once a month and I get my checkups on a yearly basis, also.”
VIDEO:
B-ROLL
More woman having mammogram
AUDIO:
SHE HOPES THIS NEW STUDY WON’T FRIGHTEN OTHER HISPANIC WOMEN, BUT SHE DOES HOPE IT WILL HELP THEM THINK MORE ABOUT CANCER DETECTION. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
TAG:
Dr. John says higher prevalence of the BRCA1 gene mutation among Hispanic women could reflect the presence of unrecognized Jewish ancestry in the Hispanic population, because this mutation is known to be more common among women of Ashkenazi Jewish descent. For more information, visit www.jama.com.
