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 13, 2008)
JAMA NEWS RELEASES
ADDING ULTRASOUND TO MAMMOGRAPHY MAY IMPROVE BREAST CANCER DETECTION IN HIGH-RISK WOMEN
EXPOSURE TO COARSE AIR POLLUTION NOT ASSOCIATED WITH HOSPITAL ADMISSION FOR RESPIRATORY DISEASES
HOSPITALS THAT PREDOMINANTLY TREAT MEDICAID PATIENTS APPEAR TO HAVE MADE SMALLER QUALITY PERFORMANCE GAINS
ANTI-PLATELET DRUG DOES NOT INCREASE SUITABILITY FOR HEMODIALYSIS OF NEW SURGICALLY ENLARGED BLOOD VESSELS
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
COMBINATION OF MAMMOGRAPHY AND ULTRASOUND INCREASES DETECTION OF BREAST CANCER IN HIGH RISK PATIENTS
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TV Note: This week's JAMA Video News Report is on the benefit of adding ultrasound screening to mammography for women at high risk of breast cancer. The report will be fed Tuesday, May 13, 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 14, 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, May 13, 2008
Media Advisory: To contact Wendie A. Berg, M.D., Ph.D., email: wendieberg{at}gmail.com or call Kathy Wetzel at 410-583-2703. To contact editorial author Christiane K. Kuhl, M.D., email: kuhl{at}uni-bonn.de.
ADDING ULTRASOUND TO MAMMOGRAPHY MAY IMPROVE BREAST CANCER DETECTION IN HIGH-RISK WOMEN
CHICAGO—The addition of an ultrasound examination to mammography for women at high-risk of breast cancer resulted in a higher rate of cancer detection, but also increased the number of false-positive results, according to a study in the May 14 issue of JAMA.
Supplemental screening ultrasound has the potential of depicting small, node-negative breast cancers (when there is no cancer in the lymph nodes) not seen on mammography, according to background information in the article.
Wendie A. Berg, M.D., Ph.D., of the American Radiology Services Inc., Johns Hopkins Green Spring, Lutherville, Md., and colleagues conducted a study to compare the diagnostic effectiveness of screening breast mammography plus ultrasound vs. mammography alone in women at increased risk of breast cancer. The study included 2,809 women with dense breast tissue who were randomized to undergo mammographic and ultrasonographic examinations.
Forty participants (41 breast lesions) were diagnosed with cancer: 8 suspicious on both ultrasound and mammography; 12 on ultrasound alone; 12 on mammography alone; and 8 participants (involving 9 breast lesions) on neither.
The diagnostic yield for mammography was 7.6 cancers per 1,000 women screened (20/2,637); 31 cancers were diagnosed in 2,637 participants by the combination of mammography plus ultrasound, producing a yield of 11.8 per 1,000 women, and an increased yield due to ultrasound of 4.2 per 1,000 over mammography alone (or an additional 1.1 to 7.2 cancers per 1,000 high-risk women).
The diagnostic accuracy of mammography was 0.78; for ultrasound, 0.80; and for combined mammography plus ultrasound, 0.91. The positive predictive value of biopsy recommendation after full diagnostic workup was 19 of 84 for mammography (22.6 percent), 21 of 235 for ultrasound (8.9 percent), and 31 of 276 for combined mammography plus ultrasound (11.2 percent).
The false-positive rate for mammography was 4.4 percent; for ultrasound, 8.1 percent; and for combined mammography plus ultrasound, 10.4 percent.
“The detection benefit of a single screening ultrasound in women at elevated risk of breast cancer is now well validated. However, it comes with a substantial risk of false-positive results (i.e., biopsy with benign results and/or short interval follow-up). Our results should be interpreted in the context of recent guidelines recommending annual magnetic resonance imaging [MRI] in women at very high risk of breast cancer,” the authors conclude.
(JAMA. 2008;299[18]:2151-2163. 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: THE ‘COMING OF AGE’ OF NONMAMMOGRAPHIC SCREENING FOR BREAST CANCER
In an accompanying editorial, Christiane K. Kuhl, M.D., of the University of Bonn, Germany, comments on the findings of Berg and colleagues.
“Mammography will probably remain the basis for breast cancer screening for the foreseeable future. However, increasing evidence suggests that for many women, mammography does not provide the best possible accuracy. Early diagnosis is important and has been the single major reason for improved breast cancer survival rates. Notwithstanding this success, a success mainly credited to mammographic screening, there is good reason to move on. As long as breast cancer remains the most common cause of cancer death in women, the search for techniques that can help cover the limitations of screening mammography must continue.”
“The concept of mammographic screening has been in use for more than 40 years. It may now be time to carefully reconsider. Individualized screening schemes tailored to the individual risk and to the personal preferences of a woman may be the way to consider how to screen for breast cancer. Whether in the long run, ultrasound or breast MRI will be more appropriate for this purpose remains to be seen.”
(JAMA. 2008;299[18]:2203-2205. 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, May 13, 2008
Media Advisory: To contact corresponding author Francesca Dominici, Ph.D., call Tim Parsons at 410-955-7619.
EXPOSURE TO COARSE AIR POLLUTION NOT ASSOCIATED WITH HOSPITAL ADMISSION FOR RESPIRATORY DISEASES
CHICAGO—Exposure to coarse particulate matter air pollution such as from agricultural activities, windblown dust and mechanical grinding is not statistically significantly associated with emergency hospital admissions for respiratory and cardiovascular diseases among Medicare patients, according to a study in the May 14 issue of JAMA.
Health risks of fine particulate matter of 2.5 µm or less in aerodynamic diameter (PM2.5) have been studied extensively over the last decade, and there is strong evidence of an association for a higher risk of illness and death. Evidence concerning the health risks of the coarse particulate matter of greater than 2.5 µm and 10 µm or less in aerodynamic diameter (PM10-2.5) is limited, and findings have been mixed, according to background information in the article. Coarse particles would likely deposit in the upper and larger airways. Particles in the PM2.5 size range, which are more likely to result from combustion processes, can reach the smaller airways and air sacs within the lungs.
Roger D. Peng, Ph.D., of the Johns Hopkins Bloomberg School of Public Health, Baltimore, and colleagues estimated the risk of hospital admissions for cardiovascular and respiratory diseases associated with PM10-2.5 exposure. The researchers used a database assembled for 108 U.S. counties (population larger than 200,000 in 2000) with daily cardiovascular and respiratory disease admission rates, temperature and dew-point temperature and monitoring of PM10-2.5 and PM2.5 concentrations. Admission rates were constructed from the Medicare National Claims History Files, for a study population of approximately 12 million Medicare enrollees living on average 9 miles from pairs of PM10 and PM2.5 monitors.
There were 3.7 million cardiovascular disease and 1.4 million respiratory disease admissions from January 1999 through December 2005. A 10-µg/m3 increase in PM10-2.5 was associated with a 0.36 percent increase in cardiovascular disease admissions on the same day. However, when adjusted for PM2.5, this association was no longer statistically significant (0.25 percent). A 10-µg/m3 increase in PM10-2.5 was associated with a nonstatistically significant unadjusted 0.33 percent increase in respiratory disease admissions and a nonstatistically significant 0.26 percent increase in respiratory disease admissions when adjusted for PM2.5. The unadjusted associations of PM2.5 with cardiovascular and respiratory disease admissions were 0.71 percent for same-day exposure and 0.44 percent for exposure 2 days before hospital admission.
There were no statistically significant differences in the regional average effects of PM10-2.5 for either outcome. There were no significant associations of PM10-2.5 or PM2.5 and cause-specific cardiovascular disease and respiratory disease outcomes.
“The National Ambient Air Quality Standard (NAAQS) for particulate matter proposed by the U.S. Environmental Protection Agency (EPA) in 2005 would have replaced the daily PM10 standard with a daily PM10-2.5 standard, but that proposed standard was not retained in the final proposal because of a need for further evidence. Currently, national evidence concerning the health risks of short-term exposure to PM10-2.5 is limited, although there is long-standing recognition of how size influences patterns of deposition within the respiratory tract. We did not find statistically significant associations between same day PM10-2.5 concentration and emergency hospital admissions for cardiovascular or respiratory diseases when we adjusted for PM2.5,” the authors write.
“Nevertheless, we recommend that these findings be considered when the NAAQS for particulate matter is next reviewed, and that the monitoring of PM10 continue so that further studies can be performed.”
(JAMA. 2008;299[18]:2172-2179. 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, May 13, 2008
Media Advisory: To contact Rachel M. Werner, M.D., Ph.D., call Holly Auer at 215-349-5659.
HOSPITALS THAT PREDOMINANTLY TREAT MEDICAID PATIENTS APPEAR TO HAVE MADE SMALLER QUALITY PERFORMANCE GAINS
CHICAGO— Hospitals that predominantly treat poor and underserved patients (often referred to as safety-net hospitals) have made smaller improvements in quality performance measures in recent years compared to hospitals that do not primarily serve this patient population, according to a study in the May 14 issue of JAMA.
Safety-net hospitals often have lower quality of care than non–safety-net hospitals. While public reporting and pay for performance have the potential to improve quality of care at poorly performing hospitals, safety-net hospitals may be unable to invest in quality improvement. As such, some have expressed concern that these incentives have the potential to worsen existing disparities between hospitals, according to background information in the article.
Rachel M. Werner, M.D., Ph.D., of the Philadelphia Veterans Affairs Medical Center, and colleagues examined changes in differences in quality of care from 2004 to 2006 between safety-net and non–safety-net hospitals (high vs. low percentage of Medicaid patients) using publicly available data on hospital performance. Of the 4,464 participating hospitals, 3,665 (82 percent) were included in the final analysis.
The researchers found that hospitals with low percentages (5 percent) of Medicaid patients improved their performance significantly more than those with high percentages (40 percent) of Medicaid patients. “For example, hospitals with low percentages of Medicaid patients improved composite acute myocardial infarction [AMI; heart attack] performance by 3.8 percentage points, vs. 2.3 percentage points at those with high percentages of Medicaid patients. This resulted in a relative difference in performance gain of 39 percent. This pattern was repeated across most individual performance measures and all 3 condition-specific composite measures [AMI, heart failure and pneumonia],” the authors write.
Over time, hospitals with high percentages of Medicaid patients were less likely to be ranked as top performers, as reported on the Centers for Medicare & Medicaid Services (CMS) Hospital Compare website. “The percentage of hospitals in the top decile for AMI performance with high percentages of Medicaid patients decreased by more than half, from 10.1 percent in 2004 to 2.8 percent in 2006. At the same time, the percentage of hospitals in the top AMI performance decile with low percentages of Medicaid patients increased from 13.6 percent to 19.7 percent. These patterns held true across all 3 conditions.”
In a simulation model, hospitals with high percentages of Medicaid patients would have received smaller bonus payments and been more likely to incur penalties under pay for performance.
“Over time, trends such as these could damage the reputations of safety-net hospitals and worsen their financial status, potentially reducing their ability to further respond to quality-improvement incentives,” the researchers write.
“Improving quality of care at U.S. hospitals is a high priority, and improving quality of care for vulnerable populations is particularly important. Incentive programs such as public reporting and pay for performance may improve quality of care at many hospitals. However, these incentives may have unintended consequences, including exacerbating existing disparities in quality of care across hospitals. Our study suggests that safety-net hospitals may be unable to compete for performance bonuses. This has the potential to have deleterious effects on existing financial and clinical disparities in performance. As the CMS and others proceed with the implementation of incentives for quality improvement, it is imperative that steps be taken to ensure that disparities are not worsened.”
(JAMA. 2008;299[18]:2180-2187. 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, May 13, 2008
Media Advisory: To contact Laura M. Dember, M.D., call Gina Digravio at 617-638-8491. To contact editorial author Marcello Tonelli, M.D., S.M., F.R.C.P.C., call Jo-Anne Nugent at 780-492-9651.
ANTI-PLATELET DRUG DOES NOT INCREASE SUITABILITY FOR HEMODIALYSIS OF NEW SURGICALLY ENLARGED BLOOD VESSELS
CHICAGO—The anti-platelet drug clopidogrel reduced the frequency of early blood clot formation in new surgically enlarged blood vessels (fistulas) created for patients requiring dialysis, but did not increase the proportion of these fistulas that subsequently became suitable for use during dialysis, according to a study in the May 14 issue of JAMA.
“Approximately 470,000 Americans have end-stage renal disease, and most are treated with hemodialysis. A major challenge in caring for patients undergoing hemodialysis is maintaining a functioning vascular access, which is essential for performing the dialysis procedure. The effect of vascular access dysfunction is substantial—it is a leading reason for hospitalization among patients with end-stage renal disease and has associated annual costs in the United States that exceed $1 billion,” the authors write.
The preferred type of hemodialysis vascular access is an arteriovenous fistula, created by surgically connecting an artery and a vein. This arterio-venous connection and the resulting increase in the blood flow through the vein cause its diameter to increase, enabling the typically thrice weekly vein puncture necessary for administering dialysis. The fistula is preferred over other types of hemodialysis vascular access such as synthetic arteriovenous grafts because of lower rates of blood clot formation (thrombosis) and infection as well as reduced access-related and total health care expenditures. Offsetting these advantages is the substantially higher proportion of fistulas than grafts that are never able to be used for dialysis because of failure to mature adequately to support effective hemodialysis, according to background information in the article. Some small trials have suggested that anti-platelet drugs may reduce thrombosis of new fistulas.
The Dialysis Access Consortium, including Laura M. Dember, M.D., of the Boston University School of Medicine, and colleagues performed a multicenter, randomized, placebo-controlled trial to determine whether clopidogrel reduces early failure of hemodialysis fistulas. The study included 877 participants with end-stage renal disease or advanced chronic kidney disease who underwent surgical creation of a fistula. Participants were randomly assigned to receive clopidogrel (n = 441) or placebo (n = 436) for 6 weeks starting within 1 day after fistula creation.
The researchers found that participants in the clopidogrel group had a 37 percent lower risk of fistula thrombosis at 6 weeks compared to participants in the placebo group. Among the 866 participants who had fistula patency (lack of obstruction) assessed, 53 participants (12.2 percent) in the clopidogrel group experienced fistula thrombosis, compared to 84 participants (19.5 percent) in the placebo group.
However, among the 86 percent of fistulas assessed for suitability for use during dialysis, the percentage with suitability failure was high and did not differ between the clopidogrel group and the placebo group (61.8 percent vs. 59.5 percent, respectively).
“In conclusion, clopidogrel reduces the incidence of early thrombosis of new arteriovenous fistulas but does not increase the proportion that become suitable for dialysis. The high rate of fistula suitability failure observed in this large trial conducted at centers with a particular interest in hemodialysis vascular access provides a compelling argument for additional efforts to identify mechanisms underlying fistula maturation failure, criteria for selecting suitable candidates for fistula creation, and interventions to enhance fistula maturation,” the authors write.
(JAMA. 2008;299[18]:2164-2171. 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: RANDOMIZED TRIALS IN HEMODIALYSIS PATIENTS
In an accompanying editorial, Marcello Tonelli, M.D., S.M., F.R.C.P.C., of the University of Alberta and Institute of Health Economics, Edmonton, Canada, discusses the results regarding the use of clopidogrel for hemodialysis patients.
“This important study has immediate implications for clinicians. Nephrologists can be reasonably confident that clopidogrel should not be prescribed for patients undergoing fistula creation because it does not lead to clinically meaningful benefit. In fact, routinely prescribing clopidogrel might actually be counterproductive because it might prolong the survival of immature fistulas that would otherwise have thrombosed, thus delaying referral for a repeat attempt at establishing vascular access. Whether clopidogrel improves patency in fistulas that have already matured is unknown. However, it seems likely that clopidogrel may not prove useful in this setting because thrombosis of an established fistula is almost always a sign of significant underlying stenosis requiring angioplasty. Speculation aside, the findings of Dember et al suggest that clopidogrel cannot currently be recommended to improve maturation or patency of arteriovenous fistulas.”
(JAMA. 2008;299[18]:2205-2207. 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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JAMA REPORTS
VIDEO: Windows Media | Quicktime
COMBINATION OF MAMMOGRAPHY AND ULTRASOUND INCREASES DETECTION OF BREAST CANCER IN HIGH RISK PATIENTS
INTRO:
Early detection of breast cancer is critical when it comes to saving thousands of lives each year. Mammography is the best test for early detection but mammograms can miss some cancers. This can happen with any woman but especially those who have dense breast tissue which makes finding cancer that much more difficult. Now a new study looking at women with this type of breast tissue indicates that combining mammography with a screening ultrasound increases the accuracy rate of finding breast cancer. Jennifer Mitchell explains in this week’s JAMA Report.
VIDEO:
B-ROLL
Bonnie at desk
Tight Bonnie face
Mammogram shows breast tissue
Talk with doctor
AUDIO:
BONNIE OSTROWSKI KNEW SHE HAD DENSE BREAST TISSUE. SHE WAS CONCERNED HER MAMMOGRAM ALONE MIGHT NOT BE ABLE TO FIND CANCER IF SHE HAD IT SO SHE ASKED HER DOCTOR TO ALSO PERFORM A SCREENING ULTRASOUND ON EACH BREAST.
VIDEO:
SOT/FULL
Super @ :14
Bonnie Ostrowski
Had breast ultrasound
Runs: 10
AUDIO:
“I just felt that ultrasound would give a different view and I felt much more secure.”
VIDEO:
B-ROLL
Bonnie’s mammogram
Bonnie’s ultrasound
AUDIO:
BONNIE’S MAMMOGRAM IN 2001 DETECTED NO CANCER. BUT HER ULTRASOUND SHOWED A SMALL IRREGULAR MASS IN HER LEFT BREAST. A BIOPSY CONFIRMED SHE HAD INVASIVE BREAST CANCER.
VIDEO:
SOT/FULL
Super @:34
Wendie Berg, M.D., Ph.D.
Radiologist, Johns Hopkins
Runs: 07
AUDIO:
“The cancers can be hidden by the normal breast tissue. Its' been likened to trying to find a polar bear in a snow storm.”
VIDEO:
B-ROLL
Dr Berg
Doctor places ultrasound films
Graphic
“2637 women studied”
“Dense breast tissue”
“Mammography & ultrasound”
AUDIO:
DOCTOR WENDIE BERG, A RADIOLOGIST WITH JOHNS HOPKINS, LED A TEAM OF RESEARCHERS WHO ANALYZED JUST HOW EFFECTIVE ULTRASOUND CAN BE. AS PART OF THEIR STUDY THEY RECRUITED MORE THAN TWO THOUSAND WOMEN. EACH HAD DENSE BREAST TISSUE AND EACH UNDERWENT BOTH MAMMOGRAPHY AND ULTRASOUND.
VIDEO:
SOT/FULL
Wendie Berg, M.D., Ph.D.
Radiologist, Johns Hopkins
Runs: 11
AUDIO:
“We found that overall mammography did pretty well but it did miss a large number of cancers. Only half of the cancers present were actually seen on mammography.”
VIDEO:
B-ROLL
Graphic here:
Detecting Breast Cancer
40 women diagnosed with cancer
20 found with mammography
12 found only with ultrasound
8 cancers undetected
GFX/ JAMA COVER
AUDIO:
FORTY WOMEN WERE DIAGNOSED WITH CANCER. TWENTY OF THOSE CANCERS WERE REVEALED WITH MAMMOGRAPHY. WHEN ULTRASOUND WAS ADDED TO MAMMOGRAPHY TWELVE MORE CANCERS WERE REVEALED. EIGHT CANCERS WENT UNDETECTED BY BOTH MAMMOGRAPHY AND ULTRASOUND. THE STUDY APPEARS THIS WEEK IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
VIDEO:
SOT/FULL
Wendie Berg, M.D., Ph.D.
Radiologist, Johns Hopkins
Runs: 13
AUDIO:
“The overall performance of mammography we had an accuracy of seventy-eight percent. If we added ultrasound to that the overall accuracy was much better at ninety-one percent.”
VIDEO:
SOT/FULL
Bonnie Ostrowski
Had breast ultrasound
Runs: 05
AUDIO:
“I really do believe that the ultrasound did help save my life.”
VIDEO:
Bonnie walks
Woman getting ultrasound
Tight ultrasound
Ultrasound shows tissue on screen
AUDIO:
BONNIE’S CANCER WAS CAUGHT EARLY. AFTER A LUMPECTOMY TO REMOVE THE CANCER FROM HER BREAST SHE HAS BEEN CANCER FREE FOR SEVEN YEARS. RESEARCHERS SAY WOMEN SHOULD TALK TO THEIR DOCTOR TO SEE IF ULTRASOUND SCREENING IS SOMETHING THEY NEED. IT IS NOT MEANT TO REPLACE MAMMOGRAPHY BUT IS AN OPTION TO HELP ENHANCE IT. JENNIFER MITCHELL, THE JAMA REPORT.
TAG:
Researchers say a screening ultrasound is meant to supplement a mammogram. It is not meant to be the only test a woman has because there are many cancers that are not seen on ultrasound. They also say women need to be aware that ultrasound screening increases your chance of a false positive exam result which can lead to unnecessary biopsies. There is currently a shortage of qualified personnel to perform ultrasound exams so it is not always available at every screening location. The study was funded by the Avon Foundation and the National Cancer Institute. For more information about this study you can log on to www.jama.com.
