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, February 23, 2009)
Calcium Associated With Lower Risk of Cancer in Women
Vitamin B and Folic Acid May Reduce Risk of Age-Related Vision Loss
Male Infertility Associated With Testicular Cancer
Mail and Electronic Reminders May Increase Colon Cancer Screening
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, February 23, 2009
Media Advisory: To contact Yikyung Park, Sc.D., call NCI Press Officers at 301-496-6641 or e-mail ncipressofficers{at}mail.nih.gov.
Calcium Associated With Lower Risk of Cancer in Women
CHICAGO—Women with higher intake of calcium appear to have a lower risk of cancer overall, and both men and women with high calcium intakes have lower risks of colorectal cancer and other cancers of the digestive system, according to a report in the February 23 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Calcium is known to benefit bone health, according to background information in the article. Because of this, the Institute of Medicine recommends 1,200 milligrams of calcium for adults age 50 and older, and the 2005 dietary guidelines for Americans recommend 3 cups per day of low-fat or fat-free dairy products. Studies of dairy products, calcium intake and cancer have revealed different results for different cancer sites.
Yikyung Park, Sc.D., of the National Cancer Institute, Bethesda, Md., and colleagues analyzed data from 293,907 men and 198,903 women who participated in the National Institutes of Health-AARP Diet and Health Study. Participants took a food frequency questionnaire when they enrolled in the study between 1995 and 1996, reporting how much and how often they consumed dairy and a wide variety of other foods and whether they took supplements. Their records were then linked with state cancer registries to identify new cases of cancer through 2003.
Over an average of 7 years of follow-up, 36,965 cancer cases were identified in men and 16,605 in women. Calcium intake was not associated with total cancer in men but was in women—the risk decreased in women with intake of up to 1,300 milligrams per day, after which no further risk reduction was observed.
"In both men and women, dairy food and calcium intakes were inversely associated with cancers of the digestive system," the authors write. The one-fifth of men who consumed the most calcium through food and supplements (about 1,530 milligrams per day) had a 16 percent lower risk of these types of cancer than the one-fifth who consumed the least (526 milligrams per day). For women, those in the top one-fifth of calcium consumption (1,881 milligrams per day) had a 23 percent lower risk than those in the bottom one-fifth (494 milligrams per day). The decreased risk was particularly pronounced for colorectal cancer. Calcium and dairy food intake was not associated with prostate cancer, breast cancer or cancer in any other anatomical system besides the digestive system.
"Dairy food, which is relatively high in potentially anticarcinogenic nutrients such as calcium, vitamin D and conjugated linoleic acid, has been postulated to protect against the development of colorectal and breast cancer," the authors write. Calcium has been shown to reduce abnormal growth and induce normal turnover among cells in the gastrointestinal tract and breast. In addition, it binds to bile and fatty acids, potentially reducing damage to the mucous membrane in the large intestine.
"In conclusion, our findings suggest that calcium intake consistent with current recommendations is associated with a lower risk of total cancer in women and cancers of the digestive system, especially colorectal cancer, in both men and women," the authors write.
(Arch Intern Med. 2009;169[4]:391-401. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: The study was funded by the Intramural Research Program of the National Cancer Institute, National Institutes of Health. 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, February 23, 2009
Media Advisory: To contact William G. Christen, Sc.D., call Lori J. Shanks at 617-732-1604 or e-mail ljshanks{at}partners.org.
Vitamin B and Folic Acid May Reduce Risk of Age-Related Vision Loss
CHICAGO—Taking a combination of vitamins B6 and B12 and folic acid appears to decrease the risk of age-related macular degeneration in women, according to a report in the February 23 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Age-related macular degeneration (AMD) is a leading cause of vision loss in older Americans, according to background information in the article. Treatment options exist for those with severe cases of the disease, but the only known prevention method is to avoid smoking. Recent studies have drawn a connection between AMD and blood levels of homocysteine, an amino acid. High levels of homocysteine are associated with dysfunction of the blood vessel lining, whereas treatment with vitamin B6, vitamin B12 and folic acid appears to reduce homocysteine levels and may reverse this blood vessel dysfunction.
William G. Christen, Sc.D., of Brigham and Women’s Hospital and Harvard Medical School, Boston, and colleagues conducted a randomized, double-blind clinical trial involving 5,442 women age 40 and older who already had heart disease or at least three risk factors. Of these, 5,205 did not have AMD at the beginning of the study. In April 1998, these women were randomly assigned to take a placebo or a combination of folic acid (2.5 milligrams per day), pyridoxine hydrochloride (vitamin B6, 50 milligrams per day) and cyanocobalamin (vitamin B12, 1 milligram per day). Participants continued the therapy through July 2005 and were tracked for the development of AMD through November 2005.
Over an average of 7.3 years of treatment and follow-up, 137 new cases of AMD were documented, including 70 cases that were visually significant (resulting in a visual acuity of 20/30 or worse). Of these, 55 AMD cases, 26 visually significant, occurred in the 2,607 women in the active treatment group, whereas 82 of the 2,598 women in the placebo group developed AMD, 44 cases of which were visually significant. Women taking the supplements had a 34 percent lower risk of any AMD and a 41 percent lower risk of visually significant AMD. "The beneficial effect of treatment began to emerge at approximately two years of follow-up and persisted throughout the trial," the authors write.
"The trial findings reported herein are the strongest evidence to date in support of a possible beneficial effect of folic acid and B vitamin supplements in AMD prevention," the authors write. Because they apply to the early stages of disease development, they appear to represent the first identified way—other than not smoking—to reduce the risk of AMD in individuals at an average risk. "From a public health perspective, this is particularly important because persons with early AMD are at increased risk of developing advanced AMD, the leading cause of severe, irreversible vision loss in older Americans."
Beyond lowering homocysteine levels, potential mechanisms for the effectiveness of B vitamins and folic acid in preventing AMD include antioxidant effects and improved function of blood vessels in the eye, they note.
(Arch Intern Med. 2009;169[4]:335-341. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by grants from the National Heart, Lung and Blood Institute and from the National Eye Institute. Vitamin E and its placebo were provided by the Cognis Corporation. All other agents and their placebos were provided by BASF corporation. 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, February 23, 2009
Media Advisory: To contact Thomas J. Walsh, M.D., M.S., call Mary Guiden at 206-616-3192 or e-mail mguiden{at}u.washington.edu.
Male Infertility Associated With Testicular Cancer
CHICAGO—Men who are infertile appear to have an increased risk of developing testicular cancer, according to a report in the February 23 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Testicular germ cell cancer, the most common cancer among young men in industrialized countries, has become even more prevalent during the last 30 to 50 years, according to background information in the article. There is evidence that semen quality and male fertility have also declined during this time in industrialized nations; however, it is unclear whether these two trends are related.
Thomas J. Walsh, M.D., M.S., then of the University of California, San Francisco, and now of the University of Washington School of Medicine, Seattle, and colleagues analyzed data from 22,562 male partners of couples seeking fertility treatment between 1967 and 1998 (4,549 of whom had male factor infertility, based on a clinical presentation with abnormal semen analysis criteria). Their records were linked to the state cancer registry, which includes information about cancer cases confirmed between 1988 and 2004.
A total of 34 of the 22,562 men were diagnosed with testicular cancer at least one year after seeking treatment for infertility. Compared with men of the same age in the general population—whose records were identified using the National Cancer Institute’s Surveillance Epidemiology and End Results program—men in couples seeking treatment for infertility were 1.3 times more likely to develop testicular cancer. Men with male factor infertility were 2.8 more likely to develop testicular cancer than those without this condition.
"In interpreting these data, we considered the postulate that male factor infertility or its treatment could cause testicular cancer," the authors write. "However, this theory is highly improbable given that in many cases infertility treatment involves the use of assisted reproductive technologies rather than specific medical or surgical treatment of the male partner." It is also unlikely that the results representing a screening phenomenon, in which men who seek treatment for infertility are diagnosed with a previously unrecognized cancer because of diagnostic testing. Most cases of testicular cancer in adults are diagnosed rapidly when a physical exam reveals a nodule or swelling in the scrotum.
"A more plausible explanation is that a common exposure underlies infertility and testicular cancer," the authors conclude. Faulty DNA repair, or errors in the way the body responds to small areas of damage in its genetic material, may contribute to both conditions, as may environmental factors.
(Arch Intern Med. 2009;169[4]:351-356. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was funded by grants from the National Institute of Child Health and Human Development and the California Urology 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, February 23, 2009
Media Advisory: To contact corresponding author John Z. Ayanian, M.D., M.P.P., call David Cameron at 617-432-0441 or e-mail david_cameron{at}hms.harvard.edu.
Mail and Electronic Reminders May Increase Colon Cancer Screening
CHICAGO—Mailed reminders to patients appear to promote colon cancer screening, according to a report in the February 23 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. In addition, electronic reminders to physicians appear to increase screening among patients with more frequent primary care visits.
"Colorectal cancer is the secondary leading cause of cancer mortality [death] in the United States," according to background information in the article. "Screening programs involving fecal occult blood testing, flexible sigmoidoscopy and colonoscopy lower the incidence of colorectal cancer by removing precancerous adenomas, detect cancers at more curable early stages and reduce colorectal cancer mortality." Although national guidelines suggest that average-risk adults age 50 and older should be screened for colorectal cancer, only 60 percent report up-to-date testing.
Thomas D. Sequist, M.D., M.P.H., of Brigham and Women’s Hospital, Harvard Vanguard Medical Associates and Harvard Medical School, Boston, and colleagues studied screening rates and colorectal adenoma (tumor) detection for 21,860 patients (age 50 to 80) of 110 physicians from April 2006 to June 2007. Fifty-five physicians were randomly assigned to receive electronic reminders during office visits with patients overdue for screening. Additionally, 10,930 patients were randomly assigned to receive mailings containing an educational pamphlet, a fecal occult blood test kit and instructions for direct scheduling of flexible sigmoidoscopy or colonoscopy. Screening rates and detection of colorectal adenomas (tumors) were noted 15 months after the start of the intervention.
Screening rates for patients who received mailings were higher than for those who did not (44 percent vs. 38.1 percent). The mailings were more effective among older patients—patients age 50 to 59 experienced a 3.7 percent increase, patients age 60 to 69 had a 7.3 percent increase and patients age 70 to 80 experienced a 10.1 percent increase in screening rates. While patients of physicians receiving electronic reminders had screening rates similar to patients of physicians who did not receive reminders (41.9 percent vs. 40.2 percent), electronic reminders tended to increase screening rates among patients with three or more primary care visits (59.5 percent vs. 52.7 percent).
"Detection of adenomas tended to increase with patient mailings (5.7 percent vs. 5.2 percent) and physician reminders (6 percent vs. 4.9 percent)," the authors write, but these increases were not statistically significant.
"Patient mailings produced modest increases in rates of colorectal cancer screening, whereas electronic physician reminders tended to promote screening only among patients who have more frequent primary care visits," they conclude. "These complementary approaches have the potential to promote the overarching goal of widespread screening to reduce the incidence, morbidity and mortality of colorectal cancer."
(Arch Intern Med. 2009;169[4]:364-371. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: The study was funded by a grant from the National Cancer Institute. 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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