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 p.m. CT Tuesday, January 27, 2009)
JAMA NEWS RELEASES
Using Heart Biomarker Levels to Guide Therapy Does Not Improve Outcomes for Heart Failure Patients
Genetic Variations Associated With Treatment Response for Childhood Leukemia
Many Women Who Survived Childhood Cancer Do Not Undergo Recommended Breast Cancer Screening
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
STUDY REVEALS MANY WOMEN TREATED WITH CHEST RADIATION FOR CANCER IN THEIR YOUTH ARE NOT GETTING THE BREAST CANCER SCREENING RECOMMENDED FOR THEM AS ADULTS
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Embargoed for Release: 3:00 p.m. CT, Tuesday, January 27, 2009
Media Advisory: To contact Matthias Pfisterer, M.D., email pfisterer{at}email.ch. To contact editorial co-author Ileana L. Piña, M.D., call Jessica Studeny at 216-368-4692 or email jessica.studeny{at}case.edu.
Using Heart Biomarker Levels to Guide Therapy Does Not Improve Outcomes for Heart Failure Patients
CHICAGO—Using a measure of the hormone N-terminal brain natriuretic peptide (BNP) to guide therapy for older patients with heart failure did not improve overall clinical or quality of life outcomes compared to patients receiving conventional symptom-guided therapy, according to a study in the January 28 issue of JAMA.
BNP is produced predominantly by the heart muscle cells, and levels of BNP are increased in patients with congestive heart failure. Therapy for heart failure guided by N-terminal BNP has been proposed to improve outcomes compared with conventional therapy in patients with chronic heart failure in some studies. However, these studies were small, not conclusive, had limited follow-up and focused on younger patients, according to background information in the article. Intensified N-terminal BNP–guided therapy may be particularly beneficial for older patients who are less physically active and in whom symptoms are less reliable. Heart failure is the most common reason for hospitalization in patients age 65 years or older.
Matthias Pfisterer, M.D., of University Hospital Basel, Switzerland, and colleagues compared a N-terminal BNP–guided strategy to the standard symptom-guided therapy for 499 patients age 60 years or older with chronic heart failure, who had prior hospitalization for heart failure within 1 year and N-terminal BNP level of 2 or more times the upper limit of normal. The study (Trial of Intensified vs. Standard Medical Therapy in Elderly Patients With Congestive Heart Failure [TIME-CHF]) had an 18-month follow-up. Patients were randomized to receive treatment to reduce symptoms of a certain level of heart failure (symptom-guided therapy) or treatment to reach BNP level of 2 times or less the upper limit of normal and reduce symptoms of a certain level of heart failure (BNP–guided therapy).
Compared with symptom-guided therapy, the BNP–guided strategy did not improve 18-month survival free of any hospitalization (41 percent for BNP–guided group vs. 40 percent for symptom-guided group). Overall survival rates did not differ significantly. Survival free of hospitalizations for heart failure was significantly improved with BNP–guided therapy (72 percent vs. 62 percent for symptom-guided group).
All measures of quality of life improved from the start of the trial to month 12 in both treatment groups and remained unchanged between month 12 and month 18. There were no significant differences in the magnitude of these improvements between the two treatment strategies.
Heart failure therapy guided by BNP improved outcomes in patients age 60 to 75 years but not in those age 75 years or older.
"The findings of the TIME-CHF study suggest that persistence in intensifying medical therapy seems to be the key for an optimal clinical outcome in patients aged 60 to 74 years, whereas it may not be beneficial to push doses to the limits in patients aged 75 years or older," the authors write. "Together with the main results of the TIME-CHF study, this study underscores the need for new trials specifically addressing the large population of older heart failure patients."
(JAMA. 2009;301[4]:383-392. 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: BNP-Guided Therapy for Heart Failure
Ileana L. Piña, M.D., of Case Western Reserve University and Louis Stokes VA Medical Center, Cleveland, and Christopher O'Connor, M.D., of Duke University, Durham, N.C., write in an accompanying editorial that there may be some usefulness of BNP as a biomarker of heart failure.
"...the time course of heart failure therapy is gradual, composed of uptitration of medications, reassessment of patient symptoms and signs, clinician persistence and patience, and obtaining BNP levels. There are no easy answers and no simple solutions in the search for a single biomarker for diagnosis, prognosis, and treatment of heart failure. While the BNP level may prove to be a useful tool for guiding therapy, it may be the method of reduction of BNP levels that matters most in improving outcomes for patients with heart failure."
(JAMA. 2009;301[4]:432-434. 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.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, January 27, 2009
Media Advisory: To contact corresponding author Mary V. Relling, Pharm.D., call Summer Freeman at 901-595-3061 or email Summer.Freeman{at}stjude.org.
Genetic Variations Associated With Treatment Response for Childhood Leukemia
CHICAGO—Children with acute lymphoblastic leukemia with certain genetic variations can have a different response to anti-cancer treatment than other patients, according to a study in the January 28 issue of JAMA.
Pediatric acute lymphoblastic leukemia (ALL) cure rates have increased from less than 10 percent in the 1960s to more than 80 percent today, although considerable unexplained individual variability exists in treatment response, according to background information in the article.
Jun J. Yang, Ph.D., of St. Jude Children's Research Hospital, Memphis, Tenn., and colleagues conducted a study to identify genetic factors that may affect treatment response in ALL. The researchers tested single nucleotide polymorphisms (SNPs; genetic variations) for their association with minimal residual disease (MRD) at the end of initial chemotherapy in two groups (totaling 487 children) treated for newly diagnosed ALL. Patients were enrolled between 1994 and 2006, with the last follow-up in 2006.
The researchers found that there were 102 SNPs associated with MRD in both groups. All 102 SNPs remained significantly associated with MRD after adjustment for race, sex, leukocyte (a type of blood cell) count at diagnosis, age, and ALL subtype. Of the 102 SNPs, 21 were significantly associated with hematologic (blood-related) relapse. Of 102 SNPs, 21 were also associated with antileukemic drug disposition, generally linking MRD eradication with greater drug exposure. The researchers found that a high proportion (63 of 102 SNPs [61.7 percent]) also were associated with early response, relapse risk, or antileukemic drug disposition.
"Although the acquired genetic characteristics of tumor cells play a critical role in drug responsiveness, our results show that inherited genetic variation of the patient also affects effectiveness of anticancer therapy, and that genome-wide approaches can identify novel and yet plausible pharmacogenetic variation. Such variation may be factored into treatment decisions in the future by placing additional emphasis on optimizing drug delivery to overcome host genetic variation, in addition to the current emphasis on tumor genetic variation," the authors conclude.
(JAMA. 2009;301[4]:393-403. 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.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, January 27, 2009
Media Advisory: To contact Kevin C. Oeffinger, M.D., call Courtney DeNicola at 646-227-3633 or email denicolc{at}mskcc.org. To contact editorial co-author Aliki J. Taylor, M.D., M.P.H., Ph.D., email A.J.Taylor{at}bham.ac.uk.
Many Women Who Survived Childhood Cancer Do Not Undergo Recommended Breast Cancer Screening
CHICAGO—Despite recommendations and being at an increased risk of breast cancer, most young women who were treated with chest radiation for a childhood cancer do not undergo appropriate mammography screening, according to a study in the January 28 issue of JAMA.
Women treated with chest radiation for a pediatric malignancy face a significantly increased risk of breast cancer at a young age. "The risk of breast cancer begins to increase as early as 8 years after radiation and the median [midpoint] age of breast cancer diagnosis ranges from 32 to 35 years," the authors write. By age 45 years, it is estimated that from 12 percent to 20 percent of women treated with moderate- to high-dose chest radiation will be diagnosed with breast cancer.
Experts recommend annual screening mammography for women exposed to moderate- to high-dose chest radiation, starting at 25 years of age or 8 years after radiation, whichever occurs last. It is estimated that in the United States there are approximately 20,000 to 25,000 women who are 25 years or older and were treated for a pediatric malignancy with moderate- to high-dose chest radiation. There is limited published information regarding the breast cancer screening practices of women who were treated with chest radiation for a childhood malignancy, according to background information in the article.
Kevin C. Oeffinger, M.D., of Memorial Sloan-Kettering Cancer Center, New York, and colleagues conducted a study that included 625 women, age 25 through 50 years, who had survived pediatric cancer, had been treated with chest radiation and were participating in the Childhood Cancer Survivor Study (CCSS), a North American group of long-term survivors diagnosed from 1970-1986. Participants received a 114-item questionnaire. Comparisons were made with similarly aged pediatric cancer survivors not treated with chest radiation (n = 639) and the siblings of the CCSS group (n = 712). Of 1,976 cancer survivors and siblings who were contacted, 87.9 percent participated.
Among women age 25 through 39 years who had received chest radiation therapy (RT), 36.5 percent reported a screening mammogram within the past 2 years; 47.3 percent had never had a mammogram; and only 23.3 percent had a screening or diagnostic mammogram within the previous year.
Women age 40 through 50 years who had received chest RT were more likely to report mammography than their younger counterparts, with 76.5 percent reporting a screening mammogram within the past 2 years compared with 70.0 percent for the group without chest RT and 67.0 percent for the CCSS sibling group. Only 52.6 percent of women in this age group with chest RT had regular screening (at least 2 mammograms within 4 years). This was not significantly higher than for women with no chest RT and only modestly higher than the CCSS siblings.
In all groups, women who were older were more likely to have been screened in the prior 2 years or to have received regular screening. For each 5-year incremental increase in age, the likelihood of reporting a mammogram increased nearly 2-fold. The strongest predictor of mammography in women ages 25 through 39 years was having a physician recommend the test, with the likelihood of reporting a mammogram 3 times higher among women who reported a physician recommendation than women who did not.
"In summary, our study suggests that most young women at risk of breast cancer following chest radiation for a pediatric cancer, including women at highest risk (Hodgkin lymphoma survivors), are not being appropriately screened. Findings from this study should provide the foundation for targeted interventions involving both clinicians and cancer survivors," the authors conclude.
(JAMA. 2009;301[4]:404-414. 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: Surveillance for Breast Cancer After Childhood Cancer
In an accompanying editorial, Aliki J. Taylor, M.D., M.P.H., Ph.D., of the University of Birmingham, United Kingdom, and Roger E. Taylor, M.D., M.A., of Swansea University, United Kingdom, write that the findings of Oeffinger and colleagues highlight several important issues.
"These include the relatively low uptake of screening mammography in a high-risk population, the importance of clinician recommendation to improve the uptake of screening mammography, and the continuing need to educate clinicians and patients about the risks of breast cancer after chest irradiation in childhood through well-designed education programs. The risk of breast cancer after exposure to annual low-dose irradiation in the form of x-ray mammography should be explored in future studies as well as the role of magnetic resonance imaging as a replacement for x-ray mammography rather than as an adjunctive examination in this group of young women. In addition, it is important to explore whether the rate of screening uptake could be improved if survivors were provided with screening at no extra cost."
(JAMA. 2009;301[4]:435-436. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, financial disclosures, funding and support, etc.
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JAMA REPORTS
VIDEO:
Windows Media |
Quicktime
STUDY REVEALS MANY WOMEN TREATED WITH CHEST RADIATION FOR CANCER IN THEIR YOUTH ARE NOT GETTING THE BREAST CANCER SCREENING RECOMMENDED FOR THEM AS ADULTS
INTRO:
They beat cancer before the age of 21, but for women who were treated with chest radiation, that means a higher risk of developing breast cancer as adults. A recent study measures how many of these women are taking the recommended steps to manage that risk. Haley Weldon explains in this week's JAMA Report.
VIDEO:
B-ROLL
Meg walking down city street, at a fruit stand
AUDIO:
IN THE UNITED STATES, THERE ARE AN ESTIMATED 20,000-25,000 WOMEN OVER THE AGE OF 25 WHO WERE TREATED WITH CHEST RADIATION FOR CANCER AS A YOUNG ADULT OR CHILD. THAT RADIATION HELPED MEG OWEN FIGHT OFF HODGKINS LYMPHOMA – TWICE – IN HER EARLY TWENTIES BUT IT HAS ALSO INCREASED HER CHANCES OF RECEIVING A BREAST CANCER DIAGNOSIS AT A YOUNG AGE.
VIDEO:
SOT/FULL
Super @ :27
Meg Owen
Cancer survivor
AUDIO:
Runs : 07
...At the time it was, “Meg we’re going to save your life” and that was really my only concern.
VIDEO:
B-ROLL
Meg & Doctor Oeffinger walk down hall
AUDIO:
NOW, MEG MUST STAY VIGILANT TO STAY CANCER-FREE.
VIDEO:
SOT/FULL
Super @ :31
Kevin Oeffinger, M.D.
Memorial Sloan-Kettering Cancer Center
AUDIO:
Runs: :17
The Children’s Oncology Group recommends initiating breast cancer screening at the age of 25 or 8 years after their radiation with an annual mammogram and a breast MRI.
VIDEO:
B-ROLL
Dr. Oeffinger with Meg in his office
AUDIO:
If we can diagnose breast cancer in an early stage in these women, their outcomes are quite good.
VIDEO:
B-ROLL
Woman getting mammogram
Super @: :53
JAMA File Footage
AUDIO:
WITH THAT IN MIND, DR. KEVIN OEFFINGER, OF MEMORIAL SLOAN-KETTERING CANCER CENTER, AND HIS COLLEAGUES, SURVEYED OVER 550 OF THESE HIGH-RISK WOMEN ABOUT THEIR SCREENING HABITS IN AN ATTEMPT TO MEASURE WHAT IMPACT THESE GUIDELINES HAVE.
VIDEO:
SOT/FULL
Kevin Oeffinger, M.D.
Memorial Sloan-Kettering Cancer Center
AUDIO:
Runs :11
We anticipated that because many of these women are unaware of the risks and their physicians might not be aware of the risks that the breast cancer screening rates would be low, but they were much lower than we even expected.
VIDEO:
GFX/JAMA COVER
FULL PAGE #1:
FEMALE CANCER SURVIVORS WHO RECEIVED CHEST RADIATION PRIOR TO THE AGE OF 21
Aged 25-39
36% had a mammogram in previous 2 years
47% never had a mammogram
FULL PAGE #2:
FEMALE CANCER SURVIVORS WHO RECEIVED CHEST RADIATION PRIOR TO THE AGE OF 21
Aged 40-50
52% had regularly scheduled mammograms
(2 over the last 4 years)
VIDEO:
B-ROLL
Doctor-patient consultation
AUDIO:
THE STUDY, FEATURED THIS WEEK IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, FOUND THAT IN WOMEN AGES 25-39, ONLY 36% HAD HAD A MAMMOGRAM IN THE PREVIOUS 2 YEARS AND 47% HAD NEVER HAD A MAMMOGRAM.
IN THESE HIGH-RISK WOMEN BETWEEN THE AGES OF 40 AND 50, JUST 52% WERE BEING REGULARLY SCREENED, ALTHOUGH AN ANNUAL MAMMOGRAM IS RECOMMENDED FOR ALL WOMEN OVER THE AGE OF 40.
RESEARCHERS FOUND THAT RAISING AWARENESS OF THE GUIDELINES COULD MAKE A DIFFERENCE.
VIDEO:
SOT/FULL
Kevin Oeffinger, M.D.
Memorial Sloan-Kettering Cancer Center
AUDIO:
Runs: 13
If a physician recommended screening for these women, especially those women between the ages of 25 & 39, they were 3x more likely to have a mammogram than those women that didn’t have a physician recommendation.
VIDEO:
SOT/FULL
Meg Owen
AUDIO:
Runs : 08
For me, knowledge is power, and knowing that I am at higher risk, the screening actually gives me peace of mind.
VIDEO:
B-ROLL
Meg looking through wedding album
AUDIO:
HAVING BEATEN CANCER BEFORE, MEG OWEN KNOWS AN ANNUAL MAMMOGRAM MAY HELP ENSURE SHE WOULD BE ABLE TO DO IT AGAIN. THIS IS HALEY WELDON WITH THE JAMA REPORT.
