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Wednesday, October 31, 2012
British Views on Mammography Similar to American
Remember the controversy that the United States Preventive Services Task Force (USPSTF) stirred up 3 years ago with its then latest recommendations on screening for breast cancer? Remember the prospective cohort study published in the Annals of Internal Medicine last October in which the authors concluded that annual mammograms increased the risk of false positive interpretations? Remember the retrospective study published earlier this past April in the Annals of Internal Medicine in which the authors concluded that breast cancer was overdiagnosed in 15-25% of women who were screened?
If so, then you might not be so surprised to hear that the Independent UK Panel on Breast Cancer Screening concluded in a review published yesterday in Lancet that every 3rd year screening from 50-70yo decreased breast cancer mortality but also increased overdiagnosis, similar to conclusions from the other side of the pond. In fact, for every 10,000 50yo British women screened for 2 decades, mammography would prevent 43 breast cancer deaths while 129 cases of breast cancer would be overdiagnosed. By overdiagnosis, we conclude that it's unlikely that cancer would've led to that person's demise. In other words, for every death prevented, 3 women were treated who would never have needed treatment and thus needlessly suffered from the side effects of treatment.
Am I anti-mammogram? Of course not! Just like I'm not anti-PSA either. Instead, rather than paint with a broad brush, we need to start wielding a very fine paintbrush and personalize testing & treatment options to the individual. So don't blindly order a mammogram but rather have a conversation with your patient and discuss both the benefits and the potential negative consequences, too.
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Tuesday, October 30, 2012
Don't Just Sit There, Do Something! Part 13 Life Expectancy
It's deja vu all over again. Yogi Berra
I had a strong sense of deja vu as I reviewed a population-based cross-sectional observational study of 11,247 Australians, New Zealanders, and British, published this month in the British Journal of Sports Medicine in which the authors concluded that television watching was associated with a reduction in life expectancy, so I kept digging (albeit nicely).
And then I found my August 18, 2011 post regarding an advance online copy of the exact same article. The good news is that I still interpret data in the same fashion as I did over a year ago. The bad news is that it takes over a year to go from an advance online copy to the real deal.
Bottom line: watching TV is bad for you. So get out there and do something.
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I had a strong sense of deja vu as I reviewed a population-based cross-sectional observational study of 11,247 Australians, New Zealanders, and British, published this month in the British Journal of Sports Medicine in which the authors concluded that television watching was associated with a reduction in life expectancy, so I kept digging (albeit nicely).
And then I found my August 18, 2011 post regarding an advance online copy of the exact same article. The good news is that I still interpret data in the same fashion as I did over a year ago. The bad news is that it takes over a year to go from an advance online copy to the real deal.
Bottom line: watching TV is bad for you. So get out there and do something.
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Monday, October 29, 2012
Lifestyles & Risk Factors for Heart Disease
But what if you haven't reached 150 minutes/week of moderate intensity or 75 minutes/week of vigorous intensity exercise? What if your body mass index is greater than 25kg/m2? What if you still smoke?
What if you consume less than 4 cups/d of fruits & vegetables, less than 2 servings/week of oily fish, less than 3 servings/d of fiber-rich whole grains, greater than 1,500mg/d of sodium (salt), and/or greater than 35 ounces/week of sugar-sweetened beverages? (You need to meet at least 4 of these nutritional guidelines to have this point count in your favor).
What if your total cholesterol is greater than 200mg/dL? What if your blood pressure is greater than 120/80mm Hg? And what if your fasting blood glucose is greater than 100mg/dL?
But you already knew this, right? Want to know what's really sad? Of the almost 12K individuals, only 29 (yeah, just over 2 dozen) met all 7 criteria for lowest risk of heart disease. As for the rest, why bother to spend money on the newest, latest tests when they've got their work already cut out for them.
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Sunday, October 28, 2012
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