Annals of Internal Medicine is published by the American College of Physicians. These highlights are not intended to substitute for articles as sources of information. For an embargoed copy of an article, call 1-800-523-1546, ext. 2653, or 215-351-2653.
The American College of Physicians released a mammography screening guideline for women between ages 40 and 49 in the April 3, 2007, issue of Annals of Internal Medicine. The guideline says that according to the evidence studied, breast cancer risk is not evenly distributed in women between the ages of 40 and 49. Thus the benefits of screening mammography are not uniform in women in this age group. A decision that tries to balance the possible benefits and harms of screening mammography must therefore take into account one’s risk of breast cancer and susceptibility to -- and concerns about -- the harms of screening. ACP does not say that women in this age group should not be screened for breast cancer. Nor does it say that all women should be screened. Rather, it says that women should discuss breast cancer screening with their primary care physician and make the decision that fits their risks and their preferences. A separate news release has been issued. (Guideline, p. 511, Background paper, p. 516, Patient summary, Editorial, p. 529.)
In the same issue of Annals of Internal Medicine, authors reviewed 23 published studies of the long-term effects of false-positive mammography screening results on the behavior and feelings of women older than 40 (Review, p. 502). Authors found disparate results, e.g., in an American study, women with false-positive results were more likely to return for routine mammography screening; in a European study, false-positives had no effect on returning for routine mammography, and in a Canadian study, women with false-positive mammograms were less likely to return for routine screening. In general, women who received false-positives worried more about breast cancer than those with normal readings, but results suggest no long-term symptoms of depression.
A study of 233 people with type 2 diabetes not well controlled with thiazolidinediones (with or without metformin) found that the addition of exenatide improved glycemic control better than a thiazolidinedione plus placebo (Article, p. 477). An editorial writer raised concerns about the study, such as studying patients not receiving maximal conventional therapy when the study began, not using lifestyle interventions to maximize diabetes control at baseline, and not providing information about subgroups prone to develop adverse drug reactions (Editorial p. 527).
Using large national databases, researchers looked at demographics, medical data and data on dialysis treatment facility in ZIP codes of U.S. metropolitan cities with differing percentages of African-American residents (Article, p. 493). They found that the racial composition of the residential area is associated with the time to kidney transplantation for residents of the neighborhood, whether they are African-American or Caucasian. Moreover, the racial composition of the neighborhood was associated with the performance of the dialysis facility that serves residents of the neighborhood.