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FOR THE PRESS

5 February 2008 Annals of Internal Medicine Tip Sheet

Annals of Internal Medicine is published by the American College of Physicians on the first and third Tuesday of every month. 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. 2656, or 215-351-2656. Past highlights are accessible as well.

1. No Clear Winner in Comparative Review of Effectiveness and Harms of Treatments for Localized Prostate Cancer

About 197,000 men will be diagnosed with clinically localized prostate cancer (cancer confined to the prostate gland) in 2008. Common treatments include watchful waiting, surgery to remove the prostate gland, radiotherapy, and androgen deprivation. A review of these treatments concluded, "Accurately assessing comparative effectiveness and harms of localized prostate cancer treatments is difficult due to limitations in the evidence." All treatments result in adverse events, primarily to urinary, bowel and sexual function, that occur soon after therapy, though the frequency, duration and severity may vary between treatments.

Note: This systematic review is being released early online at the Web site of Annals of Internal Medicine. It will appear in the March 18, 2008, print edition of the journal.

2. Gene Expression Tests for Breast Cancer Are Promising But Limited

A review of three commercial gene expression-based prognostic breast cancer tests finds they have potential for improving prognostic and therapeutic prediction, but more data are needed about the amount of improvement, which women will benefit, and how to use the test in decision making about current breast cancer treatment.

Note: This systematic review is being released early online at the Web site of Annals of Internal Medicine. It will appear in the March 18, 2008, print edition of the journal.

3. New Study Refines Thinking on Best Time to Begin HIV Treatment

Debate about the optimal time to begin HIV treatment continues, partly because current mathematical models that weigh harms and benefits over long horizons do not consider drug toxicity and side effects and accrual of HIV drug resistance mutations, which are the primary risks of initiating therapy early. A new computer simulation incorporates toxicity and side effects of combination antiretroviral therapy (Article, p. 178). It suggests that initiation of combination antiretroviral therapy when the CD4 count falls below 500 cells/mm may increase the life expectancy and quality-adjusted life expectancy of younger patients, particularly if they have higher viral loads. The simulation also strengthens the case for treating patients with CD4 counts between 200 and 350 cells/mm compared with current guidelines.

4. Expert Group: Do Not Screen Pregnant Women for Bacterial Vaginosis

Bacterial vaginosis is the most common lower genital tract syndrome among women of reproductive age and has been associated with premature births or low birthweight. Because bacterial vaginosis is easy to screen for and treat, some favor screening all pregnant women for it. But the U.S. Preventive Services Task Force (USPSTF) recommends against screening low-risk women for bacterial vaginosis because there is good evidence that treating the syndrome does not benefit pregnant women at low risk for premature delivery (Clinical Guidelines, p. 214; Update Review, p. 220). The task force finds insufficient evidence to recommend either for or against screening for the syndrome in pregnant women at high risk for premature delivery.


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