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11 September 2012 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 a copy of an article, call 215-351-2653 or e-mail Angela Collom at

1. Task Force Reaffirms its Recommendation Against Routine Screening for Ovarian Cancer

Although the mortality rate associated with ovarian cancer is high, the disease is rare, and the majority of women with a positive screening test will have a false-positive result. The United States Preventive Services Task Force (USPSTF) reviewed evidence published since its previous recommendation. The Task Force found adequate evidence that annual screening with transvaginal ultrasonography and testing for the serum tumor marker cancer antigen (CA)-125 in women does not reduce the number of deaths from ovarian cancer. Since there is adequate evidence that screening for ovarian cancer can lead to important harms, including major surgical interventions in women who do not have cancer, the Task Force concludes that there is at least moderate certainty that harms of screening for ovarian cancer outweigh the benefits. Researchers emphasize that the recommendation pertains to asymptomatic women. Women with known risk factors for ovarian cancer (certain genetic mutations, Lynch syndrome, family history) should discuss the benefits and harms of screening with their doctors. Use of oral contraceptives, pregnancy and breastfeeding, bilateral tubal ligation, and removal of the ovaries all reduce the risk for ovarian cancer.

2. Reduced Out-of-Pocket Expenses Can Improve Medication Adherence for Chronic Conditions

Poor medication adherence is a common problem with serious health consequences. Studies show that up to 30 percent of prescriptions are never filled, and about 50 percent of medications for chronic diseases are not taken as prescribed. Lack of adherence leads to approximately 125,000 deaths annually and is estimated to cost the U.S. health care system up to $289 billion. Some interventions could improve adherence. Researchers reviewed published studies to assess the comparative effectiveness of patient, provider, systems, and policy interventions that aim to improve medication adherence for chronic health conditions. The researchers found that reduced out-of-pocket expenses, case management, and patient education with behavioral support all improved medication adherence for more than one condition. The strongest evidence for improving medication adherence was for self-management of asthma and case management or collaborative care with in-person patient education visits for depression. There was limited evidence as to whether these approaches are broadly applicable, or if they can work to improve adherence over the long-term.

3. Opinion: Screen Returning Military and Others at Risk for Posttraumatic Stress Disorder

Over the past decade, more than two million Americans have deployed to wars in Iraq and Afghanistan where they were routinely exposed to life-threatening events. Such traumas may result in posttraumatic stress disorder (PTSD), a condition marked by intrusive thoughts and memories of traumatic experiences. Common symptoms of PTSD are startle, arousal, and sleep problems that can affect physical and psychological well-being. Authors suggest that PTSD is a “brain injury” that impairs forgetting. Sufferers often are depressed, or cope with symptoms through substance abuse. In addition, suicide is also a concern. The authors suggest that military returning from war should be screened for PTSD, and describe the screening tools that are useful in a primary care setting. The authors suggest that this type of “trauma informed” care (care that recognizes and plans for detecting and treating disorders that result after traumatic events) can help all patients.