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 1-800-523-1546, ext. 2656, or 215-351-2656, or visit www.annals.org. Past highlights are accessible as well.
Women suspected of having breast cancer are usually referred for a breast biopsy to determine whether the lesion is cancerous. In most cases, breast lesions are not cancers and do not require further treatment. Biopsies may be performed using minimally invasive core needle biopsy or open surgical biopsy. Researchers reviewed more than 70 published articles to assess the risks and benefits of these two different methods. They found that core needle biopsy was able to distinguish between malignant and benign lesions with approximately the same accuracy as open surgical biopsy but was associated with a lower risk of severe complications (less than 1 percent compared to 2 to 10 percent). When making the decision about which kind of biopsy to have, women should talk to their physicians about the benefits and harms of each method. The location of the lesion, the type of lesion, and the patientís risk factors may dictate which type of biopsy should be performed, but in many cases patient preference will be the most important factor in the decision.
The United States is facing a serious shortage of primary care physicians. Currently, at least 65 million citizens live in areas underserved by primary care. Many of these citizens receive care in one of 1,200 federally-qualified community health centers that operate in approximately 6,000 urban and rural sites in every U.S. state and territory. Community health centers provide an optimal training environment for graduate medical education, given their close faculty supervision and the emphasis on patient-centered care. Researchers suggest that increasing the number of resident physicians who receive training at community health centers would expand community health centersí clinical capacity and potentially replenish the pipeline of primary care physicians. According to the researchers, expanding the teaching role of community health centers could be a major step in forging a link between achieving fiscal feasibility of universal coverage and giving patients access to primary care.
In This Issue
Studies of the relationship between intense glucose control and cardiovascular events in diabetic patients have had mixed results with some showing that tight control reduces these events and others suggesting that it does not. Researchers conducted an observational study of 2,613 patients with type 2 diabetes over five years to determine if attaining a blood glucose level of less than 7 percent was associated with different benefits for patients with high versus low-to-moderate levels of comorbidity. The researchers found that intensive glucose control in younger, patients with low levels of comorbid illnesses was associated with a lower incidence of cardiovascular events within the five-year period. Conversely, this association was not present in older patients with high levels of comorbidity. The results suggest that any reduction of risk for cardiovascular events associated with tight glycemic control may not be uniform across patient subgroups.