Annals of Internal Medicine is published by the American College of Physicians-American Society of Internal Medicine (ACP-ASIM), an organization of more than 115,000 internal medicine physicians and medical students. The following highlights are not intended to substitute for articles as sources of information. For an embargoed fax of an article, call 1-800-523-1546, ext. 2656 or 215-351-2656.
(Clinical Guidelines, p. 840. News release.)
A new study provides strong, indirect evidence for recommending routine mammography screening to women over age 75 (Article, p. 783). Researchers took data on 12,038 female Medicare beneficiaries who were at least 69 years old and received a new diagnosis of breast cancer between 1995 and 1996. They found that, in general, women 75 years or older had larger tumors at diagnosis and were less likely to have had screening mammography than 69-74 year-old women. However, older women who had regular mammography had similar sized and stage tumors as the younger women, suggesting a benefit of mammography in women after age 75. Although the researchers did not study whether screening women after age 75 improved their breast cancer mortality rates or gave better quality of life, they did determine that regular mammography is associated with detecting earlier-stage disease in older women.
Data from the Nurses' Health Study found that the use of postmenopausal therapy (PMH) for five or more years and drinking 1.5 alcoholic drinks or more daily increased risk for breast cancer (Article, p. 798). Women who used both PMH and alcohol had almost twice the risk for breast cancer than women who used neither. The authors concluded that women should consider the increased risk for breast cancer when deciding about drinking alcohol, taking postmenopausal hormones and, especially, both together. The limitations of the study are that the large, ongoing Nurses' Health Study relies on self-reported information, and the study questions did not differentiate among the kind of PMH taken, e.g., estrogen alone or estrogen with progesterone.
Seeking to evaluate complementary and alternative products used for menopausal symptoms, researchers identified 29 randomized, controlled trials (Academia and Clinic, p. 805). They found that black cohosh and foods that contain phytoestrogens, such as soy, show some promise at relieving hot flashes, but they say that clinical trials do not support the use of other herbs or CAM therapies. Well-designed but small trials found that vitamin E, red clover, evening primrose oil, and dong quai were ineffective for hot flashes. Common problems with even these existing studies on CAM use for menopause are that they are small; they often test for only short periods of time, while the herbs or therapies are presumably taken for long periods of time; safety data on long-term use of herbs are inadequate; and herbs and other CAM therapies in the United States lack adequate product quality control.
The U.S. Preventive Services Task Force recommends against the use of combined estrogen and progestin therapy for preventing cardiovascular disease and other chronic conditions in postmenopausal women (Clinical Guidelines, p. 834). These recommendations were originally posted on the Annals of Internal Medicine web site on Oct. 15, 2002, and are published in today's print version of Annals.