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.
A new study finds that many women do not receive adjuvant chemotherapy after surgery for breast cancer as recommended by National Institutes of Health (NIH) consensus conferences (Article, p. 90). Further, the older the woman, the less likely she was to receive adjuvant chemotherapy. Data from a statewide tumor registry of women diagnosed with early-stage breast cancer between 1991 and 1997 showed that, overall, 29 percent of women received chemotherapy. Analyzed by age, chemotherapy was used by 66 percent of women younger than 45, with use decreasing substantially with age. Only 18 percent of women between 60 and 64 received adjuvant chemotherapy; 12 percent of women between 65 and 69, and 3 percent of those older than 75. The NIH recommends adjuvant chemotherapy for women whose breast cancer has spread to lymph nodes and for women who have a tumor larger than 1 centimeter. Authors say that the study does not address whether the NIH recommendations are overly aggressive or whether practicing oncologists are too conservative in their use of chemotherapy.
Using data from the Heart and Estrogen/Progestin Replacement Study (HERS), researchers found that women with known heart disease were at high risk for future heart events and their risk increased up to sixfold when they had many additional risk factors (Article, p. 81). Researchers identified 11 easily assessed characteristics that predicted future heart events. They also found that although all the women had heart disease, only half or fewer were taking established drugs for secondary prevention of heart disease. In fact, women who had the greatest risk for future coronary events were the least likely to be treated with aspirin or cholesterol-lowing drugs.
(Medicine and Public Issues, p. 143).