Author Insights: Much Variation Seen in How Frequently Additional Surgery After Lumpectomy Is Needed

In a new study, Laurence E. McCahill, MD, of Michigan State University in Grand Rapids, and his colleagues documented substantial variation in the rates of second surgeries among women undergoing lumpectomies at various hospitals. (Image: The Lacks Cancer Center at Saint Mary’s Health Care, in Grand Rapids, Michigan)

As many as two-thirds of women with breast cancer who have surgical treatment opt for removal of the affected tissue while preserving as much of the breast as possible, rather than undergo a complete mastectomy. Sometimes the patients who undergo lumpectomy may require additional surgery to remove more tissue, but a study published in JAMA today finds that the rates of such secondary breast cancer surgeries may vary considerably from hospital to hospital, raising questions about the reasons for such disparities.

Studies have demonstrated that lumpectomy or partial mastectomy offers many women with breast cancer the benefits of lifesaving treatment plus a better cosmetic outcome. But a potential risk of this treatment is that an estimated 30% to 60% of women who undergo this procedure will require additional surgery. Such repeat surgeries may take a physical, emotional, and financial toll on patients, so physicians and surgeons are eager to find ways to reduce the need for them. Doing so will require a detailed understanding of the many factors that contribute to the requirement for such “re-excisions.” Continue reading

Booster Seat Use Is Lower When Children Are Driven in Car Pools

The National Highway Traffic Safety Administration and American Academy of Pediatrics recommend children use a booster seat until they reach a height of 57 inches. (Image: Nina Shannon/iStockphoto.com)

Parents appear to be less vigilant about using booster seats to ensure that each child is properly protected by a seat belt when children are driven in a car pool and more rigorous about booster seat use when the parents chauffeur only their own children in the family car. This finding, by researchers from the University of Michigan in Ann Arbor and the University of Colorado in Denver, appears online today in Pediatrics.

The researchers conducted a survey and got a response rate of 71% from the 2266 parents invited to participate. The research findings are based on responses from the 681 participating parents who qualified as carpoolers with 4- to 8-year-old children. They found that 76% of parents reported their child used a booster seat when riding in the family car. However, among parents who carpool and whose children are routinely secured in the family car in a child booster seat, about 1 in 5 were reluctant to always ask another driver to use a booster seat for their child. Also, almost half of the parents reported that they did not always have their child use a booster seat in the family car when they were also driving other children who did not have boosters. Continue reading

Big Public Health Wins This Week on Reducing Whooping Cough, Diabetes Amputations

Public health campaigns emphasizing the importance of vaccination against pertussis may have helped curb deaths related to whooping cough. (Image: Leah-Anne Thompson/iStockphoto.com)

While it’s sometimes easier to identify public health failures than successes, data released this week provide strong evidence that efforts to curb whooping cough deaths in children in California and to prevent amputations among US patients with diabetes have been successful.

Public health officials in California have worked for years to combat high rates of whooping cough, which rose from just 249 reported cases in 1991 to 9000 in 2010, according to the California Department of Public Health (CDPH). Whooping cough, or pertussis, a highly contagious respiratory infection caused by Bordetella pertussis or Bordetella parapertussis, can be life threatening for young infants.

To combat this epidemic, California public health authorities launched campaigns to promote vaccination against pertussis for infants and made vaccinations freely available for parents of newborns to prevent them from exposing their children. They also promoted booster vaccinations for adolescents, who don’t become seriously ill from infection but are believed to play an important role in spreading pertussis. And these efforts appear to be making a substantial difference: On Tuesday, Ron Chapman, MD, MPH, director of CDPH, reported that the state had no pertussis-related deaths in 2011, although 3000 cases were reported that year. The announcement marked the first time in 2 decades that no infants in the state died as a result of pertussis and marked a striking decline in deaths since 2010 when 10 infants died. Continue reading

ACP to Congress: Fix Broken Politics to Preserve Needed Health Programs

The American College of Physicians called on Congress to preserve key health programs by adopting alternatives to automatic budget cuts slated to begin next year. (Image: vicm/iStockphoto.com)

The American College of Physicians (ACP) took aim today at the country’s “broken politics,” telling Congress that it should replace $1.2 trillion in across-the-board budget cuts beginning in 2013 with a new budget package that preserves essential health programs while achieving similar or greater savings.

“As we enter a 2012 election that may determine the direction of health care for decades to come, ACP calls on the candidates to rise above the fray and provide clear answers on how they would improve American health care, not use vague rhetoric about the value of the status quo or the past,” said ACP President Virginia Hood, MBBS, MPH, during a teleconference. Continue reading

CDC Researchers Cannot Conclude Morgellons Is a New Condition

Researchers with the US Centers for Disease Control and Prevention could not determine whether a constellation of symptoms known as Morgellons is a new condition. (Image: HeikeKampe/iStockphoto.com)

Reports by individuals and physicians of an unexplained skin problem commonly referred to as Morgellons prompted an investigation by researchers from the US Centers for Disease Control and Prevention (CDC) to determine whether a new condition had emerged. The CDC researchers, who said they had conducted the most comprehensive and first population-based study of Morgellons, reported that they could not determine whether this unexplained constellation of symptoms represented a new condition or was just “wider recognition of an existing condition such as delusional infestation.”

People who identify themselves as having the condition typically report poorly healing or nonhealing skin lesions; the emergence of fibers or materials from the skin; and sensations such as stinging, biting, or bugs crawling on or just under the skin. These individuals also sometimes report generalized fatigue, difficulty concentrating, short-term memory loss, and depressed mood. Reports suggest that individuals with the condition have experienced substantial declines in quality of life, including social disruption and isolation, decreased work productivity or job loss, and total disability. Continue reading

Opinion: The State of the Union—Health Care Cannot Be Ignored

By Aaron E. Carroll, MD, MS, and Austin Frakt, PhD

If you weren’t paying close attention to the State of the Union speech, you might have missed the parts about health care. In almost 7000 words of text, a total of 44 words were spent on the topic, a mere 0.6% for a subject accounting for more than one-sixth of the US economy. Medicare and Medicaid received 1 mention each, in the same sentence. Health care deserves greater attention from the president in his most prominent speech of the year.

Surprisingly, the Republican response wasn’t much different. Although cries for repeal of the Affordable Care Act (ACA) garner cheers from some quarters on the campaign trail, no such calls were uttered by Indiana Governor Mitch Daniels. In fact, just as in the State of the Union, the ACA received almost no mention at all. Continue reading

Author Insights: BRCA1 and BRCA2 Gene Mutations Associated With Improved Ovarian Cancer Survival

Paul D. P. Pharoah, BM BCh, PhD, from the University of Cambridge in England, and colleagues found that having an inherited mutation in the BRCA1 or BRCA2 gene is associated with improved survival in women with invasive epithelial ovarian cancer. (Image: Mark Pharoah)

Women with inherited mutations in the BRCA1 or BRCA2 genes have an increased risk of developing breast and ovarian cancer, although not all cases of breast and ovarian cancer are the result of mutations in these genes. Now researchers have new evidence that women with invasive epithelial ovarian cancer and mutations in the BRCA1 or BRCA2 genes are more likely than women with ovarian cancer associated with other mutated genes to survive at least 5 years.

The finding, appearing today in JAMA, may help physicians customize therapeutic options for treating ovarian cancer and could assist scientists planning future research into targeted therapies.

The pooled analysis of 26 observational studies involving 3879 women with ovarian cancer found 52% of women with a BRCA2 mutation were alive 5 years after diagnoses, as were 44% of women with a BRCA1 mutation. Only 36% of women without the mutations were alive after 5 years. The researchers noted that the survival advantage seen in women carrying a BRCA1 or BRCA2 mutation could be related to “intrinsic biological differences, their response to therapeutic agents, or both.” Continue reading