Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine . The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent. 1. Screening strategy based on baseline breast density at age 40 may be effective and cost-effective for reducing breast cancer mortality
1. Screening strategy based on baseline breast density at age 40 may be effective and cost-effective for reducing breast cancer mortality
Abstract: https://www.acpjournals.org/doi/10.7326/M20-2912
Abstract: https://www.acpjournals.org/doi/10.7326/M21-0398
URL goes live when the embargo lifts
A mammography screening strategy based on a baseline breast density measure at age 40 may be the most effective and cost effective way to reduce breast cancer mortality. Current breast cancer screening guidelines recommend that mammography begin at age 50 for women at average risk. Findings from a microsimulation modeling study are published in Annals of Internal Medicine .
High breast density not only has a masking effect on mammogram reading, it also increases the risk of breast cancer. The Breast Density Notification Act requires providers to inform women who have a mammogram whether they have dense breasts. However, most women do not know their breast density classification until after their first mammogram at age 50.
Researchers from the University of Texas MD Anderson Cancer Center and Fred Hutch Cancer Center used a microsimulation model to compare the health outcomes and cost-effectiveness of 7 breast cancer screening strategies: no screening, biennial screening between age 50-75, triennial screening between 50-75, and four density-stratified strategies (two with baseline mammogram at age 40, and the other two at age 50). All density-stratified strategies assigned annual screening to women with dense breasts, and biennial or triennial starting at age 50 for women without dense breasts.
The model suggests that the strategy with a baseline breast density assessment at age 40, followed by annual screening between age 40 and 75 for women with dense breasts and biennial screening between 50 and 75 for women without dense breasts had the greatest reduction in breast cancer mortality, but was also associated with a larger number of mammograms lifetime and higher rates of false positives and overdiagnosis. A cost-effectiveness analysis that considered the benefits and harms showed that when compared to non-density-stratified biennial screening age 50 - 75, the above density-stratified strategy yielded an incremental cost-effectiveness ratio of about $36,000 per quality-adjusted life year (QALY), which is considered cost-effective.
The authors of an accompany editorial from the University of California, San Francisco argue that breast density is an important risk factor to include in risk-based screening strategies because it is both a strong and prevalent risk factor accounting for a large proportion of breast cancers. However, it should be combined with age and other risk factors when developing risk-based screening strategies that optimize benefits and minimize harms. The editorialists believe that until a more robust risk-based strategy is identified, data supports screening biennially from ages 50 to 74 years.
Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org . The corresponding author, Ya-Chen Tina Shih, PhD, can be reached directly at yashih@mdanderson.org . The editorialists, Karla Kerlikowske, MD and Kirsten Bibbins-Domingo, MD, PhD, can be reached through Elizabeth Fernandez at Elizabeth.Fernandez@ucsf.edu . 2. Doctors debate prescribing cannabis for patient's painful neuropathy
2. Doctors debate prescribing cannabis for patient's painful neuropathy
Annals Beyond the Guidelines discussions are based on real Beth Israel Deaconess Medical Center Grand Rounds
Abstract: https://www.acpjournals.org/doi/10.7326/M20-7945
In a new Annals 'Beyond the Guideline's feature, a general internist with a focus on addiction medicine and an addiction psychiatrist discuss the potential benefits and harms of recommending cannabinoids for a patient with painful neuropathy. The grand rounds presentation and accompanying videos are published in Annals of Internal Medicine .
Since 2019, hemp-based CBD products have been available in all 50 states. Cannabinoid use has increased among patients, who now may seek advice from physicians on the role of cannabinoids for certain chronic conditions.
Dr. Jeanette M. Tetrault, a general internist with a focus on addiction medicine, does not recommend cannabinoids for the patient. Dr. Tetrault notes the poor quality of the literature and also is particularly concerned with the potential for adverse events. She cites literature showing a large potential for cannabis use disorder or cannabis withdrawl syndrom during periods of cessation or reduction in use. Dr. Kevin P. Hill, an addiction psychiatrist, has a more favorable view of the medical use of cannabinoids. Dr. Hill recommends a balanced risk-benefit discussion with the patient and suggests considering a trial of cannabinoids.
Both experts say that cannabinoid use will continue to increase and that clinicians should be prepared to counsel patients who seek advice regarding the role of cannabinoids in treating certain chronic medical conditions.
All 'Beyond the Guidelines' papers are based on the Department of Medicine Grand Rounds at BIDMC in Boston and include print, video, and educational components. A list of topics is available at http://www.annals.org/grandrounds .
Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org . The corresponding author, Gerald W. Smetana, MD, can be reached through Kendra McKinnon at Kmckinn1@bidmc.harvard.edu . Also in this issue:
Also in this issue:
Acute Pancreatitis Update
Gardner
In the Clinic
Abstract: https://www.acpjournals.org/doi/10.7326/AITC202102090
A Series of Unfortunate Events
Thomas
Graphic Medicine
Abstract: https://www.acpjournals.org/doi/10.7326/G20-0009
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Annals of Internal Medicine