WPSI says screen all women annually for urinary incontinence

August 13, 2018

  1. Women's Preventive Services Initiative says screen all women annually for urinary incontinence

Review: http://annals.org/aim/article/doi/10.7326/M18-0225
Guideline (Free): http://annals.org/aim/article/doi/10.7326/M18-0595
Editorial: http://annals.org/aim/article/doi/10.7326/M18-1768
URLs go live when the embargo lifts

All women should be screened annually for urinary incontinence, according to new guidelines from the Women's Preventive Services Initiative (WPSI). Screening should assess whether women experience urinary incontinence and whether it affects their activities and quality of life. If treatment is indicated, women should be referred for further evaluation. The clinical guideline and evidence review are published in Annals of Internal Medicine.

Urinary incontinence, or the involuntary loss of urine, affects an estimated 51 percent of women overall and can adversely affect a woman's physical, functional, and social well-being. However, many women are reluctant to discuss urinary incontinence with their health care providers, so they may endure symptoms for a long time before the issue is addressed. Urinary incontinence is often never recognized by health care providers.

Researchers from Oregon Health and Science University conducted a systematic review of published studies to evaluate whether screening for urinary incontinence in women not previously diagnosed improved physical and functional outcomes. They also assessed studies on the accuracy of screening methods and potential harms. The researchers found that no studies evaluated the overall effectiveness or harms of screening. Limited evidence suggested that some screening methods (brief questionnaires) had fairly high accuracy for identifying symptoms of urinary incontinence in primary care settings.

Despite the lack of direct evidence, the WPSI asserts that screening has the potential to identify urinary incontinence in many women who silently experience its adverse effects. Because early intervention may reduce symptom progression, improve quality of life, and limit the need for more complex and costly treatment, the WPSI recommends annual screening for women of all ages.

The authors of an accompanying editorial from the Women's Health Research Program at Monash University in Melbourne, Victoria, Australia argue that applying a screening test to a large population is a very serious responsibility and should be implemented with caution. The authors suggest advocating for a randomized trial to directly assess the benefits and harms of urinary incontinence screening in women before recommending it for all.

Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview the lead author of the evidence review, Heidi Nelson, MD, MPH, please contact Tracy Brawley at brawley@ohsu.edu. To interview a spokesperson WPSI, please contact Angela Collom at acollom@acponline.org. To interview the editorialists, please email Robin J. Bell, MBBS, PhD, MPH at robin.bell@monash.edu.

  1. Computer-aided colonoscopy reliably diagnoses small polyps that do not need to be removed
    Leaving diminutive, nonneoplastic rectosigmoid polyps can save up to $33 million annually

Abstract: http://annals.org/aim/article/doi/10.7326/M18-0249
Editorial: http://annals.org/aim/article/doi/10.7326/M18-1901
URLs go live when the embargo lifts

Real-time computer-assisted diagnosis (CAD) for colonoscopies can help endoscopists reliably distinguish diminutive (less than 5 mm) polyps in the distal colon that do not have to be removed to reduce cancer risk. Diagnosing and leaving these polyps, rather than removing them, can save time and substantial costs annually. Findings from a prospective study are published in Annals of Internal Medicine.

Most cases of colorectal cancer develop from adenomas or sessile serrated polyps, and removal of these lesions is recommended. However, hyperplastic polyps, especially if small and located in the distal part of the large bowel, are not associated with subsequent development of adenomas or colorectal cancer. Therefore, they do not have to be removed to reduce cancer risk. Diagnosing and leaving these polyps would save time and expense, as the annual cost of unnecessary polypectomy is estimated to be $33 million in the United States.

Researchers from the Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan compared diagnoses derived from real-time CAD with endocytoscopies for 791 consecutive patients undergoing colonocospy with pathologic reading of the resected specimen. They found that the CAD system provided 93.7 percent negative predictive value for identification of diminutive neoplastic polyps. According to the authors, these results suggest that computer-aided colonoscopy has the potential for replacing histological assessment of diminutive colorectal polyps in near future.

Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview the lead author, Yuichi Mori, MD, PhD, please contact him directly at ibusiginjp@gmail.com.

  1. TNF inhibitors not associated with increased cancer recurrence in patients with rheumatoid arthritis and a history of cancer

Abstract: http://annals.org/aim/article/doi/10.7326/M17-2812
URLs go live when the embargo lifts

Use of tumor necrosis factor inhibitors (TNFi) to treat rheumatoid arthritis (RA) is not associated with increased risk for cancer recurrence in patients with a history of cancer. However, meaningful risk increases could not be ruled out completely. Findings from a nationwide population-based cohort study are published in Annals of Internal Medicine.

Clinical guidelines have issued cautions about use of TNFi in patients with a history of cancer because these drugs may have tumor-promoting effects. TNFi are widely used to treat RA, which makes treating patients with RA and a history of cancer a clinical dilemma.

Researchers from the Karolinska Institutet, Stockholm, Sweden studied data from national registries in Sweden to compare cancer recurrence rates in 467 patients who had started TNFi treatment for RA after their cancer diagnosis between 2001 and 2015 versus an individually matched cohort of 2,164 patients with RA and a similar cancer history who had never been treated with TNFi. They also compared cancer recurrence rates between the TNFi patients and an umatched cohort of 3,826 patients who were diagnosed with RA during the same timeframe but had no history of biologic treatment before inclusion. Cancer recurrence rates were similar in all of the groups, suggesting that TNFi treatment did not increase risk for recurrent cancer. However, the authors caution that because several estimates had confidence intervals with upper limits around 2 or above, the clinically relevant risk for cancer recurrence could not be ruled out.

Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview the lead author, please contact Pauline Raaschou, MD, PhD directly at pauline.raaschou@sll.se.

Also new in this issue:

Treatment of Acute Intoxication From Inhaled 1,2-Difluoroethane
Juan Pablo Arroyo, MD, PhD; Daniel C. Johnson, PharmD; Julia B. Lewis, MD; Ahmed Al Sheyyab, MB BS; Adam King, MD; Matthew R. Danter, MD; Stuart McGrane, MB, ChB; Joshua P. Fessel, MD, PhD
Observation: Case Report
Abstract: http://annals.org/aim/article/doi/10.7326/L18-0186

American College of Physicians

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