Tip sheet Annals of Internal Medicine, Nov. 7, 2006

November 06, 2006

Annals of Internal Medicine Tip Sheet, Nov. 7, 2006, Issue

1. Breast Cancer Patients with Disabilities Less Likely to Get Breast-Conserving Surgery

A new study of records of women younger than 65 who received a diagnosis of localized breast cancer and who also received disability payments from the federal government found that women with disabilities were less likely than those without disabilities to be treated with breast-conserving surgery (Article, p. 637).

Women with disabilities also did not survive as long after breast cancer was diagnosed, but the shorter survival could not be explained by the difference in treatment.

2. When to Stop Screening for Colorectal Cancer? New Study Says No Need to Screen Older People with Three or More Chronic Diseases

A study of people 67 years and older who were diagnosed with colon cancer found that those with three or more chronic diseases at the time of diagnosis had life expectancies of five years or less (Article, p. 646). Life expectancy was strongly related to both age and the burden of chronic illness.

Authors say that since randomized trials have shown that a mortality difference between screened and unscreened patients does not become clear until five years after screening, physicians should consider the patient's age and number and nature of chronic diseases when deciding whether to screen and when to stop screening.

The authors acknowledge that colorectal cancer screening is underutilized, with perhaps only 50 percent of eligible patients receiving appropriate screening, but they point out that the screening has both risks and costs, so it is important to identify the patients who are most likely to benefit from screening.

An editorial writer cautions that screening decisions -- and treatment decisions -- should not be based on life expectancy numbers alone (Editorial, p. 700). "Physicians must talk to their patients about their preferences for treatment and their knowledge of the options."

3. Review Finds Inhaled Insulin Is OK for Certain Patients but Needs Long-Term Study (Review, p. 665.)
NOTE: Annals of Internal Medicine is published by the American College of Physicians. These highlights are not intended to substitute for articles as sources of information. For an embargoed copy of an article, call 1-800-523-1546, ext. 2656, or 215-351-2656.

American College of Physicians

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