1. Sigmoidoscopy reduces colon cancer risk for men, but not women
Abstract: http://annals.org/aim/article/doi/10.7326/M17-1441
URLs go live when the embargo lifts
Offering sigmoidoscopy screening to men and women in Norway reduced colorectal cancer (CRC) incidence and mortality in men, but had little or no effect in women. These findings suggest that current guidelines recommending that women get screened for CRC with flexible sigmoidoscopy should be reconsidered. Results of a randomized trial are published in Annals of Internal Medicine.
Sigmoidoscopy screening for CRC has been introduced in the United Kingdom and other countries, including a screening pilot in Norway. Previous analyses of four randomized trials have indicated that sigmoidoscopy screening reduces CRC incidence by 18 percent to 26 percent and CRC mortality by 22 percent to 31 percent after 10 to 17 years of follow-up. However, the effectiveness of sigmoidoscopy screening in women is still uncertain.
Researchers from the Norwegian Cancer Registry and the University of Oslo randomly assigned 98,678 persons aged 50 to 64 to either be screened for CRC with flexible sigmoidoscopy or to have no screening at all. At 17 years, men in the sigmoidoscopy group saw their CRC risk reduced by 34 percent and CRC mortality reduced by 37 percent. The researchers found little or no reduction in CRC risk or mortality among women screened with sigmoidoscopy compared to those not screened.
According to the researchers, these results may have implications for future screening recommendations and trial design, where sex-stratified evaluations and sample size calculations should be considered. The authors also believe that communicating absolute rather than relative risk reductions would be preferable when engaging in shared decision-making with patients.
In an accompanying editorial, Kristen Bibbins-Domingo, PhD, MD, MAS, from the University of California, San Francisco, and a former member and chair of the United States Preventative Services Task Force (USPSTF), notes that an explanation for the disparity in screening outcomes could be that men have an earlier peak incidence of CRC than women. Thus, with one-time screening, the age at screening may be too early to capture most women who will develop cancer. Dr. Bibbins-Domingo and her coauthor suggest that more research is needed to identify the best CRC screening strategy for women.
Media contact: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To interview with the lead author, Oyvind Holme, MD, PhD, please contact elisabeth.jacobsen@kreftregisteret.no. The editorialist can be reached through Scott Maier at scott.maier@ucsf.edu.
2. Electromagnetic fields from electric cars do not interfere with implantable cardiac devices
Abstract: http://annals.org/aim/article/doi/10.7326/M17-2930
URLs go live when the embargo lifts
Electric and magnetic fields generated during operation and charging of electric cars does not affect function or programming of cardiac implantable electronic devices (CIED). Findings from a brief research report are published in Annals of Internal Medicine.
Electromagnetic interference (EMI) can disrupt normal function of CIEDs, causing issues such as pacing inhibition, inappropriate shock delivery, or device reprogramming. Electric cars represent a potential source of EMI, but it is not known if their use affects patients with CIEDs.
Researchers from the German Heart Centre of the Technical University of Munich recruited 108 patients with CIEDs being seen for routine follow up to test the risk for EMI that electric cars pose on CIED function. Participants were paired with one of four electric cars with the largest European market share: the BMW i3, Nissan Leaf, Tesla Model 85S, or the Volkswagen e-up!. Participants sat in the front seat of their assigned car while it ran on a roller test bench, which allowed for maximum electromagnetic field generation. The participants then charged the same car in which they had sat.
Investigators measured magnetic field strength in and around the cars during the testing and two cardiologists independently analysed electrocardiograms for the participants to identify abnormal CIED function. They found no evidence of EMI with CIEDs. Electric cars are equipped with shielding to prevent EMI with onboard computer systems, which may explain low field strength inside the cars. According to the researchers, this shielding could also be the mechanism that protects CIEDs.
Media contact: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To interview the lead author, Carsten Lennerz, MD, M.Sc, please contact him directly at lennerz@dhm.mhn.de.
3. Rustbelt states have the largest racial disparities in firearm homicide between black and white men
FREE content: http://annals.org/aim/article/doi/10.7326/M17-2976
URLs go live when the embargo lifts
Rustbelt states have the largest racial disparities in firearm homicide between black and white men Large variations in homicide and suicide rates and their racial differences across states highlight the need for revised gun policies. Findings from a surveillance study are published in Annals of Internal Medicine.
Racial disparities in violent deaths are well established in the U.S., but whether these inequalities vary by state and by how much is unknown.
Researchers from McGill University and University of California, Davis studied cause-of-death data for all 50 states and the District of Columbia from 2008 to 2016 to compare the rates of firearm and nonfirearm homicide and suicide in black and white men by state and to examine whether those deaths were associated with state prevalence of gun ownership. The data showed that racial disparities in homicide were greatest in Missouri, Michigan, Illinois, Indiana, and Pennsylvania, with black men having far more homicides. Homicide rates were consistently lower and less variable for white men across states. However, white men were at higher risk than black men for firearm suicide in all states (except for DC), with the largest differences seen in Mississippi, Nevada, Arkansas, New Mexico, and Alabama. Northeastern states and DC had the lowest risk for firearm suicides for both blacks and whites.
Media contact: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To interview the lead author, Corinne A. Riddell, PhD, please contact Cynthia Lee at cynthia.lee@mcgill.ca or 514-398-6754.
Also new in this issue:
Integrated Inpatient Medical and Psychiatric Care: Experiences of 5 Institutions
Aubrey C. Chan, MD, PhD; Christopher Burke, MD; Ellen Coffey, MD; David R. Hilden, MD, MPH; Diego L. Coira, MD; Jessy Warner-Cohen, PhD, MPH; Margaret Grady, MSN, APN-C; Philip R. Muskin, MD, MA; and Gen Shinozaki, MD
Ideas and Opinions
Abstract: http://annals.org/aim/article/doi/10.7326/M17-3186
Clonal Hematopoiesis Confers Predisposition to Both Cardiovascular Disease and Cancer: A Newly Recognized Link Between Two Major Killers
Benjamin L. Ebert, MD, PhD; Peter Libby, MD
Ideas and Opinions
Abstract: http://annals.org/aim/article/doi/10.7326/M18-0737
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Journal
Annals of Internal Medicine