1. Despite improvements over the last decade, death rates from lupus remain disproportionately high
Abstract: http://annals.org/aim/article/doi/10.7326/M17-0102
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Despite improving trends in mortality, death rates from systematic lupus erythematosus (lupus) remain high compared to those in the general population, and disparities persist between subpopulations and geographic regions. Underreporting of lupus on death certificates may have resulted in underestimates of mortality rates. Findings from a nationwide population-based study are published in Annals of Internal Medicine.
Lupus is a chronic autoimmune disease with limited treatment options. In the 1950s, 5- and 10-year survival rates were less than 50 percent, but those rates jumped to more than 90 percent in the 1980s. The influence of more recent diagnostic and therapeutic developments on lupus mortality in the general population of the United States is unknown. Previous studies of lupus mortality were based primarily on deaths in patient cohorts, which do not capture changes in lupus incidence over time and do not reflect the true burden and trends of lupus mortality in the general population.
Researchers at the David Geffen School of Medicine at UCLA used a national mortality database and census data to identify temporal trends and demographic and regional differences in lupus mortality in the United States over a 46-year period from 1968 through 2013. They found that the reduction in mortality attributed to lupus was less than the reduction in non-lupus mortality, and the ratio of lupus to non-lupus mortality was about 35 percent higher in 2013 than in 1968. After an initial decrease between 1968 and 1975, lupus mortality increased annually for 24 years, followed by a sustained decrease for 14 years starting in 1999. Changes in lupus incidence over time could partially explain the changing trends; however, significant disparities in lupus mortality among subpopulations were observed. Mortality rates remained higher among older persons, females, blacks, and Hispanics, as well as in patients who resided in geographic regions in the West and the South. Most interestingly, according to the authors, persons of the same race/ethnicity had differences in lupus mortality, depending on where they lived. White persons living in the South had the highest lupus mortality, whereas non-Whites had the highest lupus mortality in the West.
The study authors stress that it is encouraging that lupus mortality began to decrease in 1999 and that the decrease has been sustained for 14 years, until the end of the study period. They suggest that additional research could help to identify any potentially modifiable risk factors that might inform targeted research and public health programs to address the disparities in lupus mortality rates.
Media contacts: For an embargoed PDF, please contact Cara Graeff. The lead author, Ram R. Singh, MD, can be reached directly at rrsingh@mednet.ucla.edu or 310-689-8722.
2. Internists play a vital role in identifying patients for genetic counseling for cancer risk
Abstract: http://annals.org/aim/article/doi/10.7326/M17-2512
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Patients at high risk for familial cancer, history of cancer at a young age, or history of multiple cancer occurrences may be referred to genetic counseling for genetic testing from the primary care office, which makes internists an important partner with genetic counseling. In a commentary published in Annals of Internal Medicine, experts from the Sidney Kimmel Cancer Center at Thomas Jefferson University, Dana-Farber Cancer Institute, and Memorial Sloan Kettering Cancer Center explain three main areas in oncology where genetic evaluation is changing care for patients, and how close collaboration between internists and cancer genetic specialists is crucial.
Genetic testing in oncology has expanded rapidly in recent years to encompass testing multiple genes at a time for inherited cancer risk, evaluating tumor molecular signatures for cancer risk, and testing multiple genes in tumor specimens to inform treatment. Genetic counseling is critical for helping patients understand the implications of findings from these various genetic testing strategies and how they may affect the patient and his or her family.
Because internists are privy to a patient's total health history, including cancer risk, they are in a unique position to identify patients that may benefit from genetic counseling. This is important because referral for genetic consultation and identification of an inherited gene mutation in a patient can dramatically impact cancer screening approaches and provide options for cancer prevention. Close collaboration between internists, oncologists, and cancer genetic specialists is also important in precision medicine efforts that stem from genetic testing of tumors for treatment. Once a genetic mutation is identified in their patients, internists should discuss referral of family members for genetic counseling for cascade testing, or testing among other family members to determine if they carry the familial mutation.
Media contacts: For an embargoed PDF, please contact Cara Graeff. To interview the lead author, Veda Giri, MD, please contact Mark Fortini at mark.fortini@jefferson.edu.
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Also in this issue:
Systemic Infection With Dirofilaria repens in Southwestern France
Romain Blaizot, MD; Denis J.M. Malvy, MD, PhD; Marie-Catherine Receveur, MD; Domenico Otranto, DVM, PhD; Pascal Millet, MD, PhDObservation: Case Report
Abstract: http://annals.org/aim/article/doi/10.7326/L17-0426
Journal
Annals of Internal Medicine