News Release 

Early screening may reduce breast cancer deaths by more than half in childhood cancer survivors

Embargoed news from Annals of Internal Medicine

American College of Physicians

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. Early screening may reduce breast cancer deaths by more than half in childhood cancer survivors
Abstract: https://www.acpjournals.org/doi/10.7326/M19-3481
URL goes live when the embargo lifts

Early initiation (at ages 25 to 30) of annual breast cancer screening with breast magnetic resonance imaging (MRI), with or without mammography, might reduce breast cancer mortality by half or more in female survivors of childhood cancer previously exposed to chest radiation. These findings highlight the importance of MRI in reducing deaths from breast cancer in this population. A comparative modeling study is published in Annals of Internal Medicine.

Female survivors of childhood cancer who have been exposed to chest radiation are at significantly increased risk for breast cancer. Surveillance with annual mammography and MRI is recommended for this population, yet benefits, harms, and costs are uncertain.

Researchers from Boston Children's Hospital used data from the Childhood Cancer Survivor Study and two breast cancer simulation models from the Collaborative Intervention and Surveillance Modeling Network (CISNET) to estimate the benefits, harms, and cost-effectiveness of breast cancer screening strategies in childhood cancer survivors. They found that compared with no screening, starting screening at age 25 with annual mammography with MRI averted the most deaths (56 percent to 71 percent) and annual MRI (without mammography) averted 56 percent to 62 percent of deaths. When costs and quality of life were considered, beginning screening at age 30 was preferred given commonly cited cost-effectiveness thresholds. According to the researchers, these findings underscore the importance of MRI in screening and suggest identifying effective policies and interventions to reduce barriers to screening should be priorities to ensure comprehensive and coordinated care for these high-risk survivors.

Media contacts: For an embargoed PDF please contact Lauren Evans at laevans@acponline.org. To speak with the lead author, Jennifer Yeh, please contact Peter.Cohenno@childrens.harvard.edu.


2. Steroid bursts associated with an increased risk for severe adverse events within the first month
Abstract: https://www.acpjournals.org/doi/10.7326/M20-0432
Editorial: https://www.acpjournals.org/doi/10.7326/M20-4234
URL goes live when the embargo lifts

Oral steroid bursts (short courses of oral corticosteroid prescribed for 14 days of use or less) are associated with an increased risk for severe adverse events, including gastrointestinal (GI) bleeding, sepsis, and heart failure. After initiating patients on oral steroid bursts, physicians should be on the lookout for these severe adverse events, particularly within the first month after initiation of steroid therapy. Findings from a nationwide cohort study in Taiwan are published in Annals of Internal Medicine.

Oral steroid bursts are frequently prescribed in the general adult population in Taiwan. While long-term use of corticosteroids is known to be associated with an increased risk for serious adverse events, the risks from steroid bursts are not clear.

Researchers from the Chang Gung Memorial Hospital and the National Health Research Institutes studied the entire National Health Insurance Research Database of medical claims records in Taiwan to examine the associations between steroid bursts and severe adverse events. They found that prescriptions for steroid bursts were associated with an increased risk for GI bleeding, sepsis, and heart failure within the first month after initiation of steroid therapy (incidence rate ratio, 1.80, 1.99, and 2.37, respectively). According to the researchers, these findings suggest that physicians who consider prescribing steroid bursts to their patients should weigh the benefits against the risks for rare but potentially serious adverse events.

Media contacts: For an embargoed PDF please contact Lauren Evans at laevans@acponline.org. To speak with the lead authors, Tsung-Chieh Yao, MD, PhD or Hui-Ju Tsai, MPH, PhD, please directly contact Dr. Yao at yao@adm.cgmh.org.tw or Dr. Tsai at tsaihj@nhri.edu.tw.


3. Autologous bone marrow transplant cures difficult case of Susac syndrome
Abstract: https://www.acpjournals.org/doi/10.7326/L20-0055
URL goes live when the embargo lifts

An autologous hematopoietic stem cell transplant may successfully treat difficult cases of Susac syndrome. Authors from Hospital de León in León, Spain cite the case of woman with unresolved blindness and hearing loss due to a long-term Susac syndrome who experienced remission following an autologous bone marrow transplant. A brief case report is published in Annals of Internal Medicine.

Susac syndrome is a rare, immune-mediated, ischemic vasculopathy affecting the brain, eyes, and ears. Many cases are mild and treatable, but severe cases are notoriously difficult to treat. Hemaopoietic stem cell transplantation may offer relief.

A patient with confirmed Susac syndrome experienced persistent blindness and hearing loss for more than 16 months. After a long course of prednisone, mycophenolate mofetil, and aspirin, in addition to other treatment regimens, her symptoms still did not resolve. Recognizing that the alternative treatment was necessary to relieve the patient, her physicians administered an intermediate-intensity conditioning regimen, and then infused mobilized CD34+ cells at a dose of 6.86 × 106 cells/kg. Bone marrow engraftment was rapid and sustained. At 5 years of follow-up, the patient's disease was in complete remission without treatment, and her vision and hearing were restored. The authors caution that in autologous transplants, responses might be transitory since deleting every memory autoreactive clone seems unfeasible. They suggest the possibility that a matched allogenic transplant could be curative.

Media contacts: For an embargoed PDF please contact Lauren Evans at laevans@acponline.org. To speak with the lead author, Jose Garcia Ruiz de Moreles, MD, please contact him directly at jmgarciar@saludcastillayleon.es.


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Also in this issue:

Analysis of Response Data for Assessing Treatment Effects in Comparative Clinical Studies
Bo Huang, PhD; Lu Tian, ScD; Zachary R. McCaw, PhD; Xiaodong Luo, PhD; Enayet Talukder, PhD; Mace Rothenberg, MD; Wanling Xie, MS; Toni K. Choueiri, MD; Dae Hyun Kim, MD, ScD; and Lee-Jen Wei, PhD
Research and Reporting Methods
Abstract: https://www.acpjournals.org/doi/10.7326/M20-0104

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