Public Release:  Annals of Internal Medicine tip sheet for April 8, 2014

American College of Physicians

1. Daily low-dose aspirin may protect against preeclampsia complications

Daily low-dose aspirin beginning as early as the second trimester of pregnancy may prevent complications from preeclampsia, according to an article being published in Annals of Internal Medicine. Preeclampsia is a condition characterized by high blood pressure and proteinuria during the second half of pregnancy. Poor perinatal health outcomes are associated with preeclampsia, primarily due to increased risk for intrauterine growth restriction (IUGR) or medically initiated preterm delivery. Preeclampsia is the leading cause of maternal deaths and is responsible for more than one third of serious maternal morbidities and 15 percent of preterm births. Predicting which patients will develop preeclampsia is not possible but some conditions, such as preeclampsia in a previous pregnancy or chronic illnesses such as diabetes, hypertension, and renal disease put women at high risk. Prevention is imperative because the only effective treatment for preeclampsia is delivery, which may have serious neonatal harms before 34 weeks of gestation. Researchers conducted a systematic evidence review to determine the benefits and harms of low-dose aspirin for preventing morbidity and mortality from preeclampsia. They found that when women at high-risk for preeclampsia started taking a daily low-dose aspirin after their first trimester their risk of developing preeclampsia during the pregnancy dropped by 24-percent. In addition, the risk for preterm birth dropped by 14 percent and the risk for IUGR dropped by 20 percent. No harms of daily low-dose aspirin were identified in the literature. A draft recommendation based on this review will be posted to http://www.uspreventiveservicestaskforce.org on April 7.

Note: The URL will go live at 5:00 p.m. on Monday, April 7 and can be included in news stories. For an embargoed PDF, please contact Megan Hanks or Angela Collom. To speak with the author of the evidence review, please contact Mary Sawyers at Mary.A.Sawyers@kpchr.org or 503-335-6602. For a copy of the draft recommendation, please contact Nicole Raisch at newsroom@uspstf.net or 202-572-2044.


2. Could controversial Canadian mammography study spark new thinking in the U.S.?

A recent report from the Canadian National Breast Screening Study (CNBSS) concluded that mammography screening does not reduce deaths from breast cancer. The findings refueled the heated debate that began in 2009 when the U.S. Preventive Services Task Force recommended biennial mammography screening for women ages 50 to 74 and individualized screening for younger women. Two new commentaries being published in Annals of Internal Medicine discuss the findings of the Canadian study and suggest new approaches to studying and thinking about breast cancer. In the first commentary (http://www.annals.org/article.aspx?doi=10.7326/M14-0569), the authors discuss the conclusiveness of trials that test the benefits and harms of mammography screening and suggest that it may be time for a new kind of study. They argue that the ultimate question for any cancer screening program is whether a reduction in cancer mortality really translates into saved lives. Current trials do not show evidence that mammography screening programs reduce overall mortality. In the second commentary (http://www.annals.org/article.aspx?doi=10.7326/M14-0616), the author suggests that the CNBSS report should help to reframe the issue of breast cancer to include discussion of prevention. The author suggests that we begin to look at screening in a more limited way and focus also on making lifestyle changes that are associated with a reduced risk for breast cancer.

Note: The URL will go live at 5:00 p.m. on Monday, April 7 and can be included in news stories. For an embargoed PDF, please contact Megan Hanks or Angela Collom. To speak with the author of the first commentary, please contact Vanessa Arn at varn@ispm.unibe.ch or +41 31 631 57 93. To speak with the author of the second, please contact William Davis at william_davis@med.unc.edu or 919-966-5906.

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