News Release 

Women older than 75 may not reap death benefit from continued mammography screening

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. Women older than 75 may not reap death benefit from continued mammography screening

Abstract: http://annals.org/aim/article/doi/10.7326/M18-1199
Editorial: http://annals.org/aim/article/doi/10.7326/M20-0429
Free Summary for Patients: http://annals.org/aim/article/doi/10.7326/P20-0002
URL goes live when the embargo lifts

Healthy women over the age of 75 years might not benefit from continuing breast cancer screening. Researchers used data from the Medicare program to estimate the risk of breast cancer mortality under two strategies: continuing versus stopping screening in older women. They found a small mortality benefit for continuing to screen women between the ages of 70 to 74, but not those between 75 to 84. Findings from this population-based observational study are published in Annals of Internal Medicine.

An important question in cancer screening is the age at which it should stop. At some age, the modest potential harms associated with screening will outweigh the benefits because the latter accrue in the future. Researchers from the Harvard T.H. Chan School of Public Health, the Massachusetts General Hospital, and RTI Health Solutions used Medicare data to compare deaths from breast cancer over eight years follow-up in women who continued getting yearly mammograms and those who stopped screening. More than one million women between the ages of 70 and 84 years who had a mammography, a life expectancy of at least 10 years, and no previous cancer diagnosis were included in the evaluation. The researchers found that continuing breast cancer screening would reduce 8-year breast cancer mortality by one death per 1,000 women, with the 95 percent confidence interval (CI) ranging from two deaths to none. In contrast, continuing to screen women 75 years or older does not seem to affect 8-year breast cancer mortality. Regardless of age, women were less likely to receive aggressive therapies (radical mastectomy, chemotherapy) for breast cancer if they continued screening.

According to an editorial by Otis Brawley, MD, from Johns Hopkins University, the study's main disadvantage is that it uses data gathered between 1999 and 2008 when digital mammography was being introduced. It is basically the standard today. One-third of American women who die of breast cancer are diagnosed after age 70. These current estimates of the benefits of screening in this age range also reflect the current breast cancer treatments used in women over 70 potentially more than it does on the limitations of mammography.

Media contacts: For an embargoed PDF please contact Lauren Evans at laevans@acponline.org. To speak with the lead author, Xabier García-Albéniz, MD, PhD, please contact Todd Datz at tdatz@hsph.harvard.edu.


2. Clinicians encounter case of 'urinary auto-brewery syndrome'

Abstract: http://annals.org/aim/article/doi/10.7326/L19-0797
URLs go live when the embargo lifts

Clinicians encountered a case of previously unrecognized auto-brewery syndrome in which a substantial amount of alcohol was produced by yeast fermenting sugar in a patient's urinary system, even though the patient had not consumed alcohol. This is similar to but distinct from the traditional auto-brewery syndrome, that the clinicians propose calling 'urinary auto-brewery syndrome' or 'bladder fermentation syndrome.' A brief case report is published in Annals of Internal Medicine.

Clinicians at the University of Pittsburgh Medical Center Presbyterian Hospital saw a 61-year-old woman for placement on the liver transplant waitlist who had cirrhosis and poorly controlled diabetes. She was advised to seek treatment for alcohol use disorder by two liver transplant teams rather than going on the waitlist because urine tests for alcohol were repeatedly positive even though she claimed not to have had anything to drink. The patient continued to deny alcohol use and the clinicians noted that plasma test results for ethanol and urine test results for ethyl glucuronide and ethyl sulfate, which are metabolites of ethanol, were negative, whereas urine test results for ethanol were positive. In addition, the patient had no symptoms of alcohol intoxication. The authors tested to see if yeast colonizing in the bladder could ferment sugar to produce ethanol and found that it could experimentally. Therefore, they were able to conclude that the patient had a novel form of auto-brewery syndrome and not alcohol use disorder.

Media contacts: For an embargoed PDF please contact Lauren Evans at laevans@acponline.org. To speak with the lead author, Kenichi Tamama, MD, PhD, please contact Allison Hydzik at hydzikam@upmc.edu.


3. Antibiotics and corticosteroids are effective for treating Chronic Obstructive Pulmonary Disease exacerbations

Abstract: http://annals.org/aim/article/doi/10.7326/M19-3007
URL goes live when the embargo lifts

Antibiotics and systemic corticosteroids reduce treatment failure in adults with mild to severe exacerbation of chronic obstructive pulmonary disease (COPD). A systematic review with meta-analysis is published in Annals of Internal Medicine.

COPD is characterized by frequent exacerbations that are often treated with antibiotics, systemic corticosteroids, and short-acting bronchodilators. Whether all patients, especially those with mild exacerbations treated as outpatients, benefit from these treatments is uncertain.

To compare the effectiveness of these treatments, researchers from the Mayo Clinic analyzed 68 randomized controlled trials that enrolled adults with COPD exacerbation treated in outpatient or inpatient settings other than intensive care. They compared drug therapies with placebo, "usual care," or other drug interventions. They found that compared with placebo or management without antibiotics, antibiotics given for 3 to 14 days were associated with improvement of exacerbation at the end of the intervention and less treatment failure at the end of the intervention, independent of severity of exacerbations in outpatients and inpatients. Compared with placebo in outpatients and inpatients, systemic corticosteroids given for nine to 56 days were associated with less treatment failure at the end of the intervention but also with a higher number of total and endocrine-related adverse events. Evidence was insufficient to compare other drug interventions.

Media contacts: For an embargoed PDF please contact Lauren Evans at laevans@acponline.org. To speak with the lead author, Claudia C. Dobler, MD, PhD, please contact Elizabeth Zimmermann at newsbureau@mayo.edu or 507-284-5005.


4. Sweetened beverage tax reduced volume sold of taxed beverages by more than 20 percent in Cook County

Abstract: http://annals.org/aim/article/doi/10.7326/M19-2961
URLs go live when the embargo lifts

The Cook County Sweetened Beverage Tax resulted in a substantial reduction in the volume sold of taxed beverages in Cook County, Illinois, even when accounting for cross-border shopping. Findings from a pre-post intervention-comparison study are published in Annals of Internal Medicine.

Sugar-sweetened beverage consumption is associated with adverse health outcomes. As such, public policy in some cities has focused on reducing consumption by taxing the sale of these beverages. Similar to the beverage tax in Philadelphia, the Cook County Sweetened Beverage Tax applied to both sugar-sweetened and artificially sweetened beverages. Understanding if these taxes succeed in deterring purchases of taxed beverages is important for future policy decisions.

Researchers from the University of Illinois at Chicago used UPC-level data scanned from supermarkets and grocery, convenience, and other types of stores in Cook County, Illinois, where the tax was implemented, and in St. Louis City and County, Missouri, where the tax was not implemented, to measure the volume of beverage sold of taxed and untaxed beverages, across product categories and sizes. The researchers found that the net impact of the tax was a 21 percent reduction in volume sold of taxed beverages in Cook County, IL, during the time that the tax was in place after accounting for cross-border shopping. There was no significant increase in purchases of untaxed beverages. Also, there was no significant increase in the purchase of untaxed beverages in the border area suggesting that that cross-border shopping was limited to tax avoidance (i.e., purchases of the tax products) and did not involve consumers purchasing other grocery items across the border.

Media contacts: For an embargoed PDF please contact Lauren Evans at laevans@acponline.org. To speak with the lead author, Lisa M. Powell, MD, PhD, please contact Jacqueline Carey at jmcarey@uic.edu.

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