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This Week in JAMA
JAMA. 2006;295:2327.
Screening Colonoscopy, Age, and Examination Interval
Two articles in this issue address benefits associated with screening colonoscopy. Lin and colleagues (SEE ARTICLE) analyzed cross-sectional data from individuals who had a screening colonoscopy to estimate the life-years saved when the screening examination detects colorectal cancer (CRC) in very elderly vs younger persons. Their analyses suggest that despite the higher prevalence of CRC in elderly individuals, screening colonoscopy among persons aged 80 years and older results in only 15% of the estimated gain in life expectancy experienced by persons aged 50 to 54 years. In another article, Singh and colleagues (SEE ARTICLE) report results of a retrospective analysis of Manitoba Health claims and Manitoba Cancer Registry data, from which they assessed the magnitude and duration of CRC risk reduction after a negative colonoscopy. The authors' analyses suggest that persons with a negative colonoscopy examination have a 60% to 70% reduced risk of developing CRC compared with the general population, and this reduction in risk persists for more than 10 years. In an editorial, Church (SEE ARTICLE) discusses the contributions of these studies toward resolving several unanswered questions about the benefits of screening colonoscopy.
Cost-effectiveness of Breast MRI in BRCA1/2 Carriers
Magnetic resonance imaging (MRI) detects breast cancer earlier than mammography in women at high risk, but it is substantially more expensive. Plevritis and colleagues report results of a computer simulation to evaluate the cost-effectiveness of screening women with BRCA1 or BRCA2 mutations with mammography plus breast MRI vs mammography alone. The authors found that the cost-effectiveness of adding MRI to mammography varies by age. Based on a cost-effectiveness threshold of $100 000 per quality-adjusted life-year, the authors found that among women with BRCA1 mutations annual MRI plus mammography is cost-effective from ages 35 to 54 years and biannual MRI added to annual mammography is cost-effective for women aged 35 to 54 years with BRCA2 mutations.
(SEE ARTICLE)
Poverty and Adolescent Overweight
The prevalence of overweight among adolescents in the United States has increased during the past 3 decades, but whether previously described socioeconomic disparities in overweight have increased, decreased, or held constant is not known. Miech and colleagues analyzed nationally representative data from 1971 to 2004 to examine trends in prevalence of adolescent overweight by family poverty status. The authors found that socioeconomic disparities in adolescent overweight widened from 1971 to 2004 among older adolescents aged 15 to 17 years but not among those aged 12 to 14 years.
(SEE ARTICLE)
CLINICIAN'S CORNER
Macular Degeneration
Clinical Crossroads
Dr G is a 75-year-old semiretired surgeon who experienced an acute, unilateral loss of central vision approximately 3 years ago, which has progressed. Arroyo discusses the epidemiology, pathophysiology, diagnosis, and treatment of age-related macular degeneration.
(SEE ARTICLE)
A Piece of My Mind
"The electronic medical record (EMR) arrived at our teaching hospital one year ago and the resultant changes in medical student and physician notes have been remarkable." From "Copy-and-Paste."
(SEE ARTICLE)
Medical News & Perspectives
Various studies suggest there is a link between inadequate amounts of sleep and obesity.
(SEE ARTICLE)
Science vs Politics
Potential for the Data Quality Act to silence or politicize objective scientific research and delay evidence-based public health policy.
(SEE ARTICLE)
Audio Commentary
Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.
JAMA Patient Page
For your patients: Information about age-related macular degeneration.
(SEE ARTICLE)
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