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JAMA. 2007;297:921.

CT Screening and Lung Cancer Outcomes
Computed tomography (CT) screening of high-risk patients may facilitate early diagnosis of lung cancer; however, whether CT screening is associated with improved lung cancer outcomes is unclear. Bach and colleagues (SEE ARTICLE) compared the frequency of lung cancer detection, tumor resection, advanced lung cancer diagnoses, and lung cancer deaths in 3 observational cohorts of current and former smokers who had annual CT scans, and they compared the observed events with estimates from validated prediction models. The authors found an increased rate of lung cancer diagnosis and tumor resection among the screened patients and no association between CT screening and diagnoses of advanced lung cancer cases or deaths compared with model predictions. In an editorial, Black and Baron (SEE ARTICLE) compare these findings with a previously reported favorable assessment of CT screening for lung cancer.

New Cardiac Hospitals and Coronary Procedures
As the number of specialty hospitals has increased in the United States, there has been debate over a possible association of specialty hospitals with an increased frequency of specialty-related procedures. In a study of Medicare data from 1995 through 2003, Nallamothu and colleagues (SEE ARTICLE) assessed whether the opening of cardiac hospitals was associated with increasing population-based rates of coronary revascularization procedures. The authors found that rates of revascularization procedures were higher in hospital referral regions after the opening of cardiac hospitals compared with regions with new cardiac programs in general hospitals and with regions with no new cardiac programs. In an editorial, Cram and Rosenthal (SEE ARTICLE) discuss factors related to the increase in specialty hospitals and procedures.

Carbohydrate Intake and Weight Loss in Women
National dietary weight loss guidelines (ie, energy-restricted, low-fat, high-carbohydrate diets) continue to be challenged by reports of success achieved with other diets, such as low-carbohydrate, weight-loss diets that have not been rigorously tested for benefits or risks. Gardner and colleagues assessed 1-year change in weight and related risk factors in a trial that randomly assigned overweight or obese, nondiabetic, premenopausal women to 1 of 4 diets of varying carbohydrate content: Atkins (very low carbohydrate), Zone (low carbohydrate), LEARN (low-fat, high carbohydrate), or Ornish (very high carbohydrate). The authors found that women assigned to the Atkins diet lost the most weight and experienced the most beneficial overall metabolic effects through 1 year of follow-up.

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ECG Abnormalities in Asymptomatic Women
The relationship of minor and major electrocardiographic (ECG) abnormalities at baseline and incident ECG abnormalities to long-term cardiovascular morbidity and mortality in asymptomatic postmenopausal women is not clear. In a post hoc analysis of data from the Women's Health Initiative estrogen plus progestin study, Denes and colleagues found that asymptomatic women who had minor or major ECG abnormalities at the baseline assessment and women with incident ECG abnormalities were at increased risk of future cardiovascular events and mortality. This association was independent of established risk factors and hormone treatment.

(SEE ARTICLE)

Medical News & Perspectives
Researchers have linked pancreatic cancer to an increased expression of certain gene-silencing molecules called microRNAs, a finding that may be useful for detection and treatment of the disease.

(SEE ARTICLE)

CLINICIAN'S CORNER
Calorie Restriction
Clinical Review
Physiological and clinical effects of calorie restriction with adequate nutrient intake.

(SEE ARTICLE)

Author in the Room Teleconference
Join Paul M Ridker, MD, March 21, 2007, from 2 to 3 PM eastern time to discuss an algorithm to assess cardiovascular risk in women. To register, go to http://www.ihi.org/AuthorintheRoom.

Audio Commentary
Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

NEXT WEEK
Theme Issue on Access to Care

JAMA Patient Page
For your patients: Information about lung cancer.

(SEE ARTICLE)

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