Mary Ann Moon

The long-acting insulin analogues glargine and detemir offer only minor, if any, clinical benefit, according to Dr. K. Horvath and associates in the Cochrane Library's collaborative review group on metabolic and endocrine disorders.

Given this negligible benefit and the current lack of long-term safety and efficacy data, “we suggest a cautious approach to treatment with [glargine or detemir],” they said in an online issue of the Cochrane Database of Systematic Reviews.

The researchers conducted a meta-analysis of eight studies that compared the new, long-acting analogues with NPH insulin, which they termed the current standard of treatment. These studies involved 2,293 patients with type 2 diabetes who were assessed for 24–52 weeks.

Unfortunately, the methodologic quality of all of these studies was rated low, which allows only “a cautious interpretation” of their results.

Glargine (Lantus) showed no superiority to standard insulin therapy in achieving metabolic control, and detemir (Levemir) showed only “clinically unimportant” superiority, Dr. Horvath and associates said (Cochrane Database Syst. Rev. 2007 April 18;DOI:10.1002/14651858.CD005613.pub3).

Nocturnal hypoglycemic events were less frequent in patients treated with either of the two long-acting analogues than in those on standard insulin therapy, but no statistically significant advantage was noted. Moreover, all the reviewed studies were prone to reporting bias concerning this symptom, and the frequency of hypoglycemia was very low, “making it unlikely to see an important clinical effect for the different treatments,” the investigators noted.

None of the trials investigated possible long-term effects of treatment with the new insulin analogues, and the maximum observation period was 12 months. The meta-analysis therefore “cannot provide any further guidance on potential adverse properties, such as mitogenic effects or progression of microvascular complications.”

Similarly, none of the reviewed trials reported data on quality of life or costs, so these factors could not be assessed, they added.

The long-acting insulin analogues glargine and detemir offer only minor, if any, clinical benefit, according to Dr. K. Horvath and associates in the Cochrane Library's collaborative review group on metabolic and endocrine disorders.

Given this negligible benefit and the current lack of long-term safety and efficacy data, “we suggest a cautious approach to treatment with [glargine or detemir],” they said in an online issue of the Cochrane Database of Systematic Reviews.

The researchers conducted a meta-analysis of eight studies that compared the new, long-acting analogues with NPH insulin, which they termed the current standard of treatment. These studies involved 2,293 patients with type 2 diabetes who were assessed for 24–52 weeks.

Unfortunately, the methodologic quality of all of these studies was rated low, which allows only “a cautious interpretation” of their results.

Glargine (Lantus) showed no superiority to standard insulin therapy in achieving metabolic control, and detemir (Levemir) showed only “clinically unimportant” superiority, Dr. Horvath and associates said (Cochrane Database Syst. Rev. 2007 April 18;DOI:10.1002/14651858.CD005613.pub3).

Nocturnal hypoglycemic events were less frequent in patients treated with either of the two long-acting analogues than in those on standard insulin therapy, but no statistically significant advantage was noted. Moreover, all the reviewed studies were prone to reporting bias concerning this symptom, and the frequency of hypoglycemia was very low, “making it unlikely to see an important clinical effect for the different treatments,” the investigators noted.

None of the trials investigated possible long-term effects of treatment with the new insulin analogues, and the maximum observation period was 12 months. The meta-analysis therefore “cannot provide any further guidance on potential adverse properties, such as mitogenic effects or progression of microvascular complications.”

Similarly, none of the reviewed trials reported data on quality of life or costs, so these factors could not be assessed, they added.

The long-acting insulin analogues glargine and detemir offer only minor, if any, clinical benefit, according to Dr. K. Horvath and associates in the Cochrane Library's collaborative review group on metabolic and endocrine disorders.

Given this negligible benefit and the current lack of long-term safety and efficacy data, “we suggest a cautious approach to treatment with [glargine or detemir],” they said in an online issue of the Cochrane Database of Systematic Reviews.

The researchers conducted a meta-analysis of eight studies that compared the new, long-acting analogues with NPH insulin, which they termed the current standard of treatment. These studies involved 2,293 patients with type 2 diabetes who were assessed for 24–52 weeks.

Unfortunately, the methodologic quality of all of these studies was rated low, which allows only “a cautious interpretation” of their results.

Glargine (Lantus) showed no superiority to standard insulin therapy in achieving metabolic control, and detemir (Levemir) showed only “clinically unimportant” superiority, Dr. Horvath and associates said (Cochrane Database Syst. Rev. 2007 April 18;DOI:10.1002/14651858.CD005613.pub3).

Nocturnal hypoglycemic events were less frequent in patients treated with either of the two long-acting analogues than in those on standard insulin therapy, but no statistically significant advantage was noted. Moreover, all the reviewed studies were prone to reporting bias concerning this symptom, and the frequency of hypoglycemia was very low, “making it unlikely to see an important clinical effect for the different treatments,” the investigators noted.

None of the trials investigated possible long-term effects of treatment with the new insulin analogues, and the maximum observation period was 12 months. The meta-analysis therefore “cannot provide any further guidance on potential adverse properties, such as mitogenic effects or progression of microvascular complications.”

Similarly, none of the reviewed trials reported data on quality of life or costs, so these factors could not be assessed, they added.

The choice between standard surgery to remove uterine fibroids and uterine artery embolization comes down to weighing the benefits and risks of the two procedures, because quality of life and other outcomes at 1 year are fairly comparable, according to Dr. Richard D. Edwards and his associates in the Randomized Trial of Embolization versus Surgical Treatment.

The advantages of uterine artery embolization (UAE)—significantly shorter hospital stay, less postprocedure pain, and faster return to usual activities—must be weighed against a treatment failure rate that may be as high as 20% and a small but still significantly increased risk of late adverse events, the researchers said.

“The results of our study make clear that the choice between surgery and uterine artery embolization for symptomatic uterine fibroids involves [trade-offs],” said Dr. Edwards of Gartnavel General Hospital, Glasgow, Scotland, and his associates.

The trial, specifically designed to assess quality of life and other outcomes at 1 year of follow-up, involved 140 women with one or more fibroids larger than 2 cm who were treated at 27 hospitals throughout the United Kingdom. Approximately twice as many subjects were randomly assigned to the UAE group as to the surgical group, to allow better characterization of outcomes of the embolization and minimal reduction in statistical power.

Quality of life—the primary outcome measure—was assessed using the Medical Outcomes Study's 36-item short-form general health survey (MOS SF-36). There were no significant differences between the two groups at 1 year on any of the eight components measured, the investigators said (N. Engl. J. Med. 2007;356:360–70).

Of the UAE group, 21 women (20%) required an additional invasive procedure—hysterectomy or repeat UAE—for continued or recurrent symptoms. Ten of them had the second intervention within 1 year and 11 had it within 2 years of the initial procedure. In contrast, symptom scores were significantly better in the surgery group at all time points assessed.

Women in the UAE group had significantly shorter hospital stays (1 day vs. 5 days), resumed their usual activities much sooner, and reported significantly less pain and better social function post procedure.

A similarly high percentage of women in both groups (93% of the surgical group and 88% of the UAE group) said they would recommend their procedure to a friend.

Rates of major adverse events and of minor complications did not differ significantly, but the timing and nature of these events did.

There were 16 major adverse events (15%) in the UAE group and 10 (20%) in the surgery group, results which did not differ significantly.

However, 15 of the 16 such events occurred after hospital discharge in the UAE group, whereas only one such event occurred after hospital discharge in the surgery group.

A total of 36 women in the UAE group (34%) developed minor complications, usually the pyrexia, pain, and elevated markers of inflammation of postembolization syndrome. Similarly, 10 women in the surgery group (20%) developed minor complications, usually infection.

Embolization was the more cost effective of the two procedures overall, even though it required more imaging studies in the year following the intervention and also required more secondary interventions after treatment failure, Dr. Edwards and his associates reported.

This study was supported in part by three companies that manufacture embolic agents: William Cook Europe, Cordis Corp., and Biocompatibles Ltd.

The choice between standard surgery to remove uterine fibroids and uterine artery embolization comes down to weighing the benefits and risks of the two procedures, because quality of life and other outcomes at 1 year are fairly comparable, according to Dr. Richard D. Edwards and his associates in the Randomized Trial of Embolization versus Surgical Treatment.

The advantages of uterine artery embolization (UAE)—significantly shorter hospital stay, less postprocedure pain, and faster return to usual activities—must be weighed against a treatment failure rate that may be as high as 20% and a small but still significantly increased risk of late adverse events, the researchers said.

“The results of our study make clear that the choice between surgery and uterine artery embolization for symptomatic uterine fibroids involves [trade-offs],” said Dr. Edwards of Gartnavel General Hospital, Glasgow, Scotland, and his associates.

The trial, specifically designed to assess quality of life and other outcomes at 1 year of follow-up, involved 140 women with one or more fibroids larger than 2 cm who were treated at 27 hospitals throughout the United Kingdom. Approximately twice as many subjects were randomly assigned to the UAE group as to the surgical group, to allow better characterization of outcomes of the embolization and minimal reduction in statistical power.

Quality of life—the primary outcome measure—was assessed using the Medical Outcomes Study's 36-item short-form general health survey (MOS SF-36). There were no significant differences between the two groups at 1 year on any of the eight components measured, the investigators said (N. Engl. J. Med. 2007;356:360–70).

Of the UAE group, 21 women (20%) required an additional invasive procedure—hysterectomy or repeat UAE—for continued or recurrent symptoms. Ten of them had the second intervention within 1 year and 11 had it within 2 years of the initial procedure. In contrast, symptom scores were significantly better in the surgery group at all time points assessed.

Women in the UAE group had significantly shorter hospital stays (1 day vs. 5 days), resumed their usual activities much sooner, and reported significantly less pain and better social function post procedure.

A similarly high percentage of women in both groups (93% of the surgical group and 88% of the UAE group) said they would recommend their procedure to a friend.

Rates of major adverse events and of minor complications did not differ significantly, but the timing and nature of these events did.

There were 16 major adverse events (15%) in the UAE group and 10 (20%) in the surgery group, results which did not differ significantly.

However, 15 of the 16 such events occurred after hospital discharge in the UAE group, whereas only one such event occurred after hospital discharge in the surgery group.

A total of 36 women in the UAE group (34%) developed minor complications, usually the pyrexia, pain, and elevated markers of inflammation of postembolization syndrome. Similarly, 10 women in the surgery group (20%) developed minor complications, usually infection.

Embolization was the more cost effective of the two procedures overall, even though it required more imaging studies in the year following the intervention and also required more secondary interventions after treatment failure, Dr. Edwards and his associates reported.

This study was supported in part by three companies that manufacture embolic agents: William Cook Europe, Cordis Corp., and Biocompatibles Ltd.

The choice between standard surgery to remove uterine fibroids and uterine artery embolization comes down to weighing the benefits and risks of the two procedures, because quality of life and other outcomes at 1 year are fairly comparable, according to Dr. Richard D. Edwards and his associates in the Randomized Trial of Embolization versus Surgical Treatment.

The advantages of uterine artery embolization (UAE)—significantly shorter hospital stay, less postprocedure pain, and faster return to usual activities—must be weighed against a treatment failure rate that may be as high as 20% and a small but still significantly increased risk of late adverse events, the researchers said.

“The results of our study make clear that the choice between surgery and uterine artery embolization for symptomatic uterine fibroids involves [trade-offs],” said Dr. Edwards of Gartnavel General Hospital, Glasgow, Scotland, and his associates.

The trial, specifically designed to assess quality of life and other outcomes at 1 year of follow-up, involved 140 women with one or more fibroids larger than 2 cm who were treated at 27 hospitals throughout the United Kingdom. Approximately twice as many subjects were randomly assigned to the UAE group as to the surgical group, to allow better characterization of outcomes of the embolization and minimal reduction in statistical power.

Quality of life—the primary outcome measure—was assessed using the Medical Outcomes Study's 36-item short-form general health survey (MOS SF-36). There were no significant differences between the two groups at 1 year on any of the eight components measured, the investigators said (N. Engl. J. Med. 2007;356:360–70).

Of the UAE group, 21 women (20%) required an additional invasive procedure—hysterectomy or repeat UAE—for continued or recurrent symptoms. Ten of them had the second intervention within 1 year and 11 had it within 2 years of the initial procedure. In contrast, symptom scores were significantly better in the surgery group at all time points assessed.

Women in the UAE group had significantly shorter hospital stays (1 day vs. 5 days), resumed their usual activities much sooner, and reported significantly less pain and better social function post procedure.

A similarly high percentage of women in both groups (93% of the surgical group and 88% of the UAE group) said they would recommend their procedure to a friend.

Rates of major adverse events and of minor complications did not differ significantly, but the timing and nature of these events did.

There were 16 major adverse events (15%) in the UAE group and 10 (20%) in the surgery group, results which did not differ significantly.

However, 15 of the 16 such events occurred after hospital discharge in the UAE group, whereas only one such event occurred after hospital discharge in the surgery group.

A total of 36 women in the UAE group (34%) developed minor complications, usually the pyrexia, pain, and elevated markers of inflammation of postembolization syndrome. Similarly, 10 women in the surgery group (20%) developed minor complications, usually infection.

Embolization was the more cost effective of the two procedures overall, even though it required more imaging studies in the year following the intervention and also required more secondary interventions after treatment failure, Dr. Edwards and his associates reported.

This study was supported in part by three companies that manufacture embolic agents: William Cook Europe, Cordis Corp., and Biocompatibles Ltd.

Oral human papillomavirus infection is strongly associated with head and neck cancer, reported Gypsyamber D'Souza, Ph.D., of Johns Hopkins Bloomberg School of Public Health, Baltimore, and her associates.

“Although a cause-and-effect relationship cannot be inferred from a single study, our findings confirm and extend those of other” studies, the researchers noted.

In an editorial comment accompanying the report, Stina Syrjänen, D.D.S., of the University of Turku (Finland), said that the link between oral HPV and squamous-cell oropharyngeal cancers, which “has been under investigation for at least 20 years,” now appears to be firmly established.

Questions now arise as to whether groups such as smokers and alcohol drinkers, who are at high risk for head and neck cancers, should be screened for oral HPV, Dr. Syrjänen said, and whether intraepithelial neoplastic lesions in the head and neck region, which are considered to be cancer precursors, should be treated differently if they are HPV positive.

It is also worth considering the possibility that some head and neck cancers might be prevented by HPV vaccination, Dr. Syrjänen added (N. Engl. J. Med. 2007;356:1993–5).

Dr. D'Souza and her associates conducted a case-control study using data from a longitudinal cohort study of 130 consecutive patients with head and neck cancer who were treated at the Johns Hopkins otolaryngology clinic during 2000–2005 (N. Engl. J. Med. 2007;356:1944–56). Most of the cancers involved the base of the tongue and the tonsils. They assessed markers of HPV infection in 100 of these patients and in 200 age-, sex-, and race-matched control subjects who were treated at the same clinic for benign conditions.

Oropharyngeal cancer was strongly associated with current oral HPV infection and with previous HPV exposure, as determined by serologic testing. The link was particularly strong with HPV-16, but was also noted with any of 37 HPV types tested, the researchers said.

HPV-positive head and neck cancer also was strongly associated with high-risk sexual behaviors, including a large number of lifetime sexual partners in either oral sex or vaginal sex, early age at first intercourse, frequent casual sex, and infrequent use of condoms.

In addition, HPV-16 DNA was specifically localized to tumor-cell nuclei in 72 of 100 tumor specimens examined. This finding was further corroborated by the finding of a high prevalence (64%) of antibodies to HPV-16 oncoproteins E6 and E7.

“We found that exposure to HPV increased the association with oropharyngeal cancer regardless of tobacco and alcohol use, but we uncovered no evidence of synergy between exposure to HPV and tobacco or alcohol use. For these reasons, our data suggest two distinct pathways for the development of oropharyngeal cancer: one driven predominantly by the carcinogenic effects of tobacco or alcohol (or both), and another by HPV-induced genomic instability,” Dr. D'Souza and her associates said.

Taken together with the results of previous studies, these findings “provide a rationale for HPV vaccination in both boys and girls—since oropharyngeal cancers occur in men and women,” they noted.

Their study findings also indicate that oral HPV infection is sexually acquired, though not necessarily from oral-genital contact alone. Mouth-to-mouth and other means of transmission cannot be ruled out. It is possible that “the widespread oral sexual practices among adolescents” may be contributing to annual increases in the incidence of tonsillar and base-of-tongue cancers noted in the United States since 1973, they added.

Oral human papillomavirus infection is strongly associated with head and neck cancer, reported Gypsyamber D'Souza, Ph.D., of Johns Hopkins Bloomberg School of Public Health, Baltimore, and her associates.

“Although a cause-and-effect relationship cannot be inferred from a single study, our findings confirm and extend those of other” studies, the researchers noted.

In an editorial comment accompanying the report, Stina Syrjänen, D.D.S., of the University of Turku (Finland), said that the link between oral HPV and squamous-cell oropharyngeal cancers, which “has been under investigation for at least 20 years,” now appears to be firmly established.

Questions now arise as to whether groups such as smokers and alcohol drinkers, who are at high risk for head and neck cancers, should be screened for oral HPV, Dr. Syrjänen said, and whether intraepithelial neoplastic lesions in the head and neck region, which are considered to be cancer precursors, should be treated differently if they are HPV positive.

It is also worth considering the possibility that some head and neck cancers might be prevented by HPV vaccination, Dr. Syrjänen added (N. Engl. J. Med. 2007;356:1993–5).

Dr. D'Souza and her associates conducted a case-control study using data from a longitudinal cohort study of 130 consecutive patients with head and neck cancer who were treated at the Johns Hopkins otolaryngology clinic during 2000–2005 (N. Engl. J. Med. 2007;356:1944–56). Most of the cancers involved the base of the tongue and the tonsils. They assessed markers of HPV infection in 100 of these patients and in 200 age-, sex-, and race-matched control subjects who were treated at the same clinic for benign conditions.

Oropharyngeal cancer was strongly associated with current oral HPV infection and with previous HPV exposure, as determined by serologic testing. The link was particularly strong with HPV-16, but was also noted with any of 37 HPV types tested, the researchers said.

HPV-positive head and neck cancer also was strongly associated with high-risk sexual behaviors, including a large number of lifetime sexual partners in either oral sex or vaginal sex, early age at first intercourse, frequent casual sex, and infrequent use of condoms.

In addition, HPV-16 DNA was specifically localized to tumor-cell nuclei in 72 of 100 tumor specimens examined. This finding was further corroborated by the finding of a high prevalence (64%) of antibodies to HPV-16 oncoproteins E6 and E7.

“We found that exposure to HPV increased the association with oropharyngeal cancer regardless of tobacco and alcohol use, but we uncovered no evidence of synergy between exposure to HPV and tobacco or alcohol use. For these reasons, our data suggest two distinct pathways for the development of oropharyngeal cancer: one driven predominantly by the carcinogenic effects of tobacco or alcohol (or both), and another by HPV-induced genomic instability,” Dr. D'Souza and her associates said.

Taken together with the results of previous studies, these findings “provide a rationale for HPV vaccination in both boys and girls—since oropharyngeal cancers occur in men and women,” they noted.

Their study findings also indicate that oral HPV infection is sexually acquired, though not necessarily from oral-genital contact alone. Mouth-to-mouth and other means of transmission cannot be ruled out. It is possible that “the widespread oral sexual practices among adolescents” may be contributing to annual increases in the incidence of tonsillar and base-of-tongue cancers noted in the United States since 1973, they added.

Oral human papillomavirus infection is strongly associated with head and neck cancer, reported Gypsyamber D'Souza, Ph.D., of Johns Hopkins Bloomberg School of Public Health, Baltimore, and her associates.

“Although a cause-and-effect relationship cannot be inferred from a single study, our findings confirm and extend those of other” studies, the researchers noted.

In an editorial comment accompanying the report, Stina Syrjänen, D.D.S., of the University of Turku (Finland), said that the link between oral HPV and squamous-cell oropharyngeal cancers, which “has been under investigation for at least 20 years,” now appears to be firmly established.

Questions now arise as to whether groups such as smokers and alcohol drinkers, who are at high risk for head and neck cancers, should be screened for oral HPV, Dr. Syrjänen said, and whether intraepithelial neoplastic lesions in the head and neck region, which are considered to be cancer precursors, should be treated differently if they are HPV positive.

It is also worth considering the possibility that some head and neck cancers might be prevented by HPV vaccination, Dr. Syrjänen added (N. Engl. J. Med. 2007;356:1993–5).

Dr. D'Souza and her associates conducted a case-control study using data from a longitudinal cohort study of 130 consecutive patients with head and neck cancer who were treated at the Johns Hopkins otolaryngology clinic during 2000–2005 (N. Engl. J. Med. 2007;356:1944–56). Most of the cancers involved the base of the tongue and the tonsils. They assessed markers of HPV infection in 100 of these patients and in 200 age-, sex-, and race-matched control subjects who were treated at the same clinic for benign conditions.

Oropharyngeal cancer was strongly associated with current oral HPV infection and with previous HPV exposure, as determined by serologic testing. The link was particularly strong with HPV-16, but was also noted with any of 37 HPV types tested, the researchers said.

HPV-positive head and neck cancer also was strongly associated with high-risk sexual behaviors, including a large number of lifetime sexual partners in either oral sex or vaginal sex, early age at first intercourse, frequent casual sex, and infrequent use of condoms.

In addition, HPV-16 DNA was specifically localized to tumor-cell nuclei in 72 of 100 tumor specimens examined. This finding was further corroborated by the finding of a high prevalence (64%) of antibodies to HPV-16 oncoproteins E6 and E7.

“We found that exposure to HPV increased the association with oropharyngeal cancer regardless of tobacco and alcohol use, but we uncovered no evidence of synergy between exposure to HPV and tobacco or alcohol use. For these reasons, our data suggest two distinct pathways for the development of oropharyngeal cancer: one driven predominantly by the carcinogenic effects of tobacco or alcohol (or both), and another by HPV-induced genomic instability,” Dr. D'Souza and her associates said.

Taken together with the results of previous studies, these findings “provide a rationale for HPV vaccination in both boys and girls—since oropharyngeal cancers occur in men and women,” they noted.

Their study findings also indicate that oral HPV infection is sexually acquired, though not necessarily from oral-genital contact alone. Mouth-to-mouth and other means of transmission cannot be ruled out. It is possible that “the widespread oral sexual practices among adolescents” may be contributing to annual increases in the incidence of tonsillar and base-of-tongue cancers noted in the United States since 1973, they added.

Neither spontaneous nor induced abortion appear to be related to breast cancer risk in premenopausal women, according to a retrospective study of data from the Nurses' Health Study.

“The association between abortion and breast cancer has previously been considered in numerous studies,” with conflicting results, Karin B. Michels, Ph.D., of Harvard Medical School, Boston, and her associates wrote. About half of the studies of induced abortion have found an increased risk of breast cancer, while the rest have found either no association or an inverse association. Most studies of spontaneous abortion have found no link with breast cancer risk.

The investigators reviewed about a decade's worth of relevant data from the Nurses' Health Study (NHS) and reported their results in the Archives of Internal Medicine.

The NHS is an ongoing cohort study of the associations between lifestyle factors, reproductive factors, and breast cancer and other major illnesses. The first biennial NHS survey in 1989 involved more than 100,000 female registered nurses aged 25–42 years in 14 states.

Information on induced and spontaneous abortions was first obtained in 1993. Dr. Michels and her associates assessed breast cancer incidence in 105,716 of the subjects who provided that information and were followed for approximately 10 years. Of these women, 15% reported that they had had one or more induced abortions and 21% reported that they had had one or more spontaneous abortions.

A total of 1,458 newly diagnosed cases of invasive breast cancer developed during follow-up. There was no association between induced abortion and breast cancer risk. There was a suggestion of an inverse association between spontaneous abortion and risk, but that may have been because of chance, the investigators said (Arch. Intern. Med. 2007;167:814–20).

“Breast cancer cases in our study population were almost exclusively premenopausal; therefore, our results may not be generalizable to postmenopausal women,” they noted.

In 2003, the summary report of a National Cancer Institute international expert panel concluded that the evidence to that date showed no link between induced abortion and breast cancer risk.

Neither spontaneous nor induced abortion appear to be related to breast cancer risk in premenopausal women, according to a retrospective study of data from the Nurses' Health Study.

“The association between abortion and breast cancer has previously been considered in numerous studies,” with conflicting results, Karin B. Michels, Ph.D., of Harvard Medical School, Boston, and her associates wrote. About half of the studies of induced abortion have found an increased risk of breast cancer, while the rest have found either no association or an inverse association. Most studies of spontaneous abortion have found no link with breast cancer risk.

The investigators reviewed about a decade's worth of relevant data from the Nurses' Health Study (NHS) and reported their results in the Archives of Internal Medicine.

The NHS is an ongoing cohort study of the associations between lifestyle factors, reproductive factors, and breast cancer and other major illnesses. The first biennial NHS survey in 1989 involved more than 100,000 female registered nurses aged 25–42 years in 14 states.

Information on induced and spontaneous abortions was first obtained in 1993. Dr. Michels and her associates assessed breast cancer incidence in 105,716 of the subjects who provided that information and were followed for approximately 10 years. Of these women, 15% reported that they had had one or more induced abortions and 21% reported that they had had one or more spontaneous abortions.

A total of 1,458 newly diagnosed cases of invasive breast cancer developed during follow-up. There was no association between induced abortion and breast cancer risk. There was a suggestion of an inverse association between spontaneous abortion and risk, but that may have been because of chance, the investigators said (Arch. Intern. Med. 2007;167:814–20).

“Breast cancer cases in our study population were almost exclusively premenopausal; therefore, our results may not be generalizable to postmenopausal women,” they noted.

In 2003, the summary report of a National Cancer Institute international expert panel concluded that the evidence to that date showed no link between induced abortion and breast cancer risk.

Neither spontaneous nor induced abortion appear to be related to breast cancer risk in premenopausal women, according to a retrospective study of data from the Nurses' Health Study.

“The association between abortion and breast cancer has previously been considered in numerous studies,” with conflicting results, Karin B. Michels, Ph.D., of Harvard Medical School, Boston, and her associates wrote. About half of the studies of induced abortion have found an increased risk of breast cancer, while the rest have found either no association or an inverse association. Most studies of spontaneous abortion have found no link with breast cancer risk.

The investigators reviewed about a decade's worth of relevant data from the Nurses' Health Study (NHS) and reported their results in the Archives of Internal Medicine.

The NHS is an ongoing cohort study of the associations between lifestyle factors, reproductive factors, and breast cancer and other major illnesses. The first biennial NHS survey in 1989 involved more than 100,000 female registered nurses aged 25–42 years in 14 states.

Information on induced and spontaneous abortions was first obtained in 1993. Dr. Michels and her associates assessed breast cancer incidence in 105,716 of the subjects who provided that information and were followed for approximately 10 years. Of these women, 15% reported that they had had one or more induced abortions and 21% reported that they had had one or more spontaneous abortions.

A total of 1,458 newly diagnosed cases of invasive breast cancer developed during follow-up. There was no association between induced abortion and breast cancer risk. There was a suggestion of an inverse association between spontaneous abortion and risk, but that may have been because of chance, the investigators said (Arch. Intern. Med. 2007;167:814–20).

“Breast cancer cases in our study population were almost exclusively premenopausal; therefore, our results may not be generalizable to postmenopausal women,” they noted.

In 2003, the summary report of a National Cancer Institute international expert panel concluded that the evidence to that date showed no link between induced abortion and breast cancer risk.

Performing a colonoscopy in a private office or clinic rather than a hospital triples the likelihood that the procedure will be incomplete, reported Dr. Hemant A. Shah and associates in an article in the June issue of Gastroenterology.

The University of Toronto researchers conducted a population-based study to assess the effects of patient, endoscopist, and treatment-setting factors on the risk for incomplete colonoscopy. Their sample comprised more than 331,000 index colonoscopies, and more than 43,000 (13%) were incomplete.

Older patient age, female sex, and a history of abdominal or pelvic surgery were the main patient factors that raised the risk of incomplete colonoscopy. Regarding endoscopist factors, performing a low volume of the procedures and practicing general medicine rather than specializing in gastroenterology both increase the risk of incomplete colonoscopy, they reported.

The authors combined information from four Canadian databases to identify all residents of Ontario who underwent screening colonoscopy between 1999 and 2003 when they were aged 50–74 years. The mean patient age was 61 years, and 47% of the subjects were men. Procedures in which the colonoscope was inserted to the cecum or the terminal ileum were considered complete; procedures that fell short of those landmarks were considered incomplete.

In physician specialties, general surgeons performed the largest number of procedures (47%) and gastroenterologists performed the smallest (24%). The physician category combining internists, family physicians, and general practitioners accounted for the remaining 29% of colonoscopies. Community hospitals were the most common setting (72%). Another 15% of the procedures were performed in private offices, and 13% were done in academic hospitals.

The rates of incomplete colonoscopy were highest in the office setting (24.6%), compared with the community hospital (10.8%) and academic hospital (12.6%), regardless of patient or endoscopist characteristics. This high rate is of concern because of the rapid growth of office-based colonoscopy in many areas. That growth is fueled by limited access to endoscopy resources in many hospitals, particularly in academic medical centers, they added.

The researchers did not examine the reasons for incomplete colonoscopy but suggested that less or no sedation is used in offices, so more procedures are abandoned because of patient discomfort.

Endoscopists who performed a high volume of the procedures were the most likely to achieve complete colonoscopies. Among physicians with a low volume of these procedures, generalist physicians had an incomplete colonoscopy rate of nearly 30%, whereas general surgeons and gastroenterologists had incompletion rates of about 17% and 14%, respectively.

Performing a colonoscopy in a private office or clinic rather than a hospital triples the likelihood that the procedure will be incomplete, reported Dr. Hemant A. Shah and associates in an article in the June issue of Gastroenterology.

The University of Toronto researchers conducted a population-based study to assess the effects of patient, endoscopist, and treatment-setting factors on the risk for incomplete colonoscopy. Their sample comprised more than 331,000 index colonoscopies, and more than 43,000 (13%) were incomplete.

Older patient age, female sex, and a history of abdominal or pelvic surgery were the main patient factors that raised the risk of incomplete colonoscopy. Regarding endoscopist factors, performing a low volume of the procedures and practicing general medicine rather than specializing in gastroenterology both increase the risk of incomplete colonoscopy, they reported.

The authors combined information from four Canadian databases to identify all residents of Ontario who underwent screening colonoscopy between 1999 and 2003 when they were aged 50–74 years. The mean patient age was 61 years, and 47% of the subjects were men. Procedures in which the colonoscope was inserted to the cecum or the terminal ileum were considered complete; procedures that fell short of those landmarks were considered incomplete.

In physician specialties, general surgeons performed the largest number of procedures (47%) and gastroenterologists performed the smallest (24%). The physician category combining internists, family physicians, and general practitioners accounted for the remaining 29% of colonoscopies. Community hospitals were the most common setting (72%). Another 15% of the procedures were performed in private offices, and 13% were done in academic hospitals.

The rates of incomplete colonoscopy were highest in the office setting (24.6%), compared with the community hospital (10.8%) and academic hospital (12.6%), regardless of patient or endoscopist characteristics. This high rate is of concern because of the rapid growth of office-based colonoscopy in many areas. That growth is fueled by limited access to endoscopy resources in many hospitals, particularly in academic medical centers, they added.

The researchers did not examine the reasons for incomplete colonoscopy but suggested that less or no sedation is used in offices, so more procedures are abandoned because of patient discomfort.

Endoscopists who performed a high volume of the procedures were the most likely to achieve complete colonoscopies. Among physicians with a low volume of these procedures, generalist physicians had an incomplete colonoscopy rate of nearly 30%, whereas general surgeons and gastroenterologists had incompletion rates of about 17% and 14%, respectively.

Performing a colonoscopy in a private office or clinic rather than a hospital triples the likelihood that the procedure will be incomplete, reported Dr. Hemant A. Shah and associates in an article in the June issue of Gastroenterology.

The University of Toronto researchers conducted a population-based study to assess the effects of patient, endoscopist, and treatment-setting factors on the risk for incomplete colonoscopy. Their sample comprised more than 331,000 index colonoscopies, and more than 43,000 (13%) were incomplete.

Older patient age, female sex, and a history of abdominal or pelvic surgery were the main patient factors that raised the risk of incomplete colonoscopy. Regarding endoscopist factors, performing a low volume of the procedures and practicing general medicine rather than specializing in gastroenterology both increase the risk of incomplete colonoscopy, they reported.

The authors combined information from four Canadian databases to identify all residents of Ontario who underwent screening colonoscopy between 1999 and 2003 when they were aged 50–74 years. The mean patient age was 61 years, and 47% of the subjects were men. Procedures in which the colonoscope was inserted to the cecum or the terminal ileum were considered complete; procedures that fell short of those landmarks were considered incomplete.

In physician specialties, general surgeons performed the largest number of procedures (47%) and gastroenterologists performed the smallest (24%). The physician category combining internists, family physicians, and general practitioners accounted for the remaining 29% of colonoscopies. Community hospitals were the most common setting (72%). Another 15% of the procedures were performed in private offices, and 13% were done in academic hospitals.

The rates of incomplete colonoscopy were highest in the office setting (24.6%), compared with the community hospital (10.8%) and academic hospital (12.6%), regardless of patient or endoscopist characteristics. This high rate is of concern because of the rapid growth of office-based colonoscopy in many areas. That growth is fueled by limited access to endoscopy resources in many hospitals, particularly in academic medical centers, they added.

The researchers did not examine the reasons for incomplete colonoscopy but suggested that less or no sedation is used in offices, so more procedures are abandoned because of patient discomfort.

Endoscopists who performed a high volume of the procedures were the most likely to achieve complete colonoscopies. Among physicians with a low volume of these procedures, generalist physicians had an incomplete colonoscopy rate of nearly 30%, whereas general surgeons and gastroenterologists had incompletion rates of about 17% and 14%, respectively.

The long-acting insulin analogues glargine and detemir offer only minor, if any, clinical benefit, according to Dr. K. Horvath and associates in the Cochrane Library's collaborative review group on metabolic and endocrine disorders.

Given this negligible benefit and the current lack of long-term safety and efficacy data, “we suggest a cautious approach to treatment with [glargine or detemir],” they said in an online issue of the Cochrane Database of Systematic Reviews.

The researchers conducted a meta-analysis of eight studies that compared the new, long-acting analogues with NPH insulin, which they termed the current standard of treatment. The studies involved 2,293 patients with type 2 diabetes who were assessed for 24–52 weeks. They noted that the methodologic quality of all of the studies was rated low, allowing for only “a cautious interpretation” of the results.

Glargine (Lantus) showed no superiority to standard insulin therapy in achieving metabolic control, and detemir (Levemir) showed only “clinically unimportant” superiority, the researchers said (Cochrane Database Syst. Rev. 2007 April 18;DOI: 10.1002/14651858.CD005613.pub3).

Nocturnal hypoglycemic events were less frequent in patients treated with either of the two long-acting analogues than in those on standard insulin therapy, but no statistically significant advantage was noted.

None of the trials investigated possible long-term effects of treatment with the new insulin analogues, and the maximum observation period was 12 months. The meta-analysis therefore “cannot provide any further guidance on potential adverse properties, such as mitogenic effects or progression of microvascular complications.”

The long-acting insulin analogues glargine and detemir offer only minor, if any, clinical benefit, according to Dr. K. Horvath and associates in the Cochrane Library's collaborative review group on metabolic and endocrine disorders.

Given this negligible benefit and the current lack of long-term safety and efficacy data, “we suggest a cautious approach to treatment with [glargine or detemir],” they said in an online issue of the Cochrane Database of Systematic Reviews.

The researchers conducted a meta-analysis of eight studies that compared the new, long-acting analogues with NPH insulin, which they termed the current standard of treatment. The studies involved 2,293 patients with type 2 diabetes who were assessed for 24–52 weeks. They noted that the methodologic quality of all of the studies was rated low, allowing for only “a cautious interpretation” of the results.

Glargine (Lantus) showed no superiority to standard insulin therapy in achieving metabolic control, and detemir (Levemir) showed only “clinically unimportant” superiority, the researchers said (Cochrane Database Syst. Rev. 2007 April 18;DOI: 10.1002/14651858.CD005613.pub3).

Nocturnal hypoglycemic events were less frequent in patients treated with either of the two long-acting analogues than in those on standard insulin therapy, but no statistically significant advantage was noted.

None of the trials investigated possible long-term effects of treatment with the new insulin analogues, and the maximum observation period was 12 months. The meta-analysis therefore “cannot provide any further guidance on potential adverse properties, such as mitogenic effects or progression of microvascular complications.”

The long-acting insulin analogues glargine and detemir offer only minor, if any, clinical benefit, according to Dr. K. Horvath and associates in the Cochrane Library's collaborative review group on metabolic and endocrine disorders.

Given this negligible benefit and the current lack of long-term safety and efficacy data, “we suggest a cautious approach to treatment with [glargine or detemir],” they said in an online issue of the Cochrane Database of Systematic Reviews.

The researchers conducted a meta-analysis of eight studies that compared the new, long-acting analogues with NPH insulin, which they termed the current standard of treatment. The studies involved 2,293 patients with type 2 diabetes who were assessed for 24–52 weeks. They noted that the methodologic quality of all of the studies was rated low, allowing for only “a cautious interpretation” of the results.

Glargine (Lantus) showed no superiority to standard insulin therapy in achieving metabolic control, and detemir (Levemir) showed only “clinically unimportant” superiority, the researchers said (Cochrane Database Syst. Rev. 2007 April 18;DOI: 10.1002/14651858.CD005613.pub3).

Nocturnal hypoglycemic events were less frequent in patients treated with either of the two long-acting analogues than in those on standard insulin therapy, but no statistically significant advantage was noted.

None of the trials investigated possible long-term effects of treatment with the new insulin analogues, and the maximum observation period was 12 months. The meta-analysis therefore “cannot provide any further guidance on potential adverse properties, such as mitogenic effects or progression of microvascular complications.”

Depressive symptoms appear to correlate with the development of coronary artery disease, but hostility and anxiety may not, Jesse C. Stewart, Ph.D., and his associates reported.

Several studies have linked various negative emotions with the development of coronary artery disease in initially healthy subjects. But teasing out the relative contributions of depression, anxiety, and hostility has been difficult because they tend to overlap. Dr. Stewart and his associates of the University of Pittsburgh assessed a wide range of such symptoms in a prospective cohort study of subclinical atherosclerosis in healthy subjects aged 50–70 years.

The 324 subjects underwent ultrasonographic assessment of carotid intimal medial thickness (IMT), a noninvasive measure of subclinical atherosclerosis, as well as tests evaluating emotional factors, including the Beck Depression Inventory, the Beck Anxiety Inventory, the Cooke-Medley Hostility Scale, and the State-Trait Anger Expression Inventory.

During 3-year follow-up, only mild to moderate depressive symptoms correlated with the decreasing carotid IMT that signals progression of subclinical atherosclerosis. Hostility symptoms of anxiety, the experience of anger, and the expression of anger showed no correlation with carotid IMT change.

This study is the first ever to report an association between depressive symptoms and carotid IMT change, the investigators said (Arch. Gen. Psychiatry 2007;64:225–33).

The exact mechanism underlying this association is unclear, but depression is known to affect physiologic pathways also involved in atherosclerosis, such as autonomic nervous system dysfunction, hypothalamic-pituitary-adrenal axis dysregulation, inflammatory processes, and altered platelet function, they said.

A post hoc analysis of the data showed that IMT worsening was associated with somatic-vegetative symptoms of depression such as fatigue, sleep disturbance, loss of appetite, and anhedonia, but not associated with more cognitive-affective depressive symptoms such as sadness, pessimism, discontent, or indecisiveness.

Depressive symptoms appear to correlate with the development of coronary artery disease, but hostility and anxiety may not, Jesse C. Stewart, Ph.D., and his associates reported.

Several studies have linked various negative emotions with the development of coronary artery disease in initially healthy subjects. But teasing out the relative contributions of depression, anxiety, and hostility has been difficult because they tend to overlap. Dr. Stewart and his associates of the University of Pittsburgh assessed a wide range of such symptoms in a prospective cohort study of subclinical atherosclerosis in healthy subjects aged 50–70 years.

The 324 subjects underwent ultrasonographic assessment of carotid intimal medial thickness (IMT), a noninvasive measure of subclinical atherosclerosis, as well as tests evaluating emotional factors, including the Beck Depression Inventory, the Beck Anxiety Inventory, the Cooke-Medley Hostility Scale, and the State-Trait Anger Expression Inventory.

During 3-year follow-up, only mild to moderate depressive symptoms correlated with the decreasing carotid IMT that signals progression of subclinical atherosclerosis. Hostility symptoms of anxiety, the experience of anger, and the expression of anger showed no correlation with carotid IMT change.

This study is the first ever to report an association between depressive symptoms and carotid IMT change, the investigators said (Arch. Gen. Psychiatry 2007;64:225–33).

The exact mechanism underlying this association is unclear, but depression is known to affect physiologic pathways also involved in atherosclerosis, such as autonomic nervous system dysfunction, hypothalamic-pituitary-adrenal axis dysregulation, inflammatory processes, and altered platelet function, they said.

A post hoc analysis of the data showed that IMT worsening was associated with somatic-vegetative symptoms of depression such as fatigue, sleep disturbance, loss of appetite, and anhedonia, but not associated with more cognitive-affective depressive symptoms such as sadness, pessimism, discontent, or indecisiveness.

Depressive symptoms appear to correlate with the development of coronary artery disease, but hostility and anxiety may not, Jesse C. Stewart, Ph.D., and his associates reported.

Several studies have linked various negative emotions with the development of coronary artery disease in initially healthy subjects. But teasing out the relative contributions of depression, anxiety, and hostility has been difficult because they tend to overlap. Dr. Stewart and his associates of the University of Pittsburgh assessed a wide range of such symptoms in a prospective cohort study of subclinical atherosclerosis in healthy subjects aged 50–70 years.

The 324 subjects underwent ultrasonographic assessment of carotid intimal medial thickness (IMT), a noninvasive measure of subclinical atherosclerosis, as well as tests evaluating emotional factors, including the Beck Depression Inventory, the Beck Anxiety Inventory, the Cooke-Medley Hostility Scale, and the State-Trait Anger Expression Inventory.

During 3-year follow-up, only mild to moderate depressive symptoms correlated with the decreasing carotid IMT that signals progression of subclinical atherosclerosis. Hostility symptoms of anxiety, the experience of anger, and the expression of anger showed no correlation with carotid IMT change.

This study is the first ever to report an association between depressive symptoms and carotid IMT change, the investigators said (Arch. Gen. Psychiatry 2007;64:225–33).

The exact mechanism underlying this association is unclear, but depression is known to affect physiologic pathways also involved in atherosclerosis, such as autonomic nervous system dysfunction, hypothalamic-pituitary-adrenal axis dysregulation, inflammatory processes, and altered platelet function, they said.

A post hoc analysis of the data showed that IMT worsening was associated with somatic-vegetative symptoms of depression such as fatigue, sleep disturbance, loss of appetite, and anhedonia, but not associated with more cognitive-affective depressive symptoms such as sadness, pessimism, discontent, or indecisiveness.

Computer-aided detection decreased rather than improved the accuracy of mammogram interpretation in a nationwide study involving over 429,000 screening mammograms.

Compared with standard mammography, computer-aided detection (CAD) mammography “was associated with significantly higher false-positive rates, recall rates, and biopsy rates and with significantly lower overall accuracy,” Dr. Joshua J. Fenton and his associates reported. In an editorial comment accompanying the report, Dr. Ferris M. Hall termed the study “the most comprehensive analysis of computer-aided detection in breast screening to date,” and characterized the results as surprising and disappointing. They may not spell the demise of CAD mammography, “but they constitute a substantial hit to this technology,” he said.

According to Dr. Fenton and his associates, CAD has been incorporated into mammography practices rapidly, despite only “tentative” evidence of its clinical benefit, in part because it is Food and Drug Administration approved and its use is reimbursed by Medicare and insurers.

He and his associates studied the results of routine screening mammograms and cancer outcomes for over 222,000 women screened at 43 facilities participating in the Breast Cancer Surveillance Consortium in 1998–2000. During that time, seven of the facilities (16%) implemented CAD. The study design allowed for review of the real-life experience at numerous, diverse facilities with over 150 radiologists across the country, said Dr. Fenton of the University of California, Davis, and his associates.

A total of 2,351 women were diagnosed as having invasive breast cancer or ductal carcinoma in situ within 1 year of their screening mammograms.

The use of CAD proved to be “of uncertain clinical benefit,” the researchers said (N. Engl. J. Med. 2007;356:1399–409).

The technique raised the rates of false-positive results and patient recalls for further assessments, and raised the biopsy rate by nearly 20%. Diagnostic specificity decreased from 90% before implementation of CAD to 87% afterward, and the positive predictive value of screening mammograms declined from 4% to 3%.

CAD slightly increased the diagnostic sensitivity of mammography, but the difference was nonsignificant and was largely accounted for by a slight increase in detection of carcinoma in situ rather than in invasive breast cancer, Dr. Fenton and his associates said.

In his editorial comment, Dr. Hall of Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, concurred with the researchers that larger, controlled trials of CAD are needed, with a particular eye toward determining whether use of the technology has an impact on mortality.

“But such studies will be expensive, controversial, indeterminate, or quickly passé owing to the emergence of new technology. It took 2–3 decades of controversy before it was proved that screening mammography saves lives,” he noted (N. Engl. J. Med. 2007;356:1464–6).

Computer-aided detection decreased rather than improved the accuracy of mammogram interpretation in a nationwide study involving over 429,000 screening mammograms.

Compared with standard mammography, computer-aided detection (CAD) mammography “was associated with significantly higher false-positive rates, recall rates, and biopsy rates and with significantly lower overall accuracy,” Dr. Joshua J. Fenton and his associates reported. In an editorial comment accompanying the report, Dr. Ferris M. Hall termed the study “the most comprehensive analysis of computer-aided detection in breast screening to date,” and characterized the results as surprising and disappointing. They may not spell the demise of CAD mammography, “but they constitute a substantial hit to this technology,” he said.

According to Dr. Fenton and his associates, CAD has been incorporated into mammography practices rapidly, despite only “tentative” evidence of its clinical benefit, in part because it is Food and Drug Administration approved and its use is reimbursed by Medicare and insurers.

He and his associates studied the results of routine screening mammograms and cancer outcomes for over 222,000 women screened at 43 facilities participating in the Breast Cancer Surveillance Consortium in 1998–2000. During that time, seven of the facilities (16%) implemented CAD. The study design allowed for review of the real-life experience at numerous, diverse facilities with over 150 radiologists across the country, said Dr. Fenton of the University of California, Davis, and his associates.

A total of 2,351 women were diagnosed as having invasive breast cancer or ductal carcinoma in situ within 1 year of their screening mammograms.

The use of CAD proved to be “of uncertain clinical benefit,” the researchers said (N. Engl. J. Med. 2007;356:1399–409).

The technique raised the rates of false-positive results and patient recalls for further assessments, and raised the biopsy rate by nearly 20%. Diagnostic specificity decreased from 90% before implementation of CAD to 87% afterward, and the positive predictive value of screening mammograms declined from 4% to 3%.

CAD slightly increased the diagnostic sensitivity of mammography, but the difference was nonsignificant and was largely accounted for by a slight increase in detection of carcinoma in situ rather than in invasive breast cancer, Dr. Fenton and his associates said.

In his editorial comment, Dr. Hall of Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, concurred with the researchers that larger, controlled trials of CAD are needed, with a particular eye toward determining whether use of the technology has an impact on mortality.

“But such studies will be expensive, controversial, indeterminate, or quickly passé owing to the emergence of new technology. It took 2–3 decades of controversy before it was proved that screening mammography saves lives,” he noted (N. Engl. J. Med. 2007;356:1464–6).

Computer-aided detection decreased rather than improved the accuracy of mammogram interpretation in a nationwide study involving over 429,000 screening mammograms.

Compared with standard mammography, computer-aided detection (CAD) mammography “was associated with significantly higher false-positive rates, recall rates, and biopsy rates and with significantly lower overall accuracy,” Dr. Joshua J. Fenton and his associates reported. In an editorial comment accompanying the report, Dr. Ferris M. Hall termed the study “the most comprehensive analysis of computer-aided detection in breast screening to date,” and characterized the results as surprising and disappointing. They may not spell the demise of CAD mammography, “but they constitute a substantial hit to this technology,” he said.

According to Dr. Fenton and his associates, CAD has been incorporated into mammography practices rapidly, despite only “tentative” evidence of its clinical benefit, in part because it is Food and Drug Administration approved and its use is reimbursed by Medicare and insurers.

He and his associates studied the results of routine screening mammograms and cancer outcomes for over 222,000 women screened at 43 facilities participating in the Breast Cancer Surveillance Consortium in 1998–2000. During that time, seven of the facilities (16%) implemented CAD. The study design allowed for review of the real-life experience at numerous, diverse facilities with over 150 radiologists across the country, said Dr. Fenton of the University of California, Davis, and his associates.

A total of 2,351 women were diagnosed as having invasive breast cancer or ductal carcinoma in situ within 1 year of their screening mammograms.

The use of CAD proved to be “of uncertain clinical benefit,” the researchers said (N. Engl. J. Med. 2007;356:1399–409).

The technique raised the rates of false-positive results and patient recalls for further assessments, and raised the biopsy rate by nearly 20%. Diagnostic specificity decreased from 90% before implementation of CAD to 87% afterward, and the positive predictive value of screening mammograms declined from 4% to 3%.

CAD slightly increased the diagnostic sensitivity of mammography, but the difference was nonsignificant and was largely accounted for by a slight increase in detection of carcinoma in situ rather than in invasive breast cancer, Dr. Fenton and his associates said.

In his editorial comment, Dr. Hall of Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, concurred with the researchers that larger, controlled trials of CAD are needed, with a particular eye toward determining whether use of the technology has an impact on mortality.

“But such studies will be expensive, controversial, indeterminate, or quickly passé owing to the emergence of new technology. It took 2–3 decades of controversy before it was proved that screening mammography saves lives,” he noted (N. Engl. J. Med. 2007;356:1464–6).

Older adults who report a high degree of depressive symptoms are more likely to develop type 2 diabetes than are those without depressive symptoms, according to Mercedes R. Carnethon, Ph.D., of Northwestern University, Chicago, and her associates in the Cardiovascular Health Study.

Several studies have found an association between depressive symptoms or clinical depression and diabetes, but this is the first to examine the issue in a population of people over age 65, who have a high prevalence of both disorders, Dr. Carnethon and her associates said in the Archives of Internal Medicine.

The researchers assessed data on 4,681 participants in the Cardiovascular Health Study, which took place from 1989 to 1999. Depressive symptoms had been evaluated annually using the 10-item Center for Epidemiological Studies Depression Scale.

A minimum score of 0 for each item would indicate that the subject experienced that depressive symptom never or rarely, and a maximum score of 3 for each item would indicate that the subject experienced that symptom most of the time or always. Total scores of 8 or more points, out of a possible maximum of 30 points, were considered high.

Twenty percent of the participants had high depressive symptom scores on at least one occasion. The proportion of subjects who were overweight or obese—a factor that could potentially confound the association with diabetes—was similar across those who had low, intermediate, or high depressive symptom scores.

New-onset diabetes was determined by subjects' use of insulin or oral diabetes medications and by fasting glucose levels measured on two occasions during follow-up. A total of 234 subjects developed diabetes.

A high number of depressive symptoms on a single occasion, a significant increase in such symptoms over time, and persistently high symptoms over time all were associated with an excess incidence of diabetes, the investigators reported (Arch. Intern. Med. 2007;167:802–7).

The strongest link with diabetes was found when depressive symptom scores rose by at least 5 points over time.

“These findings were present across demographic strata and persisted with statistical adjustment for known correlates of depression and diabetes, such as BMI [body mass index], physical activity, cigarette smoking, alcohol intake, and C-reactive protein level,” Dr. Carnethon and her associates said.

In summary, high depressive symptoms might be connected to the development of diabetes in older adults, and this association might not be attributable solely to adverse health behaviors or weight gain. “The pathophysiologic mechanism for this association remains unclear,” they said.

Inflammation is often proposed as a likely mechanism, because inflammatory markers are associated with both diabetes and depression. However, the findings of this study showed no attenuation of the link between the two disorders when the data were adjusted for C-reactive protein levels. This suggests that “other biological mechanisms previously proposed, such as hypothalamic-pituitary-adrenal axis dysregulation and sympathetic nervous system stimulation, may be more salient,” they added.

Older adults who report a high degree of depressive symptoms are more likely to develop type 2 diabetes than are those without depressive symptoms, according to Mercedes R. Carnethon, Ph.D., of Northwestern University, Chicago, and her associates in the Cardiovascular Health Study.

Several studies have found an association between depressive symptoms or clinical depression and diabetes, but this is the first to examine the issue in a population of people over age 65, who have a high prevalence of both disorders, Dr. Carnethon and her associates said in the Archives of Internal Medicine.

The researchers assessed data on 4,681 participants in the Cardiovascular Health Study, which took place from 1989 to 1999. Depressive symptoms had been evaluated annually using the 10-item Center for Epidemiological Studies Depression Scale.

A minimum score of 0 for each item would indicate that the subject experienced that depressive symptom never or rarely, and a maximum score of 3 for each item would indicate that the subject experienced that symptom most of the time or always. Total scores of 8 or more points, out of a possible maximum of 30 points, were considered high.

Twenty percent of the participants had high depressive symptom scores on at least one occasion. The proportion of subjects who were overweight or obese—a factor that could potentially confound the association with diabetes—was similar across those who had low, intermediate, or high depressive symptom scores.

New-onset diabetes was determined by subjects' use of insulin or oral diabetes medications and by fasting glucose levels measured on two occasions during follow-up. A total of 234 subjects developed diabetes.

A high number of depressive symptoms on a single occasion, a significant increase in such symptoms over time, and persistently high symptoms over time all were associated with an excess incidence of diabetes, the investigators reported (Arch. Intern. Med. 2007;167:802–7).

The strongest link with diabetes was found when depressive symptom scores rose by at least 5 points over time.

“These findings were present across demographic strata and persisted with statistical adjustment for known correlates of depression and diabetes, such as BMI [body mass index], physical activity, cigarette smoking, alcohol intake, and C-reactive protein level,” Dr. Carnethon and her associates said.

In summary, high depressive symptoms might be connected to the development of diabetes in older adults, and this association might not be attributable solely to adverse health behaviors or weight gain. “The pathophysiologic mechanism for this association remains unclear,” they said.

Inflammation is often proposed as a likely mechanism, because inflammatory markers are associated with both diabetes and depression. However, the findings of this study showed no attenuation of the link between the two disorders when the data were adjusted for C-reactive protein levels. This suggests that “other biological mechanisms previously proposed, such as hypothalamic-pituitary-adrenal axis dysregulation and sympathetic nervous system stimulation, may be more salient,” they added.

Older adults who report a high degree of depressive symptoms are more likely to develop type 2 diabetes than are those without depressive symptoms, according to Mercedes R. Carnethon, Ph.D., of Northwestern University, Chicago, and her associates in the Cardiovascular Health Study.

Several studies have found an association between depressive symptoms or clinical depression and diabetes, but this is the first to examine the issue in a population of people over age 65, who have a high prevalence of both disorders, Dr. Carnethon and her associates said in the Archives of Internal Medicine.

The researchers assessed data on 4,681 participants in the Cardiovascular Health Study, which took place from 1989 to 1999. Depressive symptoms had been evaluated annually using the 10-item Center for Epidemiological Studies Depression Scale.

A minimum score of 0 for each item would indicate that the subject experienced that depressive symptom never or rarely, and a maximum score of 3 for each item would indicate that the subject experienced that symptom most of the time or always. Total scores of 8 or more points, out of a possible maximum of 30 points, were considered high.

Twenty percent of the participants had high depressive symptom scores on at least one occasion. The proportion of subjects who were overweight or obese—a factor that could potentially confound the association with diabetes—was similar across those who had low, intermediate, or high depressive symptom scores.

New-onset diabetes was determined by subjects' use of insulin or oral diabetes medications and by fasting glucose levels measured on two occasions during follow-up. A total of 234 subjects developed diabetes.

A high number of depressive symptoms on a single occasion, a significant increase in such symptoms over time, and persistently high symptoms over time all were associated with an excess incidence of diabetes, the investigators reported (Arch. Intern. Med. 2007;167:802–7).

The strongest link with diabetes was found when depressive symptom scores rose by at least 5 points over time.

“These findings were present across demographic strata and persisted with statistical adjustment for known correlates of depression and diabetes, such as BMI [body mass index], physical activity, cigarette smoking, alcohol intake, and C-reactive protein level,” Dr. Carnethon and her associates said.

In summary, high depressive symptoms might be connected to the development of diabetes in older adults, and this association might not be attributable solely to adverse health behaviors or weight gain. “The pathophysiologic mechanism for this association remains unclear,” they said.

Inflammation is often proposed as a likely mechanism, because inflammatory markers are associated with both diabetes and depression. However, the findings of this study showed no attenuation of the link between the two disorders when the data were adjusted for C-reactive protein levels. This suggests that “other biological mechanisms previously proposed, such as hypothalamic-pituitary-adrenal axis dysregulation and sympathetic nervous system stimulation, may be more salient,” they added.

Patients with type 2 diabetes are at risk for amnestic mild cognitive impairment, which is thought to be a precursor of Alzheimer's disease, reported Dr. José A. Luchsinger and his associates at Columbia University, New York.

Diabetes is known to raise the risk of Alzheimer's disease (AD), but its relation to mild cognitive impairment (MCI) has not been established until now. Some researchers and physicians have described mild cognitive impairment, particularly amnestic MCI, as a transitional state between normal cognition and AD, the investigators wrote.

Dr. Luchsinger and his associates studied the relationship between diabetes and MCI using data from a longitudinal cohort study of 918 Medicare recipients residing in New York City. Baseline data were collected from 1992 to 1994, and the subjects were followed every 18 months until 2003. They underwent extensive physical and neurologic examinations, including a battery of neuropsychological testing that assessed learning, memory, orientation, abstract reasoning, language, and visuospatial ability.

Seventy percent of the study population was women, and the mean age was 76 years. The study group was 44% Hispanic, 34% African American, and 22% white. Twenty-four percent of the subjects reported having diabetes.

Cognitive impairment was diagnosed by a consensus of two neurologists, one psychiatrist, and two neuropsychologists. A total of 334 cases of MCI developed during follow-up, including 160 cases of amnestic MCI.

Diabetes was significantly related to MCI of any cause, and even more strongly related to amnestic MCI, even after the data were adjusted to account for subject age, sex, ethnicity, years of education, stroke history, hypertension, heart disease, smoking, and apolipoprotein E gene status.

The calculated risk of MCI attributable to diabetes was 9% for the overall study population, 8% for African Americans, 11% for Hispanics, and 5% for whites, “reflecting the differences in diabetes prevalence by ethnic group,” the investigators noted (Arch. Neurol. 2007;64:570–5).

“Diabetes could be related to a higher risk of AD and amnestic MCI through direct mechanisms, affecting the amyloid accumulation that is the putative culprit of AD, or indirect mechanisms, namely cerebrovascular disease,” Dr. Luchsinger and his associates wrote.

However, their results suggested that the association is independent of cerebrovascular disease.

“Hyperinsulinemia … may disrupt brain amyloid b clearance by means of the insulin degrading enzyme. Another potential mechanism is the generation of advanced products of glycosylation,” the researchers added.

Patients with type 2 diabetes are at risk for amnestic mild cognitive impairment, which is thought to be a precursor of Alzheimer's disease, reported Dr. José A. Luchsinger and his associates at Columbia University, New York.

Diabetes is known to raise the risk of Alzheimer's disease (AD), but its relation to mild cognitive impairment (MCI) has not been established until now. Some researchers and physicians have described mild cognitive impairment, particularly amnestic MCI, as a transitional state between normal cognition and AD, the investigators wrote.

Dr. Luchsinger and his associates studied the relationship between diabetes and MCI using data from a longitudinal cohort study of 918 Medicare recipients residing in New York City. Baseline data were collected from 1992 to 1994, and the subjects were followed every 18 months until 2003. They underwent extensive physical and neurologic examinations, including a battery of neuropsychological testing that assessed learning, memory, orientation, abstract reasoning, language, and visuospatial ability.

Seventy percent of the study population was women, and the mean age was 76 years. The study group was 44% Hispanic, 34% African American, and 22% white. Twenty-four percent of the subjects reported having diabetes.

Cognitive impairment was diagnosed by a consensus of two neurologists, one psychiatrist, and two neuropsychologists. A total of 334 cases of MCI developed during follow-up, including 160 cases of amnestic MCI.

Diabetes was significantly related to MCI of any cause, and even more strongly related to amnestic MCI, even after the data were adjusted to account for subject age, sex, ethnicity, years of education, stroke history, hypertension, heart disease, smoking, and apolipoprotein E gene status.

The calculated risk of MCI attributable to diabetes was 9% for the overall study population, 8% for African Americans, 11% for Hispanics, and 5% for whites, “reflecting the differences in diabetes prevalence by ethnic group,” the investigators noted (Arch. Neurol. 2007;64:570–5).

“Diabetes could be related to a higher risk of AD and amnestic MCI through direct mechanisms, affecting the amyloid accumulation that is the putative culprit of AD, or indirect mechanisms, namely cerebrovascular disease,” Dr. Luchsinger and his associates wrote.

However, their results suggested that the association is independent of cerebrovascular disease.

“Hyperinsulinemia … may disrupt brain amyloid b clearance by means of the insulin degrading enzyme. Another potential mechanism is the generation of advanced products of glycosylation,” the researchers added.

Patients with type 2 diabetes are at risk for amnestic mild cognitive impairment, which is thought to be a precursor of Alzheimer's disease, reported Dr. José A. Luchsinger and his associates at Columbia University, New York.

Diabetes is known to raise the risk of Alzheimer's disease (AD), but its relation to mild cognitive impairment (MCI) has not been established until now. Some researchers and physicians have described mild cognitive impairment, particularly amnestic MCI, as a transitional state between normal cognition and AD, the investigators wrote.

Dr. Luchsinger and his associates studied the relationship between diabetes and MCI using data from a longitudinal cohort study of 918 Medicare recipients residing in New York City. Baseline data were collected from 1992 to 1994, and the subjects were followed every 18 months until 2003. They underwent extensive physical and neurologic examinations, including a battery of neuropsychological testing that assessed learning, memory, orientation, abstract reasoning, language, and visuospatial ability.

Seventy percent of the study population was women, and the mean age was 76 years. The study group was 44% Hispanic, 34% African American, and 22% white. Twenty-four percent of the subjects reported having diabetes.

Cognitive impairment was diagnosed by a consensus of two neurologists, one psychiatrist, and two neuropsychologists. A total of 334 cases of MCI developed during follow-up, including 160 cases of amnestic MCI.

Diabetes was significantly related to MCI of any cause, and even more strongly related to amnestic MCI, even after the data were adjusted to account for subject age, sex, ethnicity, years of education, stroke history, hypertension, heart disease, smoking, and apolipoprotein E gene status.

The calculated risk of MCI attributable to diabetes was 9% for the overall study population, 8% for African Americans, 11% for Hispanics, and 5% for whites, “reflecting the differences in diabetes prevalence by ethnic group,” the investigators noted (Arch. Neurol. 2007;64:570–5).

“Diabetes could be related to a higher risk of AD and amnestic MCI through direct mechanisms, affecting the amyloid accumulation that is the putative culprit of AD, or indirect mechanisms, namely cerebrovascular disease,” Dr. Luchsinger and his associates wrote.

However, their results suggested that the association is independent of cerebrovascular disease.

“Hyperinsulinemia … may disrupt brain amyloid b clearance by means of the insulin degrading enzyme. Another potential mechanism is the generation of advanced products of glycosylation,” the researchers added.