Subject: Journal Watch General Medicine Alert for March 6, 2007

From: [email-masked]
Date: Tue, 6 Mar 2007 16:19:05 -0800

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GENERAL MEDICINE for March 6, 2007

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Continuing Uncertainty About CT Screening for Lung Cancer
[Summary and Comment | Free]

More cancers were detected, but screening affected neither the number of 
advanced cancers detected nor mortality.
   By Thomas L. Schwenk, MD
   March 6, 2007
   Covering: Bach PB et al. JAMA 2007 Mar 7; 297:953-61
   Black WC and Baron JA. JAMA 2007 Mar 7; 297:995-7
   http://general-medicine.jwatch.org/cgi/content/full/2007/306/1?q=etoc

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Living Near a Freeway Restricts Lung Development in Children
[Summary and Comment | Subscription Required]

Children living near freeways likely have impaired lung function for life.
   By Bruce Soloway, MD
   March 6, 2007
   Covering: Gauderman WJ et al. Lancet 2007 Feb 17; 369:571-7
   http://general-medicine.jwatch.org/cgi/content/full/2007/306/2?q=etoc

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Fecal Incontinence Common After Childbirth
[Summary and Comment | Subscription Required]

Nearly one third of women in a population-based study reported having fecal
incontinence in the first 3 to 6 months after delivery.
   By Robert W. Rebar, MD
   March 6, 2007
   Covering: Guise JM et al. Obstet Gynecol 2007 Feb 109:281-8
   http://general-medicine.jwatch.org/cgi/content/full/2007/306/3?q=etoc

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Increased Risk for Preterm Delivery After Surgical Treatment of CIN
[Summary and Comment | Subscription Required]

Risk was nearly doubled in a population-based case-control study from 
Finland.
   By Robert W. Rebar, MD
   March 6, 2007
   Covering: Jakobsson M et al. Obstet Gynecol 2007 Feb 109:309-13
   http://general-medicine.jwatch.org/cgi/content/full/2007/306/4?q=etoc

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FREE FULL-TEXT ARTICLE

Summary and Comment

Continuing Uncertainty About CT Screening for Lung Cancer
More cancers were detected, but screening affected neither the number of 
advanced cancers detected nor mortality.

In a recently published study of computed tomography screening for lung 
cancer, a large number of early-stage tumors were detected. However, the 
lack of a parallel control group made it impossible to determine whether 
survival was improved by early detection (Journal Watch Oct 25 2006). In 
this new study, 3246 asymptomatic current or former smokers from the U.S. 
and Italy received baseline and annual CT screening for a median of about 4
years. Results were compared with those expected in high-risk populations, 
based on validated prediction models. 

There were 144 cases of lung cancer diagnosed with CT screening, compared 
with 45 cases expected, and 109 lung resections for cancer, compared with 
11 expected. However, no significant difference was found between observed 
and expected numbers of advanced lung cancers detected (42 vs. 33) or 
deaths from lung cancer (38 vs. 39). 

Comment: In this study of CT screening for lung cancer, cases of advanced 
lung cancer or death from lung cancer were no fewer than expected in this 
population. Although proponents of CT screening point to prolonged 
individual survival after detection, individual survival is not equivalent 
to improved population-based mortality rates, primarily because of 
lead-time bias (in which cancers are detected at an earlier stage, but 
eventual outcomes are the same). These results support neither CT screening
for lung cancer nor a proposal that would require Medicare to pay for such 
screening. Both the study authors and the editorialists urge clinicians to 
await the results of ongoing randomized screening trials in the U.S. and 
Europe. 

-- Thomas L. Schwenk, MD 

Published in Journal Watch General Medicine March 6, 2007 

Citation(s):

Bach PB et al. Computed tomography screening and lung cancer outcomes. JAMA
2007 Mar 7; 297:953-61. (Subscription may be required)

Black WC and Baron JA. CT screening for lung cancer: Spiraling into 
confusion? JAMA 2007 Mar 7; 297:995-7. (Subscription may be required)

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