U.S. Preventive Services Task Force. Screening for Breast Cancer U.S. Preventive Task Force Recommendation Statement. Annals of Internal Medicine 2009; 151 (November): 716-727
Background: Breast cancer claims the lives of more than 500,000 women worldwide every year and more than one million women receive a diagnosis of breast cancer annually. It is the second most common cause of cancer deaths in women. Due to screening, early diagnosis, and treatment, mortality from breast cancer is declining.
Methods: The U.S Preventive Services Task Force (USPSTF) obtained data from numerous studies and assessed the effectiveness of various breast cancer screening methods.
Results: During the median follow-up of 3.9 years, 444 deaths and 534 recurrences were documented in 5033 surgically treated breast cancer patients. Soy food intake, as measured by either soy protein or soy isoflavone intake, was inversely associated with mortality and recurrence.
Conclusion: The USPSTF did not recommend routine breast cancer screening for women 40-49 years of age and encouraged informed individual preferences. Screening mammography was recommended every two years for women 50-74 years of age. Breast self-examination was discouraged. Routine breast cancer screening after age 75 was not supported.
KEVIN’S COMMENTS: The USPSTF recommendations touched off a firestorm of controversy in the media, in the health care community and among politicians. An immediate reaction is that this is the beginning of the government’s rationing of health care. However, if we look more deeply into the USPSTF recommendations, we find that breast cancer screening itself is associated with some risks, such as radiation exposure from mammography, biopsies for benign lesions, and the anxiety created by finding a mammographic abnormality which often ends up being benign.
It is important to recognize that the USPSTF is not a government agency and its recommendations are based on scientific evidence regarding the benefits versus the risk of screening. The important message is that women should discuss these recommendations with their personal physicians and make a decision about breast cancer screening depending upon individual risk and preference.
CHOLINESTERASE INHIBITORS AND INCIDENCE OF BRADYCARDIA IN PATIENTS WITH DEMENTIA IN THE VETERANS AFFAIRS NEW ENGLAND HEALTHCARE SYSTEM.
HERNANDEZ RK, W, ET AL: JOURNAL OF THE AMERICAN GERIATRICS SOCIETY 2009: 57 (NOVEMBER): 1997-2003
Objective: To quantify the association between cholinesterase inhibitors and a new diagnosis of slow heart rate (bradycardia) and the clinical significance of slow heart rate.
Participants: Patients with dementia from the New England Veterans Affairs Healthcare System who received care between January 1999 and June 2007.
Methods: The authors studied the association of cholinesterase inhibitors on slow heart rate, which was defined as less than 60 beats per minute.
Results: The patients on cholinesterase inhibitors had a higher risk of bradycardia than did the control group. The risk was greatest for those on higher doses of donepezil HCL (Aricept). Patients with slow heart rates were at higher risk for falls, passing out, and requiring a pacemaker.
Conclusion: There was a modestly increased risk for slow heart rates in patients with dementia taking cholinesterase inhibitors.
KEVIN’S COMMENTS: This study has important clinical implications since most persons diagnosed with dementia are placed on cholinesterase inhibitors at some time. Slow heart rates may be associated with serious adverse effects including falls and fainting. Some persons have required pacemaker insertion for symptomatic bradycardia. Monitoring pulse rates and reporting to the personal physician heart rates less than 60, especially in the presence of other symptoms such as lightheadedness/dizziness, fainting, or falls, seems prudent.
FUNCTIONAL DECLINE AND RECOVERY OF ACTIVITIES OF DAILY LIVING IN HOSPITALIZED, DISABLED OLDER WOMEN: THEWOMEN’S HEALTH AND AGING STUDY I.
BOYD CM, RICKS M, ET AL: JOURNAL OF THE AMERICAN GERIATRICS SOCIETY 2009; 57 (OCTOBER)
Objective: To examine the rates and predictors of functional decline, the probability of subsequent functional recovery, and predictors of functional recovery, in disabled older, community-dwelling women who are hospitalized.
Participants: 1,002 community-dwelling older women from the Women’s Health and Aging Study who were moderately to severely disabled and were hospitalized over the study period of 3 years (N=457).
Methods: Functional decline and partial recovery were identified using the activities of daily living (ADL) scale, which was evaluated every six months over three years. Complete recovery was defined as returning to baseline function. Partial recovery was defined as any improvement in the ADL scale after functional decline.
Results: 33% of hospitalized women experienced functional decline the first visit after hospitalization. Frailty, longer length of stay, and higher education were associated with functional decline. 50% fully recovered over the subsequent 30 months, with 33% recovering within six months, and an additional 14% over the following six months. Younger women were more likely to recover.
Conclusion: Although most recovery of function occurs by six months of hospitalization, a substantial proportion of these women recover over the following two years.
KEVIN’S COMMENTS: This study underscores the fact that many older persons may require and benefit from longer periods of rehabilitation than Medicare covers. Many health care providers are familiar with the course of many geriatric patients who experience functional decline following an injury such as a hip fracture and then experience great improvement with their rehabilitation only to decline again when their Medicare-approved days run out. This study demonstrates that older women may continue to improve with up to two years of ongoing rehabilitation. Hopefully, further research will confirm that maintenance rehabilitation following events such as hip fracture and stroke not only improve function for the individual but result in great savings for Medicare.
Dr. Kevin O’Neil is the Medical Director for Brookdale Senior Living Inc., the largest senior housing provider in the United States. He is board certified in both Internal Medicine and Geriatric Medicine. Dr. O’Neil is also a Fellow of the American College of Physicians and a member of the American Geriatrics Society as well as being a member of the American Medical Directors Association and a certified medical director.
NOTE: Brookdale associates who serve as nurses, therapists, lifestyle directors or on a community dining team are invited to submit questions for Geriatric News You Can Use directly to GeriatricNews@brookdaleliving.com.
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