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This week in the medical journals

By Peggy Peck
Medpage Today Senior Editor

Editor's note: has a business partnership with, which provides custom health content. A medical journal roundup from MedPage Today appears each Thursday.
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Better care for women cited

Women's health captured the spotlight in three major medical journals this week. In each case the research findings pointed toward improved health care for women.

The Lancet devoted 30 pages to studies of women with early breast cancer to arrive at this bottom line on chemotherapy for these women -- it works. The analysis of many studies combined found that chemotherapy saves lives and the benefit keeps getting better as chemotherapy treatments improve.

Mortality reductions ranged from 38 percent for young women with early breast cancer to 20 percent for women ages 50 to 69.

But women of all ages who had breast cancers that are fed by estrogen cut their mortality by 31 percent with five years of Nolvadex (tamoxifen) therapy.

Massive meta-analysis validates chemotherapy for breast cancerexternal link

High-tech winner

A second study from The Lancet found that adding a high-tech element to standard mammography improves detection of breast cancer in young women who have an inherited risk of the disease.

Women with a genetic mutation in the BRCA1 or BRCA2 genes have an 85 percent lifetime risk of developing breast cancer, which means they require screening beginning in the their 30s. But younger women have dense breasts, which makes it difficult to find tiny tumors using mammography.

Researchers from London's Institute of Cancer Research solved that problem by using contrast-enhanced MRI scans as well as mammography. The MRI scans found 77 percent of the tumors, while mammography detected 40 percent. Put them together, and there is a winning combination.

MRI synergistic with mammography for detecting breast tumorsexternal link

Low-tech loser

The New England Journal of Medicine's contribution to the focus on women was a report about the right way -- and the wrong way -- to do colon cancer screening in women.

Sigmoidoscopy, a screening test that can be done in a physician's office, is not the best screening test for anyone, but it is a really bad choice for women, reported researchers from the University of Michigan.

The reason that sigmoidoscopy doesn't work as well in women is that precancerous polyps tend to develop in different places in women -- those that are beyond the reach of the sigmoidoscope, which only can examine the rectum and a short length of colon.

The researchers studied almost 1,500 women and report that the flexible sigmoidoscope missed 65 percent of precancerous polyps in these women. They recommended colonoscopy with its greater reach for everyone, particularly women.

Box score? Three hits, no more errors.

Sigmoidoscopy for women has biological deficienciesexternal link

Little progress seen on patient safety

A report in this week's Journal of the American Medical Association was not good news for those concerned about patients' safety.

Five years after the Institute of Medicine pointed out that medical errors cause 98,000 preventable deaths each year, there has been a lot of talk about safety and relatively little action, said Harvard University researchers. On the plus side, doctors and nurses are discussing ways to eliminate errors these days, rather than denying the problem.

But hospital systems have been slow to implement changes -- such as electronic health records -- that could improve patients' safety.

Researchers suggested three strategies to improve patient safety: linking payment to quality, setting nationwide safety goals and urging a cultural shift that would blame "bad systems, not bad people" for errors.

Lesson learned? Mistakes still happen.

Reducing medical errors remains a goal, not a realityexternal link

Travel without worry

Just in time for summer vacation came a bit of happy news for travelers. Xifaxan, a drug used to treat Escherichia coli diarrhea, may actually prevent it.

E. coli is a bug responsible for travelers' diarrhea. Researchers from the University of Texas School of Public Health reported their findings in Annals of Internal Medicine. The researchers gave students traveling in Mexico either Xifaxan or placebo pills and told them to take the pills for two weeks.

About 16 percent of the students taking Xifaxan developed diarrhea, while more than half of the students given placebo pills developed it.

Moreover, the protective effect of Xifaxan lasted for a week after the students stopped taking the drug.

Bottom line: Let Montezuma beware, if the Food and Drug Administration OKs the drug for prevention.

Rifaximin prevents E. coli-triggered travelers' diarrheaexternal link

Rare disease leads to big discovery

A team of North Carolina researchers from the University of North Carolina at Chapel Hill and Duke University reported in the New England Journal of Medicine that a transfusion of umbilical cord blood from an unrelated donor can save newborns with a rare genetic disorder.

The key to success, however, is to give the transfusions before the infants develop symptoms of Krabbe's disease, a fatal inherited disorder that attacks brain and motor skills.

Eleven children who received the transfusions at birth developed normally and have survived more than five years. By contrast, less than half of 14 babies who received the cord blood transfusions after symptoms appeared have survived five years and all had neurologic damage caused by the disease.

The researchers say this treatment also may be effective for other rare but devastating inherited diseases such as Gaucher's disease, Fabry disease, Hurler syndrome and adrenoleukodystrophy. Genetic screening before birth could identify at-risk newborns that could be transfused immediately, the researchers reported.

Potential impact? Major.

Blood stem cells save lives of infants with genetic disorderexternal link

Surgical pointers

Colon cancer surgery can be done just as effectively with a laparoscopic approach, sometimes called keyhole surgery, as it can with a traditional open operation -- with a much shorter recovery time for patients, according to a report from The Lancet.

As an added bonus people who opt for the laparoscopic approach also have fewer complications and less post-surgical pain, said the researchers from St. James's University Hospital in Leeds, England.

But for those needing colon surgery -- or any surgery of the stomach and related organs, the Archives of Surgery has some advice: Make sure your surgeon's track record is not only good but also lengthy.

Researchers from Northwestern University analyzed discharge records from more than 120,000 adults who underwent surgeries for alimentary tract disorders -- for example, surgeries of the gallbladder, esophagus, stomach, and small and large intestines.

The investigators reported that newly minted surgeons should be confined to simple operations such as appendectomies and gallbladder surgery. Complicated procedures, they say, should be left to more experienced surgeons.

Take home? Less can be more -- sometimes.

Laparoscopic surgery succeeding in colon cancerexternal link

Pass the spinach, please

Finally, vitamin E. It may be the favorite vitamin of medical journal editors since barely a week goes by without a vitamin E paper.

This week vitamin E makes a rare appearance in the winner's circle as researchers from Montreal's Royal Victoria Hospital reported in The Lancet Nutrition that moderate intake of vitamin E-rich foods -- dark green leafy vegetables such as spinach as well as nuts, wheat germ and some vegetable oils -- may protect against Parkinson's disease.

The researchers only studied dietary intake so they don't know if supplements could achieve the same benefit, which they estimate was about a 20 percent reduction in risk of Parkinson's.

Strong to the finish? Popeye was right " 'cause he ate his spinach."

Dietary vitamin E may reduce Parkinson's riskexternal link

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