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This week in the medical journals

Results are in: Mammograms save lives

By Peggy Peck
MedPage Today Managing Editor

Editor's note: CNN.com has a business partnership with MedPageToday.com, which provides custom health content. A medical journal roundup from MedPage Today appears each Thursday.

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HEALTH LIBRARY

The numbers don't lie

Cancer was big news in the major medical journals this week, and the biggest news was about mammography screening and whether it is responsible for saving lives of women with breast cancer.

In fact, the screening test was confirmed as an important contributor to the recent decrease in breast cancer mortality.

For years cancer experts have debated the real value of mammography screening. Clearly it detects breast cancer earlier, but does that translate into better survival? The answer is yes, according to seven teams of statisticians who analyzed the same data up one side and down the other.

Although they differed on how much mammography screening contributed to the 24-percent decrease in the breast cancer death rate seen from 1990 to 2000, the average of their findings was that it was almost half. The other major contributor to survival was adjuvant therapy, meaning chemotherapy or radiation or both after surgery.

The researchers were from the M.D. Anderson Cancer Center in Houston and other institutions, and they reported the findings in the New England Journal of Medicine.

Statistical blitz helps pin down mammography benefits

New bladder cancer test

While mammography has been around for decades, a new screening test is being touted as a way to help detect bladder cancers.

Italian researchers say that measuring levels of an enzyme found in urine may provide easy, reliable early detection of bladder cancer, which has a good chance of survival if caught early. The experimental test is called a telomeric repeat amplification protocol, or TRAP test.

The researchers, who described the test in the Journal of the American Medical Association, said it is as accurate as standard urine tests. But unlike the standard tests, TRAP can detect very early bladder cancer.

Enzyme test for bladder cancer may promote early diagnosis

Treatment errors

Screening is useful for early cancer detection, and early detection may increase the chance of cancer survival, but it is only part of the cancer survival story. Treatment is equally important.

But the chemotherapy treatment given is not always the right treatment, according to investigators at Boston's Brigham and Women's Hospital. They analyzed more than 10,000 medication orders for about 1,600 cancer patients and found errors in 3 percent of those chemotherapy orders and serious errors in 2 percent of them.

In adults, 82 percent of the medication errors had the potential to cause harm. In children, about 60 percent of the errors were potentially harmful, according to a study in Cancer.

Chemotherapy errors are not stamped out

A cautionary toddler tale

Meanwhile, there was a word of caution about the urge to "fatten" up kids who start out as small, skinny babies.

Scientists from Oregon Health and Science University reported that small babies who balloon after age 2 are likely to develop heart disease as adults. The researchers, who reported the finding in the New England Journal of Medicine, said that weight gain from birth to age 2 was not associated with an increased risk of heart disease -- only after age 2.

They based the finding on a study of 8,760 people born in Finland from 1934 to 1944 and followed to adulthood.

Childhood growth pattern linked to heart disease risk

More air, please

In medicine, treatments are often decided like a sports playoff series -- best two-out-of-three.

That was the case this week when a third study broke a virtual tie between anesthesiologists who reported that increasing oxygen during surgery could reduce the risk of post-operative infections and those who had data that found no benefit of extra oxygen.

More oxygen is better -- at least for decreasing risk of post-operative infections -- according to a team of anesthesiologists from Valencia, Spain, who reported their tie-breaking results in the Journal of the American Medical Association.

Trial finds extra oxygen during surgery reduces wound infections

This one's for you, Granny

In the same issue of the Journal of the American Medical Association, infectious disease experts from the Minnesota Department of Health reported that the first step in eradicating bacterial pneumonia is a step into the pre-K playroom.

The researchers said that a welcome side-effect of the widespread use of pneumococcal conjugate vaccine among children age 5 and younger is a dramatic decrease in pneumococcal disease among those 65 and older.

So, one key to a healthy Granny is a healthy grandchild.

Kids' vaccine makes elders healthier

Viagra vigor

And that was not the only serendipitous side-effect reported this week. Researchers at Johns Hopkins said that Viagra (sildenafil), the popular little blue pill for erectile dysfunction, may slow down progression of some types of heart disease.

Writing in Circulation, Journal of the American Heart Association, the researchers said that the pill known for its ability to revive sex lives may save lives by slowing heart rate.

This could, researchers say, explain why Viagra is well-tolerated by men with some types of heart disease.

Little blue pill may put brakes on some heart disease

Fighting HIV

Sometimes simple, if painful, measures can improve outcome.

That appears to be the case with male circumcision, according to French and South African researchers, who reported that circumcision may reduce the rate of HIV-infection.

The researchers, whose study appeared in PloS Medicine, said that circumcision was associated with a 60 percent reduction in the rate of HIV in sexually active heterosexual African men.

Male circumcision equal to vaccine in preventing HIV infection

Racial balance

Also in Circulation this week there was more evidence that race can influence medical outcomes.

Researchers examined Medicare records from more than a million heart attack patients and report that both black and white patients are more likely to die within 90 days of a heart attack if they are treated at a hospital that serves a "disproportionately high" number of blacks. This was defined as a hospital where about a third of the patients are black.

That means that if the standard of care were improved at the 541 "black" hospitals that were cited, there would be an across-the-board reduction in heart attack mortality, the researchers said.

Of course, just sending patients to "high-quality hospitals" would have the same effect, they said.

MI mortality higher for all at hospitals with high black-patient prevalence

Work, work, work

And finally, from the old-time comic strip about the adventures of Dagwood to the escapades of the workers on TV's "The Office," difficult bosses are a mainstay of comedy.

But now it emerges that working for a difficult and demanding boss is no laughing matter. Working for an ogre may, in fact, be hazardous to your coronary health.

The flip-side, according to a report in Archives of Internal Medicine, is that workers who say they get a fair deal at work reduce their risk of heart attacks by about 30 percent.

Endnote: Time for a coffee break.

Heartless bosses create coronary-prone workers

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