Bowel cancer, TV viewing and obesity

A review of this week's medical research. By GP Dr Lizzie Croton.

Bowel cancer: the screening programme in England should help to reduce mortality rates (Photograph: Zephyr/SPL)

Outcomes of the bowel cancer screening programme

Gut 2012; 61: 1439-46

The bowel cancer screening programme in England has now been operating for six years.

This study analysed outcomes by focusing on patients invited to participate in the first round of screening (up to October 2008). Uptake of the faecal occult blood (FOB) test was 55-60% across the country but was lowest in the London area (40%). These figures were comparable to previous UK study pilots.

Uptake of offers for colonoscopy in those with abnormal tests was high, but only 83% of those with abnormal FOB underwent colonoscopy. In those where cancer was found, 70% were Dukes stage A or B. If these results are maintained, the programme will achieve the intended 16% reduction in overall bowel cancer mortality.

Sugar-sweetened beverages and genetic risk of obesity

N Engl J Med 2012. DOI: 10.1056/NEJMoal203039

In the past 30 years, consumption of sugar-sweetened beverages has dramatically increased. This has paralleled the rise in prevalence of obesity in the US.

These authors hypothesised that intake of such beverages would influence the association between obesity and genetic predisposition to adiposity.

They used two prospective cohorts of participants (6,934 women and 4,423 men). There was also a replication cohort, (21,740 women). Data about BMI, intake of sugar-sweetened beverages and genetic predisposition to adiposity was collected for each participant.

Analysis of the results in the prospective cohorts suggested that greater consumption of sugar-sweetened beverages was associated with greater genetic predisposition to raised BMI and adiposity. This was also seen in the replication cohort.

The combined genetic effects of BMI and obesity risk among participants consuming at least one serving of beverage per day were twice as large as those consuming less than one serving per month. Patients with greater genetic predisposition to obesity appear to be more susceptible to the deleterious effects of sugared beverages on BMI.

Television viewing time and reduced life expectancy 

Br J Sports Med 2012 46: 927-30

Sedentary behaviour is associated with higher mortality risk, particularly from cardiovascular causes. This study aimed to estimate the extent to which television viewing reduced life expectancy in Australia in 2008. The authors used a life table analysis incorporating previously reported mortality rates associated with TV time.

Participants reported the total time they spent watching TV or videos in the previous weeks when this was their main activity. Analysis of the results suggested that when compared with people who watch no TV, those spending a lifetime average of six hours a day doing so could expect to live 4.8 years less.

This study was limited by the low precision with which the relationship between TV viewing time and mortality is currently known.

In fact, watching TV for 6-6.4 hours a day reduces life expectancy by an average 4.3 years for men and 4.1 years for women.

This is comparable to the risk of lifelong smoking after the age of 50 and other major chronic disease risk factors, such as obesity and physical inactivity.

Clinicians' gut feelings about serious infections in children

BMJ 2012; 345: e6144

Around one in 200 children seen in primary care have a serious illness that is easily missed. It is known that in assessing children in primary care, the clinician's intuitive feeling that something is wrong has diagnostic value.

This observational study based in Belgium aimed to examine this 'gut feeling'. It involved a consecutive series of 3,369 children aged 0-16 years.

Of these, 0.2% (six) children were subsequently admitted to hospital with a serious infection.

Analysis of the results suggested the intuition that something was wrong, despite a reassuring clinical examination, increased the risk of serious illness. Acting on the gut feeling would have potentially led to two of the six cases being picked up at first contact.

Clinical features most associated with this gut feeling were the overall responsiveness of the child, abnormal breathing, weight loss and convulsions.

Parental concern that this illness was different to previous ones was also important.

The authors suggest that having a gut feeling something is wrong should provoke a full and careful clinical examination, seeking advice/referral from a more experienced clinician and providing the parent with good safety netting advice.

Behavioural counselling and screening for alcohol misuse

Ann Intern Med 25 Sept 2012

In this US systemic review and meta-analysis, the authors selected 23 controlled trials of at least six months' duration.

Participants were identified by screening in primary care as 'risky' or 'harmful use' drinkers. Trials included in the study generally excluded those with alcohol dependence.

The goals of behavioural counselling for alcohol misuse are to eliminate risky drinking practices (for example, by encouraging fewer drinks per occasion) rather than promoting abstinence.

Analysis of the results suggested that among adults receiving counselling, consumption decreased by 3.6 drinks a week, with 12% fewer adults reporting heavy drinking episodes and 11% more reporting drinking less than the recommended limits after counselling (moderate strength of evidence).

Younger adults and college students in particular showed reduced consumption and fewer heavy drinking episodes after counselling.

The evidence for the effectiveness of counselling in adults was strongest for brief multi-contact interventions, which generally lasted 10-15 minutes per contact. Forms of counselling included brief advice, motivational interviewing and cognitive behavioural strategies.

  • Dr Croton is a GP in Birmingham and a member of our team who regularly review the journals

These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Write an article on the benefits of the bowel cancer screening programme for your practice newsletter, incorporating data from the study, encouraging those who are eligible (or who know someone who is eligible) to take part.
  • Consider training yourself or a member of your team in brief intervention for alcohol misuse in primary care.
  • Add a question about TV viewing hours to patient screening health checks and encourage those scoring highly (more than four hours per day) to consider taking more exercise.

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