Journals Watch - Breast cancer and smoking

Too busy to catch up on all the journals? Let Dr Alison Glenesk update you on the latest research.

Childbirth after breast cancer (above) appears to reduce (Photograph: SPL)
Childbirth after breast cancer (above) appears to reduce (Photograph: SPL)

Childbirth after breast cancer treatment Br J Surg 2010; 97 (8): 1,253-59
Advising patients about pregnancy risk after breast cancer treatment is important.

The Singapore Birth Register and the Swedish Multi-Generation register were used to identify 492 women who gave birth after breast cancer. Cumulative mortality risks and standard mortality ratios (SMRs) were calculated and compared with 8,529 women who had breast cancer but who had not subsequently given birth.

Women with subsequent childbirth had a lower 15-year overall mortality rate than other women with breast cancer (16.8 versus 40.7) but still a higher relative mortality risk than the background population (SMR 13.6). Mortality risks declined with increasing interval between diagnosis and subsequent childbirth.

This study should prove very helpful in advising our younger breast cancer patients.

Acupuncture for heart failure Heart 2010; 96: 1,396-400
Complementary therapies have been a subject of great debate recently.

Although this trial in Heidelberg, Germany, was small, the results are interesting. Seventeen patients with stable, optimally treated congestive heart failure (HF) were randomised into 'acupuncture' and 'placebo acupuncture' groups.

Each patient received 10 treatments, with the placebo group being treated at the same standard acupuncture points but with a blunted telescopic placebo needle.

Cardiopulmonary function, heart-rate variability and quality of life were explored. No improvement in the cardiac ejection fraction was seen, but the six-minute walk distance was increased in the treatment group (+32 +/-7m) but not in the placebo group.

Post-exercise recovery and ventilatory efficiency were also improved, as was heart-rate variability. There was also a tendency for improvement in several quality of life variables.

Effects of sibutramine on cardiovascular outcomes N Engl J Med 2010; 363 (10): 905-15
We were recently advised to stop using sibutramine on the basis of cardiovascular risk, so I was interested to read the evidence.

A total of 10,744 overweight or obese subjects were enrolled. All were 55 years or over with pre-existing cardiovascular disease, type-2 diabetes or both. The objective was to assess the cardiovascular consequences of weight management with and without sibutramine in high-risk subjects.

All subjects received sibutramine for a six-week period after which they were randomised to sibutramine or placebo. The primary end-point was the occurrence of a cardiovascular event.

Mean weight loss in the initial period was 2.6kg, with the drug-treated subjects losing 1.6 kg subsequently. The risk of a primary outcome event was 11.4 per cent in the treated group and 10 per cent in the placebo, so it was concluded that sibutramine increased cardiovascular risk.

GPs' attitudes toward early diagnosis of dementia Br J Gen Pract 2010; 60 (578): e360-65
Over 1 per cent of the population of England has dementia, a figure that will increase as the population ages. How GPs deal with these patients is therefore of vital importance.

The aim of this study was to examine the attitudes, awareness and practice of GPs regarding early diagnosis and perceptions of local speciality service provision.

Questionnaire data was collected from 1,011 GPs. Older GPs were more confident in diagnosing and giving advice about dementia, but less likely to feel that early diagnosis was beneficial, and more likely to see dementia as a drain on resources.

Younger GPs were more positive about early diagnosis and improvements on quality of life. In general, GPs felt they needed more training on dementia.

Prenatal smoking and risk of psychiatric morbidity into young adulthood Arch Gen Psychiatry 2010; 67(8): 841-9
The objective of this Finnish population-based study was to assess the effect of maternal smoking on psychiatric morbidity in the child's adolescent life.

Data were collected on singleton pregnancies from 1987 to 1989 with information on pre-natal smoking exposure (n = 175,869). The prevalence of maternal smoking was 15.3 per cent.

Information on psychiatric diagnoses was derived from outpatient visits (1998-2007) and inpatient care (1987-2007).

The risk of psychiatric morbidity was significantly higher in the exposed children.

Among the offspring of mothers who smoked fewer than 10 cigarettes a day 21 per cent had a psychiatric diagnosis compared with 24.7 per cent of those whose mothers smoked more than 10 cigarettes a day and 13.7 per cent in unexposed children.

The strongest effects were in psychiatric disorders due to substance abuse and in behavioural and emotional disorders.

Mortality was also higher in children exposed to more than 10 cigarettes a day.

Tai Chi for fibromyalgia N Engl J Med 2010; 363: 743-54
Fibromyalgia gives some of us a slightly sinking feeling but this research demonstrates there is a safe and fun treatment for a difficult condition.

Researchers in Boston, USA randomly assigned sufferers to Tai Chi or combined sessions of wellness education with stretching exercises. All sessions lasted for 60 minutes and both groups met twice weekly for 12 weeks.

Assessments were made using the fibromyalgia impact questionnaire (FIQ) which the researchers devised and also the medical outcomes study short-form health survey. These were performed at baseline, 12 weeks and, to assess durability, at 24 weeks. The Tai Chi group showed a 27 per cent drop in FIQ compared with 10 per cent for the control group at 12 weeks and this improvement was maintained at 24 weeks.

  • Dr Glenesk is a GP in Aberdeen and a member of our team who regularly review the journals
CPD IMPACT: earn more credits

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

  • Ask your local secondary care dementia team what they think about the current quality of GP referrals. Set up a meeting for discussion and share information with your GP colleagues.

You could also perform an audit of your referral letters, with a re-audit after six months.

  • Look at all your patients who were treated for breast cancer.

Of those who had subsequent childbirth, make notes of the outcomes.

  • Audit a sample of your patients prescribed weight-loss medication in the past year. Assess whether compliance with treatment and GP adherence to guidelines affected whether the desired weight loss was achieved.

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