Journals Watch - Colon cancer and miscarriage

Too busy to read all the journals? Let Dr Gwen Lewis keep you up to date with the latest research.

Bowel screening programme in Australia - Med J Aust 2009; 191: 378-81
The National Bowel Cancer Screening Programme (NBCSP) was launched in Australia in May 2006 and offers faecal occult blood testing to 55 or 65 year olds.

A review of data of all cases of colorectal cancer diagnosed in a 26-month period from May 2006 was undertaken in 19 hospitals.

In total, 1,628 cases of colo-rectal cancer were identified, of which 1,268 cases contained information on the patient's status as part of the NBCSP. Of these, 40 (3.2 per cent) cases were recorded as being detected by the screening programme.

In the 55 and 65-year-olds who were screened, 22 cases were detected by screening out of a total of 75 cases of colorectal cancer. Those tumours detected by screening were diagnosed at an earlier stage than the symptomatic tumours with 40 per cent being Stage 1, as compared with 14 per cent of the symptomatic group.

It was noted that 63 per cent of screening-diagnosed tumours were from areas of least socioeconomic disadvantage.

So screening does appear to have a positive measurable effect on diagnosis of colorectal cancer. Of concern is the lower uptake of screening among people from disadvantaged areas.

Swine flu and critical care - N Engl J Med 2009 10.1056/NEJMoa0908481
Australia and New Zealand have just emerged from their winter, so their experience of H1N1 influenza could be useful in planning for the countries in the northern hemisphere.

This study involved all ICUs in Australia and New Zealand over the winter months of 2009.

From 1 June to 31 August 2009, a total of 722 patients with confirmed H1N1 virus (28.7 cases per million inhabitants) were admitted to an ICU.

Of these, 92.7 per cent were aged under 65 years and 9.1 per cent were pregnant women. Of the 601 adults for whom data were available, 28.6 per cent had a BMI >35. The median duration of treatment in ICU was seven days.

As of early September, 103 patients (14.3 per cent) had died while 15.8 per cent remained in hospital.

H1N1 had substantial effects on ICUs during the winter in Australia and New Zealand. I was interested to read about the type of patient severely affected by H1N1.

Management of miscarriage and future pregnancy rates - BMJ 2009; 339: b3,827
First trimester miscarriage may be managed with one of three methods: expectant (watch and wait policy), medical (treatment with mifepristone or misoprostol) or surgical (evacuation of retained products of conception). But does the management method chosen affect the future pregnancy rate?

A total of 1,199 women who had suffered an early spontaneous miscarriage, as confirmed by scan, were recruited from early pregnancy units in the south-west of England and were followed up five years later.

Of those who responded, the live birth rate five years after the index miscarriage was similar in each of the three groups, varying from 79 to 82 per cent.

Of note was that older women and those with previous history of miscarriage were significantly less likely to subsequently give birth.

It appears that we can reassure our patients who suffer a miscarriage that their future pregnancy rate is unaffected by the method of treatment.

Smoking in youngsters - J Adolesc Health 2009; 45: 402-8
Although this study was conducted in the US, I am sure that the results would be comparable in this country.

Smoking rates are declining steadily in the US but experimentation by adolescents is still widespread. Smoking has achieved the status of a 'paediatric disease', as between 80 and 90 per cent of smokers report starting smoking before the age of 18 years.

Data on smoking habits of over 20,000 adolescents in 132 schools across the US were gathered over a period of eight years. The role of peers in affecting an individual's smoking behaviour was examined using a multi-variate structured model.

Controlling for parent level characteristics and other demographic parameters, it was found that a 10 per cent increase in the proportion of classmates who smoke increases the likelihood of an individual smoking by more than 3 per cent.

An increase among an individual's close friends by 10 per cent increases the likelihood of smoking in that individual by 5 per cent.

These findings are not surprising but provide more reason to target children and adolescents on smoking.

Antidepressant use in pregnancy and child health - BJOG 2009; doi:10.1111/1471-0528.2009.02292

This study from the Netherlands looked at healthcare use by children who were exposed to antidepressants while in utero, compared with those whose mother stopped using antidepressants before pregnancy and a control group.

A total of 38,602 children born between 2000 and 2005 were involved in the study, which looked at healthcare use in the first 12 months, with particular reference to cardiac disease.

Children of mothers using antidepressants during pregnancy showed increased use of healthcare during the first year of life, independent of mother's healthcare use. The relative risk of more than two visits to GPs in the year was 1.5 in the continuous antidepressant user group and 1.3 in the group whose mothers stopped treatment, as compared with the control group.

Both groups received increased drug treatment for infections and inflammation compared with the control.

In addition, continuous exposure to antidepressants led to an increased risk of cardiac intervention such as cardiac surgery or catheterisation, the relative risk being 5.6 compared with the control group.

I am left feeling uncomfortable about the continued use of antidepressants in pregnancy.

The quick study
Bowel cancer screening by faecal occult blood testing appears to be successful in detection of cancer.

H1N1 caused substantial effects on ICUs during the winter in Australia and New Zealand.

Future pregnancy rate is unaffected by the method of treatment of a first trimester miscarriage.

Smoking is more likely in adolescents who have a higher proportion of friends or classmates who smoke.

Antidepressant use during pregnancy leads to an increase in healthcare demands for the child.

  • Dr Lewis is a GP in Windsor, Berkshire, and a member of our team who regularly review the journals

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