Research of the week
Breast cancer and genes
Nature online doi:10.1038/nature05887
This research has some potentially exciting news about breast cancer, although not directly applicable to primary care. A large-scale genetic study has identified four new genes that significantly affect a woman's risk of developing breast cancer. In the future, this could allow more accurate prediction of a woman's cancer risk and may guide researchers in the aetiology of the disease.
One of these genes - fibroblast growth factor receptor 2 (FGFR 2) has the strongest association. About 16 per cent of the population has two copies of this gene and with it a 60 per cent greater chance of developing breast cancer.
Diagnosis of endometriosis
Br J Gen Pract 2007; 57(539): 470-6
The prevalence of endometriosis is said to be 10 per cent, but in my practice we do not have this number of diagnoses.
Endometriosis is diagnosed by visualisation of the lesions, usually by laparoscopy. Studies reveal that there is an average delay in the diagnosis of the disease of between eight and 12 years, but why is this?
The notes of patients with this diagnosis from four general practices in the south of England were studied, and it was found that a third of these women had consulted their GP six or more times before being diagnosed and that ultrasound was requested frequently as a diagnostic tool, even though this was helpful in diagnosing endometriosis in only just over 10 per cent of women receiving a scan.
In this study repeated consultations and negative investigations were concluded as main factors in the median delay of nine years before the making of the diagnosis. We should be more aware of this common disease and be more prepared to refer for laparoscopy.
Cardiovascular fitness in women
JAMA 2007; 297: 2,081-91
There are certainly many overweight and obese women in the UK who would benefit from increased exercise, and many more in the US. There are several schemes around the UK to try to improve the availability of exercise in gyms.
The effects of different amounts of physical exercise, graded over four stages, from no exercise to 12kcal/kg per week were examined, in sedentary, overweight or obese postmenopausal women with hypertension in the US.
A graded dose-response change in fitness was found as measured by peak absolute O2 consumption, but unfortunately no changes in BP were seen.
BMJ doi 10.1136/bmj.39196.740995.BE
We started using liquid-based cytology (LBC) for cervical screening in my practice at the start of this year, so I was interested to read the results of this study from nine centres across Italy, which looked at the relative benefits of LBC compared with conventional cytology. The results of 45,000 screening procedures were examined, divided equally between the two techniques. It was found that LBC showed no increase in sensitivity for higher grade abnormalities but detected more grade-one lesions.
However, a large reduction in unsatisfactory smears was found, which would fit with the findings in our practice where we have reduced the rate of such smears from 8 per cent with the old technique to 2 per cent using LBC.
Deprivation and quality of primary care
Br J Gen Pract 2007; 57 (539): 441-8
In this national survey, quality framework data from every practice in England for 2004-2005 and 2005-2006 were linked with census-derived social deprivation data.
The difference in mean quality points score between practices in the least and most deprived quintiles was found to be 64.5 points in the first year of the framework and only 30.4 in the second.
However, certain indicators were found to display larger differences, including recall of patients not attending appointments for injectable neuroleptics, practices opening for more than 45 hours weekly and practices undertaking 12 or more significant event analyses in the previous three years. It was felt that certain focused interventions could be applied to these specific targets in deprived areas.
Dr Lewis is a GP in Windsor, Berkshire, and a member of our team who regularly review the journals
The quick study
Endometriosis is often diagnosed late; GPs should be more prepared to refer for laparoscopy.
Exercise in postmenopausal women with hypertension improves fitness but not BP.
Liquid-based cytology for cervical screening is no more sensitive than conventional cytology, but reduces the number of unsatisfactory smears taken.
Social deprivation is linked with various quality indicators and specific interventions may be necessary to lessen the gap between the most and least deprived areas.