Journals Watch: Familial risk of cancer and postnatal depression

A review of medical research papers selected by GPs. By Dr Louise Newson.

Colorectal cancer: risk is higher if parents were diagnosed at an early age
Colorectal cancer: risk is higher if parents were diagnosed at an early age

Familial risk of early and late onset cancer

BMJ 2012; 345: e8076

This very large study from Sweden was undertaken to determine the familial risks of developing concordant cancer by the age at diagnosis. It involved using a national family cancer database of more than 12.2 million people.

The results showed the highest familial risk was seen for offspring whose parents were diagnosed at an early age. Familial risks were significantly increased for colorectal, lung, breast, prostate and urinary bladder cancer and melanoma, skin squamous cell carcinoma and non-Hodgkin's lymphoma.

It is interesting that these risks were still significantly increased even when parents were diagnosed at the age of 70-79 or 80-89 years.

Even when parents were diagnosed at the age of over 90 years, there was still a significantly increased risk for skin squamous cell carcinoma, colorectal, breast and prostate cancer.

These results have implications for genetic counselling and advice about modifiable risk factors.

Postnatal depression in mothers bringing infants to A&E

Arch Dis Child 2013; 98: 36-40

Postnatal depression affects about 10-15% of women. It is still under-recognised and underdiagnosed.

This study was undertaken to determine the prevalence of postnatal depression in mothers of young infants presenting to A&E. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen for postnatal depression.

The study found that women who were single parents, of indigenous status, or who had a 'crying baby' as the presenting problem had a higher rate of postnatal depression.

It was concerning that 53% of the mothers in this study had not completed a postnatal depression screen of any kind before coming to the hospital. Although the EPDS should not ideally be used as a screening tool, this study serves to remind us about the importance of screening for postnatal depression in our patients.

The effects of mild alcohol intake during pregnancy

Arch Dis Child 2013; 98: 107-11

Many pregnant women are confused about whether it is safe to drink any amount of alcohol during pregnancy.

Some are convinced that even a small amount of alcohol is likely to have detrimental effects on their unborn child.

The authors of this study used data from the prospective, population based Avon Longitudinal Study of Parents and Children to investigate whether light drinking in pregnancy ( less than 1 unit  day on average in the first trimester was associated with adverse child mental health and academic outcomes when children were aged 11 years.

The study found that 39% of women had consumed less than one glass per week of alcohol and 16%, one glass or more per week of alcohol, during the first trimester.

Reassuringly, no adverse effects were seen in the children of women who were light drinkers of alcohol.

Women can be reassured that light drinking during pregnancy does not appear to be associated with clinically important adverse effects for mental health and academic outcomes at the age of 11 years.

Sequential versus triple therapy for treatment of H pylori

Lancet 2013; 381: 205-13

Whether sequential treatment can replace triple therapy as the standard treatment for Helicobacter pylori infection is still uncertain.

This multicentre, open label, randomised trial was undertaken to compare the efficacy of sequential treatment for 10 and 14 days with triple therapy for 14 days first-line.

Sequential treatment consisted of lansoprazole 30mg and amoxicillin 1g for the first seven days, followed by lansoprazole 30mg, clarithromycin 500mg and metronidazole 500mg for another seven days; with all drugs given twice daily.

The researchers found that patients on sequential treatment for 14 days had a better eradication rate.

Rates for compliance and side-effects were similar in all groups. These results support the use of sequential treatment as the standard first-line treatment for patients with H pylori infection.

Reflect on this article and add notes to your CPD Organiser on MIMS Learning

  • Dr Newson is a GP in the West Midlands 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.

  • Consider having a meeting with your local cancer family history clinic. Make sure you are familiar with its referral criteria.
  • Hold a meeting with your local midwife and health visitor. Determine your current screening tools for postnatal depression.
  • Carry out a search for all of your patients who have been pregnant in the past year. Did they have alcohol intake completed when they were pregnant?

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