Journals Watch - Prostate cancer, flu and head lice

Missed this week's journals? Dr Sally Hope brings you up to date with the latest research.

Family history of any cancer leads to an increased risk of prostate cancer (above)
Family history of any cancer leads to an increased risk of prostate cancer (above)

Family history of cancer and risk of prostate cancer JMens Health 2010; 7(1): 45-54
Several studies have shown a two to four times increased risk of prostate cancer in men who have an affected first degree relative (father or brother).

Various Scandinavian twin genetic studies have shown there are genes on seven different loci that may account for 42 per cent of the inherited risk.

Linkage studies have also shown co-clustering between prostate, breast, ovarian and colon cancer due to BRCA1 and 2 genes on chromosome 17q.

This case-controlled study looked at 600 men referred with prostate cancer, with controls referred for other urological problems, to identify whether any family history of cancer is associated with an increased risk of prostate cancer.

Results showed a history of any cancer in any first degree relative gave a 1.83 times increased risk and a sibling with any cancer gave a relative risk of 2.64.

Glycaemic control and mortality in patients with type-2 diabetes Br J Gen Pract 2010; 60(572): 172-5
In a prospective cohort study of 1,145 Dutch patients with type-2 diabetes, the results showed that patients with an HbA1c of 9 per cent and over have a 3.13 times higher cardiovascular mortality risk than those with an HbA1c of 6.5-7 per cent (current therapeutic target).

Patients with an HbA1c less than 6.5 per cent did not have a lower risk than those in the 6.5-7 per cent range.

Criticisms of this study focus on it being small and the data covers less than a decade, whereas many patients have maturity-onset diabetes mellitus for 20 or 30 years. The advantage of this study, however, is it is based in Dutch primary care, which has a similar model to the UK.

We know that 50-75 per cent of all deaths in people with type- 2 diabetes mellitus are from cardiovascular complications. Three recent RCTs (the ACCORD, ADVANCE and VADT trials) all show that a low HbA1c does not reduce mortality. Indeed, the ACCORD study showed a higher mortality in the intensive treatment group.

This study supports the evidence that for patients with moderate glycaemic control, it may be better to reduce other cardiovascular risk factors (BP, cholesterol, smoking, diet and exercise) rather than chasing an ever lower HbA1c.

Effect of influenza vaccination on children in rural communities JAMA 2010; 303 (10): 943-50
There is a high rate of refusal of the influenza vaccine in my practice. So does immunisation of children work if you can get them and their parents to accept a jab?

This cluster randomised trial involved 947 Canadian children, aged three to 15 years, who either received the trivalent influenza vaccine or hepatitis A vaccine (as placebo). These children and 2,326 controls were from isol-ated rural communities.

Subjects with viral symptoms were then swabbed and tested for virus using the reverse transcriptase polymerase chain reaction lab test.

The herd immunity resulted in 61 per cent indirect protection against influenza among persons who did not receive the study vaccine; almost the same as the protection conferred to all study participants who received the flu jab.

The data suggests a herd immunity effect can be achieved when vaccine uptake is around 80 per cent in clusters in which only children and adolescents aged three to 15 years are immunised.

Isoflavones improve postmenopausal symptoms of anxiety and depression Maturitas 2010; 65 (3): 258-61
Phytoestrogens are plant molecules present in certain foods that act on estrogen receptors. Since the published association between HRT and breast cancer, there has been a rise in menopausal women taking OTC herbal remedies - most having no evidence-base.

This study used 80 microgram isoflavones (active phytoestrogen from red clover) verses placebo. Anxiety and depression were measured at baseline and at 90 and 187 days using the hospital anxiety and depression scale (HADS) and the Zung's self rating depression scale (SDS).

In the isoflavones treatment group the HADS score reduced by 76.9 per cent and the SDS score by 80.6 per cent. It is also interesting to note that in the placebo group the HADS score reduced by 21.7 per cent.

Hot flushes were reported to have decreased by 80 per cent in the active treatment arm versus none in the placebo arm, but this data set was not included in the main paper. One could argue that women felt better psychologically because, as their hot flushes diminished, they were sleeping better.

This RCT shows that isoflavones reduce hot flushes and depression and anxiety symptoms. This helps primary care navigate the turbulent waters of OTC herbal remedies with at least one effective treatment.

Ivermectin versus malathion to treat head lice N Eng J Med 2010; 362: 896-905
Head lice is a problem in many primary schools. Topical insecticides are available OTC, but resistance of lice to insecticides, particularly pyrethroids, results in treatment failure.

Children are also re-infected when they go into school again the next day.

This multicentre, cluster-randomised, double-blind trial compared oral ivermectin (at a dose of 400 micrograms per kilogram of body weight) with 0.5 per cent malathion lotion.

The treatments were given on days one and eight, for patients with live lice not eradicated by topical insecticide used two to six weeks before enrollment. Households were treated, as long as they were over two years and not pregnant, and heads inspected with a fine toothed comb.

Of those on ivermectin, 95.2 per cent were lice-free on day 15, compared with 85 per cent of those receiving malathion. There were no differences in the frequencies of adverse events between the two groups.

  • Dr Hope is a GP in Woodstock, Oxfordshire and a member of our team who regularly review the journals.
The Quick Study
  • Prostate cancer risk almost doubles with incidence of any cancer in a sibling or parent.
  • HbA1c of greater than 9 per cent in people with type-2 diabetes increases relative risk of cardiovascular mortality by 3.1, compared with those with an HbA1c of 7 per cent or under.
  • Influenza vaccination of children reduces infection in the whole community if you can achieve 80 per cent coverage.
  • Red clover isoflavones reduce menopausal flushes and anxiety/depression scores by almost 80 per cent.
  • Head lice can be treated by both oral ivermectin and topical malathion lotion.



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