Journals watch: Screening for lung cancer | Diabetes in patients treated with statins | COPD

Too busy to read all of the journals? Dr Bryan Palmer summarises key papers of interest to GPs.

Chest x-ray did not seem to be a useful screening test for lung cancer
Chest x-ray did not seem to be a useful screening test for lung cancer

Screening for lung cancer

Chest 2013; 143 (5_suppl): e78S-e92S
Lung cancer remains a major killer worldwide, with poor improvement in survival outcomes in recent years compared with other cancers. With this in mind, this systematic review was conducted of controlled studies that address the effectiveness of methods of screening for lung cancer. They found that several large RCTs had failed to find chest X-ray useful as a screening test, but that one large RCT involving low-dose CT screening demonstrated a significant reduction in lung cancer deaths, with little harm to individuals at elevated risk when done in the context of a structured screening programme. The author acknowledged the complexity of introducing a screening test for lung cancer and that many questions remain unanswered.

Risk of incident diabetes in patients treated with statins

BMJ 2013; 346: f2610
Given the widespread use of statins to manage hypercholesterolaemia, small effects on their safety can have an important impact. This Canadian cohort study considers the risk of new-onset diabetes among patients treated with different statins.

They looked at 13 years' worth of data and measured the incidence of diabetes. The absolute risk in descending order was 34 per 1,000 person years for rosuvastatin (negated at lower doses), 31 for atorvastatin, 26 with simvastatin, 23 with pravastatin and none with fluvastatin.

These risks did not differ between primary or secondary prevention of cardiovascular disease. This will give the GP extra food for thought when considering prescribing statins.

Long-term outcomes following surgery for pelvic organ prolapse

JAMA 2013; 309 (19): 2016-24
It continues to surprise me that for some surgical procedures little is known about long-term outcomes. Take surgery for pelvic organ prolapse (POP). The authors in this US study used data from the long-term follow-up of the randomised, masked two-year colpopexy and urinary reduction efforts (CARE) trial. This trial looked at women with stress incontinence who underwent abdominal sacrocolpopexy between 2002 and 2005 for symptomatic POP and received either concomitant Burch urethropexy or no urethropexy. By year seven of follow up, the estimated probabilities of treatment failure (for example, re-prolapse or urinary incontinence re-emerging) was about 25%. With a mesh erosion, the probability of failure was 10.5%, although incidence of stress urinary incontinence was lower in the Burch urethropexy group.

Managing acute exacerbations in patients with COPD

JAMA 2013; doi:10.1001/jama.2013.5023
Acute exacerbations are common among patients with COPD, with nearly one in two patients experiencing at least one exacerbation annually. Concerned by the short-term and potential long-term side-effects of corticosteroids, the Swiss authors of this study looked to challenge the usual international convention of 10-14 days of systemic glucocorticoid therapy and asked the question, is less more?

A total of 314 patients were randomised to treatment with 40mg prednisone daily for either five or 14 days in a placebo-controlled, double-blind fashion. There were no more shortor long-term readmissions in the five-day steroid course compared to the 14-day steroid course and in time the overall steroid dose of the population studied decreased.

Consumers' estimation of calorie content at fast food restaurants

BMJ 2013; 346: f2907
No wonder England are in a shoo-in for the Ashes. Two thirds of Australians are now obese or overweight. Hence it was with interest I spotted this article from the US.

The authors wanted to investigate estimation of calorie (energy) content of meals from fast food restaurants in adults, adolescents and school-age children. They recruited nearly 3,000 individuals who visited a number of well-known fast food chains. This was in the days before calories appeared on menus.

They found that people eating at fast food restaurants underestimate the calorie content of meals, especially large meals. This was in the order of 20-35% on average, depending on the age group. There was also large variation depending on the outlet brand. Calorie menu labelling is now the norm in Australia and it has reduced my occasional fast food gorging to next to nothing as a result, but it may be too early to see any long-term national benefits.

  • Dr Palmer is a former Hampshire GP now working in Australia 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 an audit of potential low-risk primary prevention patients taking statins; for example, non-smoking women, and reassess their cardiovascular risk.
  • Develop a patient information leaflet outlining available local resources for management of urinary incontinence in women.
  • Develop practice guidelines for acute exacerbations of COPD incorporating new evidence-based practice.

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