December 11th, 2013
Screening to detect medical conditions has become standard practice for many diseases, but insufficient attention has been paid to the potential for harm, according to research conducted at the University of North Carolina.
“I think guideline groups, just as they are systematic about thinking about benefits, need to be systematic about thinking about harms. We should not implement a screening program until we know enough to have a clear understanding of both benefits and harms,” said lead author Russell Harris, MD, MPH, Professor of Medicine in the UNC School of Medicine and Adjunct Professor of Epidemiology in the UNC Gillings Global School of Public Health, and member of the UNC Lineberger Comprehensive Cancer Center. Harris worked with a number of co-investigators at the UNC Research Center for Excellence in Clinical Preventive Services in the UNC Cecil G. Sheps Center for Health Services Research.
In an article published by the Journal of American Medical Association – Internal Medicine, Harris and co-authors outline a framework that physicians, patients, policy makers and researchers can use to think systematically about the harms of screening programs. This rationale – a “taxonomy of harms” – makes it easier for decision makers to fully consider all harms to balance against anticipated benefits. Harris said the framework for understanding harms provides physicians, patients, policy makers, and researchers with an approach for reviewing the potential downsides of any screening recommendation.
December 10th, 2013
An AMA study published in the December 9 issue of JAMA suggests that using CT to screen for lung cancer is unnecessary and that other techniques or biomarkers are more appropriate. The ACA, however, disagrees and states that the overdiagnosis rate is modest with CT and that they will continue guideline and appropriateness criteria creation to support CT lung cancer screening programs. Summaries of both articles appear below.
Study Suggests Overdiagnosis in Screening for Lung Cancer with Low-Dose CT
More than 18% of all lung cancers detected by low-dose computed tomography (LDCT) appeared to represent an over-diagnosis, according to a study published by JAMA Internal Medicine.
LDCT has been shown in recent clinical trials to be an effective screening tool in some patients, but some of the tumors it finds may be indolent or clinically insignificant. Overdiagnosis is the detection of a cancer with a screening test that wouldn’t otherwise have become clinically apparent. It is a potential harm of screening because of the additional cost, anxiety and complications associated with unnecessary treatment, according to the study background.
Edward F. Patz Jr., MD, of Duke University Medical Center, Durham, North Carolina, and colleagues examined data from the National Lung Screening Trial, which compared LDCT screening vs. chest radiography (CXR) among 53,452 people at high risk for lung cancer, to estimate over-diagnosis.
December 10th, 2013
The Broad Medical Research Program, which funds innovative early-stage research into inflammatory bowel disease, will merge with the Crohn’s & Colitis Foundation of America (CCFA).
The Broad Medical Research Program was started by The Eli and Edythe Broad Foundation in 2001 to encourage research into the cause, treatment and cure of inflammatory bowel disease (IBD). The program aims to fund pilot research so that scientists can test their initial ideas and generate preliminary data in order to qualify for larger grants from other organizations. Broad has awarded more than $43 million in grants to scientists and researchers, who have gone on to receive more than $142 million in new research funding from other organizations. The National Institutes of Health has been the largest source of continuation funding, with CCFA providing nearly 11% of additional grants.
December 9th, 2013
Adding genetic data to clinical information doesn’t improve the ability to determine initial doses of warfarin. The finding contradicts earlier studies and highlights the importance of using clinical trials to assess the role of genetics in optimizing treatments.
Warfarin, a.k.a. Coumadin, is effective anticoagulation therapy, but determining the best dose for each patient can be tricky. Too much can cause excess bleeding; too little can lead to dangerous blood clots. Doctors often initially prescribe a standard dose based on clinical measures such as age, body size, smoking status, and use of certain medications. They then closely monitor the drug’s activity through blood tests and adjust the dose as needed.
Two genes are known to influence warfarin’s effectiveness. One, CYP2C9, deactivates warfarin. The other,VKORC1, activates vitamin K, which is essential for blood clotting. Variations in these genes may affect how a person responds to warfarin. Thus, dosing formulas have been developed to incorporate a person’s genetic profile, along with their clinical characteristics, to better predict the warfarin dose that person may need. This approach is known as pharmacogenetics.