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(2) HRT
HAS NO EFFECT ON PROGNOSIS OF BREAST
CANCER
(3) WOMEN
OVER SEVENTY FIVE WOULD RATHER BE
DEAD THAN BE
IN A HOME WITH A HIP FRACTURE
(1) ANTENATAL
SCREENING FOR HAEMOGLOBIN
DISORDERS ISINADEQUATE AND INEQUITABLE
(Informed choice in genetic screening
for thalassaemia during
pregnancy: audit from a national
confidential inquiry)
http://www.bmj.com/cgi/content/full/320/7231/337
Only half of the couples at risk of passing
on the haemoglobin
disorder thalassaemia to their children
have full access to
information about their condition and
the choices available to
them, find the authors of the UK Confidential
Inquiry into
Antenatal Screening for Thalassaemia published
in this week's
BMJ.
Antenatal screening for haemoglobin disorders
should be
standard practice in the United Kingdom,
explain Professor
Bernadette Modell from University College
London and
colleagues, in order to identify couples
at risk and to give them
an informed choice in every pregnancy,
including the option of
a prenatal diagnosis. This option has
been utilised less than
expected, say the authors and it is often
assumed that this is
due to the unacceptability of abortion
on genetic grounds, and
therefore of prenatal diagnosis, particularly
among British
Muslims [certain ethnic groups in the
UK are at a high risk of
such haemoglobin disorders including those
of Cypriot, Indian,
Pakistani and Bangladeshi origin].
In their study of 138 couples in the UK
who had experienced a
pregnancy affected by thalassaemia between
1990-1994,
Modell et al found that over half of all
liveborn infants affected
with this haemoglobin disorder, had been
the result of a failure
in the antenatal screening service. They
also found that the
service is not provided to many British
Pakistanis and
Bangladeshis, and they suggest that this
is because of ethnic
stereotyping, when in fact prenatal diagnosis
was found to be
highly acceptable to all ethnic groups
at risk, especially when
offered in the early stages of pregnancy.
The authors conclude that although antenatal
screening and
counselling for haemoglobin disorders
are standard practices in
the UK, they are delivered inadequately
and inequitably. An
explicit national policy is needed, they
insist, to make prenatal
diagnosis in early stages of pregnancy
available to all couples.
Contact:
Professor Bernadette Modell, Professor
of Community
Genetics, Royal Free and University College
London Medical
School, Department of Primary Care and
Population Sciences,
Whittington Hospital, London
Email: b.modell@ucl.ac.uk
(2) HRT HAS NO
EFFECT ON PROGNOSIS OF BREAST
CANCER
(Effect of hormone replacement therapy
on the pathological
stage of breast cancer: population
based, cross-sectional study)
http://www.bmj.com/cgi/content/full/320/7231/348
Some studies have suggested that women
using of hormone
replacement therapies, who get breast
cancer, develop tumours
with "favourable" pathological features
compared to women
who get breast cancer and who do not use
such therapies. In
this week's BMJ a study conducted in Scotland
finds that
there is no evidence to suggest that women
using hormone
replacement therapies develop tumours
with favourable
prognostic features, however, nor do they
develop poorer
prognosis tumours, which the authors say
is reassuring.
Dr Sheila Stallard and colleagues from
North Glasgow
Hospitals University NHS Trust and the
Cancer Surveillance
Unit at the University of Glasgow (is
this correct?) studied
1113 women aged 50-64 years of age who
underwent routine
breast screening between May 1988 and
December 1993. The
screening was undertaken in the region
covered by the West
of Scotland Breast Screening Unit and
each of the 1113
women had either a screen detected cancer
or had developed
cancer in between screens. Within this
group the authors found
that 166 (14.9 per cent) were using hormone
replacement
therapy at the time they developed breast
cancer.
Stallard et al found no difference in the
type, size or grade of
tumour in women who were using hormone
replacement
compared with those who were not. They
therefore conlcude
that the evidence presented in their study
supports the view
that using hormone replacement therapy
gives neither
favourable nor poorer prognosis to those
women who develop
breast cancer, which they say is reassuring.
Contact:
Sheila Stallard, Specialist Registrar,
Vale of Leven Hospital,
Alexandria, Dunbartonshire
Email: dr37d@udcs.gla.ac.uk
(3) WOMEN OVER
SEVENTY FIVE WOULD RATHER BE
DEAD THAN BE IN A HOME WITH A HIP FRACTURE
(Quality of life related to fear
of falling and hip fracture in
older women: a time trade off study)
http://www.bmj.com/cgi/content/full/320/7231/341
Eighty per cent of women over the age of
75 years of age say
that they would rather be dead than admitted
to a nursing home
after a hip fracture, according to researchers
from Australia in
this week's BMJ.
During interviews with 194 women aged over
75 years, Mr
Glenn Salkeld and colleagues from the
University of Sydney
and Hornsby Ku-ring-gai Hospital in New
South Wales, found
that hip fractures are perceived as a
profound threat to quality
of life. Any loss of ability to live independently
in the
commnuity has significant detrimental
effect on their quality of
life say the authors and four fifths would
prefer to be dead
than admitted to a nursing home with a
hip fracture. Compared
with other (time trade-off) studies the
results suggest that
women would perceive a hip fracture as
worse than breast
cancer, a heart attack or mild osteoarthritis,
say the authors.
Hip fractures are a major cause of morbidity
and mortality and
almost all occur after a fall, explain
Salkeld et al. Therefore
they conclude that any interventions that
can reduce the
likelihood of falls and injury in older
women will not only save
lives but will prevent a significant reduction
in their quality of
life.
Contact:
Mr Glenn Salkeld, Senior Lecturer, Social
and Public Health
Economics Research Group, Department of
Public Health and
Community Medicine, University of Sydney,
New South
Wales, Australia
Email: glenns@pub.health.usyd.edu.au
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