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Press releases Saturday 21 August 2004

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(1) BREAST SCREENING VARIES BETWEEN WOMEN

(2) UK ASTHMA RATE STABLE, BUT ALLERGIES RISING

(3) ENVIRONMENT AND DIET MAY EXPLAIN DIFFERENT RATES OF ASTHMA

(1) BREAST SCREENING VARIES BETWEEN WOMEN

(Influence of personal characteristics of individual women on sensitivity and specificity of mammography in the million women study: cohort study)
http://bmj.com/cgi/content/full/329/7464/477

Breast cancer may be harder to detect and exclude among women with certain personal and lifestyle characteristics, according to research published in this week's BMJ.

Women aged 50-64 years, who were taking part in the Million Women Study, completed a questionnaire about various personal factors before routine breast screening. A sample of 122,355 women was then monitored for 12 months to examine how these factors influenced the sensitivity and specificity of screening.

These measures provide an indication of how likely women are to have breast cancer diagnosed between routine breast screening appointments and how likely they are to be recalled for further investigation after attending for screening, without having breast cancer.

Three factors had an adverse event on both measures: use of hormone replacement therapy (HRT), previous breast surgery, and a body mass index of 25 or less. The seven other factors examined, including age, family history of breast cancer, physical activity, smoking or alcohol consumption, had no significant effect on either sensitivity or specificity.

"Our results suggest that mammography may thus be less efficient in users of HRT, in women with previous breast surgery, an in thin women compared with other women," concludes Dr Emily Banks, lead author on the paper. "These women are also more likely than other women to have breast cancer diagnosed between screens."

"While these findings suggest that mammography may be more efficient in some women than others, it remains the best way of detecting breast cancer when it is still at an early stage," adds co-author Dr Gillian Reeves. "These results highlight how important it is that, as well as attending for routine screening, women remain breast aware between the three yearly NHS screening intervals."

Contacts:

Emily Banks, National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
Email: emily.banks@anu.edu.au

Cancer Research UK Press Office
Email: pressoffice@cancer.org.uk

(2) UK ASTHMA RATE STABLE, BUT ALLERGIES RISING

(Respiratory symptoms and atopy in children in Aberdeen: questionnaire studies of a defined school population repeated over 35 years)
http://bmj.com/cgi/content/full/329/7464/489

The rate of asthma among children in the United Kingdom seems to have stabilised, but the tendency for children to develop allergies is still increasing, according to a study in this week's BMJ.

During the past 35 years, the prevalence of childhood asthma has risen. Although this is partly due to increased diagnosis in children with symptoms, there has also been a clear increase in asthma-like symptoms.

Researchers examined the current situation in the United Kingdom. Their earlier studies showed a sharp rise in diagnosed asthma since 1964.

In May 1999, the parents of 3,537 primary school children in Aberdeen completed a questionnaire about respiratory symptoms and diagnoses of asthma, eczema, and hay fever.

Prevalence of asthma or wheeze, and the proportion of children with respiratory symptoms reporting a diagnosis of asthma, changed little. However, the team did find small but significant increases in the diagnosis of both eczema and hay fever between 1994 and 1999.

The rate of rise in the prevalence of childhood asthma has slowed, although a quarter of primary school children have been diagnosed as having asthma at some time in their lives, say the authors.

Nevertheless, the continuing increases between 1994 and 1999 in diagnosed eczema and hay fever suggest that the tendency for children to develop allergies is still increasing. Although these increases may also in part reflect changes in diagnostic fashion, they conclude.

Contact:

George Russell, Honorary Consultant Paediatrician, Royal Aberdeen Children's Hospital, Aberdeen, Scotland
Email: libra@ifb.co.uk

(3) ENVIRONMENT AND DIET MAY EXPLAIN DIFFERENT RATES OF ASTHMA

(Factors associated with difference in prevalence of asthma in children from coastal and mainland China: multicentre epidemiological survey)
http://bmj.com/cgi/content/full/329/7464/486

Environmental factors and diet may explain the higher rates of asthma seen in developed countries, suggest researchers in this week's BMJ.

The study involved 10,902 primary school children from three cities in China at different stages of modernisation (Hong Kong, Beijing and Guangzhou). Parents were asked about asthmatic symptoms and exposure to environmental factors.

A smaller group of children from each city underwent a skin prick test for sensitivity to eight common allergens, such as pollen and dust. Consumption of fruit and raw vegetables was also recorded.

Asthmatic symptoms were up to three times more common in children from the more developed Hong Kong than in those from mainland China.

Factors significantly associated with wheeze were cooking with gas, foam pillows, and damp housing. Factors protecting against wheeze were cotton quilts and frequent consumption of fruit and raw vegetables.

Environmental factors and diet may explain the differences in prevalence of asthma between children living in different regions of China, conclude the authors.

Contact:

Professor Gary Wong, Department of Paediatrics, Chinese University of Hong Kong, People's Republic of China
Email: wingkinwong@cuhk.edu.hk

Online First
(4) COMPLYING WITH NEW FLU GUIDELINES MAY BE IMPRACTICAL AND COSTLY

(Implications of the incidence of influenza-like illness in nursing homes for influenza chemoprophylaxis: descriptive study)
http://bmj.bmjjournals.com/cgi/reprint/bmj.38204.674595.AE

Complying with guidelines for the use of a new drug to prevent flu may be impractical and costly, according to new research published on bmj.com today.

National Institute for Clinical Excellence (NICE) guidelines state that oseltamivir should be given to all vulnerable residents in nursing and residential homes each time a single case of flu-like illness is recognised in a resident or staff member and when flu is known to be circulating in the community.

Although oseltamivir prevents flu in young healthy people, there is little evidence of its effectiveness in elderly care home residents.

Researchers in London analysed the implications of putting these guidelines into practice. They conducted surveillance for flu-like illness in 48 nursing homes from 3 November 2003 to 25 January 2004.

Almost three-quarters (35) of the homes (with a total of 2,004 residents) had at least one case of flu-like illness at some point during the four weeks in which flu activity in the community was at "normal seasonal" levels. All these residents would have been eligible for at least one course of oseltamivir during this period.

If these results applied to all 500,000 residents of nursing and residential homes in England, then at least 360,000 courses of oseltamivir should have been offered last winter. The drug costs £12.73 for an initial seven day course.

The NICE guidelines highlight the potential usefulness of oseltamivir in nursing homes, say the authors. However, the use of a single case of flu-like illness as the threshold for preventive treatment may be impractical and costly.

It might be sensible to reserve the drug for control of outbreaks when flu is microbiologically confirmed or strongly suspected. Further studies are needed to determine the best strategy for flu prevention and control in care homes, they conclude.

Contact:

Richard Harling, Specialist Registrar in Public Health, Department of Primary Care and Population Sciences, Royal Free Hospital, London, UK
Email: r.harling@pcps.ucl.ac.uk

Online First
(5) PROBIOTICS OF NO USE FOR VAGINAL PROBLEMS

(Effect of lactobacillus in preventing post-antibiotic vulvovaginal candidiasis: a randomised controlled trial)
http://bmj.bmjjournals.com/cgi/reprint/bmj.38210.494977.DE

"Friendly" bacteria (probiotics) are widely used and recommended for general health and specifically for vaginal problems.

But new research, published on bmj.com today, shows that probiotics do not prevent inflammation of the vaginal area (vulvovaginitis) that often develops after antibiotic treatment and is usually caused by the bacteria Candida albicans.

The study involved 235 non-pregnant women aged 18-50 years who required a short course of oral antibiotics for a non-gynaecological infection.

Women took probiotic (containing lactobacillus bacteria) or placebo preparations orally or vaginally until four days after completion of their antibiotic course. They recorded any symptoms and provided vaginal swabs for analysis.

Overall, 23% of women developed vulvovaginitis after antibiotics. Compared with placebo, probiotic treatments were ineffective in preventing vulvovaginitis. In fact, the trial was stopped early because it was considered unethical to continue with no potential benefit.

The role of lactobacillus in post-antibiotic vulvovaginitis is an example of a treatment that has widespread use despite lack of a biologically plausible basis or evidence of effectiveness, say the authors.

"Our results should prompt health professionals to inform women that lactobacillus is unlikely to prevent post-antibiotic vulvovaginitis and that they should consider using proved antifungal treatment if symptoms develop," they conclude.

Contact:

Marie Pirotta, Senior Lecturer, Department of General Practice, University of Melbourne, Victoria, Australia
Email: m.pirotta@unimelb.edu.au

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