This week in the BMJ
Volume 330, Number 7485, Issue of 29 Jan 2005CMF adjuvant chemotherapy for breast cancer achieves good long term results
CMF adjuvant chemotherapy for breast cancer achieves good long term results
Adjuvant chemotherapy with cyclophosphamide, methotrexate, and fluorouracil (CMF) in patients with operable breast cancer benefits the long term prognosis. After median follow up of 28.5 years, Bonadonna and colleagues (p 217) report combined results of two previously published randomised controlled trials and one observational study. Their experience shows that CMF adjuvant chemotherapy at least halves patients' long term risk of relapse and death.
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Screening reduced deaths from breast cancer in Denmark
Ten years after the introduction of a mammography screening programme in Copenhagen, overall breast cancer mortality declined significantly compared with what was expected without screening. Olsen and colleagues (p 220), comparing breast cancer mortality adjusted for age, time period, and region, found that the screening programme reduced the overall mortality of breast cancer by 25%, while the reduction was even more distinct—37%—among women who had actually been screened.
Domestic radon increases the risk of lung cancer
Home exposure to the products of naturally occurring radon is associated with a higher risk of lung cancer, especially in smokers and recent ex-smokers. Darby and colleagues (p 223) performed a meta-analysis of 13 case-control studies that included 7148 cases of lung cancer. The risk of lung cancer increased 16% per 100 Bq/m3 increase in the concentration of radon in household air, with a linear dose-response relation and no obvious threshold. Domestic radon may be responsible for 9% of deaths from lung cancer and 2% of deaths from cancer in Europe.
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Guidelines for chaperones in primary care are not practical
Although male general practitioners' use of chaperones for intimate examinations increased in the 1980s and '90s, barriers to implementing guidelines persist. Rosenthal and colleagues (p 234) surveyed 1813 general practitioners in England and found that, among 1246 respondents, only 37% had a policy on chaperones. About 8% of male doctors and 70% of female doctors never used one. Surveying 200 general practitioners in Norfolk, Conway and Harvey (p 235) found that offering chaperones has increased in the past decade, but use of chaperones showed less change. Chaperones are often there to protect doctors rather than patients, say the authors.
Implementation of the protocol for sudden unexpected death in infancy is not satisfactory
Implementation of the protocol for sudden unexpected death in infancy, introduced in 1999, has serious deficiencies. On page 227, Livesey reports her findings from investigating deaths of all infants reported to have died suddenly during a three year period in Sussex. She discovered, reports, and discusses deficiencies in the work of the ambulance service, coroners, paediatricians, pathologists, and the police.
Inhaled steroids seem safe for pregnant women with asthma
No evidence so far links inhaled corticosteroids to pregnancy induced hypertension and pre-eclampsia in pregnant women with asthma. In a nested case-control study, Martel and colleagues (p 230) looked at 3505 women with asthma with a total of 4593 pregnancies between 1990 and 2000. They found no evidence of the association between using inhaled corticosteroids during pregnancy and pregnancy induced hypertension and pre-eclampsia (adjusted odds ratios 1.02 and 1.06, respectively; no significant dose-response relation).
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Time to rethink disaster aid
Much of the aid promised after a disaster does not reach those affected, say Walker and colleagues (p 247). Funding collected soon after a catastrophic event may meet the short term needs of those affected, but a clear plan for the medium and long term support is needed. UN agencies should be funded by assessed contributions from member countries rather than having to appeal after a disaster, argue the authors, and greater planning is required for tracking aid and expenses, together with a clear plan of support for areas more prone to disasters.
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