Press releases Monday 1 March to Friday 5 March 2010

Please remember to credit the BMJas source when publicising an article and to tell your readers that they can read its full text on the journal's website (http://www.bmj.com).

(1) Long waits for radiotherapy linked to increased recurrence of breast cancer
(2) Warning over wave of child eye injuries from liquid detergent capsules

(1) Long waits for radiotherapy linked to increased recurrence of breast cancer
(Research: Impact of interval from breast conserving surgery to radiotherapy on local recurrence in older women with breast cancer: retrospective cohort analysis)
http://www.bmj.com/cgi/content/full/340/mar02_2/c845
(Editorial: Waiting times for radiotherapy after breast cancer)
http://www.bmj.com/cgi/content/full/340/mar02_2/c1007

The longer women wait for radiotherapy after breast cancer surgery, the more chance there is of local recurrence, concludes a study published on bmj.com today.

The authors suggest that starting radiotherapy as soon as possible will minimise this risk.

Four to six weeks is generally accepted as a reasonable interval between cancer surgery and radiotherapy, but evidence on the effect of waiting times in patients with breast cancer is mixed.

So researchers from the United States, Canada and Japan studied the relation between interval to radiotherapy and recurrence of breast cancer.

They analysed national cancer records for 18,050 US women who were diagnosed with early stage breast cancer during 1991-2002 when they were aged 65 or older. All women received breast conserving surgery and radiotherapy, but not chemotherapy.

Demographic information was identified using data from the 2000 US population census, and women were followed up for an average of five years.

The results showed that starting radiotherapy more than six weeks after surgery was associated with a modest but significant increase in local recurrence. More than one in four women (30%) in the study started radiotherapy after this time and 734 (4%) experienced a local recurrence at five years.

Further analysis showed a continuous relation between time to radiotherapy and local recurrence, suggesting that initiating radiation therapy as soon as possible could minimise local recurrence risk.

Longer times to radiotherapy were also found among Black and Hispanic women and among women who lived outside the southern states of the US, where rates of breast conserving surgery were higher, suggesting limitations in capacity of radiation delivery.

The implication of a continuous relationship between start of radiotherapy and local recurrence is that there is no "safe" threshold in terms of waiting time and that radiotherapy should therefore be started as soon as possible, say the authors.

The cost of increasing capacity to ensure uniformly short waiting times could be substantial and would need to be weighed against the small absolute benefit in local recurrence, they add. But, given the known negative impact of local recurrence on overall survival, and the large numbers of women treated with radiotherapy for breast cancer, it seems appropriate to consider whether this is a price we should be prepared to pay, they conclude.

Minimising delay improves outcomes, so investment and planning are needed, say Ruth Jack and Lars Holmberg from King's College London, in an accompanying editorial.

Healthcare providers need to assess where potential delays are occurring and ensure that they are reduced, as well as ensuring equal opportunities in accessing good care, they write. However they suggest that, if substantial investment is needed, the modest effects seen in this study would have to be weighed against other opportunities and priorities in cancer care.

Contacts:

Research: Rinaa Punglia, Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, MA, USA
Email: rpunglia@lroc.harvard.edu
Editorial: Ruth Jack, Information Analyst, King's College London, Thames Cancer Registry, London, UK
Email: ruth.jack@kcl.ac.uk

(2) Warning over wave of child eye injuries from liquid detergent capsules
(Letter: Eyes and alkalis)
http://www.bmj.com/cgi/content/full/340/mar02_2/c1186

In this week's BMJ, senior eye doctors are warning people to keep liquid capsules for fabric detergents out of the reach of children after a wave of eye injuries in young children at their hospital.

Rashmi Mathew and Melanie Corbett from The Western Eye Hospital, Imperial College Healthcare NHS Trust in London report that last year chemical injuries associated with these capsules accounted for 40% of ocular chemical injuries in children under the age of five at their hospital.

They also report that Guy's and St Thomas' Poisons Unit received 192 enquires related to the capsules during 2007-8 and 225 calls during 2006-7, a fifth of which related to ocular exposure.

Of the 13 children they have seen recently, corneal burns resolved with no complications in 12 cases. However, one child received ocular irrigation (copious flushing of the eye with sterile water) only on arrival in accident and emergency and therefore sustained extensive corneal burns.

The capsule in most liquid detergent capsules is a water soluble polyvinyl alcohol membrane, explains co-author Katherine Kennedy, senior chemist at Guy's Toxicology Unit in London. The liquid detergent is a mixture of three active agents - an anionic detergent, a non-ionic detergent, and a cationic surfactant - dissolved in water to give an alkaline solution, making the capsule more dangerous than initially perceived.

The authors warn that alkali injuries are the most severe form of chemical eye injury which can cause irreversible damage and have lifelong ramifications, such as constant discomfort, scarring and even amblyopia (lazy eye).

They conclude: "After recent discussions with Guy's Poisons Unit, some manufacturers have made hazard labels more prominent. But greater consumer awareness is required to reduce injury. Such concentrated cleaning products must be kept out of the reach of children, and immediate irrigation is crucial to reduce the risk of clinically significant injury."

Contact:

Rashmi Mathew, Specialist Registrar in Ophthalmology, Western Eye Hospital, London, UK
Email rashmi.mathew@doctors.org.uk

For more information please contact:

Emma Dickinson
Tel: +44 (0)20 7383 6529
Email: edickinson@bma.org.uk

Press Office telephone : 020 7383 6254 (Weekdays : 0900hrs - 1800hrs)
British Medical Association
BMA House, Tavistock Square, London WC1H 9JP

and from:

the EurekAlert website, run by the American Association for the Advancement of Science (http://www.eurekalert.org)
[[$FOOTER]] http://intranet.bmj.com/departments/dept-bmj/bmj-team-resources/web-team-resources/General_blogging_principles.doc