Thursday, February 16, 2023 |
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Welcome to Health Rounds! Today we are highlighting three potentially practice-changing studies in the fields of breast cancer and stroke, along with data showing that infant formula health claims should be taken with a grain of salt. In breaking news, see these stories from our Reuters journalists: A drug to treat opioid overdoses might soon be available over-the-counter; Republican legislators across the United States have escalated a campaign to ban healthcare for transgender youth; just 3% of funding for health technology went to women's health in 2020. |
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Radiation therapy can safely be skipped by many older patients with early, low-risk breast cancer, researchers say. REUTERS/Khaled Abdullah. |
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| Many older breast cancer patients can skip radiation |
Women over age 65 with early breast cancer might consider skipping radiation after surgery because it likely won't help them live longer, researchers say. Adding radiotherapy to breast-conserving surgery and hormone therapy did not prolong survival in this age group in a 10-year study published on Wednesday in The New England Journal of Medicine. Skipping radiation did not affect the risk of the disease spreading to other parts of the body. It did slightly increase the risk of the cancer recurring near the original site of the tumor. Radiotherapy can cause heart problems and other side effects that "place a heavy burden on patients, particularly older ones," study leader Dr. Ian Kunkler of the University of Edinburgh said in a statement. "Our findings will help clinicians guide older patients on whether (radiation) can be omitted." The trial involved 1,326 patients over age 65 with low-risk breast cancer defined as tumors no more than 3 centimeters (1.18 inches) in size, not involving the lymph nodes, and likely to respond to hormone treatment. All underwent breast-conserving surgery and at least five years of hormone therapy. Half also received radiotherapy after surgery. At 10 years, overall survival was 81% in both groups, and most deaths were not due to breast cancer. The researchers note that skipping radiation requires that patients complete at least five years of hormone therapy, which can be difficult. |
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Essential Reading on Reuters.com |
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Outlook improving for people with severe strokes |
Patients with severe strokes had dramatically better recoveries after undergoing mechanical removal of the clot blocking an artery in addition to standard medical management rather than treatment with drugs alone, two large studies likely to become practice changing have found. While clot removal, or thrombectomy, is commonly used for smaller strokes, patients with strokes affecting large amounts of brain tissue were considered too high-risk for the procedure. "These patients are left to receive medical management only, and a significant number of them end up with very poor outcomes," Dr. Amrou Sarraj of Case Western Reserve University, who led one of the studies, said in a statement. His study, conducted at 31 hospitals on three continents, had a target enrollment of 560 patients but was stopped early - after enrollment of 352 patients - when the superior outcomes seen with thrombectomy became clear. Almost 20% of patients who underwent clot removal ended up with functional independence, nearly fully returning to normal activities or not needing support, compared to 7% of those who just received medical treatment, Sarraj said. Nearly 40% of patients in the thrombectomy group were able to walk independently, versus roughly 19% in the control group. A separate multi-center trial in China involving 456 patients with large strokes also found better outcomes with mechanical clot removal than without. This trial too was stopped early owing to the clear benefits of the treatment. Dr. Sarraj expects the results to change treatment guidelines in the near future. "This will give a large number of patients the opportunity for a chance for improvement," he said. Both studies were presented last week at the International Stroke Conference and published in The New England Journal of Medicine. |
Infant formula health claims can't be trusted |
There is little high-quality scientific evidence behind health and nutrition claims on most infant formula products, such as their supposed benefits for young infants' brain development, immunity, and growth, an international study found. As reported on Wednesday in The BMJ, researchers studied claims on websites and packaging for 757 formula products marketed in 2020-2022 for healthy, full-term infants in 15 countries: Australia, Canada, Germany, India, Italy, Japan, Nigeria, Norway, Pakistan, Russia, Saudi Arabia, South Africa, Spain, the United Kingdom, and the United States. Across all countries, only about one-in-four products with at least one claim provided a scientific reference to support it. For the other three-quarters of claims, no scientific reference was provided. When references were provided, only 56% reported findings of clinical trials – and most of those were deemed to be at high risk of bias, the research team said. Nearly 90% of the clinical trials involved researchers who either received formula industry funding or were directly affiliated with the industry. In a linked editorial, Nigel Rollins of the World Health Organization writes that responsible, ethical marketing by the formula industry seems unlikely. "Regulatory authorities must therefore decide whether the use of such apparently misleading evidence is acceptable or hold the formula industry to higher standards, require better products based on high quality evidence, and review standards," he said. This newsletter was edited by Bill Berkrot. |
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