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This Week in the Medical Journals: Jun 22, 2012


In NEJM this week, researchers from the US and Canada report on the effects of flexible sigmoidoscopy screening on colorectal cancer incidence and mortality. From 1993 to 2001, the team randomly assigned nearly 155,000 men and women aged 55 to 74 to receive either screening with flexible sigmoidoscopy or standard of care. They found that the incidence of colorectal cancer after a median follow-up of 11.9 years was 11.9 cases per 10,000 person-years in the screening group compared to 15.2 cases per 10,000 person-years in the control group. "Significant reductions were observed in the incidence of both distal colorectal cancer and proximal colorectal cancer," the authors write. "There were 2.9 deaths from colorectal cancer per 10,000 person-years in the intervention group (252 deaths), as compared with 3.9 per 10,000 person-years in the usual-care group (341 deaths), which represents a 26% reduction."

In the British Medical Journal this week, researchers in the UK and the US report on the frequency and risk factors for prevalent, incident, and persistent genital carcinogenic human papillomavirus infection in sexually active women. The team studied 2,185 sexually active women with a mean age of 21, 38 percent of whom were from ethnic minority groups. Samples from 404 of the women were positive for carcinogenic HPV at baseline, and the team found that having two or more sexual partners in the previous year and concurrent Chlamydia trachomatis or bacterial vaginosis were independent risk factors for prevalent vaginal HPV infection. Further, infection with one or more types of HPV were found in 17.7 percent of follow-up samples — an estimated annual incidence of 12.9 percent of carcinogenic HPV infection. "Incident infection was more common in women reporting two or more partners in the previous year, agedC. trachomatis [or] vaginosis at baseline," the authors write. "Multiple partners was the only independent risk factor for incident infection."

And in Lancet Oncology this week, researchers in The Netherlands report on patterns of disease recurrence in early stage non-small-cell lung cancer patients after they've undergone stereotactic ablative radiotherapy. The team conducted a retrospective analysis of 676 patients treated with SABR between 2003 and 2011. Of these, 18 percent had disease recurrence, and, of the recurrences, 66 percent were distant recurrences while 46 percent were isolated distant recurrences. "Late recurrences after SABR are infrequent and two distinct patterns account for most cases," the authors write. "The predominant pattern is out-of-field, isolated distant recurrence presenting early, despite initial PET staging. A third of patients develop isolated locoregional recurrence; for these patients standardised follow-up is important to ensure that appropriate salvage treatments are considered."

The Scan

Quality Improvement Study Compares Molecular Tumor Boards, Central Consensus Recommendations

With 50 simulated cancer cases, researchers in JAMA Network Open compared molecular tumor board recommendations with central consensus plans at a dozen centers in Japan.

Lupus Heterogeneity Highlighted With Single-Cell Transcriptomes

Using single-cell RNA sequencing, researchers in Nature Communications tracked down immune and non-immune cell differences between discoid lupus erythematosus and systemic lupus erythematosus.

Rare Disease Clues Gleaned From Mobile Element Insertions in Exome Sequences

With an approach called MELT, researchers in the European Journal of Human Genetics uncovered mobile element insertions in exomes from 3,232 individuals with or without developmental or neurological abnormalities.

Team Tracks Down Potential Blood Plasma Markers Linked to Heart Failure in Atrial Fibrillation Patients

Researchers in BMC Genomics found 10 differentially expressed proteins or metabolites that marked atrial fibrillation with heart failure cases.