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Karla Kerlikowske, MD; Weiwei Zhu, MS; Anna N.A. Tosteson, ScD; Brian L. Sprague, PhD; Jeffrey A. Tice, MD; Constance D. Lehman, MD, PhD; Diana L. Miglioretti, PhD, for the Breast Cancer Surveillance Consortium

High breast density increases breast cancer risk and can mask tumors, decreasing the sensitivity of mammography. This cohort study sought to better direct supplemental imaging discussions by determining which combinations of breast cancer risk and breast density categories were associated with high interval cancer rates. The authors found that not all women with dense breasts are at sufficiently high risk for interval cancer to justify consideration of supplemental or alternative screening methods.

Topics: breast, malignant neoplasm detection during interval between recommended screening examinations, mammography, diagnostic ...
Louis de Mestier, MD; Olivia Hentic, MD; Jérôme Cros, MD, PhD; Thomas Walter, MD; Guillaume Roquin, MD; Hedia Brixi, MD; Catherine Lombard-Bohas, MD; Pascal Hammel, MD, PhD; Marie-Danièle Diebold, MD, PhD; Anne Couvelard, MD, PhD; Philippe Ruszniewski, MD, PhD; and Guillaume Cadiot, MD, PhD

Pancreatic neuroendocrine tumors (PNETs) may evolve and cause hormonal hypersecretion–related symptoms that were not present at diagnosis, termed metachronous hormonal syndromes (MHSs). This study reported the clinical and pathologic characteristics of patients with sporadic PNETs who developed MHSs. These syndromes were identified more often in the context of PNET progression and increased Ki-67 indices, and patients with insulin-related MHSs may have decreased survival rates.

Topics: neuroectodermal tumors, primitive, islet cell tumor, neoplasms
Mildred K. Cho, PhD; David Magnus, PhD; Melissa Constantine, PhD, MPAff; Sandra Soo-Jin Lee, PhD; Maureen Kelley, PhD; Stephanie Alessi, JD; Diane Korngiebel, DPhil; Cyan James, PhD; Ellen Kuwana, MS; Thomas H. Gallagher, MD; Douglas Diekema, MD, MPH; Alexander M. Capron, LLB; Steven Joffe, MD, MPH; and Benjamin S. Wilfond, MD

Should informed consent for participants in research that compares the effectiveness of standard medical practices include notification of the potential risks of those practices? This survey of 1095 adults in the United States examines attitudes about risk and preferences for notification and consent for such research.

Topics: informed consent, attitude, cross-sectional studies, medical records review
Roger Chou, MD; Carlos Cuevas, MD; Rongwei Fu, PhD; Beth Devine, PhD, PharmD, MBA; Ngoc Wasson, MPH; Alexander Ginsburg, MA; Bernadette Zakher, MBBS; Miranda Pappas, MA; Elaine Graham, MLS; and Sean D. Sullivan, PhD

This systematic review examined the test performance of ultrasonography, computed tomography (CT), or magnetic resonance imaging (MRI) for detection of hepatocellular carcinoma (HCC) and evaluation of focal liver lesions. Reviewers found that CT and MRI have higher sensitivity than ultrasonography without contrast for detection of HCC and that sensitivity was higher for MRI than CT. For evaluation of focal liver lesions, the sensitivities of ultrasonography with contrast, CT, and MRI are similar.

Topics: magnetic resonance imaging, ultrasonography, carcinoma, hepatocellular, diagnostic imaging, lesion of liver
Russell P. Harris, MD, MPH; Timothy J. Wilt, MD, MPH; Amir Qaseem, MD, PhD, MHA, for the High Value Care Task Force of the American College of Physicians

Experts, professional societies, and consumer groups often recommend different strategies for cancer screening that vary in the intensity of their search for asymptomatic lesions and in value. This guideline outlines a framework for thinking about the value of varying intensities of cancer screening. The authors conclude that increasing intensity beyond an optimal level leads to low-value screening and speculate about pressures that encourage overly intensive, low-value screening.

Topics: cancer, cancer screening, american college of physicians, pressure-physical agent
Timothy J. Wilt, MD, MPH; Russell P. Harris, MD, MPH; Amir Qaseem, MD, PhD, MHA, for the High Value Care Task Force of the American College of Physicians

In this guideline, the High Value Care Task Force of the American College of Physicians offers screening advice for 5 types of cancer. The Task Force encourages clinicians to adopt cancer screening strategies that focus on reaching all eligible persons with high-value screening options, which provide a degree of benefits that justifies the harms and costs incurred, while reducing overly intensive, low-value screening, which provides limited or no benefits to justify the harms and costs.

Topics: cancer screening, american college of physicians, cancer
Michael R. O'Brien, MD; Marjorie S. Rosenthal, MD, MPH; Kumar Dharmarajan, MD, MBA; and Harlan M. Krumholz, MD, SM

This commentary discusses how patients in adult hospitals could benefit from the health care approach found in pediatric wards, which includes being sensitive to stressinducing procedures and offering novel programs involving music, unique life specialists, and nonpharmacologic techniques that seek to calm and uplift the spirit.

Topics: balloon dilatation, pediatrics, hospitals

Breast cancer is the topic of this issue's discussion from the Annals archive.

Topics: breast neoplasm screening

In this issue, Kerlikowske and colleagues study the risk for cancer in women with dense breasts to inform strategies for supplemental screening. The editorialists discuss the study and emphasize that breast density should not be the sole criterion to guide decisions about supplemental breast cancer screening.

Topics: breast density

In this issue, Cho and colleagues report results of a survey examining attitudes about risk and preferences for notification and consent for research among U.S. adults. The editorialist discusses the survey findings and emphasizes that research participants should have a voice in shaping the current regulatory system for clinical research.

Topics: informed consent, attitude, voice, clinical research, ethics, research, fear
Maggie R. Salinger, BA
Includes: Audio/Video

The sun sank behind the Atlanta skyline as I drove to my first Alcoholics Anonymous meeting.

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Prasanta Raghab Mohapatra, MD; and Baijayantimala Mishra, MD
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Dan Yamin, PhD; Shai Gertler; Martial L. Ndeffo-Mbah, PhD; and Alison P. Galvani, PhD
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Gary S. Collins, PhD; Johannes B. Reitsma, MD, PhD; Douglas G. Altman, DSc; and Karel G.M. Moons, PhD
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Mark J. Bolland, MBChB, PhD; Andrew Grey, MD; and Ian R. Reid, MD
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Toshihiro Sugiyama, MD, PhD; Yoon Taek Kim, MD, PhD; and Hiromi Oda, MD, PhD
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Erin S. LeBlanc, MD, MPH; Roger Chou, MD; and Miranda Pappas, MA
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D.A. Frater, MD
Includes: Audio/Video
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LeNeva Spires, BA
Includes: Audio/Video
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Topics: acute cerebrovascular accidents, ischemic stroke, follow-up
Topics: acute cerebrovascular accidents, ischemic stroke, follow-up, alteplase
Topics: ischemic stroke, alteplase, reperfusion therapy, physiologic reperfusion, follow-up
Topics: antihypertensive agents, cardiovascular diseases, cerebrovascular accident, mortality, hypertension, mild
Topics: statins, cognitive impairment
Topics: antibiotics, follow-up, osteomyelitis of vertebra
Topics: iron, adverse event
Topics: dehydroepiandrosterone, postmenopause
Topics: mortality, cerebrovascular accident, ischemic stroke
Topics: tamoxifen, breast cancer, follow-up
Topics: diabetes mellitus, type 1, insulin, mortality, follow-up
Topics: clopidogrel, percutaneous coronary intervention, cardiac event

The Consult Guys bring a new perspective to the art and science of medicine with lively discussion and analysis of real-world cases and situations.

Topics: consultation, longevity
Topics: breast, malignant neoplasm detection during interval between recommended screening examinations
Topics: cancer screening
Topics: cancer screening
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