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CT Not Advised for Lung Ca Screening
BY ROBERT FINN
San Francisco Bureau
I
n a controversial move, the American College ofChestPhysicians has formally rec-ommended against the use oflow-dose helical CT scanning for gen-eral lung cancer screening, even inhigh-risk populations, except inthe context ofclinical trials.The ACCP also recommendedagainst the use ofserial chest ra-diographs and sputum cytologicevaluation to screen for the pres-ence oflung cancer.“The evidence isn’t availableto show that low-dose CT screen-ing provides a mortality bene-fit,” Dr. W. Michael Alberts saidin an interview. Dr. Alberts, thechiefmedical officer ofthe H.Lee Moffitt Cancer Center andResearch Institute in Tampa, Fla.,chaired the ACCP committeethat developed the guidelines.“Because there’s a very real po-tential for harm, it’s going to beimportant to prove or show amortality benefit prior to rec-ommending screening with alow-dose CT scan.”The second edition ofthe col-lege’s “Diagnosis and Manage-ment ofLung Cancer” includes260 guidelines, three ofwhich in-volve lung cancer screening. Itwas published as a supplement tothe September 2007 issue ofthe journal Chest (2007;132[sup-pl.]:1S-422S). This edition updatesthe original version ofthe guide-lines, published in January 2003.The screening guidelines weredeveloped by a subcommitteeheaded by Dr. Peter B. Bach of the Memorial Sloan-Kettering Cancer Center, New York. Al-though acknowledging that low-dose CT scanning remains themost promising ofthe lung can-cer screening techniques, theguideline authors maintainthat—even though the existing data do suggest that low-dose CTincreases the rate ofdetection of early-stage lung cancers—such
BY PATRICE WENDLING
Chicago Bureau
C
HICAGO
— The quadrivalenthuman papillomavirus vaccine,Gardasil, offers cross-protectionagainst cancer-causing HPVtypes that are not included in thevaccine, according to data re-ported in a late-breaking posterat the annual Interscience Con-ference on Antimicrobial Agentsand Chemotherapy. A three-dose regimen ofthehuman papillomavirus (HPV)type 6/11/16/18 vaccine demon-strated 62% efficacy in preventing cervical intraepithelial neoplasia(CIN) grades 2 and 3 or adeno-carcinoma in situ (AIS) caused byHPV 31 or 45, the two most com-mon HPV types found in cervicalcancer after HPV 16 and 18.Efficacy was 43% against CIN2/3 or AIS due to HPV 31, 33, 45,52, or 58, the five most commontypes found in cervical cancer af-ter HPV 16 and 18.Efficacy was 38% for 10 nonva-ccine oncogenic types (HPV 31,33, 35, 39, 45, 51, 52, 56, 58, or 59),which cause more than 20% of cervical cancers worldwide, Dr.Darron Brown reported on behalf ofthe FUTURE Study Group.
Clinical trial shows need for dual therapy.
Combined InsulinRegimens OftenBecome Necessary
Gardasil: Cross-ProtectionExtends Potential Benefit
BY MIRIAM E.TUCKER
Senior Writer
A
MSTERDAM
— Most patientswith type 2 diabetes who fail toachieve adequate glucose controlwith oral agents are likely to needcombination insulin therapy inthe long run, Dr. Rury R. Hol-man said at the annual meeting ofthe European Association forthe Study ofDiabetes.That conclusion was based onthe first-year findings from the 3- year multicenter, open-labelTreating to Target in Type 2 Di-abetes (4-T) study. The study is acomparison ofthree insulintreatment strategies—basal,prandial, or biphasic—added tooral antidiabetic agents in 708patients with type 2 diabeteswho had not achieved desiredglucose targets with maximallytolerated doses ofsulfonylureasand metformin. At year 1, only 8%-24% ofthepatients achieved a glycated he-moglobin level of6.5% or less.“We’ve seen that you can useany ofthese insulins to improveglucose control, but the likeli-hood ofachieving a 6.5% targetis not that great ...and ifyou’renot successful, you’re likely toneed two insulins,” said Dr. Hol-man, chiefofthe Diabetes TrialsUnit at the University ofOxford(England), during a press briefing held at the meeting.The second and third years of
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In a 63-year-old woman and former smoker, helical CT reveals alesion identified as an adenocarcinoma on left lower lobectomy.
Cure Worse ThanThe Disease?
Cancer treatments can causeunbearable skin toxicity.
PAGE 14
Brain Protection
Diet and other lifestyle factors may help ward off Alzheimer’s disease.
PAGE 18
PET Project
Positron emissiontomography finds additionallesions in esophageal cancer.
PAGE 36
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See
Insulin Regimens
page 4See
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page 2
www.internalmedicinenews.com
The Majority of Drugs Dispensed in 2006 Were Generic
Note: Based on the average dispensing rates for Medco clients.Source: Medco Health Solutions Inc.
4.5%Less expensivebrands withgeneric alternatives9.0%Brands withgeneric alternativesby 200911.1%More expensivebrands withgeneric alternatives17.4%Brands withno genericalternatives58.0%Generic
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15, 2007
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