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Update in General Internal Medicine
- Diane Altkorn, MD;
- Keith Roach, MD;
- Scott Stern, MD; and
- Wendy Levinson, MD
- From University of Chicago Pritzker School of Medicine and University of Chicago Medical Center, Chicago, Illinois.
- Cardiovascular diseases
- Neoplasms Cerebrovascular diseases
- Metabolic diseases
- Geriatrics
- Gastrointestinal diseases
1999-2000 Series: Update Sessions from ACP-ASIM's 1999 Annual Session
Margaret Ring Gillock, Editor, and David Cramer, MD, Co-Editor
We selected the articles for this Update in General Internal Medicine on the basis of two criteria: 1) Was the study methodologically rigorous? 2) Will the article change how we diagnose conditions or treat our patients? We focus on articles in 10 subcategories: cancer, stroke and atrial fibrillation, venous thromboembolism, cardiology, gastroenterology, diabetes, osteoporosis, hormone replacement therapy, geriatrics, and headache. Although a small number of these articles may be described again in other Updates in the 1999-2000 Update Series, they are featured here to highlight their importance and to convey a composite of advances in general internal medicine.
Cancer
Three trials examining the effectiveness of tamoxifen for the prevention of breast cancer and one trial looking at mammography—all of which were conducted in 1998—are discussed here.
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Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst. 1998; 90:1371-88.
This 4-year multicenter randomized, placebo-controlled trial studied 13 388 women at increased risk for breast cancer. Seventy-six percent of the participants had a first-degree relative with breast cancer. The results showed that tamoxifen, an antiestrogen, reduced the incidence of invasive breast cancer, with a relative risk of 0.51. However, the absolute risk reduction over 5 years of treatment was only 1.7% (number needed to treat [NNT], 60). Whether this intervention decreases breast cancer mortality rates is unknown. The study showed that for every 1000 women treated for 5 years, there were 17 fewer cases of invasive breast cancer and 7 fewer cases of ductal carcinoma in situ; however, there were also 5 additional episodes of deep venous thrombosis or pulmonary embolism and 7 additional cases …
