The Malaysian Insider :: Features
The Malaysian Insider :: Features |
| Should breast cancer patients skip the pre-op MRI? Posted: 10 Dec 2012 03:48 AM PST  A study finds that women who had a pre-operative MRI might have more of their breast tissue removed. — Reuters pic MRIs produce a much clearer image than X-rays and ultrasound, and are recommended for detecting early tumours in women at increase risk for breast cancer, but routinely using the technology once any woman is diagnosed may lead to more radical surgery without any benefits, the researchers said in the Annals of Surgery. They found that about 26 per cent of women who had a pre-operative MRI to help determine the extent and severity of their tumour ended up having their entire breast removed, compared to about 18 per cent of those whose surgeons only used traditional methods of characterising the cancer. "I wasn't surprised by the results at all. What I am surprised by is the strength of the data," said Monica Morrow, the study's senior author and the chief of breast service at Memorial Sloan-Kettering Cancer Center in New York. Because MRIs are more sensitive than mammograms, some doctors think they are a good tool for identifying the precise outlines of cancerous tissue. Others, however, have begun to question whether the imaging led surgeons to remove more breast tissue than necessary. Moreover, women who have MRIs before breast surgery seem to be no less likely to need a second surgery to remove additional cancerous tissue. A study published in September, for instance, found that among more than 300 women who underwent breast cancer surgery, just as many of those who had an MRI before the first surgery ended up having a repeat operation. For the study, she and her colleagues pulled together data from nine previous studies to see if MRIs influence the number of women who had their breast removed or who had a second surgery to remove additional cancer. From the nine studies, they had information on 3,112 women who had breast cancer surgery. Overall, the team found that about 16 per cent of the women who had an MRI ended up having the entire cancerous breast removed during their first surgery. That's compared to about 8 per cent of women who did not have an MRI. They also found that having an MRI before surgery did not influence whether women would need additional surgery to remove more tissue. In each group, between 11 per cent and 12 per cent had to have more surgery. After taking into account the initial surgery and second operations, the researchers calculated that about 26 per cent of those who had an MRI ended up having their entire breast removed, compared to 18 per cent in the no-MRI group. "It causes more mastectomies to start with, but it doesn't decrease the number of women who started out wanting a lumpectomy and needing a mastectomy," said Morrow of the preoperative MRIs. The study did not look at long-term outcomes, nor did it examine the use of MRI to screen the opposite breast for signs that cancer had spread, while the results do not apply to certain subgroups of patients, including women with genetic mutations that predispose them to cancer. "There may be select circumstances where we'd use it to solve a problem, but for most women with breast cancer they don't need an MRI for their evaluation," Morrow said. — Reuters |
| Knee replacement linked to weight gain, says study Posted: 10 Dec 2012 03:20 AM PST  A study finds a knee replacement surgery may raise a person's risk of gaining weight. — AFP pic Researchers, whose findings appeared in the journal Arthritis Care & Research, analysed the medical records of nearly 1,000 knee-replacement surgery patients, and found that 30 per cent of them gained five per cent or more of their body weight in the five years following surgery. One possible explanation for the counter-intuitive results, experts said, is that if people have spent years adapting to knee pain by taking it easy, they don't automatically change their habits when the pain is reduced. "Patients who undergo knee arthroplasty are at increased risk of clinically important weight gain following surgery," wrote study leader Daniel Riddle, a professor at Virginia Commonwealth University. "Future research should develop weight loss/maintenance interventions particularly for younger patients who have lost a substantial amount of weight prior to surgery, as they are most at risk for substantial post surgical weight gain." Riddle's group used a patient registry from the Mayo Clinic in Rochester, Minnesota, which collected information on 917 knee replacement patients before and after their procedures. The researchers found that five years after surgery, 30 per cent of patients had gained at least five per cent of their weight at the time of the surgery — at least 5kg or more on a 100-kg person, for example. In contrast, fewer than 20 per cent of those in a comparison group of similar people who had not had surgery gained equivalent amounts of weight in the same period. "After knee replacement we get them stronger and moving better, but they don't seem to take advantage of the functional gains," said Joseph Zeni, a physical therapy professor at the University of Delaware, who was not part of the study. "I think that has to do with the fact that we don't address the behavioural modifications that have happened during the course of arthritis before the surgery." Riddle's team explained that this degree of weight gain can lead to "meaningful effects on cardiovascular and diabetes related risk as well as pain and function." Part of the explanation for the weight gain could be the age at which patients get surgery. People in their 50s and 60s tend to gain weight anyway. Still, in light of the lower rates of weight gain in the comparison group, which was also middle aged and older, Riddle said something else may also be at work. Indeed, the team found that patients who had lost weight before their surgery were slightly more likely to gain weight afterwards — perhaps because when people lose weight in anticipation of an event, such as surgery, they are more likely to put it back on after they're achieved the goal. Zeni said that to help people stave off weight gain after surgery, health care providers need to address the sedentary lifestyle people often adopt to accommodate their arthritis. "We need to encourage patients to take advantage of their ability to function better and get them to take on a more active lifestyle," he said. — Reuters |
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