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Long-term exposure to even low levels of air pollution increases risk of lung cancer

 MD-FM Thursday 11 July 2013 

 

Sarah:

MD FM, Medical News from around the world with Peter Goodwin.



P1

PETER:

Hello, and with me is Sarah Maxwell. To begin with, the more air pollution there is where you live, the greater the risk you have of developing lung cancer in the long term. That’s the implication of a study, published in the Lancet Oncology, that analyzed levels of particulate matter, and other pollutants such as nitrogen oxides, in more than 300,000 people’s homes over 13 years

 

SARAH:

Yes, the study spanned nine Europeans countries and found a linear relationship between particulate concentration and lung cancer risk, which was at a level similar to that of passive smoking. There was no threshold below which the risk was zero: it was still there even at levels below the European Union limit. Lead study author, Ole Raaschou-Nielsen:



Nielsen: As an individual, what we see is a relatively small increase in risk, at least when you compare to active tobacco smoking. But it’s important to notice that we are all exposed to more or less air pollution everyday and a small increase for all individuals can add up to many lung cancer cases if we consider whole populations. So I hope that the results of our study will motivate administrations to take actions to further reduce the air pollution of particules

 

SARAH:

That was Dr. Ole Raaschou-Nielsen, from Copenhagen, in Denmark.



P2  

PETER:

In adults being screened for colorectal cancer assessing the growth rate of small colorectal polyps could be a useful biomarker to identify advanced adenomas. That’s according to a study, reported in The Lancet Oncology, that found that advanced adenomas grew more rapidly than very early ones, while most with intermediate growth-rates were stable or even regressed. So by using CT colonography you could decide to go with less invasive surveillance strategies, leaving polypectomy only for lesions showing substantial growth.



VIRGULE MUSICALE



P3

PETER:

The Middle East Respiratory Syndrome coronavirus does not have pandemic potential...For now at least! That’s the result of a study published in The Lancet looking at 55 of the world’s 64 laboratory-confirmed cases…

 

SARAH:

Yes, and it showed that: in the worst-case scenario, the virus’s basic reproduction number, or “the R value”, which reflects its human transmissibility, was well below one, which corresponds to the threshold for reaching pandemic potential. Chris Bauch, wrote an editorial on the study:



Bauch-1: That value was around 0.69, which means that each infected person infects less than one person on average. What it means is that for the current strains of virus, in its current settings, it’s very unlikely to cause a pandemic. But: it doesn’t say for example what might happen in the future though. Mutations are hard to predict, they occur randomly and there’s a possibility that mutations may occur that allow the virus to infect humans more easily and, if that happens, then the R value could become greater than 1. The possible mutations that could occur are so diverse and we have so little understanding of their impact, it could be tomorrow, it could be never, we just have no idea at this stage whether the mutations will happen, or even which mutations are acquired, I don’t think we understand that yet either. 

 

SARAH:

Dr. Chris Bauch’s recommendation is to maintain strict control of the virus wherever it pops up, to trace contacts, perform epidemiologic investigations and also to search for animal hosts:



Bauch-2: We really need to get a handle of where it’s coming from, so we need to understand which animal population is currently hosting the virus and allowing it to jump to humans. Once we know that, then we can limit animal-human contact and we can also get samples to understand if there are other strains circulating in the animal populations that could also make a jump but that haven’t jumped yet. And we need to continue updating our R value as more data come in over time so that we have an understanding of whether the transmissibility of the virus is changing

 

SARAH:

Dr Chris Bauch, from Ontario, Canada.



VIRGULE MUSICALE

 

P4

PETER:

Hospitalizations for pneumonia in the United States between the years 2000 and 2010, declined overall by 10%. Which suggests that the “PCV7” pneumococcal vaccine being used, has had a profound impact on the entire population

 

SARAH:

Yes, it was given to children under the age of two and there was a sustained 40% drop in pneumonia hospitalizations over the entire decade. That’s the finding of a study, reported in the New England Journal of Medicine, that found the vaccine also had an effect in adults. Lead study author, Marie Griffin, from Nashville, Tennessee:

 

Griffin: The way adults pick up this bacteria is from children. And when children are vaccinated they no longer get colonized with these particular types of bacteria. And so since the children aren’t being colonized, they can’t transmit it to the older people 

 

SARAH:

And for people aged 85 or older, who are particularly vulnerable to pneumonia because of a decline in immunity, there was a 23% drop in hospitalizations. Dr Griffin added that the updated version of the vaccine, the PCV13, which was introduced in the US in 2010 and covers 13 different types of pneumoccocal bacteria, so six more than PCV7, could offer further hope:

 

Griffin-2: What we expect is if the PCV13 does the same thing that we could potentially have further declines in pneumonia in all age groups

 

SARAH:

That was Dr. Marie Griffin, From Vanderbilt University in Tennessee.

 

VIRGULE MUSICALE



P5

PETER:

After a myocardial infarction early invasive strategies such as angiography and percutaneous intervention bring good net benefits even in patients with existing kidney disease…

 

SARAH:

Yes, a study in the British Medical Journal showed that for patients with kidney disease, studied over two and a half years, invasive procedures were associated with a 20% reduction in the risk of dying, compared to medication alone. PCI using contrast agents for X-Ray monitoring of the coronary arteries was associated with a small increase in the risk of acute kidney injuries compared with conservative medical management. But there were some kidney outcomes such as dialysis and kidney failures. Lead study author, Dr. Matthew James:

 

James: So we hope this information will help patients and healthcare practitioners weigh the risks and benefits of doing these types of procedures in people who have kidney disease because studies have shown that people with kidney disease are less likely to receive some procedures for the management of their heart disease, in particular after a heart attack, people with kidney disease are less likely to have angiograms or angioplasties. Within our own data set we also found this, that patients were 40% less likely to receive these procedures if they had kidney disease. We believe that’s because there’s a fear of making kidney function worse when we use these tests and the dyes that can affect kidney function

 

SARAH:

That was Dr. James, from Alberta, Canada.



BREVE 1 Sur fond musical  

 

PETER:

Finally, in brief:

 

Children had a small but significant increase in the incidence of mental disorders if they were conceived using fertility treatment by ovulation induction with or without insemination. This result, published in the British Medical Journal, comes from a study that also showed, however, that the risk was not any different in children born by in-vitro fertilisation as compared with intra-cytoplasmic sperm injection, which was the most feared procedure from this point of view.



And...



BREVE 2

 

For patients with poorly-controlled type-2 diabetes, salicylate may be an effective add-on treatment, according to a report in Annals of Internal Medicine. In a year long, randomized trial with patients on one to three diabetes medications at baseline, adding daily salicylate consistently reduced hemoglobin A 1c and fasting glucose levels. However, further evaluation is needed before the agent can be recommended for widespread use.



That's all from MDFM for now. Sarah Maxwell and I will be back in the first week of September with the regular edition of MDFM direct from the European Society of Cardiology meeting. But in the meantime, you can keep an ear out for MD-FM Insight over the summer. So until then from me Peter Goodwin, goodbye!

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