The US Preventive Services Task Force is seeking comments on the latest analysis on pelvic exams. Plus: A Swedish study looks at the impact of smoking on the effectiveness of breast cancer treatments. Also, a new multidrug-resistant strain of Candida has been found.
The public has until July 25 to comment on a new systematic review of evidence on risks and benefits of period screening pelvic examination prepared by the Agency for Healthcare Research and Quality (AHRQ). The analysisâwhich shows no direct evidence on overall benefits and harms of the examination for periodic screeningâis intended to form the basis for a new recommendation statement by the US Preventive Services Task Force (USPSTF).
The literature review was designed to answer 3 questions:
1. What is the direct evidence for the effectiveness of the pelvic examination in reducing all-cause mortality, cancer- and disease-specific morbidity and mortality, and improving quality of life?;
2. What are the test performance characteristics of the pelvic examination in screening for gynecologic cancers and other gynecologic conditions?; and
3. What are the adverse effects of screening using the pelvic examination?
For the analysis, two investigators independently reviewed abstracts and full-text articles on screening pelvic examination published from 1946 to January 13, 2016. Reference lists from relevant systematic reviews, suggestions from experts, and information on ongoing trials from ClinicalTrials.gov also were used to supplement the literature search.
The investigators found no studies applicable to question #1. Eight studies of diagnostic accuracy for 4 conditionsâovarian cancer, bacterial vaginosis (BV), trichomoniasis, and genital herpes--were identified in regard to question #2. More than 26,000 patients were screened in the 4 studies of pelvic exams for diagnosis of ovarian cancer and more than 96% of the results were false positives. It was not possible to draw conclusions about the accuracy of pelvic exam for BV, trichomoniasis, or genital herpes because the studies reviewed included a high proportion of patients with symptoms, and accuracy characteristics were reported for findings from individual exams. On the question of adverse effects related to pelvic examination, the investigators cited surgery rates resulting from an abnormal pelvic exam that ranged from 5% to 36% within 1 year, and an 11% rate in the largest relevant study.
Individuals who would like to comment on the systematic review before the USPSTF issues its final Evidence Review should visit http://www.uspreventiveservicestaskforce.org/Comment/Collect/Index/draft-evidence-review148/gynecological-conditions-screening-with-the-pelvic-examination
Does smoking decrease breast cancer treatment effectiveness?
A new population-based cohort from Sweden indicates that aromatase inhibitors may not work as well among women who smoke as those who did not smoke.
Researchers looked at a cohort of 1065 breast cancer patients without preoperative treatment from 2002 to 2012 in Lund, Sweden. Smoking status was assessed in connection with patient and tumor characteristics and prognosis in different treatment groups. At the preoperative visit, 21.0% of the cohort were smokers and median follow-up was 5.1 years.
The researchers included 1016 patients in their survival analyses. Overall no significant link between smoking and the risk of breast cancer events was seen (adjusted hazard ratio [aHR]: 1.45; 95% confidence interval [CI]: 0.95â2.20). Among the 309 aromatase inhibitor-treated patients who were aged >50 years with estrogen receptor-positive tumors, smoking was tied to the risk of breast cancer events (aHR: 2.97; 95% CI: 1.44â6.13), distant metastasis (aHR: 4.19; 95% CI: 1.81â9.72), and death (aHR: 3.52; 95% CI: 1.59â7.81).
The investigators concluded that preoperative smoking was tied to greater risk for breast cancer events and distant metastasis among women who were treated with aromatase inhibitors. They urge further study and if the connection is confirmed, they believe that smoking status should be considered when selecting an endocrine therapy.
CDC warns about emergence of multidrug-resistant Candida
In a new clinical alert, the Centers for Disease Control and Prevention (CDC) is warning healthcare facilities to be on the watch for Candida auris, a new strain of yeast that is multidrug resistant and associated with high mortality. First identified in 2009 in Japan, C auris is now known to exist in 9 countries and a single case was detected in the United States in 2013.
Infections with C auris typically are hospital-acquired and occur several weeks into a patientâs hospital stay. The fungus can cause bloodstream and wound infections and otitis in individuals of all ages and it has been cultured from urine and the respiratory tract. As with other Candida species, risk factors for C auris include diabetes mellitus, recent surgery, recent exposure to antibiotics, and presence of central venous catheters.
The CDC noted that more than half of C auris isolates are resistant to voriconazole, one-third are resistant to amphotericin B and a few are resistant to echinocandins. Healthcare facilities that suspect they have a patient with C auris should contact state and local public health authorities and CDC at firstname.lastname@example.org. Patients with colonization or infection should be placed in single rooms and Standard and Contact Precautions followed as well as thorough daily and terminal cleaning and disinfection of the room using an EPA-registered hospital-grade disinfectant with a fungal claim.