News in brief

Shorter radiotherapy just as good
LONG-term results from the Standardisation of Breast Radiotherapy (START) trials confirm that radiotherapy at a lower overall dose, delivered in fewer, higher doses over a shorter treatment time (a hypofractionated schedule) is at least as effective and safe as the current international standard for most women with early breast cancer, according to research published in The Lancet Oncology. The START trials involved 4451 women recruited from 35 radiotherapy centres in the UK between 1999 and 2002. The trials compared the international standard — a total dose of 50 Gy delivered in 25 doses of 2 Gy over 5 weeks — with the hypofractionated treatment —  41.6 Gy or 39 Gy in 13 fractions over 5 weeks in the START-A trial and 40 Gy in 15 fractions over 3 weeks in the START-B trial. In both parts of the trial, after 10 years of follow-up, there were no significant differences between standard and hypofractionated schedules in tumour recurrence or damage to surrounding breast tissue such as breast induration, telangiectasia and breast oedema. The outcomes were similar irrespective of age, tumour grade, stage, chemotherapy use or use of tumour bed boost. “Although the absolute numbers of events have increased over time, the relative differences between the hypofractionated and control schedules at 10 years remain similar to those at 5 years, confirming that appropriately dosed hypofractionated radiotherapy for women with early breast cancer is safe and effective”, the researchers wrote.

Statins linked to cataracts
RESEARCH published in JAMA Ophthalmology has found statin use is associated with an increased risk of cataract, with the researchers calling for further studies to confirm or refute the findings. The score-matched research, based on more than 46 000 patients who had medication prescriptions filled in 2005, included 6972 patients who had received at least a 90-day supply of statins and 6972 patients who had never received a statin prescription during the study period. The incidence of cataract was higher among statin users than non-users (odds ratio [OR] 1.09; 95% CI, 1.02–1.17). In secondary analyses, after adjusting for identified confounders, the incidence of cataract was still higher in statin users (OR 1.27; 95% CI, 1.15–1.40). Sensitivity analysis confirmed the relationship. The researchers wrote that 33.7% of statin users received maximum statin doses, defined as 80 mg of simvastatin, 80 mg of pravastatin, 80 mg of atorvastatin, and 40 mg of rosuvastatin. “After adjusting for the identified confounders, statin use was associated with higher adjusted OR for any cataract and cataract 1 (presenile, senile, and traumatic cataract), but not for cataract 2 (cataract secondary to ocular disorders, systemic diseases, diabetes mellitus, radiation, etc)”, the researchers wrote.

Extreme binge drinking concerns
A SIGNIFICANT number of senior high school students in the US engage in extreme binge drinking of more than 15 drinks in a row according to a study reported in JAMA Pediatrics. The research sample of more than 16 000 students aged around 18 years found that 20.2% had reported consuming five or more drinks in a row, 10.5% reported 10 or more drinks and 5.6% reported 15 or more. The researchers found that rates of 5+ and 10+ binge drinking had declined during the survey period from 2005 to 2011, but rates of 15+ drinking had not significantly declined. Some subgroups, including males and students from rural areas, had particularly high rates of binge drinking. “Such high levels of alcohol intake clearly put youth at risk for injuries and fatalities from alcohol-related suicide, drowning, homicide, alcohol poisoning, and motor vehicle crashes”, the researchers wrote. An accompanying editorial said that ways to prevent consumption at extreme levels had not been tested. “Measures of extreme consumption (≥10 or ≥15 drinks) need to be routinely included in prevention studies so researchers can identify what types of interventions also reduce extreme drinking occasions or whether new approaches warrant investigation”, the editorial said.

Surgery best in incontinence
WOMEN with moderate to severe stress urinary incontinence have significantly better subjective and objective outcomes after surgery than after physiotherapy, according to research published in the New England Journal of Medicine. The multicentre trial in the Netherlands included women aged 35–80 years who had been referred to an outpatient gynaecology or urology clinic after presenting with stress urinary incontinence. The researchers randomly assigned 230 women to midurethral sling surgery and 230 women to physiotherapy for pelvic floor muscle training. The women were given the option to crossover, resulting in 49.0% of women in the physiotherapy group and 11.2% in the surgery group crossing to the alternative treatment. After 12 months subjective improvement was reported by 90.8% of women in the surgery group and 64.4% of women in the physiotherapy group. Subjective cure rates were 85.2% in the surgery group and 53.4% in the physiotherapy group. “Our findings suggest that women with this condition should be counseled regarding both pelvic-floor muscle training and midurethral-sling surgery as initial treatment options”, the researchers wrote. “Information on expected outcomes with both interventions, as well as on the potential, albeit infrequent, complications of surgery, will allow for individualized decision making by each woman and her health care provider.”

Doctor brain drain on the rise
RESEARCHERS have called for policy proposals to address inequities in the global distribution of physicians after finding that physician emigration to the US from most sub-Saharan African (SSA) countries is increasing. The research, published in PLOS Medicine, analysed US physician data and found a near doubling of the number of doctors from SSA, from 5336 in 2002 to 10 819 in 2011. Of those 10 819 physicians born or trained in 28 SSA countries, the researchers found 68% were SSA trained and 20% US trained. The remaining 12% were trained in other countries. The researchers said credible data were needed to influence the US and other high-income countries which were importing doctors from low- and middle-income countries (LMIC) to train a larger number of physicians to meet their own workforce needs. They said policies were needed to address the “social justice agenda and global health initiatives that promote the creation of opportunity structures necessary to enhance career development, improve workplace conditions, and encourage the recruitment, training, and retention of resources, talents, and skills in SSA and other LMIC source countries”. “Despite the complexities of the international migration regimes, the movement of physicians from poor countries with limited training facilities to rich countries is a modern form of primary resource transfer and may be seen as the lower income nations subsidizing the education of higher nation physicians”, the researchers wrote.