Patient Care Hematology & Oncology - October 2007 - (Page 26)

ClinicalClips JOHN J. RUSSELL, MD, Contributing Editor Associate Director, Family Medicine Residency, Abington Memorial Hospital, Abington, Pa. Dr Russell and colleagues abstract current reports and studies from evidence-based medical literature and provide commentary relevant to primary care. I Lifetime attributable cancer risk with use of CT coronary angiography Einstein AJ, Henzlova MJ, Rajagopalan S. Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography. JAMA. 2007;298(3):317-323. with CTCA. The study revealed that the LAR also is considerably greater for women, for younger patients, and for a combination heart-aorta scan. Repeat CTCAs would increase the risk. David Nicklin, MD University of Pennsylvania School of Medicine, Philadelphia, Pa. Although studies have investigated the use of coronary CT for detection of coronary artery disease, the question remains: Are there risks associated with this new technology? Radiation exposure from CT coronary angiography (CTCA) was calculated using Monte Carlo simulation methods from data taken from standard spiral CT protocols on a standardized phantom (computational model) patient population. The lifetime attributable risk (LAR) of cancer associated with radiation exposure was estimated using the most current data on health effects of radiation. The LAR estimates for cancer after standard cardiac scans varied from 1 in 143 for a 20-year-old woman to 1 in 3261 for an 80-year-old man. These risk estimates decreased to 1 in 219 and 1 in 5017, respectively, with the use of simulated electrocardiographically controlled tube current modulation (ECTCM). For 60-year-old women and men, the estimated cancer risks using ECTCM were 1 in 715 and 1 in 1911, respectively. A combined scan of the heart and aorta increased the LARs (up to 1 in 114 for a 20-year-old woman). The LARs organ cancers were highest for lung and, in younger women, breast cancer. Impact for clinicians These estimates suggest that a nonnegligible LAR of cancer is associated I Smoking marijuana increases risk of psychotic symptoms Moore TH, Zammit S, Lingford-Hughes A, et al. Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet. 2007;370(9584):319-328. Marijuana, or cannabis, is the most widely used illegal drug in the United States and the United Kingdom. Data show that 20% of young adults report weekly use. Experimental studies have determined that cannabis intoxication produces affective and psychotic experiences, but knowledge of the effects of marijuana use lasting beyond the period of intoxication is limited. This systematic review from the United Kingdom included 35 longitudinal studies from 10 databases that were published from inception to September 2006. Impact for clinicians The authors found a consistent increase in the incidence of psychosis in people who had used cannabis, with a pooled increased risk of about 40%. A dose-response effect was observed in all studies that reviewed this relationship to increasing cannabis exposure. They also found an increase in affective outcomes, including depression, suicidal thoughts, and anxiety. Although the findings for these specific occurrences were inconsistent, the authors believe the data sup- Clinical Clips Panel Jonathan D. Beck, MD Christopher V. Chambers, MD Jeff Kirchner, DO Matthew Mintz, MD David Nicklin, MD S. Scott Paist, MD Charles A. Pohl, MD 26 PATIENT CARE HEMATOLOGY & ONCOLOGY www.patientcareonline.com http://www.patientcareonline.com

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Patient Care - Hematology & Oncology - October 2007 Research Digest Contents Information for Authors Medicine in the News Strategies for Bridge Anticoagulation Therapy How to Integrate the New Cervical Cancer Guidelines into Practice Dermatology Case Challenge Clinical Clips Classified Advertising

Patient Care Hematology & Oncology - October 2007

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