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Media Advisory Date: March 24, 1997
The U.S. Department of Health and Human Services' Agency for Health Care Policy and
Research (AHCPR) works to improve the quality of health care, reduce costs, and broaden
access to essential services. Here are some of the findings described in the most recent issue of
AHCPR's Research Activities.
Older Women Are Less Likely to Receive Chemotherapy and Radiation
After Breast Cancer Treatment
Invasive breast cancer is the second leading cause of death in elderly women, and the
older women become, the less likely they are to receive chemotherapy or radiation treatment
(adjuvant therapy) in addition to surgery to prevent cancer recurrence. These women also are
less likely to undergo an assessment of their axillary lymph nodes to gauge how far their cancer
has spread, according to a study supported in part by AHCPR. Researchers from the Massey
Cancer Center, Virginia Commonwealth University examined the patterns of initial breast cancer
surgery and adjuvant therapy for 3,361 women with local and regional breast cancer listed in the
Virginia cancer registry from 1985-1989. The data were linked to Medicare claims and census
data for the same years.
The study found that although tamoxifen (anti-estrogen) therapy was
used in about 32 percent of women with estrogen-positive node cancer regardless of their age,
use of chemotherapy declined by two-thirds per decade, and radiation therapy use declined from
two thirds of women 65 to 69 to only 7 percent of women aged 85 and older. The probability
that a woman would not receive axillary lymph node assessment increased 2.5 fold for every
decade of age. The benefits of this procedure, however, remain controversial for certain elderly
"Variation in staging and treatment of local and regional breast cancer in the elderly," by Bruce
E Hillner, M.D., Lynne Penberthy, M.D., M.P.H., Christopher E. Desch, M.D., and others, in
Breast Cancer Research and Treatment, 40, pp. 75-86, 1996.
It Is More Difficult for the PSA Test to Detect Prostate Cancer in Men With Benign Prostatic Hyperplasia
Use of the prostate-specific antigen (PSA) test to detect prostate cancer may not be as
accurate in men with an enlarged prostate, a condition called benign prostatic hyperplasia (BPH). The reason is that hyperplastic prostatic tissue (abnormally large number of normal cells)
elevates blood levels of PSA, a protein that is also usually elevated when prostate cancer is
present. This overlap in interpreting PSA levels is a problem, according to an AHCPR-supported study. In randomly selected men, PSA concentrations between 4.1 and 6.0 ng/mL (4.0
ng/mL is the upper limit of normal) raised the likelihood of cancer over threefold. But PSA
concentrations greater than 10 ng/mL were needed to achieve a similar threefold increase in the
likelihood of cancer in men with typical BPH urinary tract symptoms.
"The ability of the PSA
test to discriminate potentially curable prostate cancer from BPH is dramatically lower in men
selected with lower urinary tract symptoms than in randomly selected men," concludes Michael
J. Barry, M.D., of Harvard Medical School, leader of the Prostate Patient Outcomes Research
Team. The team used PSA data from four groups of men aged 50 to 79 years of age involved in
multicenter or community-based trials.
"Interpreting the results of prostate-specific antigen testing for early detection of prostate
cancer," by James B. Meigs, M.D., Dr. Barry, Joseph E. Osterling, M.D., and Steven J. Jacobsen,
M.D., Ph.D., in the Journal of Internal Medicine 11, pp. 505-512, 1996.
Benefits of Blood Pressure Medication May Not Outweigh Risks for Some Patients
The potential benefits of taking medication to lower high blood pressure
(antihypertensives) may not outweigh their negative effects on quality of life for some patients,
reports a study funded in part by AHCPR. Side effects of these medications include fatigue,
weakness, headache, joint and stomach aches, nausea, impotence, and urinary tract problems.
Researchers from the University of Wisconsin at Madison interviewed 1,430 randomly selected
adults aged 45 to 89 years. They obtained medical histories and measured subjects' health status
using a variety of measures and self reports. Of those interviewed, 519 reported being affected
by hypertension for more than three years. Results showed that persons with hypertension had
significantly lower age-adjusted health status scores compared with those not affected by
hypertension. Among those with hypertension, increasing numbers of antihypertensive
medications were associated with lower reported general health status. The specific class of
medications did not affect health status.
"Health status and hypertension: A population-based study," by William F. Lawrence, M.D.,
M.S., Dennis G. Fryback, Ph.D., and Patricia A. Martin, M.A, and others, in the November 1996
Journal of Clinical Epidemiology 49(11), pp. 1239-1245.
A Few of California's Nonprofit Community Hospitals Do Not Provide Community Benefits to Balance Their Tax Subsidies
About 80 percent of nonprofit community hospitals in California provide uncompensated
care equal to the tax subsidies they receive, but another 20 percent do not. The average shortfall
per hospital amounted to $815,000, with a total shortfall of more than $40 million per year,
according to an AHCPR-supported study. On average, however, the amount of uncompensated
care, measured on a cost basis, exceeded the tax subsidies by almost two to one. Researchers
used 1988-1991 financial data from a Statewide hospital disclosure report on 189 nonprofit
voluntary hospitals in the state. The analysis showed that an average nonprofit hospital in
California received $1.58 million in tax subsidies in 1991. These subsidies increased with the
size of the hospital, with large hospitals receiving nearly $1 million.
"Do nonprofit hospitals pay their way?" by Michael A. Morrisey, Ph.D., and Mahmud Hassan,
Ph.D., Gerald J. Wedig, Ph.D., in the Winter 1996 issue of Health Affairs 15(4) pp. 132-144.
Other articles in Research Activities include findings on:
- Effect of equalizing payments for cesarean and vaginal deliveries.
- Leg pain patients who benefit most from revascularization.
- Physician use of stroke-prevention medications.
- How time of day influences cesarean deliveries.
- Health of Asian and Pacific Islander Americans Factors that affect counseling styles for depression.
- Patients less apt to benefit from hip replacement surgery.
- Not all eye doctors perform recommended tests following cataract surgery.
- Cost effectiveness of routine coronary angiography after heart attack certain patients.
- Overtreatment and undertreatment of children with acute gastroenteritis.
For additional information, contact AHCPR Public Affairs: Karen J.
Migdail, (301) 427-1855 , or Salina Prasad, (301) 427-1864.