Damian McNamara

HONOLULU  – Diabetes can be a challenge to control, depression can be difficult to treat and keep in remission, and growing evidence suggests the combination can be especially problematic for patients. And as if this adverse synergy were not bad enough, having these two conditions more than doubles the likelihood that a patient will develop dementia, Dr. Wayne J. Katon said.

Screening all patients with type 2 diabetes for depression, therefore, could have a big impact, he said at the annual meeting of the American Psychiatric Association. The American Diabetes Association has endorsed such screening since 2005.

Given the bidirectional relationship between these conditions, physicians treating patients with depression also should assess, counsel, and monitor them for the development of diabetes. "Some of our psychiatric education will be pushing residents to keep up their medical skills to do monitoring. If we only train psychiatrists to do blood pressure monitoring alone, it would make a big difference," said Dr. Katon, professor of psychiatry and behavioral sciences at the University of Washington in Seattle.

Major depression predicts an increased likelihood of cigarette smoking during adolescence (and more difficulty quitting), a sedentary lifestyle, and obesity. Patients with major depression also can feature decreased insulin sensitivity, increased inflammatory markers, and high cortisol levels, which all become risk factors for diabetes and heart disease.

"You can see why you would be at higher risk of earlier mortality," Dr. Katon said.

Diabetes and depression are independent risk factors for dementia, based on the findings in a prospective study of 3,837 primary care patients (J. Gen. Intern. Med. 2010;25:423-9). "It looks like these are particularly bad conditions to have together in terms of risk of dementia," he said.

Dr. Katon and his colleagues found that 7.9% of patients with diabetes and major depression developed dementia over a 5-year period (based on ICD-9 codes) compared with 4.8% of those with diabetes alone (fully adjusted hazard ratio, 2.69). "This was not explained by depression being a prodrome for dementia," he said.

A more than twofold increased risk for dementia is "especially frightening," Dr. Katon added. "It speaks to the importance of more aggressively screening diabetics for depression and more effectively treating them."

Beyond having an increased risk of mortality and dementia, people with diabetes and depression also have lower levels of self-care, do not exercise as much, and are not as adherent to medications, compared with nondepressed diabetics (Diabetes Care 2004;27:2154-60). In this study, those with diabetes and major depression had significantly more nonadherent medication days over time, compared with nondepressed diabetics. "This does not portend well for increased risk of morbidity and mortality," Dr. Katon said.

Session moderator Dr. Herbert Pardes commented, "This is a big deal. The comorbidity of depression with a major medical condition ... people have got to pay attention to the medical health as part of the comorbidities." Dr. Pardes is president and CEO of the New York Presbyterian Hospital in New York City.

The baseline severity of diabetes (higher number of symptoms) was a strong predictor of a patient having major depression in a 5-year follow-up study (Psychosomatics 2009;50:570-9). Dr. Katon and his coauthors also found having one or more coronary procedures during the 5 years predicted major depression in this prospective study of 2,759 primary care patients with diabetes.

The study also revealed a higher likelihood for all-cause mortality associated with depression (hazard ratio, 1.53, vs. 1.23 for those without depression). "Diabetics with major depression were about 50% more likely to die than nondepressed diabetics over 5 years," Dr. Katon said.

After confounders, including cigarette smoking and a sedentary lifestyle were controlled for, major depression was associated with more microvascular complications (HR, 1.33 vs. 1.05); more macrovascular complications (1.38 vs. 1.32), and a higher prevalence of foot ulcers (1.99 vs. 1.22).

Diabetes, depression, and coronary artery disease appear to be one of the "natural clusters of illnesses that doctors see," Dr. Katon said. These illnesses each have a high prevalence, high comorbidity, and bidirectional adverse interactions. Depression, chronic pain, and substance abuse comprise another natural cluster, he added "but that is a whole other lecture for another day."

Dr. Katon said he has received honoraria from Forest Laboratories, Lilly, Pfizer, and Wyeth.

HONOLULU  – Diabetes can be a challenge to control, depression can be difficult to treat and keep in remission, and growing evidence suggests the combination can be especially problematic for patients. And as if this adverse synergy were not bad enough, having these two conditions more than doubles the likelihood that a patient will develop dementia, Dr. Wayne J. Katon said.

Screening all patients with type 2 diabetes for depression, therefore, could have a big impact, he said at the annual meeting of the American Psychiatric Association. The American Diabetes Association has endorsed such screening since 2005.

Given the bidirectional relationship between these conditions, physicians treating patients with depression also should assess, counsel, and monitor them for the development of diabetes. "Some of our psychiatric education will be pushing residents to keep up their medical skills to do monitoring. If we only train psychiatrists to do blood pressure monitoring alone, it would make a big difference," said Dr. Katon, professor of psychiatry and behavioral sciences at the University of Washington in Seattle.

Major depression predicts an increased likelihood of cigarette smoking during adolescence (and more difficulty quitting), a sedentary lifestyle, and obesity. Patients with major depression also can feature decreased insulin sensitivity, increased inflammatory markers, and high cortisol levels, which all become risk factors for diabetes and heart disease.

"You can see why you would be at higher risk of earlier mortality," Dr. Katon said.

Diabetes and depression are independent risk factors for dementia, based on the findings in a prospective study of 3,837 primary care patients (J. Gen. Intern. Med. 2010;25:423-9). "It looks like these are particularly bad conditions to have together in terms of risk of dementia," he said.

Dr. Katon and his colleagues found that 7.9% of patients with diabetes and major depression developed dementia over a 5-year period (based on ICD-9 codes) compared with 4.8% of those with diabetes alone (fully adjusted hazard ratio, 2.69). "This was not explained by depression being a prodrome for dementia," he said.

A more than twofold increased risk for dementia is "especially frightening," Dr. Katon added. "It speaks to the importance of more aggressively screening diabetics for depression and more effectively treating them."

Beyond having an increased risk of mortality and dementia, people with diabetes and depression also have lower levels of self-care, do not exercise as much, and are not as adherent to medications, compared with nondepressed diabetics (Diabetes Care 2004;27:2154-60). In this study, those with diabetes and major depression had significantly more nonadherent medication days over time, compared with nondepressed diabetics. "This does not portend well for increased risk of morbidity and mortality," Dr. Katon said.

Session moderator Dr. Herbert Pardes commented, "This is a big deal. The comorbidity of depression with a major medical condition ... people have got to pay attention to the medical health as part of the comorbidities." Dr. Pardes is president and CEO of the New York Presbyterian Hospital in New York City.

The baseline severity of diabetes (higher number of symptoms) was a strong predictor of a patient having major depression in a 5-year follow-up study (Psychosomatics 2009;50:570-9). Dr. Katon and his coauthors also found having one or more coronary procedures during the 5 years predicted major depression in this prospective study of 2,759 primary care patients with diabetes.

The study also revealed a higher likelihood for all-cause mortality associated with depression (hazard ratio, 1.53, vs. 1.23 for those without depression). "Diabetics with major depression were about 50% more likely to die than nondepressed diabetics over 5 years," Dr. Katon said.

After confounders, including cigarette smoking and a sedentary lifestyle were controlled for, major depression was associated with more microvascular complications (HR, 1.33 vs. 1.05); more macrovascular complications (1.38 vs. 1.32), and a higher prevalence of foot ulcers (1.99 vs. 1.22).

Diabetes, depression, and coronary artery disease appear to be one of the "natural clusters of illnesses that doctors see," Dr. Katon said. These illnesses each have a high prevalence, high comorbidity, and bidirectional adverse interactions. Depression, chronic pain, and substance abuse comprise another natural cluster, he added "but that is a whole other lecture for another day."

Dr. Katon said he has received honoraria from Forest Laboratories, Lilly, Pfizer, and Wyeth.

HONOLULU  – Diabetes can be a challenge to control, depression can be difficult to treat and keep in remission, and growing evidence suggests the combination can be especially problematic for patients. And as if this adverse synergy were not bad enough, having these two conditions more than doubles the likelihood that a patient will develop dementia, Dr. Wayne J. Katon said.

Screening all patients with type 2 diabetes for depression, therefore, could have a big impact, he said at the annual meeting of the American Psychiatric Association. The American Diabetes Association has endorsed such screening since 2005.

Given the bidirectional relationship between these conditions, physicians treating patients with depression also should assess, counsel, and monitor them for the development of diabetes. "Some of our psychiatric education will be pushing residents to keep up their medical skills to do monitoring. If we only train psychiatrists to do blood pressure monitoring alone, it would make a big difference," said Dr. Katon, professor of psychiatry and behavioral sciences at the University of Washington in Seattle.

Major depression predicts an increased likelihood of cigarette smoking during adolescence (and more difficulty quitting), a sedentary lifestyle, and obesity. Patients with major depression also can feature decreased insulin sensitivity, increased inflammatory markers, and high cortisol levels, which all become risk factors for diabetes and heart disease.

"You can see why you would be at higher risk of earlier mortality," Dr. Katon said.

Diabetes and depression are independent risk factors for dementia, based on the findings in a prospective study of 3,837 primary care patients (J. Gen. Intern. Med. 2010;25:423-9). "It looks like these are particularly bad conditions to have together in terms of risk of dementia," he said.

Dr. Katon and his colleagues found that 7.9% of patients with diabetes and major depression developed dementia over a 5-year period (based on ICD-9 codes) compared with 4.8% of those with diabetes alone (fully adjusted hazard ratio, 2.69). "This was not explained by depression being a prodrome for dementia," he said.

A more than twofold increased risk for dementia is "especially frightening," Dr. Katon added. "It speaks to the importance of more aggressively screening diabetics for depression and more effectively treating them."

Beyond having an increased risk of mortality and dementia, people with diabetes and depression also have lower levels of self-care, do not exercise as much, and are not as adherent to medications, compared with nondepressed diabetics (Diabetes Care 2004;27:2154-60). In this study, those with diabetes and major depression had significantly more nonadherent medication days over time, compared with nondepressed diabetics. "This does not portend well for increased risk of morbidity and mortality," Dr. Katon said.

Session moderator Dr. Herbert Pardes commented, "This is a big deal. The comorbidity of depression with a major medical condition ... people have got to pay attention to the medical health as part of the comorbidities." Dr. Pardes is president and CEO of the New York Presbyterian Hospital in New York City.

The baseline severity of diabetes (higher number of symptoms) was a strong predictor of a patient having major depression in a 5-year follow-up study (Psychosomatics 2009;50:570-9). Dr. Katon and his coauthors also found having one or more coronary procedures during the 5 years predicted major depression in this prospective study of 2,759 primary care patients with diabetes.

The study also revealed a higher likelihood for all-cause mortality associated with depression (hazard ratio, 1.53, vs. 1.23 for those without depression). "Diabetics with major depression were about 50% more likely to die than nondepressed diabetics over 5 years," Dr. Katon said.

After confounders, including cigarette smoking and a sedentary lifestyle were controlled for, major depression was associated with more microvascular complications (HR, 1.33 vs. 1.05); more macrovascular complications (1.38 vs. 1.32), and a higher prevalence of foot ulcers (1.99 vs. 1.22).

Diabetes, depression, and coronary artery disease appear to be one of the "natural clusters of illnesses that doctors see," Dr. Katon said. These illnesses each have a high prevalence, high comorbidity, and bidirectional adverse interactions. Depression, chronic pain, and substance abuse comprise another natural cluster, he added "but that is a whole other lecture for another day."

Dr. Katon said he has received honoraria from Forest Laboratories, Lilly, Pfizer, and Wyeth.

TAMPA – The treatment of osteoporosis is in flux because of a variety of forces, including a substantial increase in the number of aging patients deemed eligible for treatments, a leading geriatrician said. Just as baby boomers begin reaching senior status, a recently developed tool for assessing people’s fracture risk is increasing the number of patients considered suitable for preventive therapy.

Meanwhile, those therapy options are multiplying, and emerging evidence suggests that one, bisphosphonates, is associated with an increased risk for atypical fractures, although the absolute risk appears to be low, Dr. Barbara Messinger-Rapport, said at the AMDA Dedicated to Long Term Care Medicine annual meeting.

The assessment tool making a difference is the Web-based Fracture Risk Assessment Tool (FRAX), released by the World Health Organization in 2008. FRAX guides clinicians to consider drug therapy for patients with T scores (deviations from healthy bone density) of –2.5 or lower at the femoral neck or spine, a T score between –1.0 and –2.5 as well as a 3% or higher calculated risk for hip fracture over 10 years, or a 20% or greater risk of major osteoporosis-related fracture.

Even if a person’s T score never reaches –2.5, his or her hip fracture risk can climb to 3% or higher, said Dr. Messinger-Rapport, director of the Center for Geriatric Medicine at the Cleveland Clinic and medical director of the Fairfax Health Care Center Nursing Home, also in Cleveland. "This could widen the number of people who could be put on treatment."

Bisphosphonates remain the most-common treatment strategy, but optimal duration of therapy, timing of drug holidays, and how age and gender play into risk for adverse events remains unclear, she said.

A newer option, the monoclonal antibody denosumab (Prolia, Amgen), significantly reduced vertebral fractures compared with a placebo in published studies. Administered as a subcutaneous injection every 6 months, denosumab also may be more convenient than agents requiring infusion, Dr. Messinger-Rapport said.

Higher cost is a consideration, however. Wholesale cost of denosumab is approximately $850/60-mg subcutaneous injection. In contrast, generic alendronate costs $100-$200/year; brand-name oral bisphosphonate costs up to $1,000/year; and zoledronic acid, delivered via intravenous infusion, is approximately $1,100/year, she said.

Denosumab’s impact on clinical care is not yet know, Dr. Messinger-Rapport said. She suggested that clinicians consider this agent in high-risk elders, women or men with osteoporosis, men with prostate cancer with androgen deprivation, patients with metastatic prostate or breast cancer, and possibly patients with renal impairment (denosumab clearance is not renal). Also consider denosumab for patients who cannot tolerate a bisphosphonate either orally or by infusion, she added.

Researchers showed a 68% decrease in vertebral fractures, a 40% decline in hip fractures, and a 20% decrease in nonvertebral fractures with denosumab versus placebo in the FREEDOM study of osteoporotic women treated for 36 months (N. Engl. J. Med. 2009;361:756-65). A similar 62% decrease in vertebral fractures with denosumab, compared with placebo, was observed in a 24-month study of men with androgen deprivation for prostate cancer (N. Engl. J. Med. 2009;361:745-55).

Researchers also have examined reports of atypical femoral fractures associated with bisphosphonate use and found an association. For example, in a study published last year, 17 of 20 atypical femoral fractures occurred in patients taking oral bisphosphonates (N. Engl. J. Med. 2010;363:1848-9). In a New England Journal letter (N. Engl. J. Med. 2010;362:1848-9), the researchers stated that although they found the association, "overall the anti-fracture effects of bisphosphonates far outweigh their potential risks."

More recently, other investigators found an increased risk of subtrochanteric and femoral shaft fractures in women treated for 5 years or more with oral bisphosphonates (JAMA 2011;305:783-9). The authors stated that the absolute risk of the atypical fractures is low, however.

Dr. Messinger-Rapport listed contraindications to bisphosphonates as a prior allergic reaction, vitamin D depletion (less than 30 ng/mL), hypocalcemia, dysphagia, esophageal disorders, and severe gastroesophageal reflux disorder.

A person attending the meeting asked if it is appropriate to continue bisphosphonate therapy after a patient’s T score improves. "Yes, even if the T score only improves by a few percentage points," Dr. Messinger-Rapport replied, because there is a disproportionate benefit in terms of fracture risk reduction.

Dr. Messinger-Rapport disclosed that she is an editorial board member for the National Osteoporosis Foundation.

TAMPA – The treatment of osteoporosis is in flux because of a variety of forces, including a substantial increase in the number of aging patients deemed eligible for treatments, a leading geriatrician said. Just as baby boomers begin reaching senior status, a recently developed tool for assessing people’s fracture risk is increasing the number of patients considered suitable for preventive therapy.

Meanwhile, those therapy options are multiplying, and emerging evidence suggests that one, bisphosphonates, is associated with an increased risk for atypical fractures, although the absolute risk appears to be low, Dr. Barbara Messinger-Rapport, said at the AMDA Dedicated to Long Term Care Medicine annual meeting.

The assessment tool making a difference is the Web-based Fracture Risk Assessment Tool (FRAX), released by the World Health Organization in 2008. FRAX guides clinicians to consider drug therapy for patients with T scores (deviations from healthy bone density) of –2.5 or lower at the femoral neck or spine, a T score between –1.0 and –2.5 as well as a 3% or higher calculated risk for hip fracture over 10 years, or a 20% or greater risk of major osteoporosis-related fracture.

Even if a person’s T score never reaches –2.5, his or her hip fracture risk can climb to 3% or higher, said Dr. Messinger-Rapport, director of the Center for Geriatric Medicine at the Cleveland Clinic and medical director of the Fairfax Health Care Center Nursing Home, also in Cleveland. "This could widen the number of people who could be put on treatment."

Bisphosphonates remain the most-common treatment strategy, but optimal duration of therapy, timing of drug holidays, and how age and gender play into risk for adverse events remains unclear, she said.

A newer option, the monoclonal antibody denosumab (Prolia, Amgen), significantly reduced vertebral fractures compared with a placebo in published studies. Administered as a subcutaneous injection every 6 months, denosumab also may be more convenient than agents requiring infusion, Dr. Messinger-Rapport said.

Higher cost is a consideration, however. Wholesale cost of denosumab is approximately $850/60-mg subcutaneous injection. In contrast, generic alendronate costs $100-$200/year; brand-name oral bisphosphonate costs up to $1,000/year; and zoledronic acid, delivered via intravenous infusion, is approximately $1,100/year, she said.

Denosumab’s impact on clinical care is not yet know, Dr. Messinger-Rapport said. She suggested that clinicians consider this agent in high-risk elders, women or men with osteoporosis, men with prostate cancer with androgen deprivation, patients with metastatic prostate or breast cancer, and possibly patients with renal impairment (denosumab clearance is not renal). Also consider denosumab for patients who cannot tolerate a bisphosphonate either orally or by infusion, she added.

Researchers showed a 68% decrease in vertebral fractures, a 40% decline in hip fractures, and a 20% decrease in nonvertebral fractures with denosumab versus placebo in the FREEDOM study of osteoporotic women treated for 36 months (N. Engl. J. Med. 2009;361:756-65). A similar 62% decrease in vertebral fractures with denosumab, compared with placebo, was observed in a 24-month study of men with androgen deprivation for prostate cancer (N. Engl. J. Med. 2009;361:745-55).

Researchers also have examined reports of atypical femoral fractures associated with bisphosphonate use and found an association. For example, in a study published last year, 17 of 20 atypical femoral fractures occurred in patients taking oral bisphosphonates (N. Engl. J. Med. 2010;363:1848-9). In a New England Journal letter (N. Engl. J. Med. 2010;362:1848-9), the researchers stated that although they found the association, "overall the anti-fracture effects of bisphosphonates far outweigh their potential risks."

More recently, other investigators found an increased risk of subtrochanteric and femoral shaft fractures in women treated for 5 years or more with oral bisphosphonates (JAMA 2011;305:783-9). The authors stated that the absolute risk of the atypical fractures is low, however.

Dr. Messinger-Rapport listed contraindications to bisphosphonates as a prior allergic reaction, vitamin D depletion (less than 30 ng/mL), hypocalcemia, dysphagia, esophageal disorders, and severe gastroesophageal reflux disorder.

A person attending the meeting asked if it is appropriate to continue bisphosphonate therapy after a patient’s T score improves. "Yes, even if the T score only improves by a few percentage points," Dr. Messinger-Rapport replied, because there is a disproportionate benefit in terms of fracture risk reduction.

Dr. Messinger-Rapport disclosed that she is an editorial board member for the National Osteoporosis Foundation.

TAMPA – The treatment of osteoporosis is in flux because of a variety of forces, including a substantial increase in the number of aging patients deemed eligible for treatments, a leading geriatrician said. Just as baby boomers begin reaching senior status, a recently developed tool for assessing people’s fracture risk is increasing the number of patients considered suitable for preventive therapy.

Meanwhile, those therapy options are multiplying, and emerging evidence suggests that one, bisphosphonates, is associated with an increased risk for atypical fractures, although the absolute risk appears to be low, Dr. Barbara Messinger-Rapport, said at the AMDA Dedicated to Long Term Care Medicine annual meeting.

The assessment tool making a difference is the Web-based Fracture Risk Assessment Tool (FRAX), released by the World Health Organization in 2008. FRAX guides clinicians to consider drug therapy for patients with T scores (deviations from healthy bone density) of –2.5 or lower at the femoral neck or spine, a T score between –1.0 and –2.5 as well as a 3% or higher calculated risk for hip fracture over 10 years, or a 20% or greater risk of major osteoporosis-related fracture.

Even if a person’s T score never reaches –2.5, his or her hip fracture risk can climb to 3% or higher, said Dr. Messinger-Rapport, director of the Center for Geriatric Medicine at the Cleveland Clinic and medical director of the Fairfax Health Care Center Nursing Home, also in Cleveland. "This could widen the number of people who could be put on treatment."

Bisphosphonates remain the most-common treatment strategy, but optimal duration of therapy, timing of drug holidays, and how age and gender play into risk for adverse events remains unclear, she said.

A newer option, the monoclonal antibody denosumab (Prolia, Amgen), significantly reduced vertebral fractures compared with a placebo in published studies. Administered as a subcutaneous injection every 6 months, denosumab also may be more convenient than agents requiring infusion, Dr. Messinger-Rapport said.

Higher cost is a consideration, however. Wholesale cost of denosumab is approximately $850/60-mg subcutaneous injection. In contrast, generic alendronate costs $100-$200/year; brand-name oral bisphosphonate costs up to $1,000/year; and zoledronic acid, delivered via intravenous infusion, is approximately $1,100/year, she said.

Denosumab’s impact on clinical care is not yet know, Dr. Messinger-Rapport said. She suggested that clinicians consider this agent in high-risk elders, women or men with osteoporosis, men with prostate cancer with androgen deprivation, patients with metastatic prostate or breast cancer, and possibly patients with renal impairment (denosumab clearance is not renal). Also consider denosumab for patients who cannot tolerate a bisphosphonate either orally or by infusion, she added.

Researchers showed a 68% decrease in vertebral fractures, a 40% decline in hip fractures, and a 20% decrease in nonvertebral fractures with denosumab versus placebo in the FREEDOM study of osteoporotic women treated for 36 months (N. Engl. J. Med. 2009;361:756-65). A similar 62% decrease in vertebral fractures with denosumab, compared with placebo, was observed in a 24-month study of men with androgen deprivation for prostate cancer (N. Engl. J. Med. 2009;361:745-55).

Researchers also have examined reports of atypical femoral fractures associated with bisphosphonate use and found an association. For example, in a study published last year, 17 of 20 atypical femoral fractures occurred in patients taking oral bisphosphonates (N. Engl. J. Med. 2010;363:1848-9). In a New England Journal letter (N. Engl. J. Med. 2010;362:1848-9), the researchers stated that although they found the association, "overall the anti-fracture effects of bisphosphonates far outweigh their potential risks."

More recently, other investigators found an increased risk of subtrochanteric and femoral shaft fractures in women treated for 5 years or more with oral bisphosphonates (JAMA 2011;305:783-9). The authors stated that the absolute risk of the atypical fractures is low, however.

Dr. Messinger-Rapport listed contraindications to bisphosphonates as a prior allergic reaction, vitamin D depletion (less than 30 ng/mL), hypocalcemia, dysphagia, esophageal disorders, and severe gastroesophageal reflux disorder.

A person attending the meeting asked if it is appropriate to continue bisphosphonate therapy after a patient’s T score improves. "Yes, even if the T score only improves by a few percentage points," Dr. Messinger-Rapport replied, because there is a disproportionate benefit in terms of fracture risk reduction.

Dr. Messinger-Rapport disclosed that she is an editorial board member for the National Osteoporosis Foundation.

TAMPA – The treatment of osteoporosis is in flux because of a variety of forces, including a substantial increase in the number of aging patients deemed eligible for treatments, a leading geriatrician said. Just as baby boomers begin reaching senior status, a recently developed tool for assessing people’s fracture risk is increasing the number of patients considered suitable for preventive therapy.

Meanwhile, those therapy options are multiplying, and emerging evidence suggests that one, bisphosphonates, is associated with an increased risk for atypical fractures, although the absolute risk appears to be low, Dr. Barbara Messinger-Rapport, said at the AMDA Dedicated to Long Term Care Medicine annual meeting.

The assessment tool making a difference is the Web-based Fracture Risk Assessment Tool (FRAX), released by the World Health Organization in 2008. FRAX guides clinicians to consider drug therapy for patients with T scores (deviations from healthy bone density) of –2.5 or lower at the femoral neck or spine, a T score between –1.0 and –2.5 as well as a 3% or higher calculated risk for hip fracture over 10 years, or a 20% or greater risk of major osteoporosis-related fracture.

Even if a person’s T score never reaches –2.5, his or her hip fracture risk can climb to 3% or higher, said Dr. Messinger-Rapport, director of the Center for Geriatric Medicine at the Cleveland Clinic and medical director of the Fairfax Health Care Center Nursing Home, also in Cleveland. "This could widen the number of people who could be put on treatment."

Bisphosphonates remain the most-common treatment strategy, but optimal duration of therapy, timing of drug holidays, and how age and gender play into risk for adverse events remains unclear, she said.

A newer option, the monoclonal antibody denosumab (Prolia, Amgen), significantly reduced vertebral fractures compared with a placebo in published studies. Administered as a subcutaneous injection every 6 months, denosumab also may be more convenient than agents requiring infusion, Dr. Messinger-Rapport said.

Higher cost is a consideration, however. Wholesale cost of denosumab is approximately $850/60-mg subcutaneous injection. In contrast, generic alendronate costs $100-$200/year; brand-name oral bisphosphonate costs up to $1,000/year; and zoledronic acid, delivered via intravenous infusion, is approximately $1,100/year, she said.

Denosumab’s impact on clinical care is not yet know, Dr. Messinger-Rapport said. She suggested that clinicians consider this agent in high-risk elders, women or men with osteoporosis, men with prostate cancer with androgen deprivation, patients with metastatic prostate or breast cancer, and possibly patients with renal impairment (denosumab clearance is not renal). Also consider denosumab for patients who cannot tolerate a bisphosphonate either orally or by infusion, she added.

Researchers showed a 68% decrease in vertebral fractures, a 40% decline in hip fractures, and a 20% decrease in nonvertebral fractures with denosumab versus placebo in the FREEDOM study of osteoporotic women treated for 36 months (N. Engl. J. Med. 2009;361:756-65). A similar 62% decrease in vertebral fractures with denosumab, compared with placebo, was observed in a 24-month study of men with androgen deprivation for prostate cancer (N. Engl. J. Med. 2009;361:745-55).

Researchers also have examined reports of atypical femoral fractures associated with bisphosphonate use and found an association. For example, in a study published last year, 17 of 20 atypical femoral fractures occurred in patients taking oral bisphosphonates (N. Engl. J. Med. 2010;363:1848-9). In a New England Journal letter (N. Engl. J. Med. 2010;362:1848-9), the researchers stated that although they found the association, "overall the anti-fracture effects of bisphosphonates far outweigh their potential risks."

More recently, other investigators found an increased risk of subtrochanteric and femoral shaft fractures in women treated for 5 years or more with oral bisphosphonates (JAMA 2011;305:783-9). The authors stated that the absolute risk of the atypical fractures is low, however.

Dr. Messinger-Rapport listed contraindications to bisphosphonates as a prior allergic reaction, vitamin D depletion (less than 30 ng/mL), hypocalcemia, dysphagia, esophageal disorders, and severe gastroesophageal reflux disorder.

A person attending the meeting asked if it is appropriate to continue bisphosphonate therapy after a patient’s T score improves. "Yes, even if the T score only improves by a few percentage points," Dr. Messinger-Rapport replied, because there is a disproportionate benefit in terms of fracture risk reduction.

Dr. Messinger-Rapport disclosed that she is an editorial board member for the National Osteoporosis Foundation.

TAMPA – The treatment of osteoporosis is in flux because of a variety of forces, including a substantial increase in the number of aging patients deemed eligible for treatments, a leading geriatrician said. Just as baby boomers begin reaching senior status, a recently developed tool for assessing people’s fracture risk is increasing the number of patients considered suitable for preventive therapy.

Meanwhile, those therapy options are multiplying, and emerging evidence suggests that one, bisphosphonates, is associated with an increased risk for atypical fractures, although the absolute risk appears to be low, Dr. Barbara Messinger-Rapport, said at the AMDA Dedicated to Long Term Care Medicine annual meeting.

The assessment tool making a difference is the Web-based Fracture Risk Assessment Tool (FRAX), released by the World Health Organization in 2008. FRAX guides clinicians to consider drug therapy for patients with T scores (deviations from healthy bone density) of –2.5 or lower at the femoral neck or spine, a T score between –1.0 and –2.5 as well as a 3% or higher calculated risk for hip fracture over 10 years, or a 20% or greater risk of major osteoporosis-related fracture.

Even if a person’s T score never reaches –2.5, his or her hip fracture risk can climb to 3% or higher, said Dr. Messinger-Rapport, director of the Center for Geriatric Medicine at the Cleveland Clinic and medical director of the Fairfax Health Care Center Nursing Home, also in Cleveland. "This could widen the number of people who could be put on treatment."

Bisphosphonates remain the most-common treatment strategy, but optimal duration of therapy, timing of drug holidays, and how age and gender play into risk for adverse events remains unclear, she said.

A newer option, the monoclonal antibody denosumab (Prolia, Amgen), significantly reduced vertebral fractures compared with a placebo in published studies. Administered as a subcutaneous injection every 6 months, denosumab also may be more convenient than agents requiring infusion, Dr. Messinger-Rapport said.

Higher cost is a consideration, however. Wholesale cost of denosumab is approximately $850/60-mg subcutaneous injection. In contrast, generic alendronate costs $100-$200/year; brand-name oral bisphosphonate costs up to $1,000/year; and zoledronic acid, delivered via intravenous infusion, is approximately $1,100/year, she said.

Denosumab’s impact on clinical care is not yet know, Dr. Messinger-Rapport said. She suggested that clinicians consider this agent in high-risk elders, women or men with osteoporosis, men with prostate cancer with androgen deprivation, patients with metastatic prostate or breast cancer, and possibly patients with renal impairment (denosumab clearance is not renal). Also consider denosumab for patients who cannot tolerate a bisphosphonate either orally or by infusion, she added.

Researchers showed a 68% decrease in vertebral fractures, a 40% decline in hip fractures, and a 20% decrease in nonvertebral fractures with denosumab versus placebo in the FREEDOM study of osteoporotic women treated for 36 months (N. Engl. J. Med. 2009;361:756-65). A similar 62% decrease in vertebral fractures with denosumab, compared with placebo, was observed in a 24-month study of men with androgen deprivation for prostate cancer (N. Engl. J. Med. 2009;361:745-55).

Researchers also have examined reports of atypical femoral fractures associated with bisphosphonate use and found an association. For example, in a study published last year, 17 of 20 atypical femoral fractures occurred in patients taking oral bisphosphonates (N. Engl. J. Med. 2010;363:1848-9). In a New England Journal letter (N. Engl. J. Med. 2010;362:1848-9), the researchers stated that although they found the association, "overall the anti-fracture effects of bisphosphonates far outweigh their potential risks."

More recently, other investigators found an increased risk of subtrochanteric and femoral shaft fractures in women treated for 5 years or more with oral bisphosphonates (JAMA 2011;305:783-9). The authors stated that the absolute risk of the atypical fractures is low, however.

Dr. Messinger-Rapport listed contraindications to bisphosphonates as a prior allergic reaction, vitamin D depletion (less than 30 ng/mL), hypocalcemia, dysphagia, esophageal disorders, and severe gastroesophageal reflux disorder.

A person attending the meeting asked if it is appropriate to continue bisphosphonate therapy after a patient’s T score improves. "Yes, even if the T score only improves by a few percentage points," Dr. Messinger-Rapport replied, because there is a disproportionate benefit in terms of fracture risk reduction.

Dr. Messinger-Rapport disclosed that she is an editorial board member for the National Osteoporosis Foundation.

TAMPA – The treatment of osteoporosis is in flux because of a variety of forces, including a substantial increase in the number of aging patients deemed eligible for treatments, a leading geriatrician said. Just as baby boomers begin reaching senior status, a recently developed tool for assessing people’s fracture risk is increasing the number of patients considered suitable for preventive therapy.

Meanwhile, those therapy options are multiplying, and emerging evidence suggests that one, bisphosphonates, is associated with an increased risk for atypical fractures, although the absolute risk appears to be low, Dr. Barbara Messinger-Rapport, said at the AMDA Dedicated to Long Term Care Medicine annual meeting.

The assessment tool making a difference is the Web-based Fracture Risk Assessment Tool (FRAX), released by the World Health Organization in 2008. FRAX guides clinicians to consider drug therapy for patients with T scores (deviations from healthy bone density) of –2.5 or lower at the femoral neck or spine, a T score between –1.0 and –2.5 as well as a 3% or higher calculated risk for hip fracture over 10 years, or a 20% or greater risk of major osteoporosis-related fracture.

Even if a person’s T score never reaches –2.5, his or her hip fracture risk can climb to 3% or higher, said Dr. Messinger-Rapport, director of the Center for Geriatric Medicine at the Cleveland Clinic and medical director of the Fairfax Health Care Center Nursing Home, also in Cleveland. "This could widen the number of people who could be put on treatment."

Bisphosphonates remain the most-common treatment strategy, but optimal duration of therapy, timing of drug holidays, and how age and gender play into risk for adverse events remains unclear, she said.

A newer option, the monoclonal antibody denosumab (Prolia, Amgen), significantly reduced vertebral fractures compared with a placebo in published studies. Administered as a subcutaneous injection every 6 months, denosumab also may be more convenient than agents requiring infusion, Dr. Messinger-Rapport said.

Higher cost is a consideration, however. Wholesale cost of denosumab is approximately $850/60-mg subcutaneous injection. In contrast, generic alendronate costs $100-$200/year; brand-name oral bisphosphonate costs up to $1,000/year; and zoledronic acid, delivered via intravenous infusion, is approximately $1,100/year, she said.

Denosumab’s impact on clinical care is not yet know, Dr. Messinger-Rapport said. She suggested that clinicians consider this agent in high-risk elders, women or men with osteoporosis, men with prostate cancer with androgen deprivation, patients with metastatic prostate or breast cancer, and possibly patients with renal impairment (denosumab clearance is not renal). Also consider denosumab for patients who cannot tolerate a bisphosphonate either orally or by infusion, she added.

Researchers showed a 68% decrease in vertebral fractures, a 40% decline in hip fractures, and a 20% decrease in nonvertebral fractures with denosumab versus placebo in the FREEDOM study of osteoporotic women treated for 36 months (N. Engl. J. Med. 2009;361:756-65). A similar 62% decrease in vertebral fractures with denosumab, compared with placebo, was observed in a 24-month study of men with androgen deprivation for prostate cancer (N. Engl. J. Med. 2009;361:745-55).

Researchers also have examined reports of atypical femoral fractures associated with bisphosphonate use and found an association. For example, in a study published last year, 17 of 20 atypical femoral fractures occurred in patients taking oral bisphosphonates (N. Engl. J. Med. 2010;363:1848-9). In a New England Journal letter (N. Engl. J. Med. 2010;362:1848-9), the researchers stated that although they found the association, "overall the anti-fracture effects of bisphosphonates far outweigh their potential risks."

More recently, other investigators found an increased risk of subtrochanteric and femoral shaft fractures in women treated for 5 years or more with oral bisphosphonates (JAMA 2011;305:783-9). The authors stated that the absolute risk of the atypical fractures is low, however.

Dr. Messinger-Rapport listed contraindications to bisphosphonates as a prior allergic reaction, vitamin D depletion (less than 30 ng/mL), hypocalcemia, dysphagia, esophageal disorders, and severe gastroesophageal reflux disorder.

A person attending the meeting asked if it is appropriate to continue bisphosphonate therapy after a patient’s T score improves. "Yes, even if the T score only improves by a few percentage points," Dr. Messinger-Rapport replied, because there is a disproportionate benefit in terms of fracture risk reduction.

Dr. Messinger-Rapport disclosed that she is an editorial board member for the National Osteoporosis Foundation.

DENVER – Underage, adolescent alcohol drinkers who endorse a favorite brand are significantly more likely to report recent binge drinking than are those who have no favorite brand.

In addition, the amount of money a company spent on television advertising to promote its brand was directly associated with choice of brand and increased risk for problematic alcohol use, according to a nationally-representative survey of 2,699 individuals aged 16-20 years.

(c) godfer/Fotolia.com

"Underage drinkers preferentially choose highly advertised brands as ‘favorites.’ This suggests that marketing is indeed influencing their choice of beverage," Dr. Susanne E. Tanski said at the annual meeting of the Pediatric Academic Societies.

Based on the findings, physicians could screen patients for problem drinking if they endorse a favorite brand. Doctors also could advocate for an increase in the voluntary advertising restrictions for "hard alcohol" television advertising to protect underage drinkers, Dr. Tanski said. Currently, such advertisements are placed only in media where at least 70% of audience is reasonably expected to be 21 years or older.

"If you turn on [ESPN] SportsCenter any night, you see a tremendous number of alcohol ads," said Dr. Tanski, who is on the pediatric faculty at Dartmouth Medical School in Lebanon, N.H.

Nearly two-thirds of respondents reported they had ever tried alcohol (1,734 adolescents, 64%), and almost 21% had binged in the previous 30 days. Binge drinking was defined as consuming five or more alcoholic drinks at a time.

Of those who had ever had a full drink (not a sip or taste), 68% said they had a favorite brand. "We took anything they told us. It was a long list [158 brands], but some we were not able to verify (e.g, ‘X-Ray’)."

Favorite drinks included a distilled spirit brand by 53%, beer brand by almost 43%, and wine/cider by nearly 3%. The remaining drinks were unknown brand names. Results suggest that the distilled spirits industry is making inroads into the adolescent market, the authors stated.

"The winner for this was Smirnoff, and a close second was Budweiser," Dr. Tanski said. As a caveat, she added, she and her colleagues did not distinguish between hard liquor brands and their malt beverage drinks (for example, Smirnoff vodka was not distinguished from Smirnoff Ice or Bacardi rum from Bacardi Breezers).

In addition, favorites varied by sex, with girls more likely to endorse Smirnoff and boys more likely to say Budweiser was their favorite. A meeting attendee asked if Dr. Tanski differentiated between advertising geared toward men or women. "Most of Budweiser ads are advertised to men, but there are some geared to women also. That is something we can certainly look at."

Girls also chose, in order, Budweiser, Corona, Grey Goose, Bacardi, Captain Morgan, Coors, Skyy, Miller, and Absolut as their top favorites. Male adolescents, after Budweiser, chose Smirnoff, Coors, Corona, Miller, Captain Morgan, Heineken, Grey Goose, Jack Daniels, and Bacardi.

Binge drinking within the past 30 days did not differ significantly between those who endorsed a favorite distilled spirit vs. a beer brand. Another significant difference was binge drinking prevalence among those teenagers who reported a favorite alcohol brand, which ranged from 28% to 71% depending on brand, vs. 11% among those with no favorite.

Overall prevalence of binge drinking was 25% among girls and 39% among boys. Both girls and boys who chose Coors beer as their favorite were at particularly high risk for binge drinking. For example, 70% of the boys who said they were likely to binge drink chose Coors as their favorite brand. Miller beer and Grey Goose vodka also scored high for binge drinking among girls, as did Jack Daniels and Captain Morgan among boys.

A significant correlation between brand preference among these adolescents and marketing expenditures suggest marketing plays a role in choice of a favorite brand. Using the most recent data available from Nielsen, Budweiser spent $1.1 billion on television advertising in 2009. Smirnoff advertising expenditure was $63 million during the same year, Dr. Tanski said, "So they got a lot of bang for their buck."

In 1996, the Distilled Spirits Council of the United States lifted its voluntary ban on "hard alcohol" advertising on television, starting with cable TV. The major television networks began allowing such advertisements in 2001, when NBC aired a Smirnoff ad during Saturday Night Live. More recently, in 2009, CBS aired an Absolut advertisement during the Grammy Awards. "As you all well know, there is lot more hard alcohol or distilled spirits advertising on major networks now," Dr. Tanski said. ABC, which is owned by Disney, has not aired "hard alcohol" advertising.

Self-reported drinking behavior is a potential limitation of the study. This was a sample from a longitudinal survey of media exposure and adolescent behavior. In addition, this sample, while national, might not be representative of groups with higher attrition in the survey over time, such as poorer or minority adolescents. Also, because the study was cross-sectional, no causality can be implied, Dr. Tanski said.

Dr. Tanski said that she had no relevant disclosures.

DENVER – Underage, adolescent alcohol drinkers who endorse a favorite brand are significantly more likely to report recent binge drinking than are those who have no favorite brand.

In addition, the amount of money a company spent on television advertising to promote its brand was directly associated with choice of brand and increased risk for problematic alcohol use, according to a nationally-representative survey of 2,699 individuals aged 16-20 years.

(c) godfer/Fotolia.com

"Underage drinkers preferentially choose highly advertised brands as ‘favorites.’ This suggests that marketing is indeed influencing their choice of beverage," Dr. Susanne E. Tanski said at the annual meeting of the Pediatric Academic Societies.

Based on the findings, physicians could screen patients for problem drinking if they endorse a favorite brand. Doctors also could advocate for an increase in the voluntary advertising restrictions for "hard alcohol" television advertising to protect underage drinkers, Dr. Tanski said. Currently, such advertisements are placed only in media where at least 70% of audience is reasonably expected to be 21 years or older.

"If you turn on [ESPN] SportsCenter any night, you see a tremendous number of alcohol ads," said Dr. Tanski, who is on the pediatric faculty at Dartmouth Medical School in Lebanon, N.H.

Nearly two-thirds of respondents reported they had ever tried alcohol (1,734 adolescents, 64%), and almost 21% had binged in the previous 30 days. Binge drinking was defined as consuming five or more alcoholic drinks at a time.

Of those who had ever had a full drink (not a sip or taste), 68% said they had a favorite brand. "We took anything they told us. It was a long list [158 brands], but some we were not able to verify (e.g, ‘X-Ray’)."

Favorite drinks included a distilled spirit brand by 53%, beer brand by almost 43%, and wine/cider by nearly 3%. The remaining drinks were unknown brand names. Results suggest that the distilled spirits industry is making inroads into the adolescent market, the authors stated.

"The winner for this was Smirnoff, and a close second was Budweiser," Dr. Tanski said. As a caveat, she added, she and her colleagues did not distinguish between hard liquor brands and their malt beverage drinks (for example, Smirnoff vodka was not distinguished from Smirnoff Ice or Bacardi rum from Bacardi Breezers).

In addition, favorites varied by sex, with girls more likely to endorse Smirnoff and boys more likely to say Budweiser was their favorite. A meeting attendee asked if Dr. Tanski differentiated between advertising geared toward men or women. "Most of Budweiser ads are advertised to men, but there are some geared to women also. That is something we can certainly look at."

Girls also chose, in order, Budweiser, Corona, Grey Goose, Bacardi, Captain Morgan, Coors, Skyy, Miller, and Absolut as their top favorites. Male adolescents, after Budweiser, chose Smirnoff, Coors, Corona, Miller, Captain Morgan, Heineken, Grey Goose, Jack Daniels, and Bacardi.

Binge drinking within the past 30 days did not differ significantly between those who endorsed a favorite distilled spirit vs. a beer brand. Another significant difference was binge drinking prevalence among those teenagers who reported a favorite alcohol brand, which ranged from 28% to 71% depending on brand, vs. 11% among those with no favorite.

Overall prevalence of binge drinking was 25% among girls and 39% among boys. Both girls and boys who chose Coors beer as their favorite were at particularly high risk for binge drinking. For example, 70% of the boys who said they were likely to binge drink chose Coors as their favorite brand. Miller beer and Grey Goose vodka also scored high for binge drinking among girls, as did Jack Daniels and Captain Morgan among boys.

A significant correlation between brand preference among these adolescents and marketing expenditures suggest marketing plays a role in choice of a favorite brand. Using the most recent data available from Nielsen, Budweiser spent $1.1 billion on television advertising in 2009. Smirnoff advertising expenditure was $63 million during the same year, Dr. Tanski said, "So they got a lot of bang for their buck."

In 1996, the Distilled Spirits Council of the United States lifted its voluntary ban on "hard alcohol" advertising on television, starting with cable TV. The major television networks began allowing such advertisements in 2001, when NBC aired a Smirnoff ad during Saturday Night Live. More recently, in 2009, CBS aired an Absolut advertisement during the Grammy Awards. "As you all well know, there is lot more hard alcohol or distilled spirits advertising on major networks now," Dr. Tanski said. ABC, which is owned by Disney, has not aired "hard alcohol" advertising.

Self-reported drinking behavior is a potential limitation of the study. This was a sample from a longitudinal survey of media exposure and adolescent behavior. In addition, this sample, while national, might not be representative of groups with higher attrition in the survey over time, such as poorer or minority adolescents. Also, because the study was cross-sectional, no causality can be implied, Dr. Tanski said.

Dr. Tanski said that she had no relevant disclosures.

DENVER – Underage, adolescent alcohol drinkers who endorse a favorite brand are significantly more likely to report recent binge drinking than are those who have no favorite brand.

In addition, the amount of money a company spent on television advertising to promote its brand was directly associated with choice of brand and increased risk for problematic alcohol use, according to a nationally-representative survey of 2,699 individuals aged 16-20 years.

(c) godfer/Fotolia.com

"Underage drinkers preferentially choose highly advertised brands as ‘favorites.’ This suggests that marketing is indeed influencing their choice of beverage," Dr. Susanne E. Tanski said at the annual meeting of the Pediatric Academic Societies.

Based on the findings, physicians could screen patients for problem drinking if they endorse a favorite brand. Doctors also could advocate for an increase in the voluntary advertising restrictions for "hard alcohol" television advertising to protect underage drinkers, Dr. Tanski said. Currently, such advertisements are placed only in media where at least 70% of audience is reasonably expected to be 21 years or older.

"If you turn on [ESPN] SportsCenter any night, you see a tremendous number of alcohol ads," said Dr. Tanski, who is on the pediatric faculty at Dartmouth Medical School in Lebanon, N.H.

Nearly two-thirds of respondents reported they had ever tried alcohol (1,734 adolescents, 64%), and almost 21% had binged in the previous 30 days. Binge drinking was defined as consuming five or more alcoholic drinks at a time.

Of those who had ever had a full drink (not a sip or taste), 68% said they had a favorite brand. "We took anything they told us. It was a long list [158 brands], but some we were not able to verify (e.g, ‘X-Ray’)."

Favorite drinks included a distilled spirit brand by 53%, beer brand by almost 43%, and wine/cider by nearly 3%. The remaining drinks were unknown brand names. Results suggest that the distilled spirits industry is making inroads into the adolescent market, the authors stated.

"The winner for this was Smirnoff, and a close second was Budweiser," Dr. Tanski said. As a caveat, she added, she and her colleagues did not distinguish between hard liquor brands and their malt beverage drinks (for example, Smirnoff vodka was not distinguished from Smirnoff Ice or Bacardi rum from Bacardi Breezers).

In addition, favorites varied by sex, with girls more likely to endorse Smirnoff and boys more likely to say Budweiser was their favorite. A meeting attendee asked if Dr. Tanski differentiated between advertising geared toward men or women. "Most of Budweiser ads are advertised to men, but there are some geared to women also. That is something we can certainly look at."

Girls also chose, in order, Budweiser, Corona, Grey Goose, Bacardi, Captain Morgan, Coors, Skyy, Miller, and Absolut as their top favorites. Male adolescents, after Budweiser, chose Smirnoff, Coors, Corona, Miller, Captain Morgan, Heineken, Grey Goose, Jack Daniels, and Bacardi.

Binge drinking within the past 30 days did not differ significantly between those who endorsed a favorite distilled spirit vs. a beer brand. Another significant difference was binge drinking prevalence among those teenagers who reported a favorite alcohol brand, which ranged from 28% to 71% depending on brand, vs. 11% among those with no favorite.

Overall prevalence of binge drinking was 25% among girls and 39% among boys. Both girls and boys who chose Coors beer as their favorite were at particularly high risk for binge drinking. For example, 70% of the boys who said they were likely to binge drink chose Coors as their favorite brand. Miller beer and Grey Goose vodka also scored high for binge drinking among girls, as did Jack Daniels and Captain Morgan among boys.

A significant correlation between brand preference among these adolescents and marketing expenditures suggest marketing plays a role in choice of a favorite brand. Using the most recent data available from Nielsen, Budweiser spent $1.1 billion on television advertising in 2009. Smirnoff advertising expenditure was $63 million during the same year, Dr. Tanski said, "So they got a lot of bang for their buck."

In 1996, the Distilled Spirits Council of the United States lifted its voluntary ban on "hard alcohol" advertising on television, starting with cable TV. The major television networks began allowing such advertisements in 2001, when NBC aired a Smirnoff ad during Saturday Night Live. More recently, in 2009, CBS aired an Absolut advertisement during the Grammy Awards. "As you all well know, there is lot more hard alcohol or distilled spirits advertising on major networks now," Dr. Tanski said. ABC, which is owned by Disney, has not aired "hard alcohol" advertising.

Self-reported drinking behavior is a potential limitation of the study. This was a sample from a longitudinal survey of media exposure and adolescent behavior. In addition, this sample, while national, might not be representative of groups with higher attrition in the survey over time, such as poorer or minority adolescents. Also, because the study was cross-sectional, no causality can be implied, Dr. Tanski said.

Dr. Tanski said that she had no relevant disclosures.

DENVER – Underage, adolescent alcohol drinkers who endorse a favorite brand are significantly more likely to report recent binge drinking than are those who have no favorite brand.

In addition, the amount of money a company spent on television advertising to promote its brand was directly associated with choice of brand and increased risk for problematic alcohol use, according to a nationally-representative survey of 2,699 individuals aged 16-20 years.

(c) godfer/Fotolia.com

"Underage drinkers preferentially choose highly advertised brands as ‘favorites.’ This suggests that marketing is indeed influencing their choice of beverage," Dr. Susanne E. Tanski said at the annual meeting of the Pediatric Academic Societies.

Based on the findings, physicians could screen patients for problem drinking if they endorse a favorite brand. Doctors also could advocate for an increase in the voluntary advertising restrictions for "hard alcohol" television advertising to protect underage drinkers, Dr. Tanski said. Currently, such advertisements are placed only in media where at least 70% of audience is reasonably expected to be 21 years or older.

"If you turn on [ESPN] SportsCenter any night, you see a tremendous number of alcohol ads," said Dr. Tanski, who is on the pediatric faculty at Dartmouth Medical School in Lebanon, N.H.

Nearly two-thirds of respondents reported they had ever tried alcohol (1,734 adolescents, 64%), and almost 21% had binged in the previous 30 days. Binge drinking was defined as consuming five or more alcoholic drinks at a time.

Of those who had ever had a full drink (not a sip or taste), 68% said they had a favorite brand. "We took anything they told us. It was a long list [158 brands], but some we were not able to verify (e.g, ‘X-Ray’)."

Favorite drinks included a distilled spirit brand by 53%, beer brand by almost 43%, and wine/cider by nearly 3%. The remaining drinks were unknown brand names. Results suggest that the distilled spirits industry is making inroads into the adolescent market, the authors stated.

"The winner for this was Smirnoff, and a close second was Budweiser," Dr. Tanski said. As a caveat, she added, she and her colleagues did not distinguish between hard liquor brands and their malt beverage drinks (for example, Smirnoff vodka was not distinguished from Smirnoff Ice or Bacardi rum from Bacardi Breezers).

In addition, favorites varied by sex, with girls more likely to endorse Smirnoff and boys more likely to say Budweiser was their favorite. A meeting attendee asked if Dr. Tanski differentiated between advertising geared toward men or women. "Most of Budweiser ads are advertised to men, but there are some geared to women also. That is something we can certainly look at."

Girls also chose, in order, Budweiser, Corona, Grey Goose, Bacardi, Captain Morgan, Coors, Skyy, Miller, and Absolut as their top favorites. Male adolescents, after Budweiser, chose Smirnoff, Coors, Corona, Miller, Captain Morgan, Heineken, Grey Goose, Jack Daniels, and Bacardi.

Binge drinking within the past 30 days did not differ significantly between those who endorsed a favorite distilled spirit vs. a beer brand. Another significant difference was binge drinking prevalence among those teenagers who reported a favorite alcohol brand, which ranged from 28% to 71% depending on brand, vs. 11% among those with no favorite.

Overall prevalence of binge drinking was 25% among girls and 39% among boys. Both girls and boys who chose Coors beer as their favorite were at particularly high risk for binge drinking. For example, 70% of the boys who said they were likely to binge drink chose Coors as their favorite brand. Miller beer and Grey Goose vodka also scored high for binge drinking among girls, as did Jack Daniels and Captain Morgan among boys.

A significant correlation between brand preference among these adolescents and marketing expenditures suggest marketing plays a role in choice of a favorite brand. Using the most recent data available from Nielsen, Budweiser spent $1.1 billion on television advertising in 2009. Smirnoff advertising expenditure was $63 million during the same year, Dr. Tanski said, "So they got a lot of bang for their buck."

In 1996, the Distilled Spirits Council of the United States lifted its voluntary ban on "hard alcohol" advertising on television, starting with cable TV. The major television networks began allowing such advertisements in 2001, when NBC aired a Smirnoff ad during Saturday Night Live. More recently, in 2009, CBS aired an Absolut advertisement during the Grammy Awards. "As you all well know, there is lot more hard alcohol or distilled spirits advertising on major networks now," Dr. Tanski said. ABC, which is owned by Disney, has not aired "hard alcohol" advertising.

Self-reported drinking behavior is a potential limitation of the study. This was a sample from a longitudinal survey of media exposure and adolescent behavior. In addition, this sample, while national, might not be representative of groups with higher attrition in the survey over time, such as poorer or minority adolescents. Also, because the study was cross-sectional, no causality can be implied, Dr. Tanski said.

Dr. Tanski said that she had no relevant disclosures.

DENVER – Underage, adolescent alcohol drinkers who endorse a favorite brand are significantly more likely to report recent binge drinking than are those who have no favorite brand.

In addition, the amount of money a company spent on television advertising to promote its brand was directly associated with choice of brand and increased risk for problematic alcohol use, according to a nationally-representative survey of 2,699 individuals aged 16-20 years.

(c) godfer/Fotolia.com

"Underage drinkers preferentially choose highly advertised brands as ‘favorites.’ This suggests that marketing is indeed influencing their choice of beverage," Dr. Susanne E. Tanski said at the annual meeting of the Pediatric Academic Societies.

Based on the findings, physicians could screen patients for problem drinking if they endorse a favorite brand. Doctors also could advocate for an increase in the voluntary advertising restrictions for "hard alcohol" television advertising to protect underage drinkers, Dr. Tanski said. Currently, such advertisements are placed only in media where at least 70% of audience is reasonably expected to be 21 years or older.

"If you turn on [ESPN] SportsCenter any night, you see a tremendous number of alcohol ads," said Dr. Tanski, who is on the pediatric faculty at Dartmouth Medical School in Lebanon, N.H.

Nearly two-thirds of respondents reported they had ever tried alcohol (1,734 adolescents, 64%), and almost 21% had binged in the previous 30 days. Binge drinking was defined as consuming five or more alcoholic drinks at a time.

Of those who had ever had a full drink (not a sip or taste), 68% said they had a favorite brand. "We took anything they told us. It was a long list [158 brands], but some we were not able to verify (e.g, ‘X-Ray’)."

Favorite drinks included a distilled spirit brand by 53%, beer brand by almost 43%, and wine/cider by nearly 3%. The remaining drinks were unknown brand names. Results suggest that the distilled spirits industry is making inroads into the adolescent market, the authors stated.

"The winner for this was Smirnoff, and a close second was Budweiser," Dr. Tanski said. As a caveat, she added, she and her colleagues did not distinguish between hard liquor brands and their malt beverage drinks (for example, Smirnoff vodka was not distinguished from Smirnoff Ice or Bacardi rum from Bacardi Breezers).

In addition, favorites varied by sex, with girls more likely to endorse Smirnoff and boys more likely to say Budweiser was their favorite. A meeting attendee asked if Dr. Tanski differentiated between advertising geared toward men or women. "Most of Budweiser ads are advertised to men, but there are some geared to women also. That is something we can certainly look at."

Girls also chose, in order, Budweiser, Corona, Grey Goose, Bacardi, Captain Morgan, Coors, Skyy, Miller, and Absolut as their top favorites. Male adolescents, after Budweiser, chose Smirnoff, Coors, Corona, Miller, Captain Morgan, Heineken, Grey Goose, Jack Daniels, and Bacardi.

Binge drinking within the past 30 days did not differ significantly between those who endorsed a favorite distilled spirit vs. a beer brand. Another significant difference was binge drinking prevalence among those teenagers who reported a favorite alcohol brand, which ranged from 28% to 71% depending on brand, vs. 11% among those with no favorite.

Overall prevalence of binge drinking was 25% among girls and 39% among boys. Both girls and boys who chose Coors beer as their favorite were at particularly high risk for binge drinking. For example, 70% of the boys who said they were likely to binge drink chose Coors as their favorite brand. Miller beer and Grey Goose vodka also scored high for binge drinking among girls, as did Jack Daniels and Captain Morgan among boys.

A significant correlation between brand preference among these adolescents and marketing expenditures suggest marketing plays a role in choice of a favorite brand. Using the most recent data available from Nielsen, Budweiser spent $1.1 billion on television advertising in 2009. Smirnoff advertising expenditure was $63 million during the same year, Dr. Tanski said, "So they got a lot of bang for their buck."

In 1996, the Distilled Spirits Council of the United States lifted its voluntary ban on "hard alcohol" advertising on television, starting with cable TV. The major television networks began allowing such advertisements in 2001, when NBC aired a Smirnoff ad during Saturday Night Live. More recently, in 2009, CBS aired an Absolut advertisement during the Grammy Awards. "As you all well know, there is lot more hard alcohol or distilled spirits advertising on major networks now," Dr. Tanski said. ABC, which is owned by Disney, has not aired "hard alcohol" advertising.

Self-reported drinking behavior is a potential limitation of the study. This was a sample from a longitudinal survey of media exposure and adolescent behavior. In addition, this sample, while national, might not be representative of groups with higher attrition in the survey over time, such as poorer or minority adolescents. Also, because the study was cross-sectional, no causality can be implied, Dr. Tanski said.

Dr. Tanski said that she had no relevant disclosures.

DENVER – Underage, adolescent alcohol drinkers who endorse a favorite brand are significantly more likely to report recent binge drinking than are those who have no favorite brand.

In addition, the amount of money a company spent on television advertising to promote its brand was directly associated with choice of brand and increased risk for problematic alcohol use, according to a nationally-representative survey of 2,699 individuals aged 16-20 years.

(c) godfer/Fotolia.com

"Underage drinkers preferentially choose highly advertised brands as ‘favorites.’ This suggests that marketing is indeed influencing their choice of beverage," Dr. Susanne E. Tanski said at the annual meeting of the Pediatric Academic Societies.

Based on the findings, physicians could screen patients for problem drinking if they endorse a favorite brand. Doctors also could advocate for an increase in the voluntary advertising restrictions for "hard alcohol" television advertising to protect underage drinkers, Dr. Tanski said. Currently, such advertisements are placed only in media where at least 70% of audience is reasonably expected to be 21 years or older.

"If you turn on [ESPN] SportsCenter any night, you see a tremendous number of alcohol ads," said Dr. Tanski, who is on the pediatric faculty at Dartmouth Medical School in Lebanon, N.H.

Nearly two-thirds of respondents reported they had ever tried alcohol (1,734 adolescents, 64%), and almost 21% had binged in the previous 30 days. Binge drinking was defined as consuming five or more alcoholic drinks at a time.

Of those who had ever had a full drink (not a sip or taste), 68% said they had a favorite brand. "We took anything they told us. It was a long list [158 brands], but some we were not able to verify (e.g, ‘X-Ray’)."

Favorite drinks included a distilled spirit brand by 53%, beer brand by almost 43%, and wine/cider by nearly 3%. The remaining drinks were unknown brand names. Results suggest that the distilled spirits industry is making inroads into the adolescent market, the authors stated.

"The winner for this was Smirnoff, and a close second was Budweiser," Dr. Tanski said. As a caveat, she added, she and her colleagues did not distinguish between hard liquor brands and their malt beverage drinks (for example, Smirnoff vodka was not distinguished from Smirnoff Ice or Bacardi rum from Bacardi Breezers).

In addition, favorites varied by sex, with girls more likely to endorse Smirnoff and boys more likely to say Budweiser was their favorite. A meeting attendee asked if Dr. Tanski differentiated between advertising geared toward men or women. "Most of Budweiser ads are advertised to men, but there are some geared to women also. That is something we can certainly look at."

Girls also chose, in order, Budweiser, Corona, Grey Goose, Bacardi, Captain Morgan, Coors, Skyy, Miller, and Absolut as their top favorites. Male adolescents, after Budweiser, chose Smirnoff, Coors, Corona, Miller, Captain Morgan, Heineken, Grey Goose, Jack Daniels, and Bacardi.

Binge drinking within the past 30 days did not differ significantly between those who endorsed a favorite distilled spirit vs. a beer brand. Another significant difference was binge drinking prevalence among those teenagers who reported a favorite alcohol brand, which ranged from 28% to 71% depending on brand, vs. 11% among those with no favorite.

Overall prevalence of binge drinking was 25% among girls and 39% among boys. Both girls and boys who chose Coors beer as their favorite were at particularly high risk for binge drinking. For example, 70% of the boys who said they were likely to binge drink chose Coors as their favorite brand. Miller beer and Grey Goose vodka also scored high for binge drinking among girls, as did Jack Daniels and Captain Morgan among boys.

A significant correlation between brand preference among these adolescents and marketing expenditures suggest marketing plays a role in choice of a favorite brand. Using the most recent data available from Nielsen, Budweiser spent $1.1 billion on television advertising in 2009. Smirnoff advertising expenditure was $63 million during the same year, Dr. Tanski said, "So they got a lot of bang for their buck."

In 1996, the Distilled Spirits Council of the United States lifted its voluntary ban on "hard alcohol" advertising on television, starting with cable TV. The major television networks began allowing such advertisements in 2001, when NBC aired a Smirnoff ad during Saturday Night Live. More recently, in 2009, CBS aired an Absolut advertisement during the Grammy Awards. "As you all well know, there is lot more hard alcohol or distilled spirits advertising on major networks now," Dr. Tanski said. ABC, which is owned by Disney, has not aired "hard alcohol" advertising.

Self-reported drinking behavior is a potential limitation of the study. This was a sample from a longitudinal survey of media exposure and adolescent behavior. In addition, this sample, while national, might not be representative of groups with higher attrition in the survey over time, such as poorer or minority adolescents. Also, because the study was cross-sectional, no causality can be implied, Dr. Tanski said.

Dr. Tanski said that she had no relevant disclosures.

DENVER – Underage, adolescent alcohol drinkers who endorse a favorite brand are significantly more likely to report recent binge drinking than are those who have no favorite brand.

In addition, the amount of money a company spent on television advertising to promote its brand was directly associated with choice of brand and increased risk for problematic alcohol use, according to a nationally-representative survey of 2,699 individuals aged 16-20 years.

(c) godfer/Fotolia.com

"Underage drinkers preferentially choose highly advertised brands as ‘favorites.’ This suggests that marketing is indeed influencing their choice of beverage," Dr. Susanne E. Tanski said at the annual meeting of the Pediatric Academic Societies.

Based on the findings, physicians could screen patients for problem drinking if they endorse a favorite brand. Doctors also could advocate for an increase in the voluntary advertising restrictions for "hard alcohol" television advertising to protect underage drinkers, Dr. Tanski said. Currently, such advertisements are placed only in media where at least 70% of audience is reasonably expected to be 21 years or older.

"If you turn on [ESPN] SportsCenter any night, you see a tremendous number of alcohol ads," said Dr. Tanski, who is on the pediatric faculty at Dartmouth Medical School in Lebanon, N.H.

Nearly two-thirds of respondents reported they had ever tried alcohol (1,734 adolescents, 64%), and almost 21% had binged in the previous 30 days. Binge drinking was defined as consuming five or more alcoholic drinks at a time.

Of those who had ever had a full drink (not a sip or taste), 68% said they had a favorite brand. "We took anything they told us. It was a long list [158 brands], but some we were not able to verify (e.g, ‘X-Ray’)."

Favorite drinks included a distilled spirit brand by 53%, beer brand by almost 43%, and wine/cider by nearly 3%. The remaining drinks were unknown brand names. Results suggest that the distilled spirits industry is making inroads into the adolescent market, the authors stated.

"The winner for this was Smirnoff, and a close second was Budweiser," Dr. Tanski said. As a caveat, she added, she and her colleagues did not distinguish between hard liquor brands and their malt beverage drinks (for example, Smirnoff vodka was not distinguished from Smirnoff Ice or Bacardi rum from Bacardi Breezers).

In addition, favorites varied by sex, with girls more likely to endorse Smirnoff and boys more likely to say Budweiser was their favorite. A meeting attendee asked if Dr. Tanski differentiated between advertising geared toward men or women. "Most of Budweiser ads are advertised to men, but there are some geared to women also. That is something we can certainly look at."

Girls also chose, in order, Budweiser, Corona, Grey Goose, Bacardi, Captain Morgan, Coors, Skyy, Miller, and Absolut as their top favorites. Male adolescents, after Budweiser, chose Smirnoff, Coors, Corona, Miller, Captain Morgan, Heineken, Grey Goose, Jack Daniels, and Bacardi.

Binge drinking within the past 30 days did not differ significantly between those who endorsed a favorite distilled spirit vs. a beer brand. Another significant difference was binge drinking prevalence among those teenagers who reported a favorite alcohol brand, which ranged from 28% to 71% depending on brand, vs. 11% among those with no favorite.

Overall prevalence of binge drinking was 25% among girls and 39% among boys. Both girls and boys who chose Coors beer as their favorite were at particularly high risk for binge drinking. For example, 70% of the boys who said they were likely to binge drink chose Coors as their favorite brand. Miller beer and Grey Goose vodka also scored high for binge drinking among girls, as did Jack Daniels and Captain Morgan among boys.

A significant correlation between brand preference among these adolescents and marketing expenditures suggest marketing plays a role in choice of a favorite brand. Using the most recent data available from Nielsen, Budweiser spent $1.1 billion on television advertising in 2009. Smirnoff advertising expenditure was $63 million during the same year, Dr. Tanski said, "So they got a lot of bang for their buck."

In 1996, the Distilled Spirits Council of the United States lifted its voluntary ban on "hard alcohol" advertising on television, starting with cable TV. The major television networks began allowing such advertisements in 2001, when NBC aired a Smirnoff ad during Saturday Night Live. More recently, in 2009, CBS aired an Absolut advertisement during the Grammy Awards. "As you all well know, there is lot more hard alcohol or distilled spirits advertising on major networks now," Dr. Tanski said. ABC, which is owned by Disney, has not aired "hard alcohol" advertising.

Self-reported drinking behavior is a potential limitation of the study. This was a sample from a longitudinal survey of media exposure and adolescent behavior. In addition, this sample, while national, might not be representative of groups with higher attrition in the survey over time, such as poorer or minority adolescents. Also, because the study was cross-sectional, no causality can be implied, Dr. Tanski said.

Dr. Tanski said that she had no relevant disclosures.

DENVER – Underage, adolescent alcohol drinkers who endorse a favorite brand are significantly more likely to report recent binge drinking than are those who have no favorite brand.

In addition, the amount of money a company spent on television advertising to promote its brand was directly associated with choice of brand and increased risk for problematic alcohol use, according to a nationally-representative survey of 2,699 individuals aged 16-20 years.

(c) godfer/Fotolia.com

"Underage drinkers preferentially choose highly advertised brands as ‘favorites.’ This suggests that marketing is indeed influencing their choice of beverage," Dr. Susanne E. Tanski said at the annual meeting of the Pediatric Academic Societies.

Based on the findings, physicians could screen patients for problem drinking if they endorse a favorite brand. Doctors also could advocate for an increase in the voluntary advertising restrictions for "hard alcohol" television advertising to protect underage drinkers, Dr. Tanski said. Currently, such advertisements are placed only in media where at least 70% of audience is reasonably expected to be 21 years or older.

"If you turn on [ESPN] SportsCenter any night, you see a tremendous number of alcohol ads," said Dr. Tanski, who is on the pediatric faculty at Dartmouth Medical School in Lebanon, N.H.

Nearly two-thirds of respondents reported they had ever tried alcohol (1,734 adolescents, 64%), and almost 21% had binged in the previous 30 days. Binge drinking was defined as consuming five or more alcoholic drinks at a time.

Of those who had ever had a full drink (not a sip or taste), 68% said they had a favorite brand. "We took anything they told us. It was a long list [158 brands], but some we were not able to verify (e.g, ‘X-Ray’)."

Favorite drinks included a distilled spirit brand by 53%, beer brand by almost 43%, and wine/cider by nearly 3%. The remaining drinks were unknown brand names. Results suggest that the distilled spirits industry is making inroads into the adolescent market, the authors stated.

"The winner for this was Smirnoff, and a close second was Budweiser," Dr. Tanski said. As a caveat, she added, she and her colleagues did not distinguish between hard liquor brands and their malt beverage drinks (for example, Smirnoff vodka was not distinguished from Smirnoff Ice or Bacardi rum from Bacardi Breezers).

In addition, favorites varied by sex, with girls more likely to endorse Smirnoff and boys more likely to say Budweiser was their favorite. A meeting attendee asked if Dr. Tanski differentiated between advertising geared toward men or women. "Most of Budweiser ads are advertised to men, but there are some geared to women also. That is something we can certainly look at."

Girls also chose, in order, Budweiser, Corona, Grey Goose, Bacardi, Captain Morgan, Coors, Skyy, Miller, and Absolut as their top favorites. Male adolescents, after Budweiser, chose Smirnoff, Coors, Corona, Miller, Captain Morgan, Heineken, Grey Goose, Jack Daniels, and Bacardi.

Binge drinking within the past 30 days did not differ significantly between those who endorsed a favorite distilled spirit vs. a beer brand. Another significant difference was binge drinking prevalence among those teenagers who reported a favorite alcohol brand, which ranged from 28% to 71% depending on brand, vs. 11% among those with no favorite.

Overall prevalence of binge drinking was 25% among girls and 39% among boys. Both girls and boys who chose Coors beer as their favorite were at particularly high risk for binge drinking. For example, 70% of the boys who said they were likely to binge drink chose Coors as their favorite brand. Miller beer and Grey Goose vodka also scored high for binge drinking among girls, as did Jack Daniels and Captain Morgan among boys.

A significant correlation between brand preference among these adolescents and marketing expenditures suggest marketing plays a role in choice of a favorite brand. Using the most recent data available from Nielsen, Budweiser spent $1.1 billion on television advertising in 2009. Smirnoff advertising expenditure was $63 million during the same year, Dr. Tanski said, "So they got a lot of bang for their buck."

In 1996, the Distilled Spirits Council of the United States lifted its voluntary ban on "hard alcohol" advertising on television, starting with cable TV. The major television networks began allowing such advertisements in 2001, when NBC aired a Smirnoff ad during Saturday Night Live. More recently, in 2009, CBS aired an Absolut advertisement during the Grammy Awards. "As you all well know, there is lot more hard alcohol or distilled spirits advertising on major networks now," Dr. Tanski said. ABC, which is owned by Disney, has not aired "hard alcohol" advertising.

Self-reported drinking behavior is a potential limitation of the study. This was a sample from a longitudinal survey of media exposure and adolescent behavior. In addition, this sample, while national, might not be representative of groups with higher attrition in the survey over time, such as poorer or minority adolescents. Also, because the study was cross-sectional, no causality can be implied, Dr. Tanski said.

Dr. Tanski said that she had no relevant disclosures.

DENVER – Underage, adolescent alcohol drinkers who endorse a favorite brand are significantly more likely to report recent binge drinking than are those who have no favorite brand.

In addition, the amount of money a company spent on television advertising to promote its brand was directly associated with choice of brand and increased risk for problematic alcohol use, according to a nationally-representative survey of 2,699 individuals aged 16-20 years.

(c) godfer/Fotolia.com

"Underage drinkers preferentially choose highly advertised brands as ‘favorites.’ This suggests that marketing is indeed influencing their choice of beverage," Dr. Susanne E. Tanski said at the annual meeting of the Pediatric Academic Societies.

Based on the findings, physicians could screen patients for problem drinking if they endorse a favorite brand. Doctors also could advocate for an increase in the voluntary advertising restrictions for "hard alcohol" television advertising to protect underage drinkers, Dr. Tanski said. Currently, such advertisements are placed only in media where at least 70% of audience is reasonably expected to be 21 years or older.

"If you turn on [ESPN] SportsCenter any night, you see a tremendous number of alcohol ads," said Dr. Tanski, who is on the pediatric faculty at Dartmouth Medical School in Lebanon, N.H.

Nearly two-thirds of respondents reported they had ever tried alcohol (1,734 adolescents, 64%), and almost 21% had binged in the previous 30 days. Binge drinking was defined as consuming five or more alcoholic drinks at a time.

Of those who had ever had a full drink (not a sip or taste), 68% said they had a favorite brand. "We took anything they told us. It was a long list [158 brands], but some we were not able to verify (e.g, ‘X-Ray’)."

Favorite drinks included a distilled spirit brand by 53%, beer brand by almost 43%, and wine/cider by nearly 3%. The remaining drinks were unknown brand names. Results suggest that the distilled spirits industry is making inroads into the adolescent market, the authors stated.

"The winner for this was Smirnoff, and a close second was Budweiser," Dr. Tanski said. As a caveat, she added, she and her colleagues did not distinguish between hard liquor brands and their malt beverage drinks (for example, Smirnoff vodka was not distinguished from Smirnoff Ice or Bacardi rum from Bacardi Breezers).

In addition, favorites varied by sex, with girls more likely to endorse Smirnoff and boys more likely to say Budweiser was their favorite. A meeting attendee asked if Dr. Tanski differentiated between advertising geared toward men or women. "Most of Budweiser ads are advertised to men, but there are some geared to women also. That is something we can certainly look at."

Girls also chose, in order, Budweiser, Corona, Grey Goose, Bacardi, Captain Morgan, Coors, Skyy, Miller, and Absolut as their top favorites. Male adolescents, after Budweiser, chose Smirnoff, Coors, Corona, Miller, Captain Morgan, Heineken, Grey Goose, Jack Daniels, and Bacardi.

Binge drinking within the past 30 days did not differ significantly between those who endorsed a favorite distilled spirit vs. a beer brand. Another significant difference was binge drinking prevalence among those teenagers who reported a favorite alcohol brand, which ranged from 28% to 71% depending on brand, vs. 11% among those with no favorite.

Overall prevalence of binge drinking was 25% among girls and 39% among boys. Both girls and boys who chose Coors beer as their favorite were at particularly high risk for binge drinking. For example, 70% of the boys who said they were likely to binge drink chose Coors as their favorite brand. Miller beer and Grey Goose vodka also scored high for binge drinking among girls, as did Jack Daniels and Captain Morgan among boys.

A significant correlation between brand preference among these adolescents and marketing expenditures suggest marketing plays a role in choice of a favorite brand. Using the most recent data available from Nielsen, Budweiser spent $1.1 billion on television advertising in 2009. Smirnoff advertising expenditure was $63 million during the same year, Dr. Tanski said, "So they got a lot of bang for their buck."

In 1996, the Distilled Spirits Council of the United States lifted its voluntary ban on "hard alcohol" advertising on television, starting with cable TV. The major television networks began allowing such advertisements in 2001, when NBC aired a Smirnoff ad during Saturday Night Live. More recently, in 2009, CBS aired an Absolut advertisement during the Grammy Awards. "As you all well know, there is lot more hard alcohol or distilled spirits advertising on major networks now," Dr. Tanski said. ABC, which is owned by Disney, has not aired "hard alcohol" advertising.

Self-reported drinking behavior is a potential limitation of the study. This was a sample from a longitudinal survey of media exposure and adolescent behavior. In addition, this sample, while national, might not be representative of groups with higher attrition in the survey over time, such as poorer or minority adolescents. Also, because the study was cross-sectional, no causality can be implied, Dr. Tanski said.

Dr. Tanski said that she had no relevant disclosures.

NEW ORLEANS – An association has been reported between elevated proteo­glycan biopsy results and severe mitral valve prolapse.

Dr. Paolo Romanelli and his associates compared eight patients with echocar­diography-proven severe mitral valve prolapse (MVP) and six controls with no cardiac symptoms. They took two 4-mm punch biopsies from normal-ap­pearing forearm skin of each participant to test for proteoglycan mucin levels.

Dr. Romanelli’s study, presented at the annual meeting of the American Acade­my of Dermatology demonstrated that quantitative proteoglycan analysis was greater among patients with MVP (0.6 mg/g), compared with controls (0.4 mg/g). In addition, semiquantitative as­sessment of proteoglycan deposition by hematoxylin-eosin staining and colloidal iron staining showed a mean 3.4 in MVP patients, compared with 1.0 in controls, noted Dr. Romanelli of the University of Miami. All participants were younger than 55 years. All of the MVP patients were comorbid with conditions that in­cluded atrial fibrillation, palpitations, and mild chest discomfort.

The study findings need to be validat­ed, Dr. Romanelli said. Nevertheless, he said he foresees a time when a skin biop­sy will predict the subset of patients at greatest risk for arrhythmias and sudden death from MVP.

I have checked the following facts in my story: (Please initial each.)

Dr. Romanelli said that he had no rel­evant disclosures. 

NEW ORLEANS – An association has been reported between elevated proteo­glycan biopsy results and severe mitral valve prolapse.

Dr. Paolo Romanelli and his associates compared eight patients with echocar­diography-proven severe mitral valve prolapse (MVP) and six controls with no cardiac symptoms. They took two 4-mm punch biopsies from normal-ap­pearing forearm skin of each participant to test for proteoglycan mucin levels.

Dr. Romanelli’s study, presented at the annual meeting of the American Acade­my of Dermatology demonstrated that quantitative proteoglycan analysis was greater among patients with MVP (0.6 mg/g), compared with controls (0.4 mg/g). In addition, semiquantitative as­sessment of proteoglycan deposition by hematoxylin-eosin staining and colloidal iron staining showed a mean 3.4 in MVP patients, compared with 1.0 in controls, noted Dr. Romanelli of the University of Miami. All participants were younger than 55 years. All of the MVP patients were comorbid with conditions that in­cluded atrial fibrillation, palpitations, and mild chest discomfort.

The study findings need to be validat­ed, Dr. Romanelli said. Nevertheless, he said he foresees a time when a skin biop­sy will predict the subset of patients at greatest risk for arrhythmias and sudden death from MVP.

I have checked the following facts in my story: (Please initial each.)

Dr. Romanelli said that he had no rel­evant disclosures. 

NEW ORLEANS – An association has been reported between elevated proteo­glycan biopsy results and severe mitral valve prolapse.

Dr. Paolo Romanelli and his associates compared eight patients with echocar­diography-proven severe mitral valve prolapse (MVP) and six controls with no cardiac symptoms. They took two 4-mm punch biopsies from normal-ap­pearing forearm skin of each participant to test for proteoglycan mucin levels.

Dr. Romanelli’s study, presented at the annual meeting of the American Acade­my of Dermatology demonstrated that quantitative proteoglycan analysis was greater among patients with MVP (0.6 mg/g), compared with controls (0.4 mg/g). In addition, semiquantitative as­sessment of proteoglycan deposition by hematoxylin-eosin staining and colloidal iron staining showed a mean 3.4 in MVP patients, compared with 1.0 in controls, noted Dr. Romanelli of the University of Miami. All participants were younger than 55 years. All of the MVP patients were comorbid with conditions that in­cluded atrial fibrillation, palpitations, and mild chest discomfort.

The study findings need to be validat­ed, Dr. Romanelli said. Nevertheless, he said he foresees a time when a skin biop­sy will predict the subset of patients at greatest risk for arrhythmias and sudden death from MVP.

I have checked the following facts in my story: (Please initial each.)

Dr. Romanelli said that he had no rel­evant disclosures. 

Major Finding: Overall survival was not significantly different at a median of 33 months with neoadjuvant chemotherapy-interval debulking surgery group (NACT-IDS) and 29 months with primary debulking surgery,

Data Source: Retrospective study of 221 women with newly diagnosed advanced ovarian cancer treated between 1995 and 2007.

Disclosures: Dr. Rauh-Hain said he had no disclosures. Dr. Rose is a member of the speaker's bureau for Lilly.

ORLANDO – Neoadjuvant chemotherapy with interval debulking surgery yields similar overall and longer progression-free survival when compared with primary debulking surgery for women with stage IV epithelial ovarian cancer, according to a retrospective study.

“Our study suggests a potential wider role for neoadjuvant chemotherapy in management of stage IV ovarian cancer,” Dr. Jose Alejandro Rauh-Hain said.

The researchers assessed 221 newly diagnosed women with stage IV ovarian cancer. Overall survival was not significantly different at a median of 33 months with neoadjuvant chemotherapy-interval debulking surgery group (NACT-IDS) and 29 months with primary debulking surgery, said Dr. Rauh-Hain, a clinical fellow in obstetrics and gynecology at Massachusetts General Hospital and Brigham and Women's Hospital, both in Boston.

Median progression-free survival was 14 months for the 45 women in the NACT-IDS group, compared with 10 months among the 176 women treated with primary debulking only. Patient records were evaluated to subclassify stage IV disease, site of tumor, and dissemination at time of initial diagnosis.

The strengths of the study are a large number of patients, treatment based on physician discretion, and an optimal debulking surgery rate of 58%, which is similar to other studies, said invited discussant Dr. Peter Rose. A retrospective design; an unbalanced comparison (because the majority had primary debulking surgery); and a lack of uniform criteria to select neoadjuvant chemotherapy are limitations.

“It seems like we are mixing a lot of different tomatoes, big red ones and small green ones, and what we are getting is tomato sauce,” said Dr. Rose, section head, department of obstetrics and gynecology at the Cleveland Clinic in Ohio.

Optimal cytoreduction, defined as residual disease smaller than 1 cm, was not significantly different between groups: 71% of the NACT-IDS and 58% of the primary debulking cohorts. The rate of complete resection to no residual disease was significantly higher among women who underwent NACT-IDS, 27%, vs. 7.5% of women treated with primary debulking. Median follow-up was 28 months. The longest median overall survival was observed for women who had primary debulking surgery and no residual disease (72 months), but Dr. Rauh-Hain pointed out that “only 7.5% of these patients who underwent primary debulking had no residual disease.” This success rate is similar to 8% of 360 women debulked to no residual disease in another report (J. Clin. Oncol. 2008;26:83–9). Median overall survival reached 32 months for the primary surgery group who had optimal cytoreduction and to 20 months if cytoreduction was suboptimal.

The researchers also evaluated median progression-free and overall survival rates by site of distant metastatic disease, including pleural effusion, liver, abdomen, distant lymph nodes, and spleen. The only significant difference was in median overall survival among women who had liver metastases and NACT-IDS, 43 months vs. 27 months with primary debulking. Median progression-free survival in this group was 15 months vs. 13 months. The superior overall survival with NACT-IDS among women who presented with parenchymal liver metastases suggests this therapeutic strategy may be the preferred option for these patients, Dr. Rauh-Hain said. The NACT-IDS group had a shorter mean length of hospital stay, 8 days vs. 12 days in the primary debulking surgery group. There also was a trend toward fewer postoperative complications in the NACT-IDS cohort, 15% vs. 27%. Also, no woman in the NACT-IDS group died within 30 days of their initial surgery compared with eight women (5%) of the primary debulking surgery group.

Major Finding: Overall survival was not significantly different at a median of 33 months with neoadjuvant chemotherapy-interval debulking surgery group (NACT-IDS) and 29 months with primary debulking surgery,

Data Source: Retrospective study of 221 women with newly diagnosed advanced ovarian cancer treated between 1995 and 2007.

Disclosures: Dr. Rauh-Hain said he had no disclosures. Dr. Rose is a member of the speaker's bureau for Lilly.

ORLANDO – Neoadjuvant chemotherapy with interval debulking surgery yields similar overall and longer progression-free survival when compared with primary debulking surgery for women with stage IV epithelial ovarian cancer, according to a retrospective study.

“Our study suggests a potential wider role for neoadjuvant chemotherapy in management of stage IV ovarian cancer,” Dr. Jose Alejandro Rauh-Hain said.

The researchers assessed 221 newly diagnosed women with stage IV ovarian cancer. Overall survival was not significantly different at a median of 33 months with neoadjuvant chemotherapy-interval debulking surgery group (NACT-IDS) and 29 months with primary debulking surgery, said Dr. Rauh-Hain, a clinical fellow in obstetrics and gynecology at Massachusetts General Hospital and Brigham and Women's Hospital, both in Boston.

Median progression-free survival was 14 months for the 45 women in the NACT-IDS group, compared with 10 months among the 176 women treated with primary debulking only. Patient records were evaluated to subclassify stage IV disease, site of tumor, and dissemination at time of initial diagnosis.

The strengths of the study are a large number of patients, treatment based on physician discretion, and an optimal debulking surgery rate of 58%, which is similar to other studies, said invited discussant Dr. Peter Rose. A retrospective design; an unbalanced comparison (because the majority had primary debulking surgery); and a lack of uniform criteria to select neoadjuvant chemotherapy are limitations.

“It seems like we are mixing a lot of different tomatoes, big red ones and small green ones, and what we are getting is tomato sauce,” said Dr. Rose, section head, department of obstetrics and gynecology at the Cleveland Clinic in Ohio.

Optimal cytoreduction, defined as residual disease smaller than 1 cm, was not significantly different between groups: 71% of the NACT-IDS and 58% of the primary debulking cohorts. The rate of complete resection to no residual disease was significantly higher among women who underwent NACT-IDS, 27%, vs. 7.5% of women treated with primary debulking. Median follow-up was 28 months. The longest median overall survival was observed for women who had primary debulking surgery and no residual disease (72 months), but Dr. Rauh-Hain pointed out that “only 7.5% of these patients who underwent primary debulking had no residual disease.” This success rate is similar to 8% of 360 women debulked to no residual disease in another report (J. Clin. Oncol. 2008;26:83–9). Median overall survival reached 32 months for the primary surgery group who had optimal cytoreduction and to 20 months if cytoreduction was suboptimal.

The researchers also evaluated median progression-free and overall survival rates by site of distant metastatic disease, including pleural effusion, liver, abdomen, distant lymph nodes, and spleen. The only significant difference was in median overall survival among women who had liver metastases and NACT-IDS, 43 months vs. 27 months with primary debulking. Median progression-free survival in this group was 15 months vs. 13 months. The superior overall survival with NACT-IDS among women who presented with parenchymal liver metastases suggests this therapeutic strategy may be the preferred option for these patients, Dr. Rauh-Hain said. The NACT-IDS group had a shorter mean length of hospital stay, 8 days vs. 12 days in the primary debulking surgery group. There also was a trend toward fewer postoperative complications in the NACT-IDS cohort, 15% vs. 27%. Also, no woman in the NACT-IDS group died within 30 days of their initial surgery compared with eight women (5%) of the primary debulking surgery group.

Major Finding: Overall survival was not significantly different at a median of 33 months with neoadjuvant chemotherapy-interval debulking surgery group (NACT-IDS) and 29 months with primary debulking surgery,

Data Source: Retrospective study of 221 women with newly diagnosed advanced ovarian cancer treated between 1995 and 2007.

Disclosures: Dr. Rauh-Hain said he had no disclosures. Dr. Rose is a member of the speaker's bureau for Lilly.

ORLANDO – Neoadjuvant chemotherapy with interval debulking surgery yields similar overall and longer progression-free survival when compared with primary debulking surgery for women with stage IV epithelial ovarian cancer, according to a retrospective study.

“Our study suggests a potential wider role for neoadjuvant chemotherapy in management of stage IV ovarian cancer,” Dr. Jose Alejandro Rauh-Hain said.

The researchers assessed 221 newly diagnosed women with stage IV ovarian cancer. Overall survival was not significantly different at a median of 33 months with neoadjuvant chemotherapy-interval debulking surgery group (NACT-IDS) and 29 months with primary debulking surgery, said Dr. Rauh-Hain, a clinical fellow in obstetrics and gynecology at Massachusetts General Hospital and Brigham and Women's Hospital, both in Boston.

Median progression-free survival was 14 months for the 45 women in the NACT-IDS group, compared with 10 months among the 176 women treated with primary debulking only. Patient records were evaluated to subclassify stage IV disease, site of tumor, and dissemination at time of initial diagnosis.

The strengths of the study are a large number of patients, treatment based on physician discretion, and an optimal debulking surgery rate of 58%, which is similar to other studies, said invited discussant Dr. Peter Rose. A retrospective design; an unbalanced comparison (because the majority had primary debulking surgery); and a lack of uniform criteria to select neoadjuvant chemotherapy are limitations.

“It seems like we are mixing a lot of different tomatoes, big red ones and small green ones, and what we are getting is tomato sauce,” said Dr. Rose, section head, department of obstetrics and gynecology at the Cleveland Clinic in Ohio.

Optimal cytoreduction, defined as residual disease smaller than 1 cm, was not significantly different between groups: 71% of the NACT-IDS and 58% of the primary debulking cohorts. The rate of complete resection to no residual disease was significantly higher among women who underwent NACT-IDS, 27%, vs. 7.5% of women treated with primary debulking. Median follow-up was 28 months. The longest median overall survival was observed for women who had primary debulking surgery and no residual disease (72 months), but Dr. Rauh-Hain pointed out that “only 7.5% of these patients who underwent primary debulking had no residual disease.” This success rate is similar to 8% of 360 women debulked to no residual disease in another report (J. Clin. Oncol. 2008;26:83–9). Median overall survival reached 32 months for the primary surgery group who had optimal cytoreduction and to 20 months if cytoreduction was suboptimal.

The researchers also evaluated median progression-free and overall survival rates by site of distant metastatic disease, including pleural effusion, liver, abdomen, distant lymph nodes, and spleen. The only significant difference was in median overall survival among women who had liver metastases and NACT-IDS, 43 months vs. 27 months with primary debulking. Median progression-free survival in this group was 15 months vs. 13 months. The superior overall survival with NACT-IDS among women who presented with parenchymal liver metastases suggests this therapeutic strategy may be the preferred option for these patients, Dr. Rauh-Hain said. The NACT-IDS group had a shorter mean length of hospital stay, 8 days vs. 12 days in the primary debulking surgery group. There also was a trend toward fewer postoperative complications in the NACT-IDS cohort, 15% vs. 27%. Also, no woman in the NACT-IDS group died within 30 days of their initial surgery compared with eight women (5%) of the primary debulking surgery group.

Major Finding: Some 52% of 414 internists, 40% of 591 family physicians, and 66% of 596 ob.gyns. surveyed indicated that they would refer a woman with a suspicious ovarian mass directly to a gynecologic oncologist.

Data Source: A vignette-based survey mailed to a random sample of 3,200 primary care physicians, with a 62% response rate.

Disclosures: Dr. Goff and Dr. Trope said they had no relevant financial disclosures. The study coauthors included researchers at the Centers for Disease Control and Prevention; the CDC provided funding for the survey.

ORLANDO – When a woman with a suspicious ovarian mass presents to a primary care physician, the majority of these doctors would not refer the patients directly to a gynecologic oncologist, even though early management by such specialists is associated with improved outcome, Dr. Barbara A. Goff said.

In all, 52% of 414 internists and 40% of 591 family physicians who responded to a mailed survey indicated that they would refer a patient with a suspicious pelvic mass directly to a gynecologic oncologist. Overall, 98% indicated that they would refer or consult with another physician, but half would initially refer to an ob.gyn., Dr. Goff said at the meeting.

“It's been shown in numerous studies that women who receive their care from gynecologic oncologists have a significantly higher likelihood of receiving NCCN guidelines [recommended] therapy, optimal cytoreduction, and better overall survival,” Dr. Goff said. The National Comprehensive Cancer Network (NCCN) is a consortium of 21 leading cancer centers in the United States that regularly releases and updates clinical guidelines in oncology.

The survey findings suggest a need for greater awareness of the benefits of such direct referrals and, possibly, for incentives to get internists and family physicians to refer these women more often, said Dr. Goff, director of gynecologic oncology at the University of Washington, Seattle. “Promoting direct referral to gynecologic oncologists from primary care may be the best way to increase compliance.”

A total of 596 ob.gyns. also responded to the vignette-based survey. Their answers differed from those of internists and family physicians when they were asked to consider how they would manage the same hypothetical patient. The scenario was a 57-year-old woman complaining of pelvic pain and bloating for 3 weeks, whose ultrasound reveals a 10-cm, complex, right adnexal mass with solid and cystic components and increased vascularity. Patient variables such as race and insurance status were changed in different versions of the survey.

About one-third of ob.gyns. (34%) indicated that they would perform surgery themselves. These ob.gyns. were significantly more likely to work in practices that were smaller and/or located in more remote places, according to a multivariate analysis. The other 66% responded that they would consult with or refer the woman to another physician, and 96% of these ob.gyns. would involve a gynecologic oncologist.

This combination of findings – that only about half of internists and family physicians would refer directly to a gynecologic oncologist, and about one-third of ob.gyns. would perform surgery themselves – may partially explain why many women with ovarian cancer in the United States do not receive comprehensive surgical care or get treated at a high-volume center, Dr. Goff said.

“Unfortunately, recent studies show that 30%–50% of women with ovarian cancer are not receiving care from gynecologic oncologists,” Dr. Goff said. For example, 44% of 31,897 stage III/IV ovarian cancers were treated by a different type of physician (Gynecol. Oncol. 2010;117:18–22). Those women who were treated by a gynecologic oncologist had a 40% improvement in overall survival.

Dr. Goff also examined this phenomenon in her study that showed that 67% of 9,963 women with ovarian cancer who were admitted received comprehensive surgery (Cancer 2007;109:2031–42).

Dr. Goff and her associates looked for significant patient and physician factors that were associated with referral to a gynecologic oncologist. Private insurance was the only significant, unadjusted patient factor. Among the internists and family physicians, significant factors included female sex, internal medicine specialty, board certification, fewer years in practice, group practice, fewer patients seen per week on average, involvement in clinical teaching, and an urban practice location.

In a multivariate logistic regression, factors that were significantly associated with an internist or family physician's not referring directly to a gynecologic oncologist included male sex, family physician specialty, Medicaid insurance, providers with a weekly average number of patients greater than 91, solo practice, and rural location.

The 12-page survey was mailed to 3,200 primary care physicians who were randomly sampled from the AMA master file. A $20 bill was included as an incentive. The response rate was 62%.

“This is an important and provocative paper,” said invited study discussant Dr. Claes Trope, head of the national gynecologic oncology center at Oslo University Hospital.

The sample size is large, there seems to be no selection bias because a random sample of physicians was surveyed, and the “62% response rate is quite impressive,” she said. An inability to judge whether physician responses completely reflected what the clinicians would actually do in practice, compared with a “politically correct” response, is a potential limitation, Dr. Trope added.

Major Finding: Some 52% of 414 internists, 40% of 591 family physicians, and 66% of 596 ob.gyns. surveyed indicated that they would refer a woman with a suspicious ovarian mass directly to a gynecologic oncologist.

Data Source: A vignette-based survey mailed to a random sample of 3,200 primary care physicians, with a 62% response rate.

Disclosures: Dr. Goff and Dr. Trope said they had no relevant financial disclosures. The study coauthors included researchers at the Centers for Disease Control and Prevention; the CDC provided funding for the survey.

ORLANDO – When a woman with a suspicious ovarian mass presents to a primary care physician, the majority of these doctors would not refer the patients directly to a gynecologic oncologist, even though early management by such specialists is associated with improved outcome, Dr. Barbara A. Goff said.

In all, 52% of 414 internists and 40% of 591 family physicians who responded to a mailed survey indicated that they would refer a patient with a suspicious pelvic mass directly to a gynecologic oncologist. Overall, 98% indicated that they would refer or consult with another physician, but half would initially refer to an ob.gyn., Dr. Goff said at the meeting.

“It's been shown in numerous studies that women who receive their care from gynecologic oncologists have a significantly higher likelihood of receiving NCCN guidelines [recommended] therapy, optimal cytoreduction, and better overall survival,” Dr. Goff said. The National Comprehensive Cancer Network (NCCN) is a consortium of 21 leading cancer centers in the United States that regularly releases and updates clinical guidelines in oncology.

The survey findings suggest a need for greater awareness of the benefits of such direct referrals and, possibly, for incentives to get internists and family physicians to refer these women more often, said Dr. Goff, director of gynecologic oncology at the University of Washington, Seattle. “Promoting direct referral to gynecologic oncologists from primary care may be the best way to increase compliance.”

A total of 596 ob.gyns. also responded to the vignette-based survey. Their answers differed from those of internists and family physicians when they were asked to consider how they would manage the same hypothetical patient. The scenario was a 57-year-old woman complaining of pelvic pain and bloating for 3 weeks, whose ultrasound reveals a 10-cm, complex, right adnexal mass with solid and cystic components and increased vascularity. Patient variables such as race and insurance status were changed in different versions of the survey.

About one-third of ob.gyns. (34%) indicated that they would perform surgery themselves. These ob.gyns. were significantly more likely to work in practices that were smaller and/or located in more remote places, according to a multivariate analysis. The other 66% responded that they would consult with or refer the woman to another physician, and 96% of these ob.gyns. would involve a gynecologic oncologist.

This combination of findings – that only about half of internists and family physicians would refer directly to a gynecologic oncologist, and about one-third of ob.gyns. would perform surgery themselves – may partially explain why many women with ovarian cancer in the United States do not receive comprehensive surgical care or get treated at a high-volume center, Dr. Goff said.

“Unfortunately, recent studies show that 30%–50% of women with ovarian cancer are not receiving care from gynecologic oncologists,” Dr. Goff said. For example, 44% of 31,897 stage III/IV ovarian cancers were treated by a different type of physician (Gynecol. Oncol. 2010;117:18–22). Those women who were treated by a gynecologic oncologist had a 40% improvement in overall survival.

Dr. Goff also examined this phenomenon in her study that showed that 67% of 9,963 women with ovarian cancer who were admitted received comprehensive surgery (Cancer 2007;109:2031–42).

Dr. Goff and her associates looked for significant patient and physician factors that were associated with referral to a gynecologic oncologist. Private insurance was the only significant, unadjusted patient factor. Among the internists and family physicians, significant factors included female sex, internal medicine specialty, board certification, fewer years in practice, group practice, fewer patients seen per week on average, involvement in clinical teaching, and an urban practice location.

In a multivariate logistic regression, factors that were significantly associated with an internist or family physician's not referring directly to a gynecologic oncologist included male sex, family physician specialty, Medicaid insurance, providers with a weekly average number of patients greater than 91, solo practice, and rural location.

The 12-page survey was mailed to 3,200 primary care physicians who were randomly sampled from the AMA master file. A $20 bill was included as an incentive. The response rate was 62%.

“This is an important and provocative paper,” said invited study discussant Dr. Claes Trope, head of the national gynecologic oncology center at Oslo University Hospital.

The sample size is large, there seems to be no selection bias because a random sample of physicians was surveyed, and the “62% response rate is quite impressive,” she said. An inability to judge whether physician responses completely reflected what the clinicians would actually do in practice, compared with a “politically correct” response, is a potential limitation, Dr. Trope added.

Major Finding: Some 52% of 414 internists, 40% of 591 family physicians, and 66% of 596 ob.gyns. surveyed indicated that they would refer a woman with a suspicious ovarian mass directly to a gynecologic oncologist.

Data Source: A vignette-based survey mailed to a random sample of 3,200 primary care physicians, with a 62% response rate.

Disclosures: Dr. Goff and Dr. Trope said they had no relevant financial disclosures. The study coauthors included researchers at the Centers for Disease Control and Prevention; the CDC provided funding for the survey.

ORLANDO – When a woman with a suspicious ovarian mass presents to a primary care physician, the majority of these doctors would not refer the patients directly to a gynecologic oncologist, even though early management by such specialists is associated with improved outcome, Dr. Barbara A. Goff said.

In all, 52% of 414 internists and 40% of 591 family physicians who responded to a mailed survey indicated that they would refer a patient with a suspicious pelvic mass directly to a gynecologic oncologist. Overall, 98% indicated that they would refer or consult with another physician, but half would initially refer to an ob.gyn., Dr. Goff said at the meeting.

“It's been shown in numerous studies that women who receive their care from gynecologic oncologists have a significantly higher likelihood of receiving NCCN guidelines [recommended] therapy, optimal cytoreduction, and better overall survival,” Dr. Goff said. The National Comprehensive Cancer Network (NCCN) is a consortium of 21 leading cancer centers in the United States that regularly releases and updates clinical guidelines in oncology.

The survey findings suggest a need for greater awareness of the benefits of such direct referrals and, possibly, for incentives to get internists and family physicians to refer these women more often, said Dr. Goff, director of gynecologic oncology at the University of Washington, Seattle. “Promoting direct referral to gynecologic oncologists from primary care may be the best way to increase compliance.”

A total of 596 ob.gyns. also responded to the vignette-based survey. Their answers differed from those of internists and family physicians when they were asked to consider how they would manage the same hypothetical patient. The scenario was a 57-year-old woman complaining of pelvic pain and bloating for 3 weeks, whose ultrasound reveals a 10-cm, complex, right adnexal mass with solid and cystic components and increased vascularity. Patient variables such as race and insurance status were changed in different versions of the survey.

About one-third of ob.gyns. (34%) indicated that they would perform surgery themselves. These ob.gyns. were significantly more likely to work in practices that were smaller and/or located in more remote places, according to a multivariate analysis. The other 66% responded that they would consult with or refer the woman to another physician, and 96% of these ob.gyns. would involve a gynecologic oncologist.

This combination of findings – that only about half of internists and family physicians would refer directly to a gynecologic oncologist, and about one-third of ob.gyns. would perform surgery themselves – may partially explain why many women with ovarian cancer in the United States do not receive comprehensive surgical care or get treated at a high-volume center, Dr. Goff said.

“Unfortunately, recent studies show that 30%–50% of women with ovarian cancer are not receiving care from gynecologic oncologists,” Dr. Goff said. For example, 44% of 31,897 stage III/IV ovarian cancers were treated by a different type of physician (Gynecol. Oncol. 2010;117:18–22). Those women who were treated by a gynecologic oncologist had a 40% improvement in overall survival.

Dr. Goff also examined this phenomenon in her study that showed that 67% of 9,963 women with ovarian cancer who were admitted received comprehensive surgery (Cancer 2007;109:2031–42).

Dr. Goff and her associates looked for significant patient and physician factors that were associated with referral to a gynecologic oncologist. Private insurance was the only significant, unadjusted patient factor. Among the internists and family physicians, significant factors included female sex, internal medicine specialty, board certification, fewer years in practice, group practice, fewer patients seen per week on average, involvement in clinical teaching, and an urban practice location.

In a multivariate logistic regression, factors that were significantly associated with an internist or family physician's not referring directly to a gynecologic oncologist included male sex, family physician specialty, Medicaid insurance, providers with a weekly average number of patients greater than 91, solo practice, and rural location.

The 12-page survey was mailed to 3,200 primary care physicians who were randomly sampled from the AMA master file. A $20 bill was included as an incentive. The response rate was 62%.

“This is an important and provocative paper,” said invited study discussant Dr. Claes Trope, head of the national gynecologic oncology center at Oslo University Hospital.

The sample size is large, there seems to be no selection bias because a random sample of physicians was surveyed, and the “62% response rate is quite impressive,” she said. An inability to judge whether physician responses completely reflected what the clinicians would actually do in practice, compared with a “politically correct” response, is a potential limitation, Dr. Trope added.

Major Finding: Thirty-nine percent of women with advanced ovarian cancer in the Medicare population receive recommended first-line combination of surgery and six cycles of chemotherapy.

Data Source: Retrospective study of 8,211 women diagnosed with stage III/IV epithelial ovarian cancer between 1995 and 2005.

Disclosures: Dr. Melissa Thrall and Dr. Michael Carney said they had no relevant financial disclosures.

ORLANDO – Only a minority of women in the Medicare population with advanced epithelial ovarian cancer receive optimal therapy with a combination of surgery and six cycles of chemotherapy, according to a large, retrospective study.

Of the 8,211 women diagnosed with stage III or IV epithelial ovarian cancer between 1995 and 2005, 3,241 or 39%, received full dual combination therapy as recommended by the National Institutes of Health consensus statement on Treatment of Advanced Ovarian Cancer.

Older age, nonwhite race, stage IV disease, and higher medical comorbidity were significantly associated with suboptimal care in the current study. In addition, unmarried women and women living in the Midwest were more likely not to complete treatment.

Physicians could focus on improving quality of medical care for these women, including greater referral to gynecologic oncologists, Dr. Melissa Thrall said at the meeting.

“Among U.S. women with ovarian cancer over age 65, many do not receive multimodality therapy,” Dr. Thrall said. “Some of this is likely due to medical infirmity, as evidenced by the association of older age, higher stage, and comorbidity scores with failure to complete treatment. However, the associations with marital status and geographic location suggest there are other modifiable factors in this failure to complete therapy, such as lack of social support or the unavailability of gynecologic oncologists.”

“It is truly disappointing, shocking, and sad to hear that merely one out of three patients in this study received the standard-of-care treatment,” said study discussant Dr. Michael Carney, who is on the gynecologic oncology faculty at the University of Hawaii in Honolulu.

Women were classified according to their initial treatment: Fifty-nine percent had primary debulking surgery, and 24% had primary chemotherapy. The remaining 17% had no evidence of either treatment in their Medicare claims within 1 year of their diagnosis.

“The survival for these [untreated] women is short, and reminds us we need to keep working on increasing the awareness of the symptoms of ovarian cancer, to work toward prompt diagnosis and referral so more of these women can be offered treatment,” said Dr. Thrall, a fellow in the division of gynecologic oncology at the University of Washington in Seattle.

Dr. Thrall and her colleagues identified women older than 65 diagnosed with stage III/IV epithelial ovarian cancer from 1995 to 2005 using the Surveillance, Epidemiology, and End Results (SEER) database. Treatment was identified using linked data to Medicare hospital, provider, and outpatient center claims.

A total 75.8% of the primary surgery patients had subsequent chemotherapy, and 32.2% of the primary chemotherapy group had ovarian cancer–directed surgery.

A total of 4,307 women (52.4%) had surgery and at least one cycle of chemotherapy (in either order) in the first year following diagnosis. Dr. Carney said, “Sadly, this means about 50% receive no chemotherapy after initial surgery, no surgery after initial chemotherapy, or no surgery or chemotherapy at all.”

Dr. Thrall reported that a large proportion of women in the primary chemotherapy group did not have any surgery (68% of the 2,017 women). Women were significantly more likely to receive primary chemotherapy based on increasing age, increasing stage, and comorbidity score in a multivariate analysis. In addition, African American women were more likely to receive primary chemotherapy, she said. Histology also made a difference – women with serous tumors were more likely to get primary chemotherapy, compared with those with endometrioid or clear cell histology.

Dr. Carney described the paper as “important and timely for several reasons.” Medicine is now focusing more on quality as an outcome measure. In addition, “in ovarian cancer we have a pretty good idea what appropriate treatment should be – surgery, chemo-therapy, and specialty care, all resulting in improved survival.”

It makes sense in this paper, Dr. Carney said, that if a patient has more advanced cancer, is older, or has many medical comorbidities, that patient is more likely to receive a chemotherapy or neoadjuvant chemotherapy approach.

“Things that don't make sense: Why are patients more likely to receive chemotherapy initially based on race alone, particularly African American? Why is marriage a significant variable? Why does living in the Midwest lower the rate of receiving standard-of-care treatment?”

A reliance on billing claims for treatment data and no information on why a particular treatment sequence was selected and why treatment was incomplete are among the study limitations, Dr. Thrall said. In addition, treatment information came from billing data. Also, the study was limited to women aged older than 65 years. However, Dr. Thrall said, “median age of ovarian cancer diagnosis is 64 years, so these data represent about 50% of women with ovarian cancer in the U.S.”

Identification of potential barriers to treatment should be explored in future trials, Dr. Thrall said. Also, variables not measured in this study, such as performance status, could further help to explain treatment decisions in these women with advanced epithelial ovarian cancer.

Major Finding: Thirty-nine percent of women with advanced ovarian cancer in the Medicare population receive recommended first-line combination of surgery and six cycles of chemotherapy.

Data Source: Retrospective study of 8,211 women diagnosed with stage III/IV epithelial ovarian cancer between 1995 and 2005.

Disclosures: Dr. Melissa Thrall and Dr. Michael Carney said they had no relevant financial disclosures.

ORLANDO – Only a minority of women in the Medicare population with advanced epithelial ovarian cancer receive optimal therapy with a combination of surgery and six cycles of chemotherapy, according to a large, retrospective study.

Of the 8,211 women diagnosed with stage III or IV epithelial ovarian cancer between 1995 and 2005, 3,241 or 39%, received full dual combination therapy as recommended by the National Institutes of Health consensus statement on Treatment of Advanced Ovarian Cancer.

Older age, nonwhite race, stage IV disease, and higher medical comorbidity were significantly associated with suboptimal care in the current study. In addition, unmarried women and women living in the Midwest were more likely not to complete treatment.

Physicians could focus on improving quality of medical care for these women, including greater referral to gynecologic oncologists, Dr. Melissa Thrall said at the meeting.

“Among U.S. women with ovarian cancer over age 65, many do not receive multimodality therapy,” Dr. Thrall said. “Some of this is likely due to medical infirmity, as evidenced by the association of older age, higher stage, and comorbidity scores with failure to complete treatment. However, the associations with marital status and geographic location suggest there are other modifiable factors in this failure to complete therapy, such as lack of social support or the unavailability of gynecologic oncologists.”

“It is truly disappointing, shocking, and sad to hear that merely one out of three patients in this study received the standard-of-care treatment,” said study discussant Dr. Michael Carney, who is on the gynecologic oncology faculty at the University of Hawaii in Honolulu.

Women were classified according to their initial treatment: Fifty-nine percent had primary debulking surgery, and 24% had primary chemotherapy. The remaining 17% had no evidence of either treatment in their Medicare claims within 1 year of their diagnosis.

“The survival for these [untreated] women is short, and reminds us we need to keep working on increasing the awareness of the symptoms of ovarian cancer, to work toward prompt diagnosis and referral so more of these women can be offered treatment,” said Dr. Thrall, a fellow in the division of gynecologic oncology at the University of Washington in Seattle.

Dr. Thrall and her colleagues identified women older than 65 diagnosed with stage III/IV epithelial ovarian cancer from 1995 to 2005 using the Surveillance, Epidemiology, and End Results (SEER) database. Treatment was identified using linked data to Medicare hospital, provider, and outpatient center claims.

A total 75.8% of the primary surgery patients had subsequent chemotherapy, and 32.2% of the primary chemotherapy group had ovarian cancer–directed surgery.

A total of 4,307 women (52.4%) had surgery and at least one cycle of chemotherapy (in either order) in the first year following diagnosis. Dr. Carney said, “Sadly, this means about 50% receive no chemotherapy after initial surgery, no surgery after initial chemotherapy, or no surgery or chemotherapy at all.”

Dr. Thrall reported that a large proportion of women in the primary chemotherapy group did not have any surgery (68% of the 2,017 women). Women were significantly more likely to receive primary chemotherapy based on increasing age, increasing stage, and comorbidity score in a multivariate analysis. In addition, African American women were more likely to receive primary chemotherapy, she said. Histology also made a difference – women with serous tumors were more likely to get primary chemotherapy, compared with those with endometrioid or clear cell histology.

Dr. Carney described the paper as “important and timely for several reasons.” Medicine is now focusing more on quality as an outcome measure. In addition, “in ovarian cancer we have a pretty good idea what appropriate treatment should be – surgery, chemo-therapy, and specialty care, all resulting in improved survival.”

It makes sense in this paper, Dr. Carney said, that if a patient has more advanced cancer, is older, or has many medical comorbidities, that patient is more likely to receive a chemotherapy or neoadjuvant chemotherapy approach.

“Things that don't make sense: Why are patients more likely to receive chemotherapy initially based on race alone, particularly African American? Why is marriage a significant variable? Why does living in the Midwest lower the rate of receiving standard-of-care treatment?”

A reliance on billing claims for treatment data and no information on why a particular treatment sequence was selected and why treatment was incomplete are among the study limitations, Dr. Thrall said. In addition, treatment information came from billing data. Also, the study was limited to women aged older than 65 years. However, Dr. Thrall said, “median age of ovarian cancer diagnosis is 64 years, so these data represent about 50% of women with ovarian cancer in the U.S.”

Identification of potential barriers to treatment should be explored in future trials, Dr. Thrall said. Also, variables not measured in this study, such as performance status, could further help to explain treatment decisions in these women with advanced epithelial ovarian cancer.

Major Finding: Thirty-nine percent of women with advanced ovarian cancer in the Medicare population receive recommended first-line combination of surgery and six cycles of chemotherapy.

Data Source: Retrospective study of 8,211 women diagnosed with stage III/IV epithelial ovarian cancer between 1995 and 2005.

Disclosures: Dr. Melissa Thrall and Dr. Michael Carney said they had no relevant financial disclosures.

ORLANDO – Only a minority of women in the Medicare population with advanced epithelial ovarian cancer receive optimal therapy with a combination of surgery and six cycles of chemotherapy, according to a large, retrospective study.

Of the 8,211 women diagnosed with stage III or IV epithelial ovarian cancer between 1995 and 2005, 3,241 or 39%, received full dual combination therapy as recommended by the National Institutes of Health consensus statement on Treatment of Advanced Ovarian Cancer.

Older age, nonwhite race, stage IV disease, and higher medical comorbidity were significantly associated with suboptimal care in the current study. In addition, unmarried women and women living in the Midwest were more likely not to complete treatment.

Physicians could focus on improving quality of medical care for these women, including greater referral to gynecologic oncologists, Dr. Melissa Thrall said at the meeting.

“Among U.S. women with ovarian cancer over age 65, many do not receive multimodality therapy,” Dr. Thrall said. “Some of this is likely due to medical infirmity, as evidenced by the association of older age, higher stage, and comorbidity scores with failure to complete treatment. However, the associations with marital status and geographic location suggest there are other modifiable factors in this failure to complete therapy, such as lack of social support or the unavailability of gynecologic oncologists.”

“It is truly disappointing, shocking, and sad to hear that merely one out of three patients in this study received the standard-of-care treatment,” said study discussant Dr. Michael Carney, who is on the gynecologic oncology faculty at the University of Hawaii in Honolulu.

Women were classified according to their initial treatment: Fifty-nine percent had primary debulking surgery, and 24% had primary chemotherapy. The remaining 17% had no evidence of either treatment in their Medicare claims within 1 year of their diagnosis.

“The survival for these [untreated] women is short, and reminds us we need to keep working on increasing the awareness of the symptoms of ovarian cancer, to work toward prompt diagnosis and referral so more of these women can be offered treatment,” said Dr. Thrall, a fellow in the division of gynecologic oncology at the University of Washington in Seattle.

Dr. Thrall and her colleagues identified women older than 65 diagnosed with stage III/IV epithelial ovarian cancer from 1995 to 2005 using the Surveillance, Epidemiology, and End Results (SEER) database. Treatment was identified using linked data to Medicare hospital, provider, and outpatient center claims.

A total 75.8% of the primary surgery patients had subsequent chemotherapy, and 32.2% of the primary chemotherapy group had ovarian cancer–directed surgery.

A total of 4,307 women (52.4%) had surgery and at least one cycle of chemotherapy (in either order) in the first year following diagnosis. Dr. Carney said, “Sadly, this means about 50% receive no chemotherapy after initial surgery, no surgery after initial chemotherapy, or no surgery or chemotherapy at all.”

Dr. Thrall reported that a large proportion of women in the primary chemotherapy group did not have any surgery (68% of the 2,017 women). Women were significantly more likely to receive primary chemotherapy based on increasing age, increasing stage, and comorbidity score in a multivariate analysis. In addition, African American women were more likely to receive primary chemotherapy, she said. Histology also made a difference – women with serous tumors were more likely to get primary chemotherapy, compared with those with endometrioid or clear cell histology.

Dr. Carney described the paper as “important and timely for several reasons.” Medicine is now focusing more on quality as an outcome measure. In addition, “in ovarian cancer we have a pretty good idea what appropriate treatment should be – surgery, chemo-therapy, and specialty care, all resulting in improved survival.”

It makes sense in this paper, Dr. Carney said, that if a patient has more advanced cancer, is older, or has many medical comorbidities, that patient is more likely to receive a chemotherapy or neoadjuvant chemotherapy approach.

“Things that don't make sense: Why are patients more likely to receive chemotherapy initially based on race alone, particularly African American? Why is marriage a significant variable? Why does living in the Midwest lower the rate of receiving standard-of-care treatment?”

A reliance on billing claims for treatment data and no information on why a particular treatment sequence was selected and why treatment was incomplete are among the study limitations, Dr. Thrall said. In addition, treatment information came from billing data. Also, the study was limited to women aged older than 65 years. However, Dr. Thrall said, “median age of ovarian cancer diagnosis is 64 years, so these data represent about 50% of women with ovarian cancer in the U.S.”

Identification of potential barriers to treatment should be explored in future trials, Dr. Thrall said. Also, variables not measured in this study, such as performance status, could further help to explain treatment decisions in these women with advanced epithelial ovarian cancer.