Sharon Worcester

CHICAGO — A specific pattern of X and Y chromosome losses—and in particular the loss of an important tumor-suppression gene—was shown in a recent study to be associated with melanoma progression.

This "very new and very unexpected finding" could help explain gender differences that are seen in melanoma, such as the increased risk of death in men with melanoma, compared with women with melanoma, Dr. Alan Spatz said at the American Society of Clinical Oncology annual meeting, where he presented the findings.

Frozen sections from 48 melanomas—taken from 32 women and 16 men with a median follow-up of 4 years—were analyzed as part of a European Organisation for Research and Treatment of Cancer (EORTC) study. Analyses of DNA and mRNA were conducted; the end point was distant metastasis-free survival.

A significant correlation was found between DNA copy number and mRNA level for 1,455 genes (P less than .05). In the women's samples, losses in the X chromosome were significantly associated with distant metastasis-free survival (P = .009), and the affected X chromosome was always the inactive X.

In the men, losses in the Y chromosome were significantly associated with distant metastasis-free survival (P = .015), reported Dr. Spatz of Institut Gustave Roussy in Villejuif, France.

Further investigation to identify any particular gene or genes that fulfilled the criteria of being located on the X chromosome in women and escaping inactivation of X chromosome, as well as being located on the Y chromosome in men, showed that only the PPP2R3B gene, also know as PR48, did so.

The normalized expression of the gene, which is located on Xp22 in women and on Yp11 in men was found to be associated with distant metastasis-free survival at a "totally unexpected level of significance," (P = .0007), after adjusting for clinical and pathologic prognostic variables, including gender, age, ulceration, and thickness, Dr. Spatz said.

PR48 is a lesser-known subunit of a well-known and very important gene (serine/threonine protein phosphatase 2A) which he described as "kind of a gatekeeper in cell biology," he said.

PR48 mediates the dephosphorylation of CDC6 by phosphatase 2A and controls initiation of DNA replication in human cancer cells, especially melanoma, he explained.

The findings, along with those from other ongoing studies that are designed to help improve understanding of PPP2R3B biology, could potentially provide biologic clues regarding gender differences in melanoma progression and survival; the gender effect in melanoma is strong—men have been shown to have a relative excess risk of death of 1.87, compared with women with melanoma.

"We can conclude that there is a very specific pattern of X and Y chromosome losses associated with melanoma progression … and that PPP2R3B appears from this study to be a very important tumor suppression gene whose loss is associated with tumor progression.

"Does this explain the gender effect? Maybe if indeed we show that there is a differential frequency of inactivated X chromosome in females, as compared with Y chromosome—but this is still an open question," Dr. Spatz said.

In a discussion of the findings, Elizabeth Grimm, Ph.D., a professor at the University of Texas M.D. Anderson Cancer Center, Houston, called these and other emerging data a "snapshot of finest biomarker work in melanoma at this time." Dr. Spatz's work is particularly provocative, she said.

She asked, however, how—given the findings—one would explain that the incidence of melanoma in young women is higher than that in young men. The increased incidence in men only begins to become evident around age 50 years, she noted, questioning whether other lifestyle parameters are in play.

"Just food for thought," she said.

Dr. Grimm also noted that it would be interesting, should the findings be validated in the ongoing studies that Dr. Spatz mentioned, to see how they might change the course of treatment or provide prognostic information, and to determine whether some form of gene therapy to redeliver the X and Y chromosome losses could be developed.

CHICAGO — A specific pattern of X and Y chromosome losses—and in particular the loss of an important tumor-suppression gene—was shown in a recent study to be associated with melanoma progression.

This "very new and very unexpected finding" could help explain gender differences that are seen in melanoma, such as the increased risk of death in men with melanoma, compared with women with melanoma, Dr. Alan Spatz said at the American Society of Clinical Oncology annual meeting, where he presented the findings.

Frozen sections from 48 melanomas—taken from 32 women and 16 men with a median follow-up of 4 years—were analyzed as part of a European Organisation for Research and Treatment of Cancer (EORTC) study. Analyses of DNA and mRNA were conducted; the end point was distant metastasis-free survival.

A significant correlation was found between DNA copy number and mRNA level for 1,455 genes (P less than .05). In the women's samples, losses in the X chromosome were significantly associated with distant metastasis-free survival (P = .009), and the affected X chromosome was always the inactive X.

In the men, losses in the Y chromosome were significantly associated with distant metastasis-free survival (P = .015), reported Dr. Spatz of Institut Gustave Roussy in Villejuif, France.

Further investigation to identify any particular gene or genes that fulfilled the criteria of being located on the X chromosome in women and escaping inactivation of X chromosome, as well as being located on the Y chromosome in men, showed that only the PPP2R3B gene, also know as PR48, did so.

The normalized expression of the gene, which is located on Xp22 in women and on Yp11 in men was found to be associated with distant metastasis-free survival at a "totally unexpected level of significance," (P = .0007), after adjusting for clinical and pathologic prognostic variables, including gender, age, ulceration, and thickness, Dr. Spatz said.

PR48 is a lesser-known subunit of a well-known and very important gene (serine/threonine protein phosphatase 2A) which he described as "kind of a gatekeeper in cell biology," he said.

PR48 mediates the dephosphorylation of CDC6 by phosphatase 2A and controls initiation of DNA replication in human cancer cells, especially melanoma, he explained.

The findings, along with those from other ongoing studies that are designed to help improve understanding of PPP2R3B biology, could potentially provide biologic clues regarding gender differences in melanoma progression and survival; the gender effect in melanoma is strong—men have been shown to have a relative excess risk of death of 1.87, compared with women with melanoma.

"We can conclude that there is a very specific pattern of X and Y chromosome losses associated with melanoma progression … and that PPP2R3B appears from this study to be a very important tumor suppression gene whose loss is associated with tumor progression.

"Does this explain the gender effect? Maybe if indeed we show that there is a differential frequency of inactivated X chromosome in females, as compared with Y chromosome—but this is still an open question," Dr. Spatz said.

In a discussion of the findings, Elizabeth Grimm, Ph.D., a professor at the University of Texas M.D. Anderson Cancer Center, Houston, called these and other emerging data a "snapshot of finest biomarker work in melanoma at this time." Dr. Spatz's work is particularly provocative, she said.

She asked, however, how—given the findings—one would explain that the incidence of melanoma in young women is higher than that in young men. The increased incidence in men only begins to become evident around age 50 years, she noted, questioning whether other lifestyle parameters are in play.

"Just food for thought," she said.

Dr. Grimm also noted that it would be interesting, should the findings be validated in the ongoing studies that Dr. Spatz mentioned, to see how they might change the course of treatment or provide prognostic information, and to determine whether some form of gene therapy to redeliver the X and Y chromosome losses could be developed.

CHICAGO — A specific pattern of X and Y chromosome losses—and in particular the loss of an important tumor-suppression gene—was shown in a recent study to be associated with melanoma progression.

This "very new and very unexpected finding" could help explain gender differences that are seen in melanoma, such as the increased risk of death in men with melanoma, compared with women with melanoma, Dr. Alan Spatz said at the American Society of Clinical Oncology annual meeting, where he presented the findings.

Frozen sections from 48 melanomas—taken from 32 women and 16 men with a median follow-up of 4 years—were analyzed as part of a European Organisation for Research and Treatment of Cancer (EORTC) study. Analyses of DNA and mRNA were conducted; the end point was distant metastasis-free survival.

A significant correlation was found between DNA copy number and mRNA level for 1,455 genes (P less than .05). In the women's samples, losses in the X chromosome were significantly associated with distant metastasis-free survival (P = .009), and the affected X chromosome was always the inactive X.

In the men, losses in the Y chromosome were significantly associated with distant metastasis-free survival (P = .015), reported Dr. Spatz of Institut Gustave Roussy in Villejuif, France.

Further investigation to identify any particular gene or genes that fulfilled the criteria of being located on the X chromosome in women and escaping inactivation of X chromosome, as well as being located on the Y chromosome in men, showed that only the PPP2R3B gene, also know as PR48, did so.

The normalized expression of the gene, which is located on Xp22 in women and on Yp11 in men was found to be associated with distant metastasis-free survival at a "totally unexpected level of significance," (P = .0007), after adjusting for clinical and pathologic prognostic variables, including gender, age, ulceration, and thickness, Dr. Spatz said.

PR48 is a lesser-known subunit of a well-known and very important gene (serine/threonine protein phosphatase 2A) which he described as "kind of a gatekeeper in cell biology," he said.

PR48 mediates the dephosphorylation of CDC6 by phosphatase 2A and controls initiation of DNA replication in human cancer cells, especially melanoma, he explained.

The findings, along with those from other ongoing studies that are designed to help improve understanding of PPP2R3B biology, could potentially provide biologic clues regarding gender differences in melanoma progression and survival; the gender effect in melanoma is strong—men have been shown to have a relative excess risk of death of 1.87, compared with women with melanoma.

"We can conclude that there is a very specific pattern of X and Y chromosome losses associated with melanoma progression … and that PPP2R3B appears from this study to be a very important tumor suppression gene whose loss is associated with tumor progression.

"Does this explain the gender effect? Maybe if indeed we show that there is a differential frequency of inactivated X chromosome in females, as compared with Y chromosome—but this is still an open question," Dr. Spatz said.

In a discussion of the findings, Elizabeth Grimm, Ph.D., a professor at the University of Texas M.D. Anderson Cancer Center, Houston, called these and other emerging data a "snapshot of finest biomarker work in melanoma at this time." Dr. Spatz's work is particularly provocative, she said.

She asked, however, how—given the findings—one would explain that the incidence of melanoma in young women is higher than that in young men. The increased incidence in men only begins to become evident around age 50 years, she noted, questioning whether other lifestyle parameters are in play.

"Just food for thought," she said.

Dr. Grimm also noted that it would be interesting, should the findings be validated in the ongoing studies that Dr. Spatz mentioned, to see how they might change the course of treatment or provide prognostic information, and to determine whether some form of gene therapy to redeliver the X and Y chromosome losses could be developed.

CHICAGO — Micro-RNA-21 and micro-RNA-155 are expressed at significantly higher levels in primary malignant melanoma tumor samples than in samples from benign nevi—and in indeterminate melanocytic lesions with an aggressive histological phenotype, according to data presented at the American Society of Clinical Oncology annual meeting.

Samples from eight dermal nevi, 28 malignant melanomas, and 49 pathologically indeterminate melanocytic lesions were evaluated using real-time polymerase chain reaction. Investigators found a mean 7.6-fold increase in micro-RNA-21 expression (P = .0001) and a mean 13.3-fold increase (P = .0001) in micro-RNA-155 expression, compared with the benign nevus samples, reported Gregory B. Lesinski, Ph.D., of Ohio State University, Columbus.

Another potential biomarker—micro-RNA-21b—showed a trend toward increased expression, but the difference did not reach statistical significance in this small sample size (P = .07). However, micro-RNA-21b remains of interest, Dr. Lesinski noted.

Micro-RNA-21 and micro-RNA-155 also appear to be expressed at higher levels in certain indeterminate melanocytic lesions. Indeterminate lesions, including deep penetrating nevi, dysplastic nevi, and Spitz nevi, pose a particular challenge in that diagnosis and determination of the appropriate course of action are uncertain.

A false-positive diagnosis could lead to unnecessary treatment; a false-negative diagnosis could lead to undertreatment and increased risk of melanoma development.

In this study, expression of micro-RNA-21 and micro-RNA-155 was analyzed in indeterminate lesions with more than one mitosis per 10x high-power field.

When they were compared with those with less than one mitosis per 10x high-power field, there was significantly higher expression of micro-RNA-21 (P = .0005) and micro-RNA-155 (P = .04).

Melanocytic lesions that were greater than 1 mm in depth, compared with thinner lesions, also had significantly higher levels of micro-RNA-155 (P = .01), suggesting these might have more malignant potential; micro-RNA-21 was higher in the thicker lesions as well, but the difference did not reach statistical significance, Dr. Lesinski said.

In a subset of 13 patients with indeterminate lesions whose lesions were considered suspicious enough that the patients were sent for sentinel node biopsy, micro-RNA-21 and micro-RNA-155 expression were compared with expression in benign nevi—in both those that proved node positive and those that proved node negative.

Micro-RNA expression was significantly higher in the lesions from node-positive patients, compared with expression in benign nevi (mean 6.5-fold increase), than in node-negative patients, compared with expression in benign nevi (1.3-fold increase).

"Surprisingly, we didn't find the same relationship for micro-RNA-155; the data were highly variable [for micro-RNA-155] regardless of whether the patients were node negative or node positive," said Dr. Lesinski, who reported he has no disclosures relevant to the data he presented.

These data are "very preliminary," he added, noting that the sample size for this portion of the study is being expanded to include at least 50 patients to make a more accurate statistical determination about the expression of these micro-RNAs.

"Nonetheless, these data are very enticing to us, and they suggest that micro-RNA-21, at least, may in fact be a relevant marker that can be used to complement the traditional histological analyses used to diagnose these lesions," he said.

The expression of micro-RNAs—a group of more than 200 recently identified noncoding molecules considered to be a new class of oncogenes—is altered in many types of tumors.

This study is among the first to explore this expression in melanoma. Studies to further assess the potential value of micro-RNAs as diagnostic and prognostic tools in melanoma are ongoing, Dr. Lesinski said.

During a discussion of Dr. Lesinski's findings and those from other melanoma biomarker studies, Elizabeth Grimm, Ph.D., said they are part of a "fabulous set of new data."

Dr. Lesinski's findings regarding indeterminate lesions are particularly important given the therapeutic dilemma they pose, she said.

She expressed concern, however, about difficulty in determining whether micro-RNA expression is increased in melanomas, compared with indeterminate lesions. Differences were marked between melanoma and benign nevi, but based on her review of the data, it appears there was little difference in expression between melanoma and indeterminate lesions, Dr. Grimm said, adding that research regarding other micro-RNAs should continue.

She also noted that she is curious about whether there is a micro-RNA signature that adds value to the current staging system and markers commonly used, and whether micro-RNAs can be used independently of common diagnostic markers used by pathologists, such as MAGE, MART, and S100B.

While many questions remain, she applauded the research effort, noting that there are valid markers in other tumor types; thus, the "noble" efforts to identify molecular markers for melanoma are worthwhile. "We're not just dreaming—we will have them for melanoma some day," said Dr. Grimm of M.D. Anderson Cancer Center, Houston.

CHICAGO — Micro-RNA-21 and micro-RNA-155 are expressed at significantly higher levels in primary malignant melanoma tumor samples than in samples from benign nevi—and in indeterminate melanocytic lesions with an aggressive histological phenotype, according to data presented at the American Society of Clinical Oncology annual meeting.

Samples from eight dermal nevi, 28 malignant melanomas, and 49 pathologically indeterminate melanocytic lesions were evaluated using real-time polymerase chain reaction. Investigators found a mean 7.6-fold increase in micro-RNA-21 expression (P = .0001) and a mean 13.3-fold increase (P = .0001) in micro-RNA-155 expression, compared with the benign nevus samples, reported Gregory B. Lesinski, Ph.D., of Ohio State University, Columbus.

Another potential biomarker—micro-RNA-21b—showed a trend toward increased expression, but the difference did not reach statistical significance in this small sample size (P = .07). However, micro-RNA-21b remains of interest, Dr. Lesinski noted.

Micro-RNA-21 and micro-RNA-155 also appear to be expressed at higher levels in certain indeterminate melanocytic lesions. Indeterminate lesions, including deep penetrating nevi, dysplastic nevi, and Spitz nevi, pose a particular challenge in that diagnosis and determination of the appropriate course of action are uncertain.

A false-positive diagnosis could lead to unnecessary treatment; a false-negative diagnosis could lead to undertreatment and increased risk of melanoma development.

In this study, expression of micro-RNA-21 and micro-RNA-155 was analyzed in indeterminate lesions with more than one mitosis per 10x high-power field.

When they were compared with those with less than one mitosis per 10x high-power field, there was significantly higher expression of micro-RNA-21 (P = .0005) and micro-RNA-155 (P = .04).

Melanocytic lesions that were greater than 1 mm in depth, compared with thinner lesions, also had significantly higher levels of micro-RNA-155 (P = .01), suggesting these might have more malignant potential; micro-RNA-21 was higher in the thicker lesions as well, but the difference did not reach statistical significance, Dr. Lesinski said.

In a subset of 13 patients with indeterminate lesions whose lesions were considered suspicious enough that the patients were sent for sentinel node biopsy, micro-RNA-21 and micro-RNA-155 expression were compared with expression in benign nevi—in both those that proved node positive and those that proved node negative.

Micro-RNA expression was significantly higher in the lesions from node-positive patients, compared with expression in benign nevi (mean 6.5-fold increase), than in node-negative patients, compared with expression in benign nevi (1.3-fold increase).

"Surprisingly, we didn't find the same relationship for micro-RNA-155; the data were highly variable [for micro-RNA-155] regardless of whether the patients were node negative or node positive," said Dr. Lesinski, who reported he has no disclosures relevant to the data he presented.

These data are "very preliminary," he added, noting that the sample size for this portion of the study is being expanded to include at least 50 patients to make a more accurate statistical determination about the expression of these micro-RNAs.

"Nonetheless, these data are very enticing to us, and they suggest that micro-RNA-21, at least, may in fact be a relevant marker that can be used to complement the traditional histological analyses used to diagnose these lesions," he said.

The expression of micro-RNAs—a group of more than 200 recently identified noncoding molecules considered to be a new class of oncogenes—is altered in many types of tumors.

This study is among the first to explore this expression in melanoma. Studies to further assess the potential value of micro-RNAs as diagnostic and prognostic tools in melanoma are ongoing, Dr. Lesinski said.

During a discussion of Dr. Lesinski's findings and those from other melanoma biomarker studies, Elizabeth Grimm, Ph.D., said they are part of a "fabulous set of new data."

Dr. Lesinski's findings regarding indeterminate lesions are particularly important given the therapeutic dilemma they pose, she said.

She expressed concern, however, about difficulty in determining whether micro-RNA expression is increased in melanomas, compared with indeterminate lesions. Differences were marked between melanoma and benign nevi, but based on her review of the data, it appears there was little difference in expression between melanoma and indeterminate lesions, Dr. Grimm said, adding that research regarding other micro-RNAs should continue.

She also noted that she is curious about whether there is a micro-RNA signature that adds value to the current staging system and markers commonly used, and whether micro-RNAs can be used independently of common diagnostic markers used by pathologists, such as MAGE, MART, and S100B.

While many questions remain, she applauded the research effort, noting that there are valid markers in other tumor types; thus, the "noble" efforts to identify molecular markers for melanoma are worthwhile. "We're not just dreaming—we will have them for melanoma some day," said Dr. Grimm of M.D. Anderson Cancer Center, Houston.

CHICAGO — Micro-RNA-21 and micro-RNA-155 are expressed at significantly higher levels in primary malignant melanoma tumor samples than in samples from benign nevi—and in indeterminate melanocytic lesions with an aggressive histological phenotype, according to data presented at the American Society of Clinical Oncology annual meeting.

Samples from eight dermal nevi, 28 malignant melanomas, and 49 pathologically indeterminate melanocytic lesions were evaluated using real-time polymerase chain reaction. Investigators found a mean 7.6-fold increase in micro-RNA-21 expression (P = .0001) and a mean 13.3-fold increase (P = .0001) in micro-RNA-155 expression, compared with the benign nevus samples, reported Gregory B. Lesinski, Ph.D., of Ohio State University, Columbus.

Another potential biomarker—micro-RNA-21b—showed a trend toward increased expression, but the difference did not reach statistical significance in this small sample size (P = .07). However, micro-RNA-21b remains of interest, Dr. Lesinski noted.

Micro-RNA-21 and micro-RNA-155 also appear to be expressed at higher levels in certain indeterminate melanocytic lesions. Indeterminate lesions, including deep penetrating nevi, dysplastic nevi, and Spitz nevi, pose a particular challenge in that diagnosis and determination of the appropriate course of action are uncertain.

A false-positive diagnosis could lead to unnecessary treatment; a false-negative diagnosis could lead to undertreatment and increased risk of melanoma development.

In this study, expression of micro-RNA-21 and micro-RNA-155 was analyzed in indeterminate lesions with more than one mitosis per 10x high-power field.

When they were compared with those with less than one mitosis per 10x high-power field, there was significantly higher expression of micro-RNA-21 (P = .0005) and micro-RNA-155 (P = .04).

Melanocytic lesions that were greater than 1 mm in depth, compared with thinner lesions, also had significantly higher levels of micro-RNA-155 (P = .01), suggesting these might have more malignant potential; micro-RNA-21 was higher in the thicker lesions as well, but the difference did not reach statistical significance, Dr. Lesinski said.

In a subset of 13 patients with indeterminate lesions whose lesions were considered suspicious enough that the patients were sent for sentinel node biopsy, micro-RNA-21 and micro-RNA-155 expression were compared with expression in benign nevi—in both those that proved node positive and those that proved node negative.

Micro-RNA expression was significantly higher in the lesions from node-positive patients, compared with expression in benign nevi (mean 6.5-fold increase), than in node-negative patients, compared with expression in benign nevi (1.3-fold increase).

"Surprisingly, we didn't find the same relationship for micro-RNA-155; the data were highly variable [for micro-RNA-155] regardless of whether the patients were node negative or node positive," said Dr. Lesinski, who reported he has no disclosures relevant to the data he presented.

These data are "very preliminary," he added, noting that the sample size for this portion of the study is being expanded to include at least 50 patients to make a more accurate statistical determination about the expression of these micro-RNAs.

"Nonetheless, these data are very enticing to us, and they suggest that micro-RNA-21, at least, may in fact be a relevant marker that can be used to complement the traditional histological analyses used to diagnose these lesions," he said.

The expression of micro-RNAs—a group of more than 200 recently identified noncoding molecules considered to be a new class of oncogenes—is altered in many types of tumors.

This study is among the first to explore this expression in melanoma. Studies to further assess the potential value of micro-RNAs as diagnostic and prognostic tools in melanoma are ongoing, Dr. Lesinski said.

During a discussion of Dr. Lesinski's findings and those from other melanoma biomarker studies, Elizabeth Grimm, Ph.D., said they are part of a "fabulous set of new data."

Dr. Lesinski's findings regarding indeterminate lesions are particularly important given the therapeutic dilemma they pose, she said.

She expressed concern, however, about difficulty in determining whether micro-RNA expression is increased in melanomas, compared with indeterminate lesions. Differences were marked between melanoma and benign nevi, but based on her review of the data, it appears there was little difference in expression between melanoma and indeterminate lesions, Dr. Grimm said, adding that research regarding other micro-RNAs should continue.

She also noted that she is curious about whether there is a micro-RNA signature that adds value to the current staging system and markers commonly used, and whether micro-RNAs can be used independently of common diagnostic markers used by pathologists, such as MAGE, MART, and S100B.

While many questions remain, she applauded the research effort, noting that there are valid markers in other tumor types; thus, the "noble" efforts to identify molecular markers for melanoma are worthwhile. "We're not just dreaming—we will have them for melanoma some day," said Dr. Grimm of M.D. Anderson Cancer Center, Houston.

NEW ORLEANS — Moderate aerobic fitness has a significant beneficial effect on various components of metabolic syndrome in nondiabetic overweight or obese African American women.

In 68 African American women with a mean age of 47 years and a mean body mass index of 33.6 kg/m

The overall prevalence of metabolic syndrome was 25%, with the 29 women with moderate aerobic fitness having the lowest prevalence (14%), compared with the 14 women with low aerobic fitness (29%) and the 25 women with very low aerobic fitness (32%), Trudy Gaillard, Ph.D, R.N., said at a meeting sponsored by the International Society on Hypertension in Blacks.

In addition, the percentage of women in the study with a waist circumference meeting Adult Treatment Panel III (ATP III) criteria for metabolic syndrome was 31% in the moderate fitness group, compared with 84% and 64% in the low and very low fitness groups, respectively, said Dr. Gaillard of the Ohio State University Medical Center, Columbus.

The percentages meeting the high-density lipoprotein cholesterol ATP III criteria for metabolic syndrome were 46% in the moderate fitness group, and 57% and 60% in the low and very low fitness groups, and the percentages meeting the systolic blood pressure ATP III criteria for metabolic syndrome were 7% in the moderate fitness group, and 36% and 21% in the low and very low fitness groups.

The prevalence of metabolic syndrome and the individual components of the syndrome varied by aerobic fitness level for all components of metabolic syndrome except serum glucose and triglycerides.

Assessments were made using fasting and 2-hour postprandial serum glucose, insulin, and C-peptide levels obtained during an oral glucose tolerance test. Insulin resistance was measured by the homeostasis assessment model, and aerobic fitness was empirically categorized based on VO₂ max, with VO₂ max less than 21 mL/kg per minute considered very low aerobic fitness; VO₂ max between 21 and 24.4 mL/kg per minute, low aerobic fitness; and VO₂ max greater than 24.4 mL/kg per minute, moderate aerobic fitness. Moderate aerobic fitness is roughly the equivalent of brisk walking for 30 minutes a day, Dr. Gaillard said.

Findings from other studies link reduced levels of physical fitness and increased levels of sedentary activity to increased risk of metabolic syndrome. Still other studies suggest a sedentary lifestyle doubles the risk of cardiovascular disease, and that an active lifestyle halves the risk of hypertension.

African American women have been shown in studies to have the highest levels of inactivity. They also expend less energy during exercise, regardless of weight, suggesting that more exercise is needed to achieve the same benefits seen at lower levels in other populations, Dr. Gaillard noted, adding that health care providers should encourage moderate physical activity in all African American women, regardless of their level of obesity, physical activity, or risk for comorbidities.

NEW ORLEANS — Moderate aerobic fitness has a significant beneficial effect on various components of metabolic syndrome in nondiabetic overweight or obese African American women.

In 68 African American women with a mean age of 47 years and a mean body mass index of 33.6 kg/m

The overall prevalence of metabolic syndrome was 25%, with the 29 women with moderate aerobic fitness having the lowest prevalence (14%), compared with the 14 women with low aerobic fitness (29%) and the 25 women with very low aerobic fitness (32%), Trudy Gaillard, Ph.D, R.N., said at a meeting sponsored by the International Society on Hypertension in Blacks.

In addition, the percentage of women in the study with a waist circumference meeting Adult Treatment Panel III (ATP III) criteria for metabolic syndrome was 31% in the moderate fitness group, compared with 84% and 64% in the low and very low fitness groups, respectively, said Dr. Gaillard of the Ohio State University Medical Center, Columbus.

The percentages meeting the high-density lipoprotein cholesterol ATP III criteria for metabolic syndrome were 46% in the moderate fitness group, and 57% and 60% in the low and very low fitness groups, and the percentages meeting the systolic blood pressure ATP III criteria for metabolic syndrome were 7% in the moderate fitness group, and 36% and 21% in the low and very low fitness groups.

The prevalence of metabolic syndrome and the individual components of the syndrome varied by aerobic fitness level for all components of metabolic syndrome except serum glucose and triglycerides.

Assessments were made using fasting and 2-hour postprandial serum glucose, insulin, and C-peptide levels obtained during an oral glucose tolerance test. Insulin resistance was measured by the homeostasis assessment model, and aerobic fitness was empirically categorized based on VO₂ max, with VO₂ max less than 21 mL/kg per minute considered very low aerobic fitness; VO₂ max between 21 and 24.4 mL/kg per minute, low aerobic fitness; and VO₂ max greater than 24.4 mL/kg per minute, moderate aerobic fitness. Moderate aerobic fitness is roughly the equivalent of brisk walking for 30 minutes a day, Dr. Gaillard said.

Findings from other studies link reduced levels of physical fitness and increased levels of sedentary activity to increased risk of metabolic syndrome. Still other studies suggest a sedentary lifestyle doubles the risk of cardiovascular disease, and that an active lifestyle halves the risk of hypertension.

African American women have been shown in studies to have the highest levels of inactivity. They also expend less energy during exercise, regardless of weight, suggesting that more exercise is needed to achieve the same benefits seen at lower levels in other populations, Dr. Gaillard noted, adding that health care providers should encourage moderate physical activity in all African American women, regardless of their level of obesity, physical activity, or risk for comorbidities.

NEW ORLEANS — Moderate aerobic fitness has a significant beneficial effect on various components of metabolic syndrome in nondiabetic overweight or obese African American women.

In 68 African American women with a mean age of 47 years and a mean body mass index of 33.6 kg/m

The overall prevalence of metabolic syndrome was 25%, with the 29 women with moderate aerobic fitness having the lowest prevalence (14%), compared with the 14 women with low aerobic fitness (29%) and the 25 women with very low aerobic fitness (32%), Trudy Gaillard, Ph.D, R.N., said at a meeting sponsored by the International Society on Hypertension in Blacks.

In addition, the percentage of women in the study with a waist circumference meeting Adult Treatment Panel III (ATP III) criteria for metabolic syndrome was 31% in the moderate fitness group, compared with 84% and 64% in the low and very low fitness groups, respectively, said Dr. Gaillard of the Ohio State University Medical Center, Columbus.

The percentages meeting the high-density lipoprotein cholesterol ATP III criteria for metabolic syndrome were 46% in the moderate fitness group, and 57% and 60% in the low and very low fitness groups, and the percentages meeting the systolic blood pressure ATP III criteria for metabolic syndrome were 7% in the moderate fitness group, and 36% and 21% in the low and very low fitness groups.

The prevalence of metabolic syndrome and the individual components of the syndrome varied by aerobic fitness level for all components of metabolic syndrome except serum glucose and triglycerides.

Assessments were made using fasting and 2-hour postprandial serum glucose, insulin, and C-peptide levels obtained during an oral glucose tolerance test. Insulin resistance was measured by the homeostasis assessment model, and aerobic fitness was empirically categorized based on VO₂ max, with VO₂ max less than 21 mL/kg per minute considered very low aerobic fitness; VO₂ max between 21 and 24.4 mL/kg per minute, low aerobic fitness; and VO₂ max greater than 24.4 mL/kg per minute, moderate aerobic fitness. Moderate aerobic fitness is roughly the equivalent of brisk walking for 30 minutes a day, Dr. Gaillard said.

Findings from other studies link reduced levels of physical fitness and increased levels of sedentary activity to increased risk of metabolic syndrome. Still other studies suggest a sedentary lifestyle doubles the risk of cardiovascular disease, and that an active lifestyle halves the risk of hypertension.

African American women have been shown in studies to have the highest levels of inactivity. They also expend less energy during exercise, regardless of weight, suggesting that more exercise is needed to achieve the same benefits seen at lower levels in other populations, Dr. Gaillard noted, adding that health care providers should encourage moderate physical activity in all African American women, regardless of their level of obesity, physical activity, or risk for comorbidities.

DESTIN, FLA. — Azelaic acid 15% gel is as effective when used once daily as when used twice daily for the treatment of papulopustular rosacea, and the concomitant use of moisturizer appears to reduce the stinging and burning that a small subset of patients experience with treatment, data from recent studies suggest.

In a randomized, double-blind study of 72 patients with at least moderate inflammatory rosacea, once-daily treatment with azelaic acid 15% gel was as effective as twice daily treatment on all measures at 12 weeks, including qualitative and quantitative assessments (J. Drugs Dermatol. 2008;7:541-6), Dr. James Q. Del Rosso said at a meeting sponsored by the Alabama Dermatology Society.

The mean inflammatory lesion count at 12 weeks was reduced from 19.8 at baseline to 6 in the 37 patients in the twice-daily group, and from 18.2 to 6.6 in 35 patients in the once-daily group, he reported.

As long as patients apply treatment appropriately, they can get twice as much duration out of a single tube, and will have outcomes with once-daily application comparable with twice-daily use in terms of lesion count reduction and overall assessment of improvement, said Dr. Del Rosso, a dermatologist in Las Vegas, who was an investigator for the study.

Also, when the treatment is used along with a moisturizer (an important component of rosacea treatment), the incidence and severity of stinging and burning can be reduced, another study suggested.

Preliminary findings from that split-face study by Dr. Del Rosso and his colleagues showed a definite trend toward reduced stinging and burning when patients used moisturizer (Cerave or Cetaphil cream) after the azelaic acid (J. Clin. Aesthet. Dermatol. 2008;1:20-5). It appears that moisturization repairs the moisture barrier and reduces sensitivity to the drug, he said.

As for whether moisturization or treatment should be applied first—in a recent study, Dr. Del Rosso found that regardless of which of three different moisturizers were used (Cerve, Dove, or Cetaphil), azelaic acid penetration was not impaired, whether the moisturizer was applied before or after the azelaic acid 15% gel in a human skin assay test.

In a recent clinical study of patients with acne vulgaris, the efficacy of tazarotene 0.1% cream was not affected by prior application of a ceramide-based moisturizer (Cerave) but tolerability was improved with application of the moisturizer first, he said.

These findings are a good start for helping dermatologists advise rosacea and acne patients about what, when, and how to use their medications and adjunctive skin care products, he said.

Dr. Del Rosso serves as a consultant, speaker, and/or clinical researcher for Intendis, Allergan, Coria Laboratories, Galderma, Medicis, OrthoNeutrogena, Quinnova Pharmaceuticals, Ranbaxy, SkinMedica, Stiefel, Triax Pharmaceuticals, Unilever, and Warner Chilcott.

DESTIN, FLA. — Azelaic acid 15% gel is as effective when used once daily as when used twice daily for the treatment of papulopustular rosacea, and the concomitant use of moisturizer appears to reduce the stinging and burning that a small subset of patients experience with treatment, data from recent studies suggest.

In a randomized, double-blind study of 72 patients with at least moderate inflammatory rosacea, once-daily treatment with azelaic acid 15% gel was as effective as twice daily treatment on all measures at 12 weeks, including qualitative and quantitative assessments (J. Drugs Dermatol. 2008;7:541-6), Dr. James Q. Del Rosso said at a meeting sponsored by the Alabama Dermatology Society.

The mean inflammatory lesion count at 12 weeks was reduced from 19.8 at baseline to 6 in the 37 patients in the twice-daily group, and from 18.2 to 6.6 in 35 patients in the once-daily group, he reported.

As long as patients apply treatment appropriately, they can get twice as much duration out of a single tube, and will have outcomes with once-daily application comparable with twice-daily use in terms of lesion count reduction and overall assessment of improvement, said Dr. Del Rosso, a dermatologist in Las Vegas, who was an investigator for the study.

Also, when the treatment is used along with a moisturizer (an important component of rosacea treatment), the incidence and severity of stinging and burning can be reduced, another study suggested.

Preliminary findings from that split-face study by Dr. Del Rosso and his colleagues showed a definite trend toward reduced stinging and burning when patients used moisturizer (Cerave or Cetaphil cream) after the azelaic acid (J. Clin. Aesthet. Dermatol. 2008;1:20-5). It appears that moisturization repairs the moisture barrier and reduces sensitivity to the drug, he said.

As for whether moisturization or treatment should be applied first—in a recent study, Dr. Del Rosso found that regardless of which of three different moisturizers were used (Cerve, Dove, or Cetaphil), azelaic acid penetration was not impaired, whether the moisturizer was applied before or after the azelaic acid 15% gel in a human skin assay test.

In a recent clinical study of patients with acne vulgaris, the efficacy of tazarotene 0.1% cream was not affected by prior application of a ceramide-based moisturizer (Cerave) but tolerability was improved with application of the moisturizer first, he said.

These findings are a good start for helping dermatologists advise rosacea and acne patients about what, when, and how to use their medications and adjunctive skin care products, he said.

Dr. Del Rosso serves as a consultant, speaker, and/or clinical researcher for Intendis, Allergan, Coria Laboratories, Galderma, Medicis, OrthoNeutrogena, Quinnova Pharmaceuticals, Ranbaxy, SkinMedica, Stiefel, Triax Pharmaceuticals, Unilever, and Warner Chilcott.

DESTIN, FLA. — Azelaic acid 15% gel is as effective when used once daily as when used twice daily for the treatment of papulopustular rosacea, and the concomitant use of moisturizer appears to reduce the stinging and burning that a small subset of patients experience with treatment, data from recent studies suggest.

In a randomized, double-blind study of 72 patients with at least moderate inflammatory rosacea, once-daily treatment with azelaic acid 15% gel was as effective as twice daily treatment on all measures at 12 weeks, including qualitative and quantitative assessments (J. Drugs Dermatol. 2008;7:541-6), Dr. James Q. Del Rosso said at a meeting sponsored by the Alabama Dermatology Society.

The mean inflammatory lesion count at 12 weeks was reduced from 19.8 at baseline to 6 in the 37 patients in the twice-daily group, and from 18.2 to 6.6 in 35 patients in the once-daily group, he reported.

As long as patients apply treatment appropriately, they can get twice as much duration out of a single tube, and will have outcomes with once-daily application comparable with twice-daily use in terms of lesion count reduction and overall assessment of improvement, said Dr. Del Rosso, a dermatologist in Las Vegas, who was an investigator for the study.

Also, when the treatment is used along with a moisturizer (an important component of rosacea treatment), the incidence and severity of stinging and burning can be reduced, another study suggested.

Preliminary findings from that split-face study by Dr. Del Rosso and his colleagues showed a definite trend toward reduced stinging and burning when patients used moisturizer (Cerave or Cetaphil cream) after the azelaic acid (J. Clin. Aesthet. Dermatol. 2008;1:20-5). It appears that moisturization repairs the moisture barrier and reduces sensitivity to the drug, he said.

As for whether moisturization or treatment should be applied first—in a recent study, Dr. Del Rosso found that regardless of which of three different moisturizers were used (Cerve, Dove, or Cetaphil), azelaic acid penetration was not impaired, whether the moisturizer was applied before or after the azelaic acid 15% gel in a human skin assay test.

In a recent clinical study of patients with acne vulgaris, the efficacy of tazarotene 0.1% cream was not affected by prior application of a ceramide-based moisturizer (Cerave) but tolerability was improved with application of the moisturizer first, he said.

These findings are a good start for helping dermatologists advise rosacea and acne patients about what, when, and how to use their medications and adjunctive skin care products, he said.

Dr. Del Rosso serves as a consultant, speaker, and/or clinical researcher for Intendis, Allergan, Coria Laboratories, Galderma, Medicis, OrthoNeutrogena, Quinnova Pharmaceuticals, Ranbaxy, SkinMedica, Stiefel, Triax Pharmaceuticals, Unilever, and Warner Chilcott.

DESTIN, FLA. — Since Epstein-Barr virus is known in rare cases to initially present as severe, painful genital ulcerations without other clinical or laboratory evidence of acute disease, this infection should be considered in the differential diagnosis of patients who present with such lesions.

“You won't see it presenting this way very often, but … if you have young patients presenting like this, remember to test for EBV,” Dr. Bari Cunningham said at a meeting sponsored by the Alabama Dermatology Society.

Dr. Cunningham, of the University of California, San Diego, described the case of a 15-year-old girl who presented with extremely painful vaginal lesions.

“Of course, sexually transmitted diseases were first and foremost on everybody's mind,” she said, noting that the patient, who was adamant that she was not sexually active, was traumatized by the constant questioning about her sexual history and by the fact that no one believed her.

When the cultures came back negative, the differential was broadened, and Behçet's syndrome, systemic lupus erythematosus, pyoderma gangrenosum, and inflammatory bowel disease were among the diagnoses considered. The girl's conditioned worsened. She became sicker and stopped eating, and more skin surfaces became involved. She was noted to have a swollen liver.

All cultures up to that point were negative and a complete blood count was unremarkable; however, mild elevations on liver function tests, which developed during hospitalization, were noted, and the test for EBV immunoglobulin M came back positive.

Several cases of EBV presenting in this manner have been reported in the literature, Dr. Cunningham said.

'If you have young patients presenting like this, remember to test for EBV.' DR. CUNNINGHAM

DESTIN, FLA. — Since Epstein-Barr virus is known in rare cases to initially present as severe, painful genital ulcerations without other clinical or laboratory evidence of acute disease, this infection should be considered in the differential diagnosis of patients who present with such lesions.

“You won't see it presenting this way very often, but … if you have young patients presenting like this, remember to test for EBV,” Dr. Bari Cunningham said at a meeting sponsored by the Alabama Dermatology Society.

Dr. Cunningham, of the University of California, San Diego, described the case of a 15-year-old girl who presented with extremely painful vaginal lesions.

“Of course, sexually transmitted diseases were first and foremost on everybody's mind,” she said, noting that the patient, who was adamant that she was not sexually active, was traumatized by the constant questioning about her sexual history and by the fact that no one believed her.

When the cultures came back negative, the differential was broadened, and Behçet's syndrome, systemic lupus erythematosus, pyoderma gangrenosum, and inflammatory bowel disease were among the diagnoses considered. The girl's conditioned worsened. She became sicker and stopped eating, and more skin surfaces became involved. She was noted to have a swollen liver.

All cultures up to that point were negative and a complete blood count was unremarkable; however, mild elevations on liver function tests, which developed during hospitalization, were noted, and the test for EBV immunoglobulin M came back positive.

Several cases of EBV presenting in this manner have been reported in the literature, Dr. Cunningham said.

'If you have young patients presenting like this, remember to test for EBV.' DR. CUNNINGHAM

DESTIN, FLA. — Since Epstein-Barr virus is known in rare cases to initially present as severe, painful genital ulcerations without other clinical or laboratory evidence of acute disease, this infection should be considered in the differential diagnosis of patients who present with such lesions.

“You won't see it presenting this way very often, but … if you have young patients presenting like this, remember to test for EBV,” Dr. Bari Cunningham said at a meeting sponsored by the Alabama Dermatology Society.

Dr. Cunningham, of the University of California, San Diego, described the case of a 15-year-old girl who presented with extremely painful vaginal lesions.

“Of course, sexually transmitted diseases were first and foremost on everybody's mind,” she said, noting that the patient, who was adamant that she was not sexually active, was traumatized by the constant questioning about her sexual history and by the fact that no one believed her.

When the cultures came back negative, the differential was broadened, and Behçet's syndrome, systemic lupus erythematosus, pyoderma gangrenosum, and inflammatory bowel disease were among the diagnoses considered. The girl's conditioned worsened. She became sicker and stopped eating, and more skin surfaces became involved. She was noted to have a swollen liver.

All cultures up to that point were negative and a complete blood count was unremarkable; however, mild elevations on liver function tests, which developed during hospitalization, were noted, and the test for EBV immunoglobulin M came back positive.

Several cases of EBV presenting in this manner have been reported in the literature, Dr. Cunningham said.

'If you have young patients presenting like this, remember to test for EBV.' DR. CUNNINGHAM

DESTIN, FLA. — Success in a rheumatology practice requires that the medical practice also be viewed as a business, and a cornerstone of a good business is its business plan, according to Dr. Max I. Hamburger.

Almost all other entities in medicine have business plans, including insurance and pharmaceutical companies and government agencies, he said. These groups study the marketplace; they know the leadership, have a plan for achieving their goals, and have tools for measuring their success.

Physicians can level the playing field by being equally prepared with a working business plan in place, Dr. Hamburger said.

Rheumatologists tend to resist defining their practices as businesses, but thinking of them as such can improve both quality of care and the bottom line, said Dr. Hamburger, assistant professor of clinical medicine at the State University of New York, Stony Brook.

It helps to recognize that the skill sets required for good patient management and good practice management are similar in many ways.

For example, both require evaluation and management through the collection of subjective and objective data, assessment, and planning.

It also helps to view a business plan as a tool that simply defines what you are going to do, where you are going, and how to get there, he said, challenging his audience to “resolve to draft a practice and business plan upon returning home.”

“You have to write it down,” he said, explaining that the act of putting the plan on paper serves as a “cognitive commitment” to follow the plan.

The goals, however, must be achievable, which requires a solid knowledge of the environment in which you are practicing.

Not only does a business plan document your vision of all the details of your practice, it also can help you identify gaps in preparedness, force an objective examination of all the details of the practice, identify necessary resources, project financial needs, and serve as an “owner's manual” for daily operations and activities.

A number of metrics tools are needed to evaluate the practice's progress and success. Year-to-year budget comparisons, cost accounting, and claims analysis are particularly important, Dr. Hamburger explained at a rheumatology meeting sponsored by Virginia Commonwealth University. He added that other useful tools include 3- to 5-year projection spreadsheets, relative value unit-based provider and payer analyses, and productivity formulations.

Practices are more likely to fail when they don't have a good business plan in place and when they fail to employ proper metrics; there are ways of improving the odds of success: Agree on a practice vision, write (and follow) a business plan, employ proper metrics to measure performance and refine goals, and review and modify the plan annually, he advised.

Dr. Hamburger's presentation was made during a symposium supported by an unrestricted educational grant from Centocor, Genentech, and Smith and Nephew, all of which he has served as a member of the speakers bureau, and from which he has received educational grants, and/or conducted clinical trials.

DESTIN, FLA. — Success in a rheumatology practice requires that the medical practice also be viewed as a business, and a cornerstone of a good business is its business plan, according to Dr. Max I. Hamburger.

Almost all other entities in medicine have business plans, including insurance and pharmaceutical companies and government agencies, he said. These groups study the marketplace; they know the leadership, have a plan for achieving their goals, and have tools for measuring their success.

Physicians can level the playing field by being equally prepared with a working business plan in place, Dr. Hamburger said.

Rheumatologists tend to resist defining their practices as businesses, but thinking of them as such can improve both quality of care and the bottom line, said Dr. Hamburger, assistant professor of clinical medicine at the State University of New York, Stony Brook.

It helps to recognize that the skill sets required for good patient management and good practice management are similar in many ways.

For example, both require evaluation and management through the collection of subjective and objective data, assessment, and planning.

It also helps to view a business plan as a tool that simply defines what you are going to do, where you are going, and how to get there, he said, challenging his audience to “resolve to draft a practice and business plan upon returning home.”

“You have to write it down,” he said, explaining that the act of putting the plan on paper serves as a “cognitive commitment” to follow the plan.

The goals, however, must be achievable, which requires a solid knowledge of the environment in which you are practicing.

Not only does a business plan document your vision of all the details of your practice, it also can help you identify gaps in preparedness, force an objective examination of all the details of the practice, identify necessary resources, project financial needs, and serve as an “owner's manual” for daily operations and activities.

A number of metrics tools are needed to evaluate the practice's progress and success. Year-to-year budget comparisons, cost accounting, and claims analysis are particularly important, Dr. Hamburger explained at a rheumatology meeting sponsored by Virginia Commonwealth University. He added that other useful tools include 3- to 5-year projection spreadsheets, relative value unit-based provider and payer analyses, and productivity formulations.

Practices are more likely to fail when they don't have a good business plan in place and when they fail to employ proper metrics; there are ways of improving the odds of success: Agree on a practice vision, write (and follow) a business plan, employ proper metrics to measure performance and refine goals, and review and modify the plan annually, he advised.

Dr. Hamburger's presentation was made during a symposium supported by an unrestricted educational grant from Centocor, Genentech, and Smith and Nephew, all of which he has served as a member of the speakers bureau, and from which he has received educational grants, and/or conducted clinical trials.

DESTIN, FLA. — Success in a rheumatology practice requires that the medical practice also be viewed as a business, and a cornerstone of a good business is its business plan, according to Dr. Max I. Hamburger.

Almost all other entities in medicine have business plans, including insurance and pharmaceutical companies and government agencies, he said. These groups study the marketplace; they know the leadership, have a plan for achieving their goals, and have tools for measuring their success.

Physicians can level the playing field by being equally prepared with a working business plan in place, Dr. Hamburger said.

Rheumatologists tend to resist defining their practices as businesses, but thinking of them as such can improve both quality of care and the bottom line, said Dr. Hamburger, assistant professor of clinical medicine at the State University of New York, Stony Brook.

It helps to recognize that the skill sets required for good patient management and good practice management are similar in many ways.

For example, both require evaluation and management through the collection of subjective and objective data, assessment, and planning.

It also helps to view a business plan as a tool that simply defines what you are going to do, where you are going, and how to get there, he said, challenging his audience to “resolve to draft a practice and business plan upon returning home.”

“You have to write it down,” he said, explaining that the act of putting the plan on paper serves as a “cognitive commitment” to follow the plan.

The goals, however, must be achievable, which requires a solid knowledge of the environment in which you are practicing.

Not only does a business plan document your vision of all the details of your practice, it also can help you identify gaps in preparedness, force an objective examination of all the details of the practice, identify necessary resources, project financial needs, and serve as an “owner's manual” for daily operations and activities.

A number of metrics tools are needed to evaluate the practice's progress and success. Year-to-year budget comparisons, cost accounting, and claims analysis are particularly important, Dr. Hamburger explained at a rheumatology meeting sponsored by Virginia Commonwealth University. He added that other useful tools include 3- to 5-year projection spreadsheets, relative value unit-based provider and payer analyses, and productivity formulations.

Practices are more likely to fail when they don't have a good business plan in place and when they fail to employ proper metrics; there are ways of improving the odds of success: Agree on a practice vision, write (and follow) a business plan, employ proper metrics to measure performance and refine goals, and review and modify the plan annually, he advised.

Dr. Hamburger's presentation was made during a symposium supported by an unrestricted educational grant from Centocor, Genentech, and Smith and Nephew, all of which he has served as a member of the speakers bureau, and from which he has received educational grants, and/or conducted clinical trials.

Preoperative magnetic resonance imaging may be a factor in the rising rate of mastectomy in women with early-stage breast cancer, a study suggests.

Investigators reviewed 5,596 stage 0-II breast cancers in 5,463 women who underwent surgery for the malignancy between 1997 and 2006 at the Mayo Clinic in Rochester, Minn. They found mastectomy rates decreased from 45% in 1997 to 30% in 2003, but then increased to 43% in 2006.

The rebound occurred in tandem with a doubling in the percentage of women who underwent preoperative breast MRI, investigator Matthew Goetz noted in a preview of the findings during a press briefing conducted by the American Society of Clinical Oncology (ASCO).

The study at ASCO's annual meeting. Its abstract was among thousands posted on the society's Web site in advance of the meeting. Under a new ASCO policy, only plenary and late-breaking abstracts have yet to be posted.

Dr. Goetz and his colleagues at the Mayo Clinic reported that 11% of women studied in 2003 underwent preoperative breast MRI, compared with 22% in 2006.

Patients who underwent preoperative breast MRI were significantly more likely to undergo mastectomy than were those who did not undergo preoperative breast MRI (52% vs. 38%). A similar increase in mastectomy rates was seen, however, in those who did not undergo preoperative MRI, with those rates increasing from 28% in 2003 to 41% in 2006.

After adjustment for age, stage, contralateral breast cancer, and density, preoperative MRI was found to be an independent predictor of mastectomy (odds ratio 1.7). Surgical year was also found to be a predictor of mastectomy: Odds ratios vs. 2003 for mastectomy were 1.4 for 2004, 1.9 for 2005, and 1.7 for 2006.

Dr. Goetz noted that other factors might also play a role in the increasing number of women undergoing mastectomy. He cited patient preference—some women choose mastectomy over lumpectomy to maximize their risk reduction—and changes in medical procedures and technologies, such as improved breast reconstruction options and the introduction of genetic testing.

Dr. Julie Gralow, chair of the ASCO Cancer Communications Committee and moderator of the press briefing, said studies have shown that when breast MRI is performed at the time of early-stage breast cancer diagnosis, more cancer is found in the breast known to be affected and in the contralateral breast than is found on mammography. “These surgeries based on MRI [may be] appropriate.”

MRI referral bias might also play a role in the increased mastectomy rates, said Dr. Gralow of the University of Washington and the Fred Hutchinson Cancer Research Center, both in Seattle.

MRIreferral bias may also play a role in the increased mastectomyrates. DR. GRALOW

Preoperative magnetic resonance imaging may be a factor in the rising rate of mastectomy in women with early-stage breast cancer, a study suggests.

Investigators reviewed 5,596 stage 0-II breast cancers in 5,463 women who underwent surgery for the malignancy between 1997 and 2006 at the Mayo Clinic in Rochester, Minn. They found mastectomy rates decreased from 45% in 1997 to 30% in 2003, but then increased to 43% in 2006.

The rebound occurred in tandem with a doubling in the percentage of women who underwent preoperative breast MRI, investigator Matthew Goetz noted in a preview of the findings during a press briefing conducted by the American Society of Clinical Oncology (ASCO).

The study at ASCO's annual meeting. Its abstract was among thousands posted on the society's Web site in advance of the meeting. Under a new ASCO policy, only plenary and late-breaking abstracts have yet to be posted.

Dr. Goetz and his colleagues at the Mayo Clinic reported that 11% of women studied in 2003 underwent preoperative breast MRI, compared with 22% in 2006.

Patients who underwent preoperative breast MRI were significantly more likely to undergo mastectomy than were those who did not undergo preoperative breast MRI (52% vs. 38%). A similar increase in mastectomy rates was seen, however, in those who did not undergo preoperative MRI, with those rates increasing from 28% in 2003 to 41% in 2006.

After adjustment for age, stage, contralateral breast cancer, and density, preoperative MRI was found to be an independent predictor of mastectomy (odds ratio 1.7). Surgical year was also found to be a predictor of mastectomy: Odds ratios vs. 2003 for mastectomy were 1.4 for 2004, 1.9 for 2005, and 1.7 for 2006.

Dr. Goetz noted that other factors might also play a role in the increasing number of women undergoing mastectomy. He cited patient preference—some women choose mastectomy over lumpectomy to maximize their risk reduction—and changes in medical procedures and technologies, such as improved breast reconstruction options and the introduction of genetic testing.

Dr. Julie Gralow, chair of the ASCO Cancer Communications Committee and moderator of the press briefing, said studies have shown that when breast MRI is performed at the time of early-stage breast cancer diagnosis, more cancer is found in the breast known to be affected and in the contralateral breast than is found on mammography. “These surgeries based on MRI [may be] appropriate.”

MRI referral bias might also play a role in the increased mastectomy rates, said Dr. Gralow of the University of Washington and the Fred Hutchinson Cancer Research Center, both in Seattle.

MRIreferral bias may also play a role in the increased mastectomyrates. DR. GRALOW

Preoperative magnetic resonance imaging may be a factor in the rising rate of mastectomy in women with early-stage breast cancer, a study suggests.

Investigators reviewed 5,596 stage 0-II breast cancers in 5,463 women who underwent surgery for the malignancy between 1997 and 2006 at the Mayo Clinic in Rochester, Minn. They found mastectomy rates decreased from 45% in 1997 to 30% in 2003, but then increased to 43% in 2006.

The rebound occurred in tandem with a doubling in the percentage of women who underwent preoperative breast MRI, investigator Matthew Goetz noted in a preview of the findings during a press briefing conducted by the American Society of Clinical Oncology (ASCO).

The study at ASCO's annual meeting. Its abstract was among thousands posted on the society's Web site in advance of the meeting. Under a new ASCO policy, only plenary and late-breaking abstracts have yet to be posted.

Dr. Goetz and his colleagues at the Mayo Clinic reported that 11% of women studied in 2003 underwent preoperative breast MRI, compared with 22% in 2006.

Patients who underwent preoperative breast MRI were significantly more likely to undergo mastectomy than were those who did not undergo preoperative breast MRI (52% vs. 38%). A similar increase in mastectomy rates was seen, however, in those who did not undergo preoperative MRI, with those rates increasing from 28% in 2003 to 41% in 2006.

After adjustment for age, stage, contralateral breast cancer, and density, preoperative MRI was found to be an independent predictor of mastectomy (odds ratio 1.7). Surgical year was also found to be a predictor of mastectomy: Odds ratios vs. 2003 for mastectomy were 1.4 for 2004, 1.9 for 2005, and 1.7 for 2006.

Dr. Goetz noted that other factors might also play a role in the increasing number of women undergoing mastectomy. He cited patient preference—some women choose mastectomy over lumpectomy to maximize their risk reduction—and changes in medical procedures and technologies, such as improved breast reconstruction options and the introduction of genetic testing.

Dr. Julie Gralow, chair of the ASCO Cancer Communications Committee and moderator of the press briefing, said studies have shown that when breast MRI is performed at the time of early-stage breast cancer diagnosis, more cancer is found in the breast known to be affected and in the contralateral breast than is found on mammography. “These surgeries based on MRI [may be] appropriate.”

MRI referral bias might also play a role in the increased mastectomy rates, said Dr. Gralow of the University of Washington and the Fred Hutchinson Cancer Research Center, both in Seattle.

MRIreferral bias may also play a role in the increased mastectomyrates. DR. GRALOW

DESTIN, FLA. — Since Epstein-Barr virus is known in rare cases to initially present as severe, painful genital ulcerations without other clinical or laboratory evidence of acute disease, this infection should be considered in the differential diagnosis of patients who present with such lesions.

"You won't see it presenting this way very often, but … if you have young patients presenting like this, remember to test for EBV," Dr. Bari Cunningham said at a meeting sponsored by the Alabama Dermatology Society.

Dr. Cunningham, of the University of California, San Diego, described the case of a 15-year-old girl who presented with extremely painful vaginal lesions.

"Of course, sexually transmitted diseases were first and foremost on everybody's mind," she said, noting that the patient, who was adamant that she was not sexually active, was traumatized by the constant questioning about her sexual history and by the fact that no one believed her.

When the cultures came back negative, the differential was broadened, and Behçet's syndrome, systemic lupus erythematosus, pyoderma gangrenosum, and inflammatory bowel disease were among the diagnoses considered. The girl's conditioned worsened. She became sicker and stopped eating, and more skin surfaces became involved. She was noted to have a swollen liver.

All cultures up to that point were negative and a complete blood count was unremarkable; however, mild elevations on liver function tests, which developed during hospitalization, were noted, and the test for EBV immunoglobulin M came back positive.

Several cases of EBV presenting in this manner have been reported in the literature, Dr. Cunningham said.

DESTIN, FLA. — Since Epstein-Barr virus is known in rare cases to initially present as severe, painful genital ulcerations without other clinical or laboratory evidence of acute disease, this infection should be considered in the differential diagnosis of patients who present with such lesions.

"You won't see it presenting this way very often, but … if you have young patients presenting like this, remember to test for EBV," Dr. Bari Cunningham said at a meeting sponsored by the Alabama Dermatology Society.

Dr. Cunningham, of the University of California, San Diego, described the case of a 15-year-old girl who presented with extremely painful vaginal lesions.

"Of course, sexually transmitted diseases were first and foremost on everybody's mind," she said, noting that the patient, who was adamant that she was not sexually active, was traumatized by the constant questioning about her sexual history and by the fact that no one believed her.

When the cultures came back negative, the differential was broadened, and Behçet's syndrome, systemic lupus erythematosus, pyoderma gangrenosum, and inflammatory bowel disease were among the diagnoses considered. The girl's conditioned worsened. She became sicker and stopped eating, and more skin surfaces became involved. She was noted to have a swollen liver.

All cultures up to that point were negative and a complete blood count was unremarkable; however, mild elevations on liver function tests, which developed during hospitalization, were noted, and the test for EBV immunoglobulin M came back positive.

Several cases of EBV presenting in this manner have been reported in the literature, Dr. Cunningham said.

DESTIN, FLA. — Since Epstein-Barr virus is known in rare cases to initially present as severe, painful genital ulcerations without other clinical or laboratory evidence of acute disease, this infection should be considered in the differential diagnosis of patients who present with such lesions.

"You won't see it presenting this way very often, but … if you have young patients presenting like this, remember to test for EBV," Dr. Bari Cunningham said at a meeting sponsored by the Alabama Dermatology Society.

Dr. Cunningham, of the University of California, San Diego, described the case of a 15-year-old girl who presented with extremely painful vaginal lesions.

"Of course, sexually transmitted diseases were first and foremost on everybody's mind," she said, noting that the patient, who was adamant that she was not sexually active, was traumatized by the constant questioning about her sexual history and by the fact that no one believed her.

When the cultures came back negative, the differential was broadened, and Behçet's syndrome, systemic lupus erythematosus, pyoderma gangrenosum, and inflammatory bowel disease were among the diagnoses considered. The girl's conditioned worsened. She became sicker and stopped eating, and more skin surfaces became involved. She was noted to have a swollen liver.

All cultures up to that point were negative and a complete blood count was unremarkable; however, mild elevations on liver function tests, which developed during hospitalization, were noted, and the test for EBV immunoglobulin M came back positive.

Several cases of EBV presenting in this manner have been reported in the literature, Dr. Cunningham said.

Preoperative magnetic resonance imaging may be a factor in the rising rate of mastectomy among women with early-stage breast cancer, a retrospective study suggests.

Investigators reviewed 5,596 stage 0-II breast cancers in 5,463 women who underwent surgery for the malignancy between 1997 and 2006 at the Mayo Clinic in Rochester, Minn. They found mastectomy rates decreased from 45% in 1997 to 30% in 2003, but then increased to 43% in 2006.

The rebound occurred in tandem with a doubling in the percentage of women who underwent preoperative breast MRI, lead study investigator Dr. Matthew Goetz noted in a preview of the findings during a press briefing conducted by the American Society of Clinical Oncology (ASCO).

The study's abstract was among thousands posted on the society's Web site in advance of its annual meeting. Under a new ASCO policy, only plenary and late-breaking abstracts have yet to be posted.

Dr. Goetz and his colleagues at the Mayo Clinic reported that 11% of women studied in 2003 underwent preoperative breast MRI, compared with 22% in 2006.

Patients who underwent preoperative breast MRI were significantly more likely to undergo mastectomy than were those who did not undergo preoperative breast MRI (52% vs. 38%). A similar increase in mastectomy rates was seen, however, in those who did not undergo preoperative MRI, with rates in those patients increasing from 28% in 2003 to 41% in 2006.

After adjustment for age, stage, contralateral breast cancer, and density, preoperative MRI was found to be an independent predictor of mastectomy (odds ratio 1.7, P less than .0001). Surgical year was also found to be a predictor of mastectomy. Compared with 2003, the odds ratios for mastectomy were 1.4 for 2004, 1.9 for 2005, and 1.7 for 2006 (P less than .0001).

Dr. Goetz noted that other factors might also play a role in the increasing number of women undergoing mastectomy. He cited patient preference—some women choose mastectomy over lumpectomy to maximize their risk reduction—and changes in medical procedures and technologies, such as improved breast reconstruction options and the introduction of genetic testing.

Dr. Julie Gralow, chair of the ASCO Cancer Communications Committee and moderator of the press briefing, added that studies have shown that when breast MRI is performed at the time of early-stage breast cancer diagnosis, more cancer is found in both the breast known to be affected and the contralateral breast than is found on mammography.

“It may be that these surgeries based on MRI are appropriate,” said Dr. Gralow of the University of Washington and the Fred Hutchinson Cancer Research Center, both in Seattle. MRI referral bias might also play a role in the increased mastectomy rates, she noted.

Additional study is required to further elucidate the influence of these various factors on surgical management, and to assess whether the changing trends in surgical management improve outcomes for women with breast cancer, Dr. Goetz said.

When breast MRI is performed at early-stage breast cancer diagnosis, more cancer is found than on mammography. DR. GRALOW

Preoperative magnetic resonance imaging may be a factor in the rising rate of mastectomy among women with early-stage breast cancer, a retrospective study suggests.

Investigators reviewed 5,596 stage 0-II breast cancers in 5,463 women who underwent surgery for the malignancy between 1997 and 2006 at the Mayo Clinic in Rochester, Minn. They found mastectomy rates decreased from 45% in 1997 to 30% in 2003, but then increased to 43% in 2006.

The rebound occurred in tandem with a doubling in the percentage of women who underwent preoperative breast MRI, lead study investigator Dr. Matthew Goetz noted in a preview of the findings during a press briefing conducted by the American Society of Clinical Oncology (ASCO).

The study's abstract was among thousands posted on the society's Web site in advance of its annual meeting. Under a new ASCO policy, only plenary and late-breaking abstracts have yet to be posted.

Dr. Goetz and his colleagues at the Mayo Clinic reported that 11% of women studied in 2003 underwent preoperative breast MRI, compared with 22% in 2006.

Patients who underwent preoperative breast MRI were significantly more likely to undergo mastectomy than were those who did not undergo preoperative breast MRI (52% vs. 38%). A similar increase in mastectomy rates was seen, however, in those who did not undergo preoperative MRI, with rates in those patients increasing from 28% in 2003 to 41% in 2006.

After adjustment for age, stage, contralateral breast cancer, and density, preoperative MRI was found to be an independent predictor of mastectomy (odds ratio 1.7, P less than .0001). Surgical year was also found to be a predictor of mastectomy. Compared with 2003, the odds ratios for mastectomy were 1.4 for 2004, 1.9 for 2005, and 1.7 for 2006 (P less than .0001).

Dr. Goetz noted that other factors might also play a role in the increasing number of women undergoing mastectomy. He cited patient preference—some women choose mastectomy over lumpectomy to maximize their risk reduction—and changes in medical procedures and technologies, such as improved breast reconstruction options and the introduction of genetic testing.

Dr. Julie Gralow, chair of the ASCO Cancer Communications Committee and moderator of the press briefing, added that studies have shown that when breast MRI is performed at the time of early-stage breast cancer diagnosis, more cancer is found in both the breast known to be affected and the contralateral breast than is found on mammography.

“It may be that these surgeries based on MRI are appropriate,” said Dr. Gralow of the University of Washington and the Fred Hutchinson Cancer Research Center, both in Seattle. MRI referral bias might also play a role in the increased mastectomy rates, she noted.

Additional study is required to further elucidate the influence of these various factors on surgical management, and to assess whether the changing trends in surgical management improve outcomes for women with breast cancer, Dr. Goetz said.

When breast MRI is performed at early-stage breast cancer diagnosis, more cancer is found than on mammography. DR. GRALOW

Preoperative magnetic resonance imaging may be a factor in the rising rate of mastectomy among women with early-stage breast cancer, a retrospective study suggests.

Investigators reviewed 5,596 stage 0-II breast cancers in 5,463 women who underwent surgery for the malignancy between 1997 and 2006 at the Mayo Clinic in Rochester, Minn. They found mastectomy rates decreased from 45% in 1997 to 30% in 2003, but then increased to 43% in 2006.

The rebound occurred in tandem with a doubling in the percentage of women who underwent preoperative breast MRI, lead study investigator Dr. Matthew Goetz noted in a preview of the findings during a press briefing conducted by the American Society of Clinical Oncology (ASCO).

The study's abstract was among thousands posted on the society's Web site in advance of its annual meeting. Under a new ASCO policy, only plenary and late-breaking abstracts have yet to be posted.

Dr. Goetz and his colleagues at the Mayo Clinic reported that 11% of women studied in 2003 underwent preoperative breast MRI, compared with 22% in 2006.

Patients who underwent preoperative breast MRI were significantly more likely to undergo mastectomy than were those who did not undergo preoperative breast MRI (52% vs. 38%). A similar increase in mastectomy rates was seen, however, in those who did not undergo preoperative MRI, with rates in those patients increasing from 28% in 2003 to 41% in 2006.

After adjustment for age, stage, contralateral breast cancer, and density, preoperative MRI was found to be an independent predictor of mastectomy (odds ratio 1.7, P less than .0001). Surgical year was also found to be a predictor of mastectomy. Compared with 2003, the odds ratios for mastectomy were 1.4 for 2004, 1.9 for 2005, and 1.7 for 2006 (P less than .0001).

Dr. Goetz noted that other factors might also play a role in the increasing number of women undergoing mastectomy. He cited patient preference—some women choose mastectomy over lumpectomy to maximize their risk reduction—and changes in medical procedures and technologies, such as improved breast reconstruction options and the introduction of genetic testing.

Dr. Julie Gralow, chair of the ASCO Cancer Communications Committee and moderator of the press briefing, added that studies have shown that when breast MRI is performed at the time of early-stage breast cancer diagnosis, more cancer is found in both the breast known to be affected and the contralateral breast than is found on mammography.

“It may be that these surgeries based on MRI are appropriate,” said Dr. Gralow of the University of Washington and the Fred Hutchinson Cancer Research Center, both in Seattle. MRI referral bias might also play a role in the increased mastectomy rates, she noted.

Additional study is required to further elucidate the influence of these various factors on surgical management, and to assess whether the changing trends in surgical management improve outcomes for women with breast cancer, Dr. Goetz said.

When breast MRI is performed at early-stage breast cancer diagnosis, more cancer is found than on mammography. DR. GRALOW

The incidence of pulmonary arterial hypertension in patients with systemic sclerosis is 0.61 per 100 patient-years, according to data on 384 patients in a longitudinal study presented at the annual meeting of the European League Against Rheumatism in Paris.

The prevalence of pulmonary arterial hypertension (PAH) in a cohort of patients from the ItinerAir-HTAP registry, which is a 3-year, multicenter study of patients with systemic sclerosis, was found to be 7.85% (confidence interval range, 5.70–10.00), prompting this study to determine the incidence of PAH over 3 years of follow-up, explained Dr. Eric Hachulla of Hôpital Claude Huriez, Lille, France.

The patients underwent Doppler echocardiography screening for PAH. PAH was suspected in those with peak velocity of tricuspid regurgitation (VTR) of 2.8–3 m/sec and unexplained dyspnea, or with VTR greater than 3 m/sec, according to Dr. Hachulla.

Right heart catheterization (RHC) was used to confirm the presence of pulmonary hypertension.

The patients, 87% of whom were women, had a mean age of 53 years and were followed for a mean of 41 months.

Pulmonary hypertension was found in 18 patients (incidence of 1.37 per 100 patient-years).

Of those 18 patients, 8 were found to have pre-capillary pulmonary hypertension identified by RHC, and 8 had post-capillary hypertension detected despite the absence of left heart dysfunction on echocardiography (incidence of 0.61 per 100 patient-years for both groups).

The remaining two patients had pulmonary hypertension resulting from severe interstitial lung disease, Dr. Hachulla noted.

The findings show that post-capillary pulmonary hypertension is common in systemic sclerosis, which indicates that RHC is necessary to confirm pre-capillary PAH, he concluded.

Right heart catheterization is necessary to confirm pre-capillary PAH. DR. HACHULLA

The incidence of pulmonary arterial hypertension in patients with systemic sclerosis is 0.61 per 100 patient-years, according to data on 384 patients in a longitudinal study presented at the annual meeting of the European League Against Rheumatism in Paris.

The prevalence of pulmonary arterial hypertension (PAH) in a cohort of patients from the ItinerAir-HTAP registry, which is a 3-year, multicenter study of patients with systemic sclerosis, was found to be 7.85% (confidence interval range, 5.70–10.00), prompting this study to determine the incidence of PAH over 3 years of follow-up, explained Dr. Eric Hachulla of Hôpital Claude Huriez, Lille, France.

The patients underwent Doppler echocardiography screening for PAH. PAH was suspected in those with peak velocity of tricuspid regurgitation (VTR) of 2.8–3 m/sec and unexplained dyspnea, or with VTR greater than 3 m/sec, according to Dr. Hachulla.

Right heart catheterization (RHC) was used to confirm the presence of pulmonary hypertension.

The patients, 87% of whom were women, had a mean age of 53 years and were followed for a mean of 41 months.

Pulmonary hypertension was found in 18 patients (incidence of 1.37 per 100 patient-years).

Of those 18 patients, 8 were found to have pre-capillary pulmonary hypertension identified by RHC, and 8 had post-capillary hypertension detected despite the absence of left heart dysfunction on echocardiography (incidence of 0.61 per 100 patient-years for both groups).

The remaining two patients had pulmonary hypertension resulting from severe interstitial lung disease, Dr. Hachulla noted.

The findings show that post-capillary pulmonary hypertension is common in systemic sclerosis, which indicates that RHC is necessary to confirm pre-capillary PAH, he concluded.

Right heart catheterization is necessary to confirm pre-capillary PAH. DR. HACHULLA

The incidence of pulmonary arterial hypertension in patients with systemic sclerosis is 0.61 per 100 patient-years, according to data on 384 patients in a longitudinal study presented at the annual meeting of the European League Against Rheumatism in Paris.

The prevalence of pulmonary arterial hypertension (PAH) in a cohort of patients from the ItinerAir-HTAP registry, which is a 3-year, multicenter study of patients with systemic sclerosis, was found to be 7.85% (confidence interval range, 5.70–10.00), prompting this study to determine the incidence of PAH over 3 years of follow-up, explained Dr. Eric Hachulla of Hôpital Claude Huriez, Lille, France.

The patients underwent Doppler echocardiography screening for PAH. PAH was suspected in those with peak velocity of tricuspid regurgitation (VTR) of 2.8–3 m/sec and unexplained dyspnea, or with VTR greater than 3 m/sec, according to Dr. Hachulla.

Right heart catheterization (RHC) was used to confirm the presence of pulmonary hypertension.

The patients, 87% of whom were women, had a mean age of 53 years and were followed for a mean of 41 months.

Pulmonary hypertension was found in 18 patients (incidence of 1.37 per 100 patient-years).

Of those 18 patients, 8 were found to have pre-capillary pulmonary hypertension identified by RHC, and 8 had post-capillary hypertension detected despite the absence of left heart dysfunction on echocardiography (incidence of 0.61 per 100 patient-years for both groups).

The remaining two patients had pulmonary hypertension resulting from severe interstitial lung disease, Dr. Hachulla noted.

The findings show that post-capillary pulmonary hypertension is common in systemic sclerosis, which indicates that RHC is necessary to confirm pre-capillary PAH, he concluded.

Right heart catheterization is necessary to confirm pre-capillary PAH. DR. HACHULLA