Among the proposed origins of breast cancer are intrauterine influences such as exposure to sex hormones. Such exposure may also influence cerebral lateralisation with hand preference being one of its manifestations. Starting with this hypothesis a group of Dutch researchers have reviewed prospective data from a breast cancer screening study. 11.6% of the women were left handed. They reported, “that left handed women are more than twice as likely to develop premenopausal breast cancer as non-left handed women. This risk is compatible with left handedness being a marker of constitutional risk rather than of environmental risk as with postmenopausal breast cancer”. Interesting but not particularly helpful.

Now for the good news—almost two thirds of the women in England and Wales now diagnosed with breast cancer are likely to survive for at least 20 years Cancer Research UK experts predict. Women aged between 50 and 69 have an even better prognosis with 72% surviving for 20 years.

See www.cancerresearchuk.org/news/pressreleases/

Several randomised trials have shown that interventions that lower LDL cholesterol concentrations can significantly reduce the incidence of coronary heart disease and other major vascular events in a wide range of individuals. But what do they add up to? Well, recently a prospective meta-analysis of data from 90,056 individuals in 14 randomised trials of statins has been reported. During a mean of 5 years there were 8186 deaths, 14348 individuals had major vascular events, and 5103 developed cancer.

The results—there was a 12% proportional reduction in all-cause mortality per mmol/L reduction in LDL. This reflected a 19% reduction in coronary mortality and non-significant reductions in non-coronary vascular mortality. Fortunately, there was no evidence that statins increased the incidence of cancer overall or at any particular site. The conclusions were that statin therapy can safely reduce the 5-year incidence of major coronary events, coronary revascularisation, and stroke by about one fifth per mmol/L reduction in LDL cholesterol, largely irrespective of the initial lipid profile or other presenting characteristics.

A review of this topic makes several points of note. Some are familiar. For example—the use of non-steroidal anti-inflammatory drugs (NSAIDs) to treat most muscle, ligament and tendon injuries may be potentially deleterious to tissue healing. And paracetamol has similar efficacy to NSAIDs in soft tissue injury, is cheaper, and has a lower side-effect profile. It is the analgesic of choice for most soft tissue injury.

On the other hand, soft tissue injury associated with definite inflammatory conditions such as bursitis or synovitis or involving nerve impingement does warrant short-term treatment with NSAIDs. Cyclo-oxygenase-2 (COX-2) inhibitors should probably not be used. Corticosteroid injections for tendon injuries may achieve a mild to moderate reduction in pain for up to 6 weeks. However, they do not promote tendon healing so should generally be used only when healing is not a critical goal. And the new option—topical glyceryl trinitrate—apparently very useful in the management of chronic tendinopathy—1.25 mg (quarter cardiac patch) every 24 hours.

Myringotomy with the insertion of tympanostomy tubes has often been undertaken in young children who have persistent otitis media with effusion, the rationale being that the condition is alleviated and later developmental impairments are prevented. This view is contested by a group of American paediatricians. They prospectively studied 6350 healthy infants younger than 62 days of age and evaluated them regularly for middle-ear effusion. Before 3 years of age, 429 children with persistent middle-ear effusion were randomly assigned to have tympanostomy tubes inserted either promptly or up to nine months later if effusion persisted. At 6 years of age there were no significant differences in terms of development between the two arms of the study.

They concluded that in otherwise healthy children younger than 3 years of age who have persistent middle-ear effusion, prompt insertion of tympanostomy tubes does not improve developmental outcomes at 6 years of age.

It is believed that our genetic makeup influences the way our bodies deal with medications. Recently, Shimadzu, a Japanese scientific equipment making company, say they have built a desk-top machine that will allow doctors to assess patients’ DNA from a single drop of blood, and so tailor treatment to an individual’s genes. Furthermore, the machine can deliver results within an hour and will be on sale for 5 million yen (US$44,000) by autumn 2006. The machine will first be tested on patients being prescribed one or two medicines—irinotecan and warfarin. Good luck to them.

But there is scepticism over how useful the device will be. For example, the metabolism of warfarin is related to at least two genes whose interaction is not understood. Other factors, such as the patient’s age or additional drugs being taken, also need to be considered. Don’t expect to see this in the clinic next year.