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doi:10.1136/bmj.b409

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CT angiography is a promising diagnostic tool in people with claudication

JAMA2009;301:415-24

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Computed tomography (CT) angiography is a reliable diagnostic tool for people with peripheral artery disease, according to a systematic review of 20 cohort studies. This technique performed well against digital subtraction angiography, the current reference standard, with a sensitivity of 95% (95% CI 92% to 97%) and a specificity of 96% (93% to 97%) for detecting clinically important stenoses and occlusions. A segment by segment analysis of the entire vascular tree from lower abdomen to ankles showed that computed tomography angiography tended to overstage 8% of segments and understage 15% of segments.

The authors conclude that it looks like a reasonably accurate way to diagnose peripheral arterial disease, with the caveat that most of the patients studied so far have had intermittent claudication only. Few patients had critical limb ischaemia, even though they are the ones most likely to need accurate imaging to help guide invasive treatments such as surgery. The studies in the review were of average quality, and the authors found some evidence of publication bias. More work is clearly needed, not least to compare computed tomography angiography with other available technologies such as magnetic resonance imaging and duplex ultrasonography.

Survivors of childhood cancer miss out on recommended cancer screening

JAMA2009;301:404-14

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Female survivors of childhood cancers treated with radiotherapy to the chest have a high risk of breast cancer.⇑ Guidelines recommend yearly screening with mammography, magnetic resonance imaging, or both from early adulthood, but a questionnaire survey from the US shows that few women are actually getting it. Among 551 respondents with a history of chest radiotherapy only 55% (303/551) reported having had a mammogram in the past two years. Few women under 40 reported having had regular mammograms (53/296; 18.6%), and 47.3% (140/296) had never had one.

The authors surveyed a random sample from an established cohort of survivors of childhood cancer. Participants were well motivated and …