Medical practices

The importance of looking twice

Michael Burke

Some alarming results

Tyler Rouse · Jordan Radigan

N/A

Helen Zorbas

Modifiable lifestyle factors may reduce the risk of developing breast cancer. Obesity is associated particularly with post-menopausal breast cancer. Diet is important, and exercise equivalent to running for up to 8 hours each week reduces the risk of breast cancer, both in its own right and through reducing obesity. Alcohol consumption may be responsible for 5.8% of breast cancers in Australia and it is recommended to reduce this to two standard drinks per day. Drinking alcohol and smoking increases the risk for breast cancer and, therefore, it is important to quit tobacco smoking. Prolonged use of combined oestrogen and progesterone hormone replacement therapy and oral contraceptives may increase breast cancer risk and this must be factored into individual decisions about their use. Ionising radiation, either from diagnostic or therapeutic radiation or through occupational exposure, is associated with a high incidence of breast cancer and exposure may be reduced in some cases. Tamoxifen chemoprevention may reduce the incidence of oestrogen receptor positive cancer in 51% of women with high risk of breast cancer. Uncommon but serious side effects include thromboembolism and uterine cancer. Raloxifene, which can also reduce osteoporosis, can be used in post-menopausal women and is not associated with the development of uterine cancer. Surgical prophylaxis with bilateral mastectomy and salpingo-oophorectomy can reduce the risk of breast cancer in patients carrying BRCA1 or BRCA2 mutations. For preventive treatments, mammographic screening can identify other women at high risk.

Ian N Olver

Maturity onset diabetes of the young (MODY), the most common monogenic form of diabetes, accounts for 1–2% of all diabetes diagnoses. Glucokinase (GCK)-MODY (also referred to as MODY2) constitutes 10–60% of all MODY cases and is inherited as an autosomal dominant heterozygous mutation, resulting in loss of function of the GCK gene. Patients with GCK-MODY generally have mild, fasting hyperglycaemia that is present from birth, are commonly leaner and diagnosed at a younger age than patients with type 2 diabetes, and rarely develop complications from diabetes. Hence, treatment is usually unnecessary and may be ceased. Therefore, genetic screening is recommended in all young patients (< 40 years) with an autosomal dominant family history of diabetes and who lack features of the metabolic syndrome and type 1 diabetes. Further, treatment discontinuation should be discussed with the patient as part of the informed consent process, as the realisation that prior treatment may have not been necessary — or that it could have been less burdensome — may have psychological implications for the patient. This is true for other forms of MODY, such as hepatocyte nuclear factor 1A mutations (MODY3) where hyperglycaemia is managed with low dose sulfonylurea rather than insulin. Patients with GCK-MODY, in line with trends in the general population, are becoming older and more overweight and obese, and are concomitantly developing features of insulin resistance and glucose intolerance. Therefore, controversy exists as to whether such “treatment-exempt” patients should be reassessed for treatment later in life. As testing becomes more accessible, clinicians and patients are likely to embrace genetic screening earlier in the course of diabetes, which may avert the consequences of delayed testing years after diagnosis and treatment initiation.

Ramy H Bishay · Jerry R Greenfield

We need to ensure that those who need care most receive it

Ian A Scott

Cardiac imaging is a rapidly evolving field, with improvements in the diagnostic capabilities of non-invasive cardiac assessment

Christian Hamilton-Craig · Jonathan Chan

HIV infection is an important risk factor for stroke and testing should be performed in all young stroke patients

Abhay R Venkat · Jason Wenderoth · Louise Evans · Cecilia Cappelen-Smith

About 450 000 individuals in Australia may be eligible for lung cancer screening

David Manners MB BS(Hons) · Jennie Hui PhD · Michael Hunter PhD(Dist) · Alan James MB BS, FRACP, PhD · Matthew W Knuiman PhD · Annette McWilliams FRACP, FRCPC, MD · Siobhain Mulrennan MRCP, MD, FRACP · Arthur W (Bill) Musk MB BS, MD, FRACP · Fraser JH Brims MD, MRCP, FRACP

A new option would complement the existing screening program, not replace it

Annabelle Farnsworth MB BS(Hons), FRCPA, FIAC

This rare but potentially fatal condition is a diagnostic conundrum, often presenting as systemic toxicity and widespread myalgia without focal features

Henrique Nicola MD · David JR Morgan MB BS, FACEM, FCICM

Caution is required in using mobile phone images in clinical practice

Jarrel Seah · Andrew D Nichols MB BS · Philip M Lewis PhD, BAppSc · Jeffrey V Rosenfeld MD, FRACS, FAHMS

Malpositioning of the kidneys and renal ectopia are rare causes of intrathoracic mass

David R Darley MB BS, BSc(Hons) · Deborah H Yates MSc, FRACP, FRCP

Two interdependent entities giving rise to each other

Pietro Maggi MD, PhD · Jean Christophe Bier MD · Sandra De Breucker MD

Vertebroplasty has been controversial but remains clinically useful and new evidence awaits publication

William A Clark MB BS, FRANZCR, EBIR

Turfed to eternity was how we euphemized

Jan Steckel MD

Metastatic lymphadenopathy as the primary provisional diagnosis in adults with cystic neck masses

Chris Wratten MB BS, BMedSci, FRANZCR · Sravan Anne · Minh Thi Tieu MB BS, BSc(Med), FRANZCR · Balasubramaniam Kumar MD, DNB, FRANZCR · Robert Eisenberg MB BS, FRACS

An unsuspected neck injury sustained during an amusement ride

Monica S Badve MB BS, FRACP · Sandeep Bhuta MB BS, FRANZCR

Despite ongoing progress in basic and preclinical cancer nanomedicine research, arguably the single most important challenge is clinical translation

Zdenka Kuncic FAIP, PhD, BSc(Hons)

Splenic abscesses are a rare but potentially life-threatening complication of non-typhoidal bacteraemia

Jonathan R Sillar BEng(Hons)/BCom, MB BS(Hons) · Aiveen M Bannan MB BS, FRACP, MPH · Leigh Dahlenburg BMedSc, MB BS(Hons), FRACP

Toxic epidermal necrolysis associated with use of contrast medium (comment on case report)

Lloyd J Ridley MB BS, FRANZCR · Sandhya Limaye PhD, FRACP, FRCPA

How should we redesign our stroke services in light of neurointerventional advances?

Richard I Lindley MD, FRCP(Edin), FRACP · Christopher R Levi BMedSci, MB BS, FRACP

Coordinated support from major national institutions is necessary

Peter Stewart · Raymond C Chan PhD, FRACP, FRCPA · Wendy Pryor PhD, FRCPA