COMMENTARY

Morning Report: Low Back Pain Guidance, Visceral Fat and Cardiometabolic Risk, False-Positive Mammograms

Arefa Cassoobhoy, MD, MPH

Disclosures

February 24, 2017

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Hello. I'm Dr Arefa Cassoobhoy, a practicing internist and a medical editor for Medscape and WebMD. Welcome to our weekly brief on recent medical news and findings.

New Back Pain Guidance

In our first report, the American College of Physicians (ACP) is recommending a more conservative approach to nonradicular, acute, subacute and chronic low back pain.

ACP's new guidelines are based on a review of research on noninvasive, nondrug therapies, as well as medications for low back pain.

The first line of management for acute or subacute low back pain should incorporate nondrug therapies, such as superficial heat, massage, or even acupuncture, or spinal manipulation. Nonsteroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants can be considered if other therapies fail.

For chronic back pain, also consider exercise, rehab, mindfulness-based stress reduction, tai chi, or yoga. Other medications to try after NSAIDs include tramadol and duloxetine. Prescribing opioids is strongly discouraged.

The bottom line? Most patients with acute or subacute low back pain improve over time, regardless of management, and ordering costly tests and treatments is counterproductive.

Abdominal Fat Predicts Risk

Next, a new study supports an association between a genetic predisposition for abdominal adiposity, and the development of type 2 diabetes and coronary heart disease.

Using genetic variants from genome-wide-association studies and from the UK BioBank, researchers developed a genetic risk score that predicted the tendency to carry abdominal fat. They showed that a higher waist-to-hip ratio, adjusted for body mass index (BMI), correlated with higher triglycerides, fasting blood sugars, and systolic blood pressure.

These findings may explain some of the variation in the incidence of type 2 diabetes and heart disease observed across individuals and subpopulations—for example, the high risk for coronary heart disease seen in South Asians, and the excess risk in men vs women.

The Harms of False-Positive Mammograms

And finally, a recent study highlights one of the unintended consequences of screening mammography.

Among more than 250,000 women, those who had a suspicious mammogram that turned out to be benign, were more likely to delay—or even skip—their next screening. The women who had a false-positive mammogram delayed their next test for a median of 10 months longer than women who had experienced a negative mammogram. And women who had a biopsy were 19% less likely to return for regular screening compared with women who underwent only additional imaging.

Why is this important? The odds of being diagnosed with late-stage cancer were higher for women who had experienced false-positive mammograms. Breast cancer survival depends on early detection, and we should continue to encourage our patients to adhere to regular mammography screening.

For Medscape and WebMD, I'm Dr Arefa Cassoobhoy.

Follow Dr Cassoobhoy on Twitter: @ArefaMD

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