News in brief - June 30, 2003

Fewer EDs, more visits - Men's breast cancer detected later than women's - CDC notes high costs of intimate partner violence

Fewer EDs, more visits

The number of visits to emergency departments has increased 20% over the past decade, but the number of departments has decreased by 15%, according to the annual report of the Centers for Disease Control and Prevention's National Hospital Ambulatory Medical Care Survey released this month.

The survey also found that abdominal pain, chest pain and fever were the most common reasons for a patient visit. The most common diagnoses were contusions, acute upper respiratory infections and open wounds. Those older than 75 had the highest rate of emergency department visits and were most likely to visit in the late morning. Visits for children peak in the early evening, around 7 p.m.

Patients spent an average of three hours per visit. Private insurance paid for 40% of visits. Medicaid paid for 18% and Medicare paid for 15%.

"The CDC report underscores the vital and growing role emergency departments play in safeguarding the public's health," said George Molzen, MD, president of the American College of Emergency Physicians. "It also recognizes the importance of emergency care for older Americans and the unique roles of emergency departments as detectors of biologic agents."

Men's breast cancer detected later than women's

Breast cancer in men is diagnosed at a later stage than in women. Tumors are larger at the time of detection and more likely to test positive for estrogen-receptors. Men with breast cancer also tend to be older when they develop the disease, according to a study presented at the American Society of Clinical Oncology annual meeting in Chicago last month.

Researchers at the University of Texas MD Anderson Cancer Center analyzed more than 2,000 cases of male breast cancer and 300,000 female ones from the National Cancer Institute's Surveillance, Epidemiology, and End Results database. They found significant differences in diagnosis times as well as the characteristics of the tumor. They did not, however, find any difference in survival at the one-, five- and 10-year marks.

Breast cancer in men accounts for only 1% of all breast cancers and previous studies have been hampered by small sample sizes. Authors of the paper hope that research like this will result in better treatment for men with the disease.

"It's perhaps ironic that tumors in men are easier to feel than they are in women, yet the disease is being discovered at a later stage," said Sharon Giordano, MD, lead investigator and assistant professor in the breast medical oncology department at Anderson. "Now that we have a clearer understanding of the biology of breast cancer in men, further research is needed to determine the optimal treatment."

CDC notes high costs of intimate partner violence

The health-related costs of rape, physical assault, stalking and homicide by intimate partners exceeds $5.8 billion each year, according to an April 28 report issued by the Centers for Disease Control and Prevention in conjunction with the CDC Injury Center's national conference. Specifically, direct medical expenses and mental health services accounted for nearly $4.1 billion of this total. Productivity losses amount to nearly $1.8 billion.

The report estimates the incidence, prevalence and health-related costs of intimate partner violence against women, whether fatal or non-fatal. It also identifies areas and possible interventions that warrant future research.

"Violent acts against women don't end with visits to the emergency room," said CDC Director Julie Gerberding, MD. "They are a major public health problem that we are committed to preventing. Intimate partner violence costs women and their families a high price financially, physically and emotionally."

Intimate partner violence is defined as violence committed by a spouse, ex-spouse, current or former boyfriend or girlfriend.