Combining Chantix (needs a prescription) with the nicotine patch
available OTC is more effective at achieving smoking cessation than
Chantix alone, according to a new study published in JAMA.

More than 400 adults (mean age: 46 years) who smoked at least 10
cigarettes per day during the past year were randomized to receive
Chantix plus either a 15-mg nicotine patch or placebo patch. Roughly
62% of participants finished the study. Those who received the Chantix/
NRT combination achieved higher continuous abstinence rates than those
who took varenicline plus placebo at both 12 weeks (55% vs. 41%) and
24 weeks (49% vs. 33%). At 6 months, the point prevalence abstinence
rate for the combination group was 65%, compared with 47% for the
varenicline-alone group.

The combination group experienced more constipation, disturbed sleep,
depression, and nausea, but the difference was statistically
significant only for skin reactions.

JAMA

Children who eat fortified cereals and snack bars are at risk for
consuming potentially dangerous levels of niacin, vitamin A, and zinc,
according to a report from the Environmental Working Group.

Upon reviewing nutrition information for over 1500 breakfast cereals
and 1000 snack bars, the EWG found that nearly 115 cereals were
fortified with 30% or more of the adult recommended Daily Value for
niacin, vitamin A, or zinc, and about 30 snack bars were fortified
with 50% or more. Such products include General Mills Total Raisin
Bran, Kellogg’s Cocoa Krispies, and Balance Bars.

When children eat these products, they put themselves at risk for
overexposure. Among the potential side effects: excessive niacin can
cause skin reactions, too much vitamin A can lead to liver damage, and
excessive zinc can inhibit immune function.

The EWG calls for the FDA to mandate age-specific Daily Value
information on nutrition labels. In the meantime, the group says
children should consume foods with no more than 20%-25% of the adult
Daily Value for these nutrients per serving.

Environmental Working Group press release

The FDA is warning that “rare but serious and potentially life-
threatening” allergic reactions may occur with some over-the-counter
topical acne products containing benzoyl peroxide or salicylic acid.
Symptoms can include shortness of breath and swelling of the eyes,
face, lips, or tongue and may appear within minutes to longer than a
day after application.

The products in question include those marketed as Proactiv,
Neutrogena, MaxClarity, Oxy, Ambi, Aveeno, Clean & Clear, and store
brands.

From 1969 to 2013, roughly 130 serious reactions associated with such
treatments have been reported to the FDA, most since 2012. It’s
unclear whether the reactions were caused by the active ingredients,
the inactive ingredients, or both.

FDA MedWatch safety alert

The CDC has updated its recommendations on polio vaccination for
travelers in light of the World Health Organization’s recent
declaration of polio as a public health emergency of international
concern.

The CDC recommends that people planning to travel to a country with
active wild poliovirus receive the inactivated poliovirus (IPV)
booster. Travelers should document proof of immunization in the yellow
International Certificate of Vaccination to avoid travel delays. The
U.S. is not planning to change its requirements for U.S. entry.

In its declaration, the WHO noted that 10 countries have ongoing
poliovirus transmission:

Cameroon, Pakistan, and Syria have recently exported wild poliovirus.
Residents and people traveling to these countries for more than 4
weeks are required to receive IPV or oral polio vaccine 4 to 52 weeks
before departing these countries.
Afghanistan, Equatorial Guinea, Ethiopia, Iraq, Israel, Somalia, and
Nigeria are infected with poliovirus but have not yet exported it.
Residents and long-term travelers to these countries are encouraged to
get boosters.

CDC health advisory

Screening previously unscreened elders for colorectal cancer (CRC) can
be cost-effective as late as age 86, according to an Annals of
Internal Medicine study.

Reaearchers evaluated to what age colorectal cancer screening should
be considered in unscreened, average-risk elders (age range, 76–90).
Strategies included one-time colonoscopy, sigmoidoscopy, or fecal
immunochemical testing (FIT).

Compared with no screening, CRC screening at age 80 prevented 4.2
(FIT) to 10.7 (colonoscopy) CRC-related deaths for every 1000 people
screened. Screening was cost-effective in those without comorbid
conditions until ages 83 (colonoscopy), 84 (sigmoidoscopy), and 86
(FIT). In elders with severe comorbidities, screening was cost-
effective until ages 77, 78, and 80, respectively.

Nearly a quarter of people older than 75 have never undergone
colorectal cancer screening. This study suggests that one-time
screening for CRC in people older than 75 is cost-effective and
probably should be considered in elders without comorbid conditions.

Annals of Internal Medicine article

The U.S. Preventive Services Task Force now recommends screening for
hepatitis B virus (HBV) infection in high-risk groups, given the
accuracy of serologic testing and the effectiveness of antiviral
therapy.

High-risk groups include:

People born in areas with an HBV prevalence of 2% or more, including
Africa, Asia, the Middle East, Eastern Europe, and parts of South
America;
HIV-positive patients
Injection-drug users
Men who have sex with men
Household contacts of HBV-infected patients
Pregnant women

USPSTF recommendation statement in the Annals of Internal Medicine

The number of measles cases reported in the U.S. so far this year is
the highest since 1994, according to an MMWR article. The disease was
declared eliminated in 2000.

As of May 23, some 288 confirmed cases were reported to the CDC from
18 states and New York City. Nearly all cases (97%) were associated
with importations, and most were in people who were not vaccinated
(69%) or who had unknown vaccination status (20%). Among imported
cases, the disease was acquired during travel to 18 countries, with
most cases acquired in the Philippines and India. An ongoing outbreak
among unvaccinated Amish people in Ohio accounted for nearly half of
the cases. Patients cited religious beliefs and philosophical
objections as the primary reasons for not being vaccinated.

The authors conclude: “Maintenance of high vaccination coverage,
ensuring timely vaccination before travel, and early detection and
isolation of cases are key factors to limit importations and the
spread of disease.”

MMWR article

Low-dose estradiol and venlafaxine (Effexor) are both effective
treatments for vasomotor symptoms in menopausal women.

Some 340 peri- or postmenopausal women with bothersome vasomotor
symptoms (hot flashes, night sweats) were randomized to receive low-
dose estradiol (0.5 mg/day), low-dose venlafaxine or placebo daily for
8 weeks.

Symptom frequency was reduced significantly more with estradiol (by
53%) and with venlafaxine (48%) than with placebo (29%). Both active
treatments were well tolerated, although estradiol was more often
associated with abnormal vaginal bleeding and venlafaxine with blood
pressure increases.

JAMA Internal Medicine article

Tamoxifen is now recommended for 10 years instead of just 5 for women
with hormone receptor–positive breast cancer, according to new
guidelines from the American Society of Clinical Oncology published in
the Journal of Clinical Oncology. Studies have shown improved survival
with extended tamoxifen, as well as reduced risk for recurrence and
contralateral breast cancer.

Women who are pre- or perimenopausal should begin with 5 years of
tamoxifen. After that, if they are still pre- or perimenopausal, they
should take tamoxifen for another 5 years. If they have become
postmenopausal, however, they should be given the choice of tamoxifen
or an aromatase inhibitor for 5 years.

Women who are postmenopausal at diagnosis should be offered the choice
of 10 years of tamoxifen, 5 years of an aromatase inhibitor, or either
2–3 or 5 years of tamoxifen followed by up to 5 years of an aromatase
inhibitor.

Journal of Clinical Oncology article

Although many women are aware that breast and ovarian cancers can have
hereditary components, the public’s knowledge about BRCA mutations,
testing, and ramifications of carrier status is limited. The goal of
the CDC’s Know:BRCA initiative is to raise awareness of how BRCA
mutations affect risk for breast and ovarian cancer, particularly
among women younger than 40.

The Know:BRCA general website allows users to create secure online
accounts for entering personal and family history, age, and ethnicity.
The assessment calculator then indicates whether or not the woman has
excess risk for carrying a BRCA mutation. Users can print their
results or share them online with their clinicians.

Centers for Disease Control and Prevention.New tool helps women assess
risk for hereditary breast and ovarian cancers. May 8 2014. (http://content.govdelivery.com/accounts/USCDC/bulletins/b6954c)