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Steven R Cummings

Publications and source records attributed to Steven R Cummings.

78 records · Page 5Linked to original sources
PubMed2002

Older women with diabetes have a higher risk of falls: a prospective study.

OBJECTIVE: To determine whether older women with diabetes have an increased risk of falls and whether known risk factors for falls account for any increased risk. RESEARCH DESIGN AND METHODS: This prospective cohort study included 9,249 women > or =67 years of age enrolled in the Study of Osteoporotic Fractures. Diabetes was determined by questionnaire at baseline. Physical performance was measured at the second examination. Subsequently, falls were ascertained every 4 months by postcard. RESULTS: A total of 629 (6.8%) women had diabetes, including 99 who used insulin. During an average of 7.2 years, 1,640 women (18%) fell more than once a year. Diabetes, stratified by insulin use, was associated with an increased risk of falling more than once a year (age-adjusted odds ratio [OR] 1.68 [95% CI 1.37-2.07] for non-insulin-treated diabetes; age-adjusted OR 2.78 [1.82-4.24] for insulin-treated diabetes). In the first 2 years of follow-up, women with diabetes were not more likely to fall than women without diabetes (44 vs. 42%; P = 0.26), but they had more falls (3.1 vs. 2.4; P < 0.01). Women with diabetes were more likely to have other risk factors for falls, which appeared to account for the increased risk of falls associated with non-insulin-treated diabetes (adjusted OR 1.18 [0.87-1.60]) but not insulin-treated diabetes (adjusted OR 2.76 [1.52-5.01]). CONCLUSIONS: Older women with diabetes have an increased risk of falling, partly because of the increased rates of known fall risk factors, and may benefit from interventions to prevent falls. Further research is needed to determine whether diabetes treatment reduces fall risk.

Accidental Falls↗
PubMed2002

Accuracy of mammographic breast density analysis: results of formal operator training.

Mammographic density is a major risk factor for breast cancer. Breast density is not routinely quantified for research studies because present methods are time intensive and manual, and require expert training. We investigated whether individuals with and without backgrounds in radiology or medicine can achieve sufficient accuracy when compared with an expert (gold standard) reader of mammographic breast density. Nine readers (three radiologists, two non-radiology physicians, and four nonphysicians) assessed breast density on 144 digitized films (60 contralateral films of breast cancer cases and 84 controls) on a computer workstation with custom software. Readings were compared with a radiologist with training in mammography and density reading that read the same films. A correlation of r = 0.9 or higher with the gold standard reading was met by three of three radiologists, one of two nonradiology physicians, and one of four nonphysicians. Intrareader reproducibility measured as the residual sum of mean errors averaged 10% mammographic density for all readers and 9% for readers with a correlation of 0.9 or higher with the gold standard. The odds ratios associated with breast cancer when films with mammographic breast density of 50% or greater are considered "dense" ranged from 3.1 to 3.9 or a 1.9-2.4-per-population-SD increase in percentage density. Although it is advantageous to have a radiological background when quantifying mammographic density, it is not a prerequisite. Applying strict validation criteria to qualify readers to quantify mammographic breast density for research studies will enhance the chance of accurately assessing breast density and discriminating women at high and low risk of breast cancer.

Adult↗
PubMedDate not supplied

Effect of ultra-low-dose transdermal estradiol on breast density in postmenopausal women.

OBJECTIVE: Women with higher mammographic breast density have increased risk for breast cancer, and there is some evidence that a change in breast density may be a marker for change in risk for breast cancer. The purpose of this study was to determine whether 2 years of treatment with ultra-low-dose transdermal estradiol results in a change in breast density. DESIGN: The Ultra-Low-dose Transdermal Estradiol Assessment was a randomized, blinded, placebo-controlled trial of 2 years of treatment with unopposed ultra-low-dose (0.014 mg/d) transdermal estradiol for prevention of osteoporosis in 417 postmenopausal women with no history of breast cancer who had not had a hysterectomy. We obtained mammograms at baseline and after 1 and 2 years of treatment from 276 of the participants. Right craniocaudal views were analyzed at a central radiology facility by a trained clinician blinded to treatment group and order of acquisition. Contour analysis was performed to define dense areas versus fatty tissue. Between-group differences in mean change in percent breast density from baseline to 1 and to 2 years of follow-up were assessed using linear regression models adjusted for clinical site. RESULTS: Participants were 66 +/- 5 years old and 94% were white. The average percent breast density at baseline was 34%. There was no significant difference between treatment groups in change in percent breast density after 1 year (between-group difference, 0.1%; 95% confidence interval, -1.3% to 1.6%) or 2 years of treatment (0.8%; -0.6% to 2.1%). CONCLUSIONS: Two years of treatment with ultra-low-dose transdermal estradiol did not increase breast density.

Age Factors↗