"Harvard Web Site Helps Evaluate Risks of Cancer" [The Cutting Edge, Jan. 25] contained an incorrect Web site address. "Your Cancer Risk" is at www.yourcancerrisk.harvard.edu (Published 02/15/2000)



Costly laboratory tests routinely performed before cataract eye surgery could be eliminated without adversely affecting health, according to a study by Johns Hopkins University researchers.

The study of more than 19,000 patients undergoing elective surgery for cataracts found that preoperative testing did not improve the surgery's success. Neither did it reduce complications or deaths from this eye operation. The preoperative testing included such standard items as blood counts and electrocardiograms.

Based on these findings, "we should stop ordering routine preoperative laboratory tests for patients before cataract operations or other relatively simple surgical procedures," concluded University of Chicago physician Michael Roizen in an editorial accompanying the study. Both were published last week in the New England Journal of Medicine.

Cataracts occur when proteins in the lens of the eye begin to clump together and cloud vision. To correct vision, surgeons remove the opaque lens and usually replace it with an intraocular artificial lens.

In the outpatient procedure, patients receive a local anesthetic and an intravenous sedative rather than general anesthesia. Death rates for cataract surgery are very low, and the operation has become so routine that it is the most common surgical procedure performed on seniors.

In 1996 alone, an estimated 1.5 million Medicare beneficiaries had cataract surgery, according to the Health Care Financing Administration, the federal agency that runs Medicare. The pre-op tests cost $150 million annually, according to HCFA.

The study found that ending routine testing before cataract surgery "could reduce costs without any negative effect," said Oliver Schein, professor of ophthalmology at Johns Hopkins's Wilmer Eye Institute and lead author of the study.

Schein and his team randomly assigned the 19,000 patients in the study to receive the standard pre-op tests or to simply be interviewed by a physician. The study found that patients who did not undergo pre-op medical tests fared as well during and after surgery as those who received it.

--Sally Squires



Hypothermia, an abnormal drop in body temperature, is a bigger threat during frigid weather like the recent arctic blast, but it can strike even in moderate weather, the federal Centers for Disease Control and Prevention warns.

Hypothermia occurs when the body's internal temperature falls below 95 degrees. It is a medical emergency with a high fatality rate. During a recent 15-year period, nearly 12,000 deaths occurred in which hypothermia was the underlying cause, according to CDC.

The highest rates of reported hypothermia are in northern states with harsh winters and mountainous western states, where overnight temperatures often plummet at higher elevations. But deaths from hypothermia occur even in states with milder climates, such as Georgia and North Carolina, where rapid changes in temperature are common, CDC said.

Hypothermia can strike at moderate temperatures around 60 degrees, if inadequate clothing, dampness, high winds or prolonged exposure overcomes the body's ability to conserve heat. Alcohol also worsens the risk by impairing judgment.

Deaths from hypothermia have become less common during the past 20 years, possibly because of stepped-up warnings and prevention efforts or relatively moderate winter weather, CDC reported this month in its Morbidity and Mortality Weekly Report.

People most at risk of hypothermia include the elderly, very young children, the homeless and the mentally ill, and anyone with a serious medical condition, especially if they use drugs that widen the blood vessels and suppress the body's shivering response. Such drugs--including sedatives, anti-anxiety medication and antidepressants--can mask hypothermia symptoms and hinder the body's attempts to warm itself.

"The onset of hypothermia is often insidious," CDC experts warned, "with early manifestations of exposure including shivering, numbness, fatigue, poor coordination, slurred speech, impaired [thought], blueness or puffiness of the skin and irrationality."

During cold snaps such as the current one, the CDC report advised, people should wear warm clothing (including a hat), drink plenty of fluids but refrain from alcohol, and avoid fatigue and over-exertion.

--Don Colburn



Worried about cancer?

The Harvard School of Public Health offers a new way for people to evaluate their risk of breast, colon, lung and prostate cancer--four of the leading types of cancer in the United States.

Run by Harvard's Center for Cancer Prevention, this Web site calculates individual risk based on a questionnaire that is completed online. Known as "Your Cancer Risk," it also evaluates the answers and immediately provides a risk assessment based on the latest scientific evidence. Users then receive tips, tailored to their specific needs, for reducing risk. They also are shown how their odds of developing cancer drop based on following the tips.

Estimates are that 50 percent of all cancer can be prevented, provided that people take the right steps. "Studies show that people are more likely to make a health change if they believe it is relevant to their own situation," said Graham Colditz, director of education at the Harvard center.

"Your Cancer Risk," which was largely funded by Canyon Ranch Health Resorts, is located at www.yourcancerisk.harvard.edu.

--Sally Squires