Ruhee Chaudhry and coworkers carried out a retrospective population-based cohort study of the survival of women who were newly diagnosed with breast cancer in 1991. Michael McKee and colleagues describe a series of 15 cases of osteonecrosis of the femoral head in patients who had received relatively short courses of steroids. Only 3 of the patients had other potential risk factors, none of which was felt to be sufficient, in isolation, to cause osteonecrosis. The authors discuss possible improvements to the program. In 1998 CMAJ published a supplement of clinical practice guidelines for breast cancer produced by the Steering Committee for Clinical Practice Guidelines for the Care and Treatment of Breast Cancer.
Medicine marches on, and in the breast cancer field the pace is brisk.
In this issue we start a series, overseen by the same committee, that is intended to update the original guidelines and cover new topics. The first new guideline is on the management of lymphedema related to breast cancer treatment. The 1998 guideline on adjuvant systemic therapy for node-negative breast cancer has been updated , and Mark Levine describes the changes . CMAJ editor John Hoey describes the context of the series and strategies for dissemination of the updated guidelines. Stephen Hwang describes the health consequences of homelessness.