[Perception of the causes of cancer and its prevention in women of Girona]

BACKGROUND

To analyze the perception of causes and prevention of cancer among women, from Girona, Spain, as well as to assess the knowledge of initial symptoms and participation in cancer screening activities.

SUBJECTS AND METHODS

Crossectional survey with the following items: cancer risk factors, initial symptoms, perceived susceptibility, knowledge and practice of screening, beliefs regarding prevention and treatment of cancer, intention to attend screening tests and socio-demographic variables. A stratified random sample of 408 women aged 40 to 70 from two counties in Girona, Spain was selected.

RESULTS

More than 80% of women identified tobacco, radioactivity and other environmental factors as causes of cancer, being the alcohol identified by 70% of women. It was clearly observed that a high level of these women (97.5%) considered a lump in the breast as an initial symptom of cancer, whereas only a 6.6% thought it was always due to cancer. With regard to cancer screening, 21.9% of women have ever practiced a mammography, 28.5% a cervical citology with Papanicolaou staining and 53.2% self-breast examinations. All these screening activities were inversely associated to age (p < 0.05) and directly to educational level (p < 0.05).

CONCLUSION

A high knowledge regarding the causes of cancer with the exception of diet was observed in women from Girona, Spain. Knowledge and participation in screening activities is still low in practice of population cancer screening programmes.

[Sources of information about cancer]

OBJECTIVE

To study the present and preferred sources of information about cancer.

DESIGN

Cross-sectional study.

PLACE

Counties of Gironés and Pla de l'Estany from the province of Girona.

PARTICIPANTS

Stratified random sample of 408 women aged 40 to 70 years.

RESULTS

Main present source of information about cancer were friends and relatives (34.9%), followed by radio and Tv (34.0%) and newspapers (19.9%). Health care professionals only were considered main source of information by 11.3% of the sample. Women with incomplete primary school and women from older age groups answered more frequently Radio and Tv as their main source of information. However, the preferred source of information about cancer were health care professionals (73.3%).

CONCLUSION

Health care professionals are the preferred source of information about cancer but only a small percentage of population receive information from them. These results indicate the need to redefine educational strategies regarding cancer in primary health care.

Phase II trial of carboplatin in combination with etoposide in locally advanced large cell carcinoma and adenocarcinoma of the lung

A total of 18 patients with locally advanced (Stage III) adenocarcinoma and large cell undifferentiated carcinoma of the lung, previously untreated, were enrolled in a Phase II trial. Treatment consisted of carboplatin 325 mg/m2, day 1 and etoposide 100 mg/m2 on days 2 and 3. All patients were evaluable for response. Of these, one patient had a partial response (5.5%; confidence interval 0-24%). Toxicity comprised mainly leukopenia and anaemia. Other toxicities were mild. This Phase II study evidenced a poor response rate for these regimes on adenocarcinoma and large cell undifferentiated carcinoma of the lung.

Cervical cancer: incidence and survival in migrants within Spain

STUDY OBJECTIVE

This study examined the incidence of cervical cancer and survival rates according to migrant experience of women from different regions of Spain to Girona, Catalonia (Spain).

DESIGN

Using data from the population based cancer registry of Girona for the period 1980-89, crude and age adjusted incidence rates were calculated for local-born and first generation migrants from other Spanish regions. The age standardised rate ratio (SRR) was calculated and Cox's regression model was used to adjust survival according to migrant status for age and stage at diagnosis.

MAIN RESULTS

The incidence of cervical cancer was significantly higher in first generation Spanish migrants compared with locally born women (SRR: 2.02; 95% CI 1.40:2.92). The stage at diagnosis was more advanced among migrants. Survival probability was significantly associated with stage at diagnosis, but age and region of birth were not.

CONCLUSIONS

Migrants from the southern Spanish regions show a twofold excess in the incidence of cervical cancer compared with the Girona-born female population. Cases of cervical cancer in migrants are diagnosed at a more advanced stage and as a consequence have a poorer prognosis.

Alternating sequential endocrine therapy: tamoxifen and medroxyprogesterone acetate versus tamoxifen in postmenopausal advanced breast cancer patients

The effects of tamoxifen (TAM) versus the alternating sequential combination of TAM plus medroxy-progesterone acetate (MPA) has been evaluated in 20 postmenopausal patients with advanced breast cancer in a randomized controlled trial. In the TAM arm, patients received 20 mg b.i.d. of TAM. In the TAM-MPA arm, patients received only 20 mg b.i.d. of TAM for 7 days and, on the following 7 days. TAM plus an oral daily dose of 500 mg of MPA, in alternating sequence. Objective tumor reduction was achieved in 22 (41%) of the 54 patients in the TAM arm and in 25 (43%) of the 58 patients in the TAM-MPA arm. With regard to the stabilization of disease, a significant difference was observed between patients treated with the TAM-MPA combination and those treated with TAM alone (47% vs 22%). The percentage of nonresponders was also significantly higher in the TAM group (37%) than in the TAM-MPA group (10%). The time to progression was significantly shorter for the TAM arm than for the TAM-MPA arm (median, 7 vs 15 months), but the duration of remission was not significantly different for either treatment.

Protein composition of human milk in relation to mothers' weight and socioeconomic status

In the past few years there has been a resurgence of interest in the protein composition of human milk. Up to now the influence of maternal diet and of the mothers' nutritional status on the protein composition of human milk have not been fully clarified. We have evaluated the relationship between the mothers' socioeconomic status and weight and the protein composition of human milk. Protein fractions were determined by a polyacrylamide gel electrophoresis method in 181 samples of human milk obtained from voluntary donors. Samples were classified according to the time of lactation and in relation to the socioeconomic status and to the weight of the lactating women. Total protein and non-protein nitrogen decreased with advancing lactation but there were no differences among the socioeconomic and weight groups of mothers who were considered. beta- and kappa-caseins fell during lactation and beta-casein was significantly increased in the milk of the upper socioeconomic class with respect to that of the low one. alpha-lactalbumin increased from transitional to mature milk (16-30 d) and then declined. The milk from the low socioeconomic group presented the lowest levels of this protein. Lysozyme increased during lactation, whereas lactoferrin decreased. Both proteins were significantly influenced by the mothers' socioeconomic status; the highest concentrations for these proteins were found in the milk of the low socioeconomic group. Deficit or excess of mothers' weight did not influence the levels of the different protein fractions of human milk.

Changes in the protein fractions of human milk during lactation

The changes in the absolute and relative contents of alpha- and kappa-caseins, lactoferrin, alpha-lactalbumin, serum albumin and lysozyme in human milk have been studied through the period of lactation. Protein fractions of 209 samples were analyzed by a discontinuous polyacrylamide gel electrophoresis method. beta- and kappa-caseins decreased from colostrum to mature milk although their relative percentages remained constant. They accounted for 12-15 and 9-13% of the total protein in human milk, respectively. Lactoferrin decreased in absolute and relative amounts with advancing lactation. This protein represented 32-19% of the human milk proteins. alpha-Lactalbumin slightly decreased from colostrum to transitional milk but there was an increase in mature milk by 16-30 days. The percentages of this protein in colostrum and mature milk were approximately 23 and 30%, respectively. Serum albumin also decreased with advancing lactation, but the differences between transitional and mature milk were not statistically significant. Lysozyme increased from colostrum to mature milk both in relative and absolute amounts. Colostrum contained about 262 micrograms/ml, and mature milk 1,246 micrograms/ml, representing 1.5 and 12.1% of total milk proteins.