B. Herity

A case-control study of head and neck cancer in the Republic of Ireland.

A retrospective case-control study of 200 patients with head and neck cancer, and 200 controls matched for age and sex, confirmed the importance of tobacco and alcohol consumption in the aetiology of malignant tumours of the upper gastrointestinal and upper respiratory tracts. A male-female ratio of 3:1 was found, and the association of smoking with laryngeal cancer and of alcohol with cancer of the tongue was particularly strong. A significant excess of alcohol-related occupations was found among the cases. These findings are discussed.

Hypothermia and mortality and morbidity. An epidemiological analysis.

STUDY OBJECTIVE--The aim was to identify socioeconomic variables associated with deaths and hospital admissions due to hypothermia and to quantify the risk due to ambient outside temperature. DESIGN--The study was a survey of deaths and hospital admissions due to hypothermia (ICD 991.6), for the period 1979-85 inclusive, identified from death certificates and Hospital Inpatient Enquiry (HIPE) data. SETTING--The study included all deaths and hospital admissions due to hypothermia (1979-85) in the 26 counties of the Republic of Ireland, population 3.5 million. SUBJECTS--All deaths coded during the study period as being due to hypothermia and all persons admitted to hospital during the study period for whom hypothermia was recorded as a discharge diagnosis in HIPE data. MEASUREMENTS AND MAIN RESULTS--Demographic data and date of death/diagnosis were obtained from both data sets. Complete national temperature records were obtained from the meteorological service and a temperature was assigned to each case representing ambient outside temperature at which hypothermia developed. Risk of hypothermia at a given temperature was obtained by dividing the number of cases at that temperature by the appropriate person-years of exposure of the entire national population. Incidence of and mortality from hypothermia doubled with each 5 degrees C and 4 degrees C fall in temperature respectively; the majority of deaths and hospital admissions occurred between October and March. Incidence and mortality increased with age and men had 30% higher case fatality than women. Single men had four times the incidence and 6.5 times the mortality, and single women had double the incidence and four times the mortality of married men and women respectively. Low population density was also an important risk marker. CONCLUSIONS--The risk of hypothermia due to ambient outside temperature has been quantified and a high risk group was identified. A combination of statutory support measures and good neighbourliness could prevent illness and deaths from hypothermia.

The role of tobacco and alcohol in the aetiology of lung and larynx cancer.

A RECENT STUDY of head and neck cancer in Ireland (Herity et al., 1981) confirmed that tobacco and alcohol consumption were significant risk factors in the development of cancer of the larynx; a heavy smoker had a risk almost 40 times that of a non-smoker and a heavy drinker had a 3-fold increase in risk over a nondrinker. Many other workers have described similar findings (Wynder et al., 1956, 1976; Vincent & Marchetta, 1963; Rothman & Keller, 1972; Feldman & Hazan, 1975; McMichael, 1978; Ward Hinds et al., 1979). Another neoplasm which has been consistently related to heavy smoking is lung cancer; a comparative study of lung and larynx cancer in relation to tobacco and alcohol consumption is thus of interest. Sixty-eight cases of larynx cancer were included in the sample of 200 headand neck-cancer patients in the abovementioned study 59 males and 9 females-and details of age, marital status, occupation, education and tobacco/ alcohol consumption had been recorded for these patients. A presenting sample of 68 lung-cancer patients matched with the larynx-cancer patients for sex but not for age, was interviewed using the same precoded questionnaire as in the earlier study. The control group for the earlier study was again used. Diagnoses of the control group included cancers of the skin, haemopoietic system, gastrointestinal tract, breast, male and female genital tracts, brain, endocrine system, and connective tissue and preAccepted 23 September 1982

A study of breast cancer in Irish women.

In a study of 100 women with breast cancer and 200 unaffected women the epidemiological characteristic of breast cancer most commonly described--namely, an excess of nonparous women among cases when compared with controls, was not observed. It is suggested that two factors, a dearth of first births born to mothers under 20 years of age and an unusually high proportion of first births when aged 30 years or more, are responsible for this finding. No association was found between breast cancer and socioeconomic status, marital status, age at marriage, age at first pregnancy, parity, or age at menarche. Significant associations with breast cancer included age at natural menopause, hysterectomy, and breast trauma. These findings are discussed.

A re-appraisal of risk factors for skin carcinoma in Ireland. A case control study.

SummaryA CASE control study of risk factors in patients with histologically proven skin carcinoma was undertaken. One hundred and twenty-one consecutive patients with skin carcinoma were compared with 121 patients with other malignancies individually matched for age and sex. The results indicated that patients with skin carcinoma when compared to controls did not have excess exposure to ultra violet radiation, did not show increased sensitivity to the effects of ultra violet radiation and did not exhibit differences in skin type, eye or hair colouring.These results indicate that in Ireland, which has a particularly high incidence of skin carcinoma, other possible risk factors should be investigated in future studies of skin carcinoma.

Anencephaly and potato blight in the Republic of Ireland

National potato tuber blight scores in the Republic of Ireland for the years 1961-70 were ascertained and evaluated in relation to incidence of anencephalic births in the following years. No significant relationship between annual tuber blight scores and incidence of anencephaly one year later could be demonstrated. Examination of the records of a maternity hospital for the years before, during, and after the great midnineteenth century potato famine in Ireland failed to show any appreciable fluctuation in anencephaly/spina bifida incidence during this period.

Views of Irish general practitioners on screening for cervical cancer

BackgroundA national cervical screening programme is being established in Ireland and there is little information on the level of resources required.AimsTo obtain information on attitudes of Irish general practitioners (GPs) and on the resources needed by them in relation to participation in the programme.MethodsAn anonymous postal questionnaire was sent to a random sample of 600 GPs, approximately 25% of the total population of GPs in Ireland.ResultsA response rate of 87.5% was obtained. The majority (88%) would participate in a national programme. Those who would not were more likely to be in single-handed practice, aged over 44 years, have no ancillary staff, no computer and be in rural practice. GPs were in favour of a special fee for smear taking, a training programme and management guidelines on the test report. They did not want bonus payments for achieving targets or the report to be sent to the client as well as the doctor.ConclusionGPs will support a national cervical screening programme but a number of organisational issues must be discussed with them to ensure a successful programme.

A study of the needs of cancer patients and their relatives

SummaryA Study of the views of a representative sample of 200 cancer patients attending two Dublin hospitals on the care received by them during their illness was undertaken. Information on communication, physical and psychological symptoms and care in hospital and in the community was obtained.Over 40% of patients had some reservations regarding the way in which the diagnosis was communicated to them and in relation to opportunities for discussion with their doctors. More than 50% of patients stated that they had lassitude, pain or insomnia during the four week period prior to interview, however many of the patients studied had been referred to the two tertiary care centres for treatment of symptoms, therefore the prevalence of reported symptoms in this study is probably higher than in the total population of cancer patients in Ireland. Psychological symptoms were also frequently reported and an association between the presence of physical and psychological symptoms points to the need for a multidisciplinary approach to symptom control. In contrast, symptoms following therapy were less severe and on the whole were well managed.Overall satisfaction with hospital care was high but where possible most patients preferred to be nursed at home and relatives were willing to provide care for them. Supportive services at home for terminal patients were reported as deficient, particularly nursing care, but very few patients or relatives considered that a short term stay in a convalescent home or attendance at a day hospital was a desirable solution. Long journeys to outpatient departments were also a hardship for some patients.Financial provision for their illness was not seen as a problem by most patients.Further research into symptom control and community services for cancer patients would contribute to an improved quality of life for those who develop the disease.

A pilot study of cervical screening in an inner city area—lessons for a national programme

The objectives of this study were to examine aspects of organization of a proposed national screening programme based in general practice. The target population of women aged 25–59 years and their general practitioners (GPs), in a defined inner city area, was identified from a population register of persons eligible for free medical services; a computerized system was developed for invitations and record linkage of cytology results. Smears were examined in one laboratory and follow up of women with abnormal smears was undertaken by one gynaecologist. A random sample of non‐responders was surveyed by questionnaire. Response following two invitations was only 20%. Practices with male doctors only had significantly lower reponse rates (P<0.001) than those with a female doctor/nurse. A survey of non‐responders showed that over 20% of addresses were incorrect and 16% of those interviewed were ineligible for smear tests. A preference for a female to undertake smears was expressed by 67%, and 77% believed that the purpose of the cervical smear was to detect cancer. An accurate population register, health promotion, support for GP practices, provision of alternative venues for smear tests, development of computer systems, accurate data entry and fail‐safe follow up are aspects of a cervical screening service which must be addressed prior to setting up a national service.

Area of residence and risk of cancer of the cervix uteri in Ireland.

SummaryASTUDY of 85 women attending a national centre for treatment of invasive squamous cell carcinoma of the cervix uteri (SCC) and 85 age-matched female controls attending the same centre showed no significant difference for area of residence. A previously reported1 excess of rural women among cases was probably an artefact of sample selection. An increased risk for women resident in urban areas described in studies elsewhere is not apparent in the women studied and demographic features of the Irish population may influence this result.