Herbert L. Lombard

Epidemiological aspects of cancer of the cervix. II. Hereditary and environmental factors.

Data based on records of 2 Massachusetts state cancer hospitals and on personal interviews were analyzed for 523 women with cancer of the cervix. Numerous variables were considered. The syphilitic rate was higher for cancer patients. Long-term douching with coal tar derivatives showed significance in the zero order but failed to meet the criterion used for significance. Unrepaired lacerations were present in 26% cancer patients compared with 13.2% with cervical cancer. The reasons for the relationship between low economic status and cancer of the cervix are not clearly defined. Such parallel factors as poor obstetrical care improper housing and poor nutrition are important. Persons who had been either separated or divorced were 20.7% of the cancer group compared with 6.7% of the controls. The significance of this is not apparent. Marriage before age 20 occurred in 44.6% of the cancer group 23.7% of the controls. Infections chronic irritation and hormonal imbalance are considered important in the cause of cancer of the cervix.

Certification of death of 1,000 diabetic patients

A perusal of the trend of the diabetic death rates indicates that following the introduction of insulin there was a short drop in the deaths from the disease, but the upward trend was resumed within two years and over a dozen years elapsed before any pronounced change occurred in the trend. For the past eight years the adjusted diabetic death rate has shown no increase and there is even some indication of a regression. The cause of this change is unknown although chronological it follows the use of protamine zinc insulin. Morbidity, on the other hand, has been on the increase and as yet has not shown a tendency to change. A stationary adjusted death rate and an increasing morbidity rate cannot continue indefinitely. A change must occur in one or the other of these rates.

Underlying causes of death of 1000 patients with diabetes.

STUDIES of long-term trends of death rates were made more difficult by the adoption, in 1948, of the sixth revision of the Manual of the International Statistical Classification of Diseases, Injuri...

The public and cancer control

This paper supports the thesis that the dissemination of cancer information is a valuable means for increasing knowledge of the disease that may lead to early diag nosis and prompt treatment. In cancer control three types of educa tional activity should be considered: fur nishing information (1) for propaganda purposes, (2) merely to create awareness, and (3) to motivate action if the need arises. The three types of educational effort require different methods of evalua tion. Propaganda can usually be meas ured immediately. Here the effort is so closely connected with the results that failure to meet quotas or to attract inter ested individuals is apparent at once and suggests the need for improved tech niques. It is not easy to evaluate tech niques that merely create awareness of the subject, and it is even more difficult to evaluate methods of furnishing informa tion that motivate action. There are many studies demonstrating that the cancer situation is improving. The death records give pertinent information of this type. In the early part of the cen tury the adjusted cancer death rates for both sexes were rising about 2 per cent per year in Massachusetts and in the U. S. Registration Area of 1900. Shortly before this country entered World War I, the in crease among females lessened, somewhat more in Massachusetts than in the Regis tration Area. A change occurred in the male rate around 1926 for both Massa chusetts and the Registration Area. From then on the annual percentage increase was only about one half its previous value. In the middle thirties, a downward trend was noted in Massachusetts among fe males, and a few years later a similar drop occurred in the Registration Area of 1900.1 The increasing number of cures re ported by surgeons is another example of improvement in the cancer situation. Sur vival rates are also used in evaluation. In the four oldest State-aided cancer clinics, Worcester, Springfield, Lowell, and Lynn, there were 13 per cent ten-year survivals for patients admitted in the first year of the clinics and 26.5 per cent for those ad mitted fifteen years later. The increased percentage of cures or survivals, however, represents such factors as improved diag nosis, better surgery, more knowledge of cancer by the lay public, and probably other factors. Such data could not be used as a sole measure of any one of these items. The extent of background knowledge of cancer in the general population and the sources of the medical information may be ascertained by surveys, somewhat similar to the Gallup Poll. Surveys re peated in the same community at a later period will determine whether there has been improvement in cancer knowledge. Evaluation of educational activities in Massachusetts has been carried on by ob taining information as to the extent of cancer knowledge, and the media through which the information was acquired, in sample populations from a number of communities in the State. This paper deals primarily with a com parison of the community knowledge of cancer in the years 1949 and 1953 in Waltham, Massachusetts. The city con tains diversified industries and excellent medical facilities. The population is ap proaching 50,000, which includes a large number of skilled workers. Prior to 1949 no long-term intensive educational cam paign in cancer control had been con ducted. In 1949 the Division of Cancer and