Philip E. Sartwell

Epidemiology of Benign Breast Lesions: Lack of Association with Oral Contraceptive Use

Abstract Women with benign breast lesions were compared with matched hospital controls to determine epidemiologic features and use of oral contraceptives and estrogens. There were 306 patients with cystic disease and related conditions, 71 with fibroadenoma and 39 with miscellaneous other lesions. In the cystic-disease group there was a deficit of postmenopausal women and women whose first pregnancy was under age 25. A history of use of oral contraceptives or estrogens was given no more frequently by patients with cystic disease and fibroadenoma than by their respective controls. Fewer patients with cystic disease (14) than controls (34) had used oral contraceptives for more than one year. These findings imply that use of oral contraceptives or estrogens has no role in the occurrence of benign breast neoplasms. The reproductive histories of patients with benign and malignant breast neoplasms appear similar in some respects.

Overview: Pulmonary embolism mortality in relation to oral contraceptive use☆

Abstract United States mortality trends due to pulmonary embolism during the period 1960–1972 were analyzed to determine if death trends were consistent with the hypothesis that mortality would be reduced among females with a switch to the lower estrogen oral contraceptives during the end of the 1960s and early 1970s. Data were consistent with this hypothesis, but must be interpreted cautiously.

Cigarette Smoking and Changes in Respiratory Findings

Standardized surveys of cardiorespiratory findings were conducted among male telephone company employees 40 to 59 years of age, and repeated five to six years later. Cigarette smokers had considerably more cough, phlegm, and chronic wheeze and slightly more nasal catarrh and breathlessness on exertion than nonsmokers. Pipe and cigar smokers had intermediate levels of these symptoms. Men who quit cigarette smoking between two surveys showed considerable improvement in cough and phlegm. Respiratory symptoms and among smokers of nonfilter cigarettes. Forced expiratory volume decreased and sputum volume increased among all groups over the observation period. Both changes were least marked among men who quit smoking cigarettes and were most marked among those who continued to smoke cigarettes.

THE COMPARATIVE EPIDEMIOLOGY OF LEPROSY AND TUBERCULOSIS

Thirty years ago the American Association for the Advancement of Science held a symposium called “Tuberculosis and Leprosy.” A monograph was published the following year and included as the final paper a section called “Summary and Unification : Tuberculosis, Leprosy and Allied Mycobacterial Diseases” by Esmond R. Long,’ and again in 1964 Dr. Long dealt with this subject,2 as numerous other workers have done, It should be understood that the present paper is a review of the topic and contains no new data. Only tuberculosis and leprosy will be discussed; too little is known about the others. I believe that a proper organization of the topic embraces two aspects: first, the general epidemiology, and second, those bits and pieces of knowledge that have developed from field application of immunologic skin tests, relevant to both diseases, in healthy persons and the diseased. Perhaps the most striking common feature of tuberculosis and leprosy, apart from their etiological relationship and their chronicity, is the fact that scarcely any condition can be thought of that has afflicted mankind with more suffering over the centuries than these two have done. Even today when tuberculosis is in recession in most parts of the world and leprosy now has a restricted distribution, one, or in places, both of these diseases is a major problem in most of the developing nations. An exploration of the epidemiology of a disease usually begins, in traditional fashion, with a statement about the mode of transmission. Here we find the first contrast between tuberculosis and leprosy. The former has been worked out with considerable certainty, although only on the basis of indirect evidence and animal experiments. The latter is still a mystery. We know from pathological landmarks left by the invading organism, from animal experiments, and from epidemiological observations, that the usual route by which tubercle bacilli invade the body is the lower respiratory tract, with occasional substitution of other routes such as the alimentary tract or skin. A mere recital of the terms employed is an indication of the detail in which our knowledge is held, for example, primary tubercle, regional lymph node, post primary hematogenous dissemination and so forth. About leprosy, we have no similarly detailed vocabulary. The route of entry is still a mystery despite the intense observation of .this disease. It is known that the first lesions can occur at the site of a presumed inoculation of bacilli into the skin years earlier, but this is about all we can say. Usually direct personal contact appears to be required, often for a long period, and infection through the skin by mechanical means seems a likely route. Yet the pos:ibility of arthropod transmission cannot be excluded, nor can the upper respiratory tract. One of the reasons for the difficulty in establishing the epidemiologic features of the two diseases is their extremely long period of incubation. In tuberculosis it is often impossible to estimate the incubation period, defined as the interval from acquisition of infection to first symptoms, since the first symptoms are often SO vague as to be historically unidentifiable. Nevertheless it is known that the incubation period can be as short as two or three months or as long as several years, the highest risk, however, coming in the first year after infection, The usual incubation period of leprosy is even harder to determine, because the time