Robert Flamant

Preoperative versus postoperative radiotherapy, single versus multiple courses of actinomycin d, in the treatment of Wilms' tumor. Preliminary results of a controlled clinical trial conducted by the international society of paediatric oncology (S.I.O.P.)

The preliminary results of a controlled clinical trial organized by the S.I.O.P. of radiotherapy and chemotherapy in patients with nephroblastoma are presented. Forty‐two centers have participated. Between September 1971 and October 1974, 398 patients were registered; 195 were eligible for the trial and were randomized. The remaining 203 patients were excluded from the trial, but were followed in the same way as the patients in the trial. The results were evaluated in terms of recurrence‐free survival rate and survival rate. Results in patients who received preoperative and postoperative radiotherapy (group A, 73 patients) were compared with the results in patients who recieved only postoperative radiotherapy (group B, 64 patients). The tumor ruptured at surgery in three patients of group A, and in 20 patients of group B, a difference that is statistically significant. No significant difference in survival and recurrence‐free survival between groups A and B is observed at present. Results in patients treated with a single course of actinomycin D (group I, 80 patients) were compared with the results in patients treated with multiple courses (group II, 80 patients). At present, no significant difference is found between the two groups.

DECREASED MORTALITY AMONG MALE PRISONERS

The mortality among a population of male prisoners between 1977 and 1983 was compared with that among the general French population. The overall mortality rate (for all deaths except external causes) was lower among prisoners (SMR = 84; p less than 0.05). Moreover, the risk of dying from all causes, as well as from malignant neoplasms, diseases of the circulatory system, and suicides fell significantly with increasing duration of imprisonment. These findings suggest that the lifestyle specific to imprisonment might overcome the prejudicial effect of risk factors such as alcohol, tobacco, or drug abuse that tend to be common among prisoners.

Breast cancer and oral contraceptives: A review

The relationship between oral contraceptive use and breast cancer was investigated in 22 major epidemiological studies, which are reviewed in this paper. The overall risk ratio was never found to increase when computed among all users vs. nonusers. Risk increases were found in some studies within specific subgroups; but in general, if any risk exists, it is not much more than one. Future studies should focus specifically on women under age 25, on women before a first full-term pregnancy and, to a lesser extent, on perimenopausal women and on women who have had a benign breast disease.

Cancer epidemiology: implications for prevention and treatment

Due to the results achieved in epidemiological research for the last 30 years, we are able to reduce considerably mortality from cancer through prevention and early diagnosis. The data required to accomplish these actions have been provided by epidemiology: (a) Descriptive epidemiology is the study of the frequency and the distribution of cancers, based on data concerning mortality and morbidity. These frequencies vary according to different parameters (i.e., sex, age, geographical situation). (b) Analytical epidemiology is able to pinpoint different risk factors (i.e., alcohol, tobacco, iatrogenic factors) through adequately conducted surveys. Primary prevention can attenuate the incidence of cancers by the suppression or reduction of certain risk factors. Secondary prevention permits the screening and treatment of precancerous lesions and avoids the secondary emergence of cancer (cervix uteri, colon). Early diagnosis is able to detect lesions at an early stage in their evolution where treatment is facilitated and where there are optimal chances of survival (breast). All of these measures for prevention and early diagnosis are being organized as large-scale strategic campaigns (e.g., National Cancer Institute, European Communities).