[Breast cancer prognosis in Salah Azaiez Institute of Cancer, Tunis]

We estimated survival rate at 9 years of all [470] women with breast cancer diagnosed at Salah Aza‹ez Institute of Cancer in Tunis to identify the main prognosis factors. Data were collected on residence, socioeconomic level, circumstances of discovery of the tumour, histological type, tumour size, presence of metastases, extension of the tumour, treatment and survival. Comparison of survival curves was done with Log Rank test. Cox model was used for multivariate adjustments and calculation of the hazard ratio [HR] [relative risk of death]. There was a survival rate of 61% at 5 years and of 51% at 9 years. Tumour size > 5 cm was significantly associated with lower survival as was capsular rupture. After stratification for tumour size and age, only surgery and radiotherapy were significantly associated with improved survival

[Health transition in Tunisia over the past 50 years]

We describe the dramatic demographic, socioeconomic and health changes witnessed in Tunisia over the past 50 years. Demographically, the gross mortality rate and the infant mortality rate have gone from 19 per 1000 and 150 per 1000 respectively in 1956 to 5.7 per 1000 and 26.2 per 1000 now, and life expectancy at birth going from 50 to 72 years for the same period. Socioeconomically, the urban population has risen from 25% to 62%, the literacy rate from 15% to 73%, and the per capita income has increased 5-fold in real terms. Epidemiologically, the infectious and perinatal diseases prevailing in the 1960s have decreased whereas chronic and degenerative diseases have risen. The proportion of the GNP related to health expenditure has risen from 3.8% to 6.2%. The implication of these changes on the Tunisian health system and the need to adapt in terms of curative care and prevention of risks are discussed

[Knowledge, attitudes and behaviours of women towards breast cancer screening]

The objective of this study was to describe knowledge, attitudes and behaviour of women towards breast cancer screening methods in two regions of north Tunisia. Thus 936 women from Ariana [urban region] and 993 women from Zaghouan [rural region] were selected and answered a questionnaire on their perception of the gravity of breast cancer, the vulnerability of women, the efficacy of screening and their use of screening. The use of screening was significantly more frequent in Ariana for both clinical breast examination and mammography, but screening use was modest. This low use of breast cancer screening contrasts with a positive attitude to breast cancer screening methods. The factors positively associated with use of screening were urban residence, age between 35 and 49 years, educational level and the perception that cancer treatment had advanced in Tunisia

[Knowledge and practice of doctors and midwives working in primary health care regarding screening for cervical and breast cancers]

We assessed the knowledge and practices of breast and cervical cancer of 286 physicians and 126 midwives working in primary health care in Tunis who responded to an anonymous questionnaire. Questions were related to knowledge of the epidemiology and survival rates in the early stages of breast and cervical cancers, to training in this domain and to the degree of involvement in this screening. The knowledge of the two cancers was relatively modest among both physicians and midwives. The systematic practice of Pap smear was significantly more frequent among midwives than physicians.The same result was observed for systematic clinical breast examination. Lack of training about carrying out Pap smears and the large number of consultations were the main factors negatively associated with systematic Pap smear and clinical breast examination practice

[Trends in tobacco consumption in Tunisia]

Because tobacco-related diseases are a growing health problem, we assessed tobacco smoking in Tunisia since 1970 using different sources. The average consumption of tobacco calculated over the period of 10 years [1981-90] was 1493 g per person and per year; equivalent of 75 packets of cigarettes. Cigarettes are the most popular form of tobacco smoking. Cigarette smoking increased from 1981 to 1993 but since has decreased slightly. According to a national study of respiratory diseases conducted in 1996, the current prevalence of tobacco smoking is 30.4% for both sexes: around 52% for males and 6% for females. Average consumption is 17.7 cigarettes/day, irrespective of sex. For young people, the prevalence is 29.21%: 50% for males and 3.9% for females. Young people who attend school smoke less than those who do not [18.1% versus 38.4%]. Most started smoking between 14 years and 18 year