[Evaluation and comparison of tobacco control legislation in member states of the European Union]. / Evaluation et comparaison de la législation de contrôle du tabagisme dans les Etats membres de l'Union Européenne.

BACKGROUND: Nowadays, tobacco use represents the main cause of avoidable deaths in Europe. Public health authorities have several means at their disposal to fight against this epidemic. For instance, legislative action can operate on the supply side as well as on the demand side, with the aim of reducing tobacco consumption in the targetted populations. METHODS: A systematic data collection of all legislative texts dealing with tobacco control was carried out within the framework of the EuroLego project. This was done, either through direct contact with the countries or through a systematic computer and manual search of data bases concerning the 15 member states of the European Union. RESULTS: At present, the legislative context varies widely from one country to another, whether regarding the number of texts adopted or the subject that is covered. Since the 1950s, a marked increase in the number of legislative texts has been noted as well as a trend towards harmonization of the texts among the different member states. CONCLUSIONS: Several health recommendations can be put forward in the context of public health activities with priority to be given to the protection of the children and the young and to the defense of the rights of non-smokers.

[Endometrial cancer and tamoxifen. Discussion apropos of a series of cases]. / Cancer de l'endomètre et tamoxifène. Discussion à partir d'une série de cas.

Tamoxifen is widely used nowadays in the management of breast cancer, having established its efficacy in this indication, especially for postmenopausal patients with ER-positive breast tumours. However, tamoxifen has recently been recognized as carcinogenic for the human endometrium, probably with an effect of duration of treatment. Moreover, this drug may be associated with the occurrence of endometrial cancers of unusual histological types and/or of a more aggressive nature. We describe a case series of 11 patients who developed such cancers after having previously received tamoxifen for breast cancer. Several assumptions on the mechanisms underlying the attributed carcinogenic properties of tamoxifen, for the endometrium and potentially for other organs, are discussed on the basis of current knowledge.

Tamoxifen and ocular toxicity.

Tamoxifen, widely used in the management of breast cancer, has been associated with a reduction of mortality and recurrence as well as occurrence of controlateral tumors. It is generally well tolerated, apart from certain well-documented adverse effects concerning mainly the reproductive organs, the most worrying being its carcinogenicity for the endometrium. Ocular toxicity has also been reported as one possible complication of the drug, with lesions described in the retina, the cornea, or the optic nerve, especially in women treated with high daily or cumulated doses of tamoxifen, although some cases have also been reported with standard doses. The incidence of such ocular complications is rather low considering the large number of patients receiving tamoxifen. The possible reversibility of these lesions, if discovered in time, emphasizes the need for clinicians to be aware of these ocular reactions and raises the question of periodic ophthalmological screening examinations among patients receiving tamoxifen.

[Medical adverse effects of chemoprevention: the example of tamoxifen]. / Effets secondaires médicaux d'une intervention de chimioprévention: l'exemple du tamoxifène.

Tamoxifen, a synthetic antiestrogen widely used for the treatment of breast cancer, is also being proposed for the prevention of this cancer among women at high risk for the disease. Such an approach requires an objective and accurate evaluation, not only of the expected beneficial effects, but also of the potential iatrogenic side effects which could result from the administration of this drug to a population of healthy women. The present article summarizes our present knowledge which results from studies, all carried out on women with breast cancer: we review the side effects on the female genital apparatus, the ovarian and non ovarian endocrine side effects, the effects on cardio-vascular and thromboembolic risks, on bone metabolism and on ocular and hepatic side effects. The potential carcinogenic role is only briefly mentioned since it has already been the subject of a publication in this journal.