Evolución de la prevalencia del tabaquismo en la Comunidad de Madrid, España: dos décadas de vigilancia epidemiológica, dos décadas de disminución progresiva (1995-2013) / Evolution of smoking prevalence in the Community of Madrid, Spain: two decades of epidemiological surveillance, two decades of progressive decrease (1995-2013)

Introducción. La vigilancia epidemiológica del tabaquismo constituye una medida esencial para combatir esta epidemia. La Consejería de Sanidad de la Comunidad de Madrid dispone de un Sistema para la Vigilancia Integral del Tabaquismo (VITa), integrado por diversos sistemas de información que se han ido desarrollando en el Servicio de Epidemiología desde 1995. Este trabajo analiza la evolución de la prevalencia de consumo de tabaco en la población adulta de la Comunidad de Madrid a lo largo del período 1995-2013. Material y métodos. Los datos proceden del Sistema de Vigilancia de Factores de Riesgo asociados a las Enfermedades No Transmisibles en la población adulta (SIVFRENT-A), uno de los sistemas que integran el sistema VITa, que mide de forma continua en la población de 18-64 años de la Comunidad de Madrid la prevalencia, distribución y características de los principales factores relacionados con el comportamiento o estilos de vida, entre ellos, el tabaco. Se ha calculado la prevalencia de consumo de tabaco anual en el período 1995-2013 y las razones de prevalencia de cada uno de los años respecto al primero, 1995. Resultados. Entre 1995 y 2013 la prevalencia de consumo de tabaco disminuyó en el conjunto de la población de 18-64 años de la Comunidad de Madrid del 42,4% (IC95%: 40,2-44,6%) en 1995 al 27,4% (IC95%: 25,4-29,5%) en 2013. En los hombres, la tendencia fue descendente, con una reducción del 45,8% (IC95%: 42,6-48,9%) en 1995 al 29,3% (IC95%: 26,4-32,3%) en 2013. En las mujeres, la tendencia fue descendente en las de 18-29 años, con una reducción del 52,2% (IC95%: 46,6-57,8%) en 1995 al 22,9% (IC95%: 17,4-29,1%) en 2013, y en las de 30-44 años, con una reducción del 48,5% (IC95%: 43,1-54,0%) en 1995 al 23,7% (IC95%: 19,5-28,3%) en 2013. En las mujeres de 45-64 años la tendencia fue ascendente, con un aumento del 19,1% (IC95%: 15,2-23,5%) en 1995 al 28,9% (IC95%: 24,5-33,7%) en 2013. Conclusiones. Entre 1995 y 2013 la prevalencia de consumo de tabaco disminuyó en el conjunto de la población de 18-64 años de la Comunidad de Madrid un 35,4% (36,0% en hombres y 34,5% en mujeres). La tendencia fue descendente durante todo el período en todos los grupos de edad y sexo, excepto en las mujeres de 45-64 años, en quienes la tendencia fue ascendente. El importante descenso no puede hacer perder de vista que el consumo de tabaco es aún elevado, con un fumador por cada 3,5-4 personas, también en los más jóvenes. Se necesitan intervenciones serias, contundentes y sostenidas para prevenir el inicio y ayudar al abandono del consumo. La epidemia de tabaquismo es un problema enteramente provocado por el ser humano y completa e inexcusablemente erradicable (AU)

Introduction. Tobacco epidemiologic surveillance is essential to fight against this epidemic. The Regional Ministry of Health of Madrid has a comprehensive system, the Tobacco Epidemic Comprehensive Surveillance System (Sistema para la Vigilancia Integral del Tabaquismo, VITa), which has been developed by the Department of Epidemiology since 1995. This study analyzes the prevalence of tobacco consumption from 1995 to 2013. Material and methods. Data from the Non-Communicable Diseases Associated Risk Factors Surveillance System in the adult population (Sistema de Vigilancia de Factores de Riesgo asociados a las Enfermedades No Transmisibles en la población adulta, SIVFRENT-A) have been analyzed. SIVFRENT-A is one of the systems that comprises the VITa system. This system measures on an annual basis the prevalence, distribution and characteristics of the main health behaviour risk factors, one of which is tobacco consumption. Annual prevalence of smokers was estimated for the period 1995-2013. Prevalence ratios were estimated for every year in respect of the first one, 1995. Results. Between 1995 and 2013, the prevalence of tobacco consumption in the population of the Community of Madrid aged 18-64 years decreased from 42.4% (95%CI: 40.2%-44.6%) in 1995 to 27.4% (95%CI: 25.4%-29.5%) in 2013. Men showed a downward trend, with a decrease from 45.8% (95%CI: 42.6%-48.9%) in 1995 to 29.3% (95%CI: 26.4%-32.3%) in 2013. Women showed a downward trend in those aged 18-29 years and 30-44 years, with declines from 52.2% (95%CI: 46.6%-57.8%) in 1995 to 22.9% (95%CI: 17.4%- 29.1%) in 2013 and from 48.5% (95%CI: 43.1%- 54.0%) in 1995 to 23.7% (95%CI: 19.5%-28.3%) in 2013, respectively. Women aged 45-64 years showed an upward trend, increasing from 19.1% (95%CI: 15.2%- 23.5%) in 1995 to 28.9% (95%CI: 24.5%-33.7%) in 2013. Conclusions. Between 1995 and 2013, the prevalence of tobacco consumption declined by 35.4% (36.0% for men and 34.5% for women). A downward trend was observed for the whole period in all the analyzed groups, except women aged 45-64 years, who showed an upward trend. Despite the important global reduction, current prevalence is still high and must not be overlooked (there is one smoker out of every 3.5-4 individuals in this population, even the youngest). Strong, dedicated and sustained interventions are needed to prevent people from starting to smoke and to promote smoking cessation. Tobacco epidemic is an entirely human-made epidemic and it is completely and undeniably eradicable (AU)

Sigamos trabajando duro para que los niños crezcan sin tabaco / We are continuing to work hard for children to grow up without smoking

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Informe: Vigilancia del consumo de tabaco y de la exposición ambiental al humo de tabaco en la Comunidad de Madrid en 2012. Resultados del sistema de Vigilancia Integral del Tabaquismo (VITa) / Report: Control of tobacco consumption and environmental exposure to tobacco smoke in the Community of Madrid in 2012. Results of the Global Tobacco Surveillance System

La Consejería de Sanidad de la Comunidad de Madrid dispone de un Sistema para la Vigilancia Integral del Tabaquismo (VITa) integrado por diversos sistemas de información que se han ido desarrollando en el Servicio de Epidemiología desde 1995. Su objetivo es proporcionar la información necesaria para combatir una epidemia que causa anualmente más de 5.000 muertes en la región de Madrid y más de 53.000 en España. En este informe se describe la situación de la epidemia hasta 2012, último año disponible. Entre 1995 y 2012 la prevalencia de consumo de tabaco en adultos disminuyó globalmente un 33,7%. En la población juvenil, la prevalencia de fumadores diarios disminuyó globalmente un 63,5% entre 1996/1997 y 2011/2012. Por otro lado, la prevalencia de exposición pasiva al humo de tabaco en espacios públicos descendió drásticamente hasta niveles inferiores al 5% en todos los espacios que han sido regulados de manera taxativa por las normativas sanitarias de prevención y control del tabaquismo (en concreto, las leyes de medidas sanitarias frente al tabaquismo en España 28/2005 y 42/2012), entre ellos, los bares, pubs, restaurantes y otros lugares de ocio (AU)

The Regional Ministry of Health of Madrid has a comprehensive system for the surveillance of the tobacco epidemic (Tobacco Epidemic Comprehensive Surveillance System). This system is comprised of several information systems that have been developed by the Department of Epidemiology since 1995. The aim of this system is to provide the information needed to fight an epidemic that causes more than 5,000 deaths in the Community of Madrid every year and more than 53.000 per year in Spain. This report describes the epidemic until 2012, the most recent year available. Between 1995 and 2012 the prevalence of tobacco consumption within the adult population decreased 33.7%. Among adolescents, the prevalence of daily smokers decreased 63.5% from 1996/1997 to 2011/2012. Additionally, the prevalence of involuntary exposure to tobacco smoke dropped dramatically to less than 5% in all public places that have been firmly regulated by the Spanish comprehensive public health smoke-free laws (National Law 28/2005 and National Law 42/2012), among which are bars, pubs, restaurants and other leisure facilities (AU)

[Mortality from cancer in children and adolescents in Madrid, 1977-2001]. / Mortalidad por cáncer en niños y adolescentes de la Comunidad de Madrid, 1977-2001.

INTRODUCTION: In the last few decades mortality from cancer among children and adolescents has not decreased homogeneously in industrialized countries. The aim of this study was to determine the epidemiological pattern and temporal trend of mortality from cancer in individuals aged less than 20 years old living in the Autonomous Community of Madrid from 1977 to 2001. MATERIAL AND METHODS: Data on deaths from cancer among children and adolescents were obtained from Spain's National Institute of Statistics and from the Mortality Registry of Madrid. Populations were obtained from official publications of the Institute of Statistics of Madrid. Variables analyzed were sex, 5-year age groups, 5-year death periods and underlying cause of death. The epidemiological pattern was studied and a Poisson's regression model was used to analyze cancer mortality trends in children and adolescents from 1977 to 2001. RESULTS: Cancer mortality among children and adolescents decreased by 41 % from 1977 to 2001. The decrease in mortality differed according to sex (46 % in boys and 33 % in girls) and type of cancer (leukemias: 38 %, non-Hodgkin's lymphomas: 58 %, malignant brain tumors: 45 %, malignant bone tumors: 19 %, ill-defined malignant tumors: 78 %). Moreover, the annual decrease was much greater in the last 5 years (4. 7 %) than during the entire period (2. 2 %). CONCLUSIONS: Cancer mortality among children and adolescents decreased between 1977 and 2001 and our results are similar to those observed in other European and North American regions. To improve knowledge of the epidemiology of cancer among children and adolescents in the Autonomous Community of Madrid, future assessments including mortality, incidence, and survival indicators are required.

Mortalidad por cáncer en niños y adolescentes de la Comunidad de Madrid, 1977-2001 / Mortality from cancer in children and adolescents in Madrid, 1977-2001

Introducción: La mortalidad por cáncer en niños y adolescentes ha disminuido de modo desigual en los diferentes países desarrollados en las últimas décadas. El objetivo del estudio es conocer el patrón y la tendencia de la mortalidad por cáncer en menores de 20 años residentes en la Comunidad de Madrid entre 1977 y 2001. Material y métodos: Las defunciones fueron cedidas por el Instituto Nacional de Estadística y por el Registro de Mortalidad de la Comunidad de Madrid y las poblaciones se tomaron a partir de publicaciones oficiales del Instituto de Estadística de la Comunidad de Madrid. Las variables estudiadas fueron: sexo, grupo quinquenal de edad, período quinquenal de defunción y causa básica de defunción. Se describe el patrón epidemiológico y se analiza la evolución temporal de la mortalidad por cáncer infantil entre 1977 y 2001 mediante el ajuste de un modelo de Poisson log-lineal. Resultados: La mortalidad por cáncer infantil ha disminuido un 41 % a lo largo del período de estudio. El descenso ha sido desigual para los distintos sexos (varones: 46%; mujeres: 33%) y tipos tumorales (leucemias: 38 %; linfomas no hodgkinianos: 58 %; tumores malignos encefálicos: 45 %; tumores malignos osteoarticulares: 19 %; tumores malignos mal definidos: 78 %). El porcentaje de disminución anual de la mortalidad ha sido mucho mayor para el último quinquenio (4,7 %) que para el período completo (2,2 %). Conclusiones: La mortalidad infantil por cáncer ha descendido entre 1977 y 2001, acercando la situación de nuestra región a la de otras regiones europeas y norteamericanas. Serán necesarias futuras evaluaciones que integren indicadores de mortalidad, incidencia y supervivencia para un mejor conocimiento de la epidemiología del cáncer infantil en la Comunidad de Madrid

Introduction: In the last few decades mortality from cancer among children and adolescents has not decreased homogeneously in industrialized countries. The aim of this study was to determine the epidemiological pattern and temporal trend of mortality from cancer in individuals aged less than 20 years old living in the Autonomous Community of Madrid from 1977 to 2001. Material and methods: Data on deaths from cancer among children and adolescents were obtained from Spain’s National Institute of Statistics and from the Mortality Registry of Madrid. Populations were obtained from official publications of the Institute of Statistics of Madrid. Variables analyzed were sex, 5-year age groups, 5-year death periods and underlying cause of death. The epidemiological pattern was studied and a Poisson’s regression model was used to analyze cancer mortality trends in children and adolescents from 1977 to 2001. Results: Cancer mortality among children and adolescents decreased by 41% from 1977 to 2001. The decrease in mortality differed according to sex (46 % in boys and 33 % in girls) and type of cancer (leukemias: 38 %, non-Hodgkin’s lymphomas: 58 %, malignant brain tumors: 45 %, malignant bone tumors: 19 %, ill-defined malignant tumors: 78 %). Moreover, the annual decrease was much greater in the last 5 years (4. 7 %) than during the entire period (2. 2 %). Conclusions: Cancer mortality among children and adolescents decreased between 1977 and 2001 and our results are similar to those observed in other European and North American regions. To improve knowledge of the epidemiology of cancer among children and adolescents in the Autonomous Community of Madrid, future assessments including mortality, incidence, and survival indicators are required

Morbilidad y mortalidad derivadas del consumo de tabaco. Especial referencia a España / Morbidity and mortality derived from tobacco usage. Special reference to Spain

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[CEA and Cyfra 21.1 study pre-treatment in 252 patients with head and neck carcinomas]. / Estudio de CEA y Cyfra 21.1 pre-tratamiento en 252 pacientes con carcinoma de cabeza y cuello.

INTRODUCTION: Squamous cell carcinoma is the most frequent malignant tumor in the head and neck. As in most malignant tumors, the earlier the diagnosis, is made the longer the survivalis. Several molecules, including CEA and Cyfra 21.1, have been evaluated in an attempt to improve diagnosis and follow-up. OBJECTIVE: To investigate whether CEA and Cyfra 21.1 present pathological increased values prior to treatment, and to correlate tumor and patient characteristics with CEA and Cyfra 21.1 levels. MATERIAL AND METHODS: CEA and Cyfra 21.1 were measured pre-treatment in sera of 252 patients treated for head and neck tumors from1999 to 2003. RESULTS: Increases of CEA were detected in 23.6%, and increases of Cyfra 21.1 in 19.1% of patients. Significative differences were found between the concentrations of Cyfra 21.1 related to the tumor stage, local extension, histological grade, and an increasing relation with age. No differences were found in relation to the primary tumor site. Regarding CEA, the only finding was an increased relation between concentrations of this marker and cigarette and alcohol habits. CONCLUSIONS: Cyfra 21.1 does not appear to be a good marker for tumoral screening of head and neck carcinomas. However, a good correlation was observed between sera concentrations of Cyfra 21.1, tumoral burden, and histological grade of the tumor, but this was not the case with CEA.

Estudio de CEA y Cyfra 21.1 Pre-tratamiento en 252 pacientes con carcinoma de cabeza y cuello / CEA and Cyfra 21.1 Study pre-treatment in 252 patients with head and neck carcinomas

Introducción: El carcinoma escamoso es el tumor maligno predominante en cabeza y cuello. Como en la mayoría de tumores malignos, su diagnóstico precoz conlleva una mayor supervivencia. Diferentes moléculas, entre ellas el CEA y el Cyfra 21.1 han sido evaluadas en un intento de facilitar el diagnóstico y la evolución de la enfermedad. Objetivo: Demostrar si existe una elevación patológica de CEA y Cyfra 21.1 pre-tratamiento en nuestros pacientes, y buscar correlación entre sus concentraciones y diferentes parámetros con relación al tumor y al paciente. Material y métodos: Se midieron antes deltratamiento las concentraciones de CEA y Cyfra 21.1 en suero en 252 pacientes entre 1999 y 2003. Resultados: Se detectó una elevación de CEA en 23,6 por ciento, y de Cyfra 21,1 en 19.1 por ciento de pacientes. Se encontró una diferencia significativa de las concentraciones de Cyfra 21.1 en función del estadiaje tumoral, la extensión local y regional, entre los diferentes grados histológicos, y una relación de tendencia creciente con la edad. No hubo diferencias significativas para las localizaciones delprimario. Respecto al CEA sólo se encontró relación de tendencia creciente con el hábito tabáquico y enólico de los pacientes. Conclusiones: El Cyfra 21.1 está lejos de ser un marcador adecuado para cribaje del carcinoma en cabeza y cuello. Existe, sin embargo, correlación entre sus concentraciones séricas y la carga de tumor y su grado de diferenciación histológica, no siendo así para el CEA (AU)

INTRODUCTION: Squamous cell carcinoma is the most frequent malignant tumor in the head and neck. As in most malignant tumors, the earlier the diagnosis, is made the longer the survivalis. Several molecules, including CEA and Cyfra 21.1, have been evaluated in an attempt to improve diagnosis and follow-up. OBJECTIVE: To investigate whether CEA and Cyfra 21.1 present pathological increased values prior to treatment, and to correlate tumor and patient characteristics with CEA and Cyfra 21.1 levels. MATERIAL AND METHODS: CEA and Cyfra 21.1 were measured pre-treatment in sera of 252 patients treated for head and neck tumors from1999 to 2003. RESULTS: Increases of CEA were detected in 23.6%, and increases of Cyfra 21.1 in 19.1% of patients. Significative differences were found between the concentrations of Cyfra 21.1 related to the tumor stage, local extension, histological grade, and an increasing relation with age. No differences were found in relation to the primary tumor site. Regarding CEA, the only finding was an increased relation between concentrations of this marker and cigarette and alcohol habits. CONCLUSIONS: Cyfra 21.1 does not appear to be a good marker for tumoral screening of head and neck carcinomas. However, a good correlation was observed between sera concentrations of Cyfra 21.1, tumoral burden, and histological grade of the tumor, but this was not the case with CEA (AU)

Recidivas ganglionares aisladas en pacientes con carcinomas de cabeza y cuello / Isolated lymphatic recurrencies in patients with head and neck carcinomas

Objetivo: La existencia de una recidiva ganglionar comporta un empeoramiento notable en el pronóstico de los pacientes con carcinoma de cabeza y cuello. El objetivo del presente estudio es analizar las posibilidades de tratamiento de rescate tras una recidiva ganglionar aislada. Material y Métodos: Estudio retrospectivo de 144 pacientes con carcinomas de cabeza y cuello afectos de una recidiva regional aislada. Se analizaron los tratamientos empleados y los resultados de control regional y supervivencia. Resultados: Un 64 por ciento (92/144) de los pacientes no fueron candidatos a tratamiento de rescate con intención radical. Se efectuó un rescate quirúrgico en el 36 por ciento (52/144) restante de pacientes, obteniéndose una supervivencia ajustada en este grupo del 46 por ciento. La variable relacionada de forma más importante con la posibilidad de llevar a cabo un tratamiento de rescate fue el tratamiento inicial de las áreas ganglionares, contando con peor pronóstico los pacientes en los que el tratamiento inicial incluyó cirugía. Conclusiones: La aparición de una recidiva regional cuenta con mal pronóstico, con una supervivencia ajustada a los 5 años en nuestros pacientes del 16 por ciento. Tan sólo un 36 por ciento de los pacientes fueron considerados candidatos a un tratamiento de rescate, consiguiéndose una supervivencia en este grupo del 46 por ciento (AU)

OBJECTIVE: Recurrencies of lymphatic metastasis implies a poor prognosis in patients with head and neck carcinoma. The aim of our study is to analyse the results of salvage treatment after an isolated regional tumour recurrence. MATERIAL AND METHODS: Retrospective study of 144 patients with head and neck carcinoma with an isolated neck recurrence. The treatments used, regional control and patient's survival were analysed. RESULTS: Sixty-four percent (92/144) of patients were not candidates to salvage treatment with radical intention. Salvage surgery was performed in 36% (52/144) of patients, with a survival of 46% in this group of patients. Previous treatment of the neck was the most relevant variable to decide a salvage surgery. Patients treated initially with neck dissection had the worst prognosis. CONCLUSIONS: The existence of a regional recurrence has a bad prognosis, with 16% 5-year survival. Only 36% of patients were considered candidates to salvage treatment, achieving 46% of survival (AU)

[Treatment for the early stages (T1-T2NO) of squamous cell carcinoma of the mobile tongue]. / Tratamiento de los estadios iniciales (T1-T2N0) del carcinoma de lengua móvil.

OBJECTIVE: The aim of this study is to define the best local treatment in patients with squamous cell carcinoma of mobile tongue in the early stages (I-II) and to establish the best election for neck management. MATERIAL AND METHODS: We evaluated 90 patients classified as stage I and II between 1984 and 1999. Sixty-eight patients out of the ninety (75%) were treated with radio-therapy and twenty-two (25%) with surgery. Neck dissection was used in 39% (35/90) of patients. RESULTS: The rates of ultimate local control for T1NO lesions were similar for both treatment groups (94% vs. 95%). For T2N0 lesions the ultimate local control did improved in those patients treated with surgery (100%) compared to those that had radiotherapy (77%). Regional control was better in the group that underwent neck dissection compared to the group that had just ganglionar control (89% vs. 79%). CONCLUSIONS: We recommend local surgical treatment for T1-T2NO and in our experience prophylactic treatment of lymph nodes leads to a better regional control.

Relation between body weight and health-related quality of life among the elderly in Spain.

OBJECTIVE: This study examines the relation between body weight and the physical and mental components of health-related quality of life (HRQL) in the population aged 60 y and over in Spain. RESEARCH METHODS AND PROCEDURES: Cross-sectional study covering 3605 subjects, representative of the noninstitutionalised Spanish population aged 60 y and over. Information was collected through home-based personal interview and measurement of blood pressure and anthropometric variables. Logistic regression was used to examine the relation of suboptimal HRQL (score<100) on each SF-36 questionnaire scale with body mass index (BMI) and waist circumference. Separate regression models were constructed for each sex and adjusted for sociodemographic variables, tobacco and alcohol consumption, physical activity, arterial hypertension and diagnosed chronic disease. RESULTS: Mean age of the study population was 70.9 y for men and 72.2 y for women. The percentage of overweight subjects was 48.5% in men and 39.8% in women, and of obese subjects, 31.9 and 41.1% respectively. Men registered a better HRQL than women on most of the SF-36 scales. Compared to normal-weight subjects (BMI: 18.5-24.9 kg/m(2)), frequency of suboptimal physical functioning was higher among obese subjects (BMI>or=30 kg/m(2)), both male (OR: 1.91; 95% CI: 1.22-3.00) and female (OR: 2.58; 95% CI: 1.59-4.19). The aspects of physical functioning most affected were bending, kneeling or stooping, climbing stairs and strenuous effort. Male, though not female, obesity was nonetheless associated with a better HRQL on the SF-36 mental scales. Frequencies of suboptimal scores for overweight persons (BMI: 25-29.9 kg/m(2)) were similar to those for normal-weight subjects on most of the SF-36 scales. Results proved similar for subjects in both the 60-74 and 75-and-over age groups, and also when waist circumference was used as the measure of obesity (>102 cm in men and >88 cm in women). CONCLUSIONS: Obese men and women showed worse physical functioning than normal-weight persons. This occurred irrespective of whether subjects were over or under 74 y of age, or whether obesity was measured by BMI or waist circumference, and was not explained by unhealthy lifestyles or obesity-related chronic disease.

Tratamiento de los estadios iniciales (T1-T2N0) del carcinoma de lengua móvil / Treatment For The Early Stages (T1-T2N0) of squamous cell carcinoma of the mobile tongue

Objetivo: Analizar los resultados del tratamiento local en los pacientes afectos de un carcinoma de lengua móvil en estadios iniciales y establecer la mejor actitud en el manejo de las áreas ganglionares clínicamente negativas (N0). Material y Métodos: Se realizó un estudio retrospectivo sobre 90 pacientes clasificados como T1-T2N0 de lengua móvil, 68 (75 por ciento) tratados con radioterapia y 22 (25 por ciento) con cirugía entre los años 1984 y 1999. En el 39 por ciento (35/90) de los pacientes se realizó tratamiento ganglionar y en el 61 por ciento (55/90) seguimiento clínico estrecho. Resultados: El control local final en los pacientes T1N0 tratados tanto con cirugía como con radioterapia fue excelente (94 por ciento vs. 95 por ciento). En los T2N0 el control local final fue del 100 por ciento en los pacientes tratados quirúrgicamente superior al 77 por ciento de los pacientes irradiados. El control regional final fue superior en el grupo de pacientes donde se trataron las áreas ganglionares respecto al grupo donde se realizó seguimiento clínico (89 por ciento vs 79 por ciento). Conclusiones: Tanto la cirugía como la radioterapia son modalidades terapéuticas que ofrecen resultados similares. La tendencia actual es llevar a cabo un tratamiento quirúrgico en los T1-T2 N0, por la sencillez de la técnica y las mínimas secuelas encontradas. En nuestra experiencia, el tratamiento profiláctico de las áreas ganglionares conduce a un mejor control regional de la enfermedad. (AU)

OBJECTIVE: The aim of this study is to define the best local treatment in patients with squamous cell carcinoma of mobile tongue in the early stages (I-II) and to establish the best election for neck management. MATERIAL AND METHODS: We evaluated 90 patients classified as stage I and II between 1984 and 1999. Sixty-eight patients out of the ninety (75%) were treated with radio-therapy and twenty-two (25%) with surgery. Neck dissection was used in 39% (35/90) of patients. RESULTS: The rates of ultimate local control for T1NO lesions were similar for both treatment groups (94% vs. 95%). For T2N0 lesions the ultimate local control did improved in those patients treated with surgery (100%) compared to those that had radiotherapy (77%). Regional control was better in the group that underwent neck dissection compared to the group that had just ganglionar control (89% vs. 79%). CONCLUSIONS: We recommend local surgical treatment for T1-T2NO and in our experience prophylactic treatment of lymph nodes leads to a better regional control (AU)

[Treatment of T1N0 glottis carcinoma with radiotherapy. Results at our center and review of the literature]. / Tratamiento de los carcinomas de glotis T1N0 con radioterapia. Resultados de nuestro centro y una revisión de la literatura.

OBJECTIVE: To evaluate the results of radiotherapy in the treatment of patients with T1N0 glottic squamous cell carcinoma. MATERIAL AND METHODS: Retrospective study of a cohort of 338 patients with T1N0 glottic carcinoma treated with radiotherapy at our institution between 1985-1997. A review of the literature published during the last ten years was carried out. RESULTS: Local control with radiotherapy in our patients was 82%, reaching 97% when salvage surgery was included. The local control with radiotherapy in most of the published series ranges between 81.90%. CONCLUSIONS: Treatment with radiotherapy achieves local control in early glottic carcinomas (T1N0) in 80-90% of cases. In our centre such treatment achieved local control in 82% of cases.

Tratamiento de los carcinomas de glotis T1N0 con radioterapia. Resultados de nuestro centro y una revisión de la literatura / Radiotherapy in the treatment of T1N0 glottic carcinomas. Our results and review of the literature

Objetivo: Evaluar los resultados conseguidos con radioterapia en el tratamiento de pacientes con carcinomas escamosos de la glotis T1N0. Material y métodos: Estudio retrospectivo de una cohorte de 338 pacientes con carcinomas glóticos T1N0 tratados con radioterapia en nuestro centro durante el período 1985-1997. Se efectuó una revisión de la bibliografía publicada en los diez últimos años. Resultados: El control local con la radioterapia en nuestros pacientes fue del 82 por ciento, alcanzando un control local final al incluir la cirugía de rescate del 97 por ciento. La tasa de preservación de la función laríngea fue del 86 por ciento. El control local con radioterapia en la mayoría de las series publicadas en los últimos años osciló entre el 81-90 por ciento. Conclusiones: La radioterapia consigue un control local de los tumores incipientes del plano glótico (T1N0) en un 80-90 por ciento de las ocasiones. En nuestro centro este tipo de tratamiento consiguió un control local en el 82 por ciento de las ocasiones. (AU)

OBJECTIVE: To evaluate the results of radiotherapy in the treatment of patients with T1N0 glottic squamous cell carcinoma. MATERIAL AND METHODS: Retrospective study of a cohort of 338 patients with T1N0 glottic carcinoma treated with radiotherapy at our institution between 1985-1997. A review of the literature published during the last ten years was carried out. RESULTS: Local control with radiotherapy in our patients was 82%, reaching 97% when salvage surgery was included. The local control with radiotherapy in most of the published series ranges between 81.90%. CONCLUSIONS: Treatment with radiotherapy achieves local control in early glottic carcinomas (T1N0) in 80-90% of cases. In our centre such treatment achieved local control in 82% of cases (AU)

[Isolated lymphatic recurrences in patients with head and neck carcinomas]. / Recidivas ganglionares aisladas en pacientes con carcinomas de cabeza y cuello.

OBJECTIVE: Recurrencies of lymphatic metastasis implies a poor prognosis in patients with head and neck carcinoma. The aim of our study is to analyse the results of salvage treatment after an isolated regional tumour recurrence. MATERIAL AND METHODS: Retrospective study of 144 patients with head and neck carcinoma with an isolated neck recurrence. The treatments used, regional control and patient's survival were analysed. RESULTS: Sixty-four percent (92/144) of patients were not candidates to salvage treatment with radical intention. Salvage surgery was performed in 36% (52/144) of patients, with a survival of 46% in this group of patients. Previous treatment of the neck was the most relevant variable to decide a salvage surgery. Patients treated initially with neck dissection had the worst prognosis. CONCLUSIONS: The existence of a regional recurrence has a bad prognosis, with 16% 5-year survival. Only 36% of patients were considered candidates to salvage treatment, achieving 46% of survival.

[Smoking-attributable deaths in Spain in 1998]. / Mortalidad atribuible al tabaquismo en España en 1998.

BACKGROUND: Between 1993 and 1997, smoking prevalence remained stable in Spain yet age-adjusted death rates by smoking-related diseases decreased. Our study aimed to estimate the burden of smoking-attributable mortality in Spain in 1998. POPULATION AND METHOD: Spain's smoking prevalence, mortality and relative risks for death from the Cancer Prevention Study II were used to estimate smoking-attributable mortality in the population aged 35 years and over. RESULTS: In 1998, 55,613 deaths were attributable to smoking. One out of 4 deaths in males and one out of 40 deaths in females were attributable to tobacco. Two thirds of the attributable mortality corresponded to deaths due to lung cancer, chronic obstructive pulmonary disease, ischemic heart disease and stroke. CONCLUSIONS: Smoking actually represents a remarkable burden of avoidable deaths in Spain. Smoking-attributable mortality appears to continue increasing in the last years.

Consumption of alcoholic beverages and subjective health in Spain.

STUDY OBJECTIVE: To examine the relation between alcohol and main alcoholic beverage consumption and subjective health in Spain. DESIGN: Logistic regression analysis using a cross sectional survey based on self reported data on alcohol and alcoholic beverage consumption, subjective health and the principal confounding factors (age, sex, civil status, educational level, job status, social support, region of residence, size of town or city, tobacco consumption, physical activity during leisure time and work hours, and chronic disease). SETTING: The 1993 Spanish National Health Survey. PARTICIPANTS: A 19 573 person sample, representative of the non-institutionalised Spanish population aged 16 years and over. MAIN RESULTS: Among Spaniards, 31.4% reported their health as suboptimal (fair, poor or very poor) and 56.9% consumed alcohol regularly, with the majority having a preference for wine. Light (1-2 drinks per day) or moderate consumption (3-4 drinks per day) was the most frequent pattern. After adjusting for confounding factors, a negative dose-response relation was observed between consumption of total alcohol, wine and beer, and prevalence of suboptimal health (linear trend: p<0.001 for total alcohol, p=0.023 for wine, and p=0.030 for beer). In contrast, for consumption of spirits the prevalence of ill health in moderate drinkers was lower than in non-drinkers, with no clear relation at higher consumption. While persons reporting a preference for wine had a lower frequency of suboptimal health than did abstainers, they showed no difference in frequency of subjective ill health with respect to persons with preference for other types of drink or no preference whatsoever. CONCLUSIONS: The higher the consumption of total alcohol, wine and beer, the lower the prevalence of suboptimal health. These results differ from those obtained in several Nordic countries, where a "J shaped" relation has been observed for total alcohol and wine, and suggest that the relation between alcohol consumption and subjective health may be different in Mediterranean countries.

[Smoking and subjective health in Spain]. / Consumo de tabaco y salud subjetiva en España.

BACKGROUND: To examine the relationship between smoking and subjective health in Spain. MATERIAL AND METHOD: Datacome from the 1993 National Health Survey. Analyses were performed with logistic regression, adjusting for the main confounding factors. RESULTS: Among those less than 25 years, there is a dose-response relationship (p = 0.0001)between cigarette consumption and suboptimal health (fair, pooror very poor health). CONCLUSIONS: Smoking controlactivities should inform on the worse subjective health of youngsmokers, for whom other effects of tobacco smoking are less relevant because they appear to happen in the distant future.