Hospital admissions and social deprivation of patients with diabetes mellitus.

This study examined the relationship between hospital admissions for patients with diabetes mellitus and residence in an area of social deprivation. Admissions of patients with diabetes mellitus were identified during a 5-year period between 1987 and 1992 using the district patient information service. All persons admitted were assigned to an electoral ward on the basis of their postcode. Age standardized admission rates were compared to the Townsend Deprivation Score for each electoral ward. A positive correlation was found between age standardized admission rate and Townsend Score (r = 0.76, p < 0.001). We believe this has significance for planning health care resources.

Survival among women with cancer of the uterine cervix: influence of marital status and social class.

STUDY OBJECTIVE: The aim was to investigate whether the survival of women with cancer of the uterine cervix is associated with their marital status and social class. DESIGN: The study was a survey of survival up to 5 years from diagnosis of women with cancer of the cervix registered in the South Thames Cancer Registry, using Cox regression to adjust for marital status, social class, age, and stage at registration. Because of deficiencies in social class data held by the Registry (social class was assigned in only 51% of cases, as opposed to 93% for marital status), the findings were compared with survival data from the OPCS Longitudinal Study. SETTING: During the period of study (1977-81) the South Thames Cancer Registry covered a female population of about 3.5 million in the south east of England. PATIENTS: Data on 1728 women were analysed. MEASUREMENTS AND AND MAIN RESULTS: Apparent differences in crude survival by marital status and social class were examined. These were found to be accounted for by adjustment for age and stage. The better survival of those whose social class was unknown was found to be an artefact of the way in which cancer registries assign social class, but this did not appear to bias registry based studies of social class survival seriously. CONCLUSIONS: (1) After adjusting for age, factors affecting survival in women with cancer of the cervix, such as stage at presentation or host resistance, appear to be similarly distributed in the different marital status and social class groups; (2) for cervical cancer, the marked social class gradient and unusual marital status distribution found in cross sectional mortality data reflect the incidence of the disease, not differences in survival; (3) explanations for these patterns in incidence and mortality data are to be found in the aetiology of the disease.

Anal cancer and marital status.

Anal cancer is a rare tumour in Britain and its epidemiology has not previously been studied in this country. Several studies from the United States have shown an association between single marital status at the time of tumour registration (as a marker of male homosexuality in these populations) and the incidence of anal cancer. This study has used registry information on martial status for anal cancer and for colon cancer (controls) from the Thames, West of Scotland and West Midlands Cancer Registries. The registry data on marital status was validated using death certificate information. The relative risk of developing anal cancer was found to be significantly increased in single men for all three registries individually and for the combined data sets (OR 2.2' 95% CI 1.8-2.8). This accords with the findings of similar studies in the United States and supports the hypothesis that a sexually transmissible agent may be involved in the aetiology of anal cancer. For women, being unmarried was found to be protective against anal cancer in the combined data sets (OR 0.6; 95% CI 0.5-0.8).

Adjuvant chemotherapy for medulloblastoma: the first multi-centre control trial of the International Society of Paediatric Oncology (SIOP I).

Two hundred and eighty-six patients with medulloblastoma from 46 centres in 15 countries were treated in a prospective randomized trial designed to assess the value of adjuvant chemotherapy. All patients were treated by craniospinal irradiation. Those randomly allocated to receive adjuvant chemotherapy were given vincristine during irradiation and maintenance CCNU and vincristine, given in 6-weekly cycles, for 1 year. The overall survival was 53% at 5 years and 45% at 10 years. At the close of the trial in 1979, the difference between the disease-free survival rate for the chemotherapy and control groups was statistically significant (P = 0.005). Since then, late relapses have occurred in the chemotherapy arm and the statistically significant difference between the two groups has been lost. Although there is now no statistical difference between the two arms of the trial, a benefit for chemotherapy persists in a number of sub-groups; partial or sub-total surgery (P = 0.007), brainstem involvement (P = 0.001), and stage T3 and T4 disease (P = 0.002). A number of prognostic factors for medulloblastoma have emerged; sub-total resection, extent of disease and being male sex carry a poor prognosis.

Making cancer statistics more informative: measures of the quality of recorded diagnosis in a population-based registry.

The quality of the recorded diagnosis is a major limit to the usefulness of Cancer Registry statistics that is easily overlooked by users of the data. With data from a large population-based cancer registry as an example, we demonstrate how Registry statistics could be improved by wider use of three simple indices, namely (1) the proportion histologically verified (adjusted for age), (2) the proportion of verified cases with an uninformative diagnosis, and (3) the proportion of cases that are staged. We believe that greater awareness of the deficiencies of Cancer Registry statistics will lead to a more critical interpretation of them, and help stimulate efforts to rectify matters.

Can we achieve 100% ascertainment in cancer registration?

Completeness of ascertainment is a central issue for any disease register. We outline the process of cancer registration as carried out in a large population-based Registry and argue that none of the various methods proposed to estimate the completeness of ascertainment are satisfactory. We suggest an alternative way of looking at the issue and describe various constraints that hamper attempts to achieve complete registration.

Squamous and adenocarcinoma of the uterine cervix: a comparison using routine data.

We studied the clinical, demographic and survival characteristics of more than 5,000 women registered with either squamous or adenocarcinoma of the uterine cervix in South Thames Cancer Registry over the period 1968-81. There were similarities with respect to social class, smoking habit, oestrogen/oral contraceptive use and time trends in incidence but differences between the two cancers were found with respect to age distribution, parity, method of detection and survival. Some of the data are of limited value, having been obtained only from case notes, so the results need some caution in their interpretation. However the results are broadly consistent with those of studies performed in other countries on smaller samples. A methodological issue is also raised, viz. the appropriateness of a disease with well-known characteristics as a comparison group. From our results the likely size of various associations can be judged and used in the design of future studies to clarify the epidemiology of cervical adenocarcinoma.

PIP: Compared were the clinical, demographic, and survival characteristics of over 5000 women registered in the South Thames Cancer Registry in 1968-81 with either squamous carcinoma (4599 women) or adenocarcinoma (704 women) of the uterine cervix. There were no significant differences between these 2 groups in terms of social class, cigarette smoking, use of estrogen therapy or oral contraception, and time trends in cancer incidence. However, there were differences between these 2 cancers with respect to age distribution, parity, methods of detection, and survival. Women with adenocarcinoma were 2.7 years older on average than those with squamous carcinoma, were more likely to be single, and were more often nulliparous. Patients with adenocarcinoma were also more likely to present with symptoms of advanced disease rather than through screening, and their median survival time was 2 years less than that for women with squamous carcinoma. The methodology of this study can be criticized for its use of a disease with well-known characteristics as a comparison group. Moreover, it is recommended that future studies specify histologic type of cancer wherever possible: the quality of histologic diagnosis and its changes with time should also be studied to validate conclusions based on routine data. In general, the findings of this comparative study are consistent with those performed in other countries on smaller samples. The results of the present study can be used to judge the likely size of various associations and to design future studies aimed at clarifying the epidemiology of cervical adenocarcinoma.

Prognostic significance of peritumoral vascular invasion in breast cancer.

A prospective study of 232 patients with primary invasive breast cancer (UICC Stages I, II and III) and histologically confirmed axillary node status was carried out to assess the prognostic significance of several readily available clinical and pathological characteristics. In addition to the recognised utility of tumour size and axillary lymph node status, the presence or absence of cohesive clumps of malignant cells in peritumoral vascular spaces (both lymphatic and blood vessels) was found to be prognostically important.