Risk factors for second primary tumours in breast cancer survivors.

Breast cancer (BC) survivors have an increased risk of developing second primary cancer (SPC). The aim of this study was to detect and compare SPC predictors linked to the host, the first BC and its treatment. Two hundred and seventeen patients with a nonbreast SPC and 465 matched controls, nested in the cohort of BC patients diagnosed in a Spanish region between 1975 and 2003, were involved in a case-control study. The Tumour Registry database provided information about the host, BC and its treatment factors. Their contribution to the risk of developing SPC was measured by means of a conditional logistic regression. After controlling for differences between cases and controls at baseline, obesity [odds ratio (OR): 7.48; 95% confidence interval (CI): 1.25-44.88], smoking (OR: 3.16; 95% CI: 1.23-8.15), high blood pressure (OR: 1.68; 95% CI: 1.04-2.71) and having first-degree relatives suffering from cancer (OR: 1.69; 95% CI: 1.05-2.72) were the best SPC predictors. The risk of SPC increases by 1% per month of survival from BC (OR: 1.01; 95% CI: 1.007-1.012), while having metastases (OR: 0.23; 95% CI: 0.14-0.37) and being premenopausal at diagnosis of the BC (OR: 0.44; 95% CI: 0.247-0.792) diminish the risk, probably decreasing survival. The treatments were the regression model's worst predictors. Controlling modifiable factors linked to lifestyle such as obesity and smoking is essential to prevent SPC in survivors of BC. Health education to remove persistent risk factors should be included in the treatment protocol of BC patients, because they are important predictors of SPC.

Attitude to primary prevention advice of the European Code against cancer in relatives of cancer patients: implications for the development of preventive programmes.

Achieving a preventive attitude is the first step in eliminating cancer risk behaviours. This cross-sectional study evaluated the attitude towards the European Code against Cancer, in 3,031 relatives of cancer patients. The study looked for keys to improve attitude by means of educational interventions. Attitude was evaluated using a questionnaire with 63 items and a Likert's scale. Measured from -2 to +2 , the mean score was 0.905 [0.894 - 0.971]. Five per cent had a mean score under 0.38 and another 5% over 1.46. A multivariate analysis found that age, sex and level of education were significantly associated with attitude: young men with a low cultural level were those with the lowest preventive attitude. The family history of cancer was not associated with attitude. Educational interventions should modify the perceived advantages of smoking and drinking, and the disadvantages related to preventive diet and sun and workplace protection.