A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation☆

Systematic review and meta-analysis

Estimates of the worldwide incidence, mortality and prevalence of 26 cancers in the year 2002 are now available in the GLOBOCAN series of the International Agency for Research on Cancer. The results are presented here in summary form, including the geographic variation between 20 large "areas" of the world. Overall, there were 10.9 million new cases, 6.7 million deaths, and 24.6 million persons alive with cancer (within three years of diagnosis). The most commonly diagnosed cancers are lung (1.35 million), breast (1.15 million), and colorectal (1 million); the most common causes of cancer death are lung cancer (1.18 million deaths), stomach cancer (700,000 deaths), and liver cancer (598,000 deaths). The most prevalent cancer in the world is breast cancer (4.4 million survivors up to 5 years following diagnosis). There are striking variations in the risk of different cancers by geographic area. Most of the international variation is due to exposure to known or suspected risk factors related to lifestyle or environment, and provides a clear challenge to prevention.

https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.3322/canjclin.55.2.74

Global cancer statistics, 2002.

Background Patients with congestive heart failure have a high mortality rate and are also hospitalized frequently. We studied the effect of an angiotensin-converting-enzyme inhibitor, enalapril, on mortality and hospitalization in patients with chronic heart failure and ejection fractions less than or equal to 0.35. Methods Patients receiving conventional treatment for heart failure were randomly assigned to receive either placebo (n = 1284) or enalapril (n = 1285) at doses of 2.5 to 20 mg per day in a double-bind trial. Approximately 90 percent of the patients were in New York Heart Association functional classes II and III. The follow-up averaged 41.4 months. Results There were 510 deaths in the placebo group (39.7 percent), as compared with 452 in the enalapril group (35.2 percent) (reduction in risk, 16 percent; 95 percent confidence interval, 5 to 26 percent; P = 0.0036). Although reductions in mortality were observed in several categories of cardiac deaths, the largest reduction occurred among the deaths attributed to progressive heart failure (251 in the placebo group vs. 209 in the enalapril group; reduction in risk, 22 percent; 95 percent confidence interval, 6 to 35 percent). There was little apparent effect of treatment on deaths classified as due to arrhythmia without pump failure. Fewer patients died or were hospitalized for worsening heart failure (736 in the placebo group and 613 in the enalapril group; risk reduction, 26 percent; 95 percent confidence interval, 18 to 34 percent; P less than 0.0001). Conclusions The addition of enalapril to conventional therapy significantly reduced mortality and hospitalizations for heart failure in patients with chronic congestive heart failure and reduced ejection fractions.

Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure.

Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials

Immunological treatment for multiple sclerosis

EDITOR—In a news article Woodman reports that “controversy about the contraceptive pill and its effect on the risk of breast cancer was rekindled” in an editorial that I wrote in the Journal of Epidemiology and Community Health. 1 The editorial was intended in part to reduce undue complacency about the safety of the pill. Ex cathedra statements by Professor John Guillebaud in Woodman's article—that my argument “is biologically implausible”—need to be well justified, since …

Arguments in editorial were not “biologically implausible”

Although Richards’s independent review of the evidence on this important policy for women—including the screening publicity—is welcome, it is long overdue.1 2 For many years maturing trials, proper scrutiny, and new independent studies have increasingly questioned the bases on which the decision to implement screening was made in the 1980s. It is obviously incumbent on those responsible for screening policy to ensure that it—and the information—take account …

https://www.bmj.com/content/bmj/343/bmj.d7529.full.pdf

We need scientific consensus founded on all the evidence.

The purpose of this paper was to study the relationship of post-menopausal hormone therapy to cardiovascular mortality by time trend analysis. Mortality and incidence figures by age and sex in 1970–1993 in Finland were obtained from published and unpublished statistics and the extent of hormone therapy use by age from previous nationwide surveys. Percent changes in mortality were calculated for different age groups and time periods (1970–1976, 1977–1987 and 1988–1993, chosen by the extent of hormone use). A theoretical reduction in mortality among 50–54 and 55–59 year old women was calculated by using the time trends among men and older women (60–64 years) as the bases and by multiplying the proportion of users by four hypothetical estimates (100, 50, 30, and 0% of benefit among users). The actual reduction in ischaemic heart disease and total cardiovascular mortality in the age groups with highest post-menopausal hormone use was not larger than in other female age groups or among men. Until 1987, the actual mortality of 50–54 and 55–59 year old women was lower than that predicted from both the data of older women and men and from the assumed benefits of hormone therapy. In the last time period the actual mortality was relatively nearer the predicted mortality both among 50–54 and 55–59 year old women. This time trend analysis does not support the claim that post-menopausal hormone therapy notably prevents cardiovascular mortality.

Klim McPherson

Papers

Immunological treatment for multiple sclerosis

Arguments in editorial were not “biologically implausible”

We need scientific consensus founded on all the evidence.

Time trends of cardiovascular mortality and post-menopausal hormone use in Finland.

Patient information study: the information preferences of people with cancer: final report to CRC