Women's risk of dying of heart disease is always greater than their risk of dying of breast cancer.
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Biomedical subjects
Publications and source records attributed to J Haybittle.
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Data from the Cancer Research Campaign trial for early breast cancer have been used to study the effect of social class and weight on prognosis after primary treatment either by a simple mastectomy plus post-operative radiotherapy or by a simple mastectomy followed by a watch policy. There were 2455 patients for whom both social class could be determined and weight was recorded. These patients presented in clinical stages I and II and were recruited between June 1970 and April 1975. The cut-off date for the analysis was 31 December 1991. When the survival curves of patients in manual classes were compared with those in non-manual classes, there was a tendency for the latter to do better, but the difference was not statistically significant (P = 0.12). By contrast, there was a highly significant difference (P = 0.002) in survival favouring patients weighing less than or equal to 60 kg compared with those weighing greater than 60 kg. The difference was confined to post-menopausal patients and was still highly significant when included in a multivariate analysis with social class, age, tumour size, clinical stage and tumour grade. The effect of weight was to increase the mortality due to breast cancer rather than other causes.
Geographical variation in the standardized years of potential life lost ratio (SYPLR) in women aged 20-74 dying from breast cancer has been mapped by local authority district in England and Wales and compared with the variation as described by the standardized mortality ratio (SMR). The geographical distribution of areas of low and high SMRs is similar to that observed some 15 years earlier, showing an increase from north to south. In contrast, the pattern of SYPLRs shows a less obvious trend. Years of life lost because of breast cancer mortality were particularly high in eight of the 401 county districts (SYPLR 1.22-1.48) and particularly low in nine (0.60-0.86). Mapping SYPLRs for breast cancer gives a different pattern from mapping SMRs, and one which is possibly more appropriate for targeting resources in circumstances in which death at younger age will have major social consequences. Care is required in interpreting maps indicating high and low rates in the presence of multiple comparisons. However, the range of values observed is suggestive of the need to investigate districts with contrasting values of SYPLR with respect to the inter-relationships between sociodemographic characteristics, duration of symptoms, clinical presentation and treatment efficacy.
Sixty patients with advanced breast cancer unresponsive to tamoxifen have been randomised to receive four course of mitozantrone, 14 mg m-2 (n = 30) intravenously every 3 weeks (9 weeks total) or megesterol acetate, 160 mg bd (n = 30). One in three patients (11 from each group) had substantial disease control for a minimum period of 6 months i.e., lack of progression; seven patients (23%) showed objective response to mitozantrone compared to four (13%) receiving megesterol. Non-progressive disease occurred in all sites, including visceral metastases and receptor negative patients. There were no significant differences between treatment groups in the median time (5 months each) to disease progression response duration or survival (13 months megesterol, 11 months mitozantrone) from commencing second-line therapy. Toxicity was considerably higher in the mitozantrone group. Second-line hormonal therapies can produce similar therapeutic results as those achieved from a short course of a 'short option' single agent cytotoxic in patients who were previously thought hormone insensitive. Provided that the patient does not have life threatening disease a trial of megesterol acetate is worth consideration in that it does not prejudice subsequent response to combination cytotoxic chemotherapy.
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