bmj.com -- Press Releases

Releases Saturday 16 September 2000
No 7262 Volume 321

Please remember to credit the BMJ as source when publicising an
article and to tell your readers that they can read its full text on the
journal's web site (http://bmj.com).

If your story is posted on a website please include a link back to
the source BMJ article (URL's are given under titles).

(1) SCREENING LEADS TO SUBSTANTIAL REDUCTION
IN BREAST CANCER DEATHS

(2) EUROPEANS WILL ADJUST TO GLOBAL WARMING
BUT WILL STILL DIE OF COLD

(3) WOMEN WITH EPILEPSY ARE POORLY MANAGED
DURING PREGNANCY

(4) ONSET OF FOREARM PAIN CAN BE PREDICTED

(1) SCREENING LEADS TO SUBSTANTIAL REDUCTION
IN BREAST CANCER DEATHS

(Effect of NHS breast screening programme on mortality
from breast cancer in England and Wales, 1990-8:
comparison of observed with predicted mortality)
http://bmj.com/cgi/content/full/321/7262/665

(Editorial : How effective is screening for breast cancer ?)
http://bmj.com/cgi/content/full/321/7262/647

The introduction of an NHS breast screening programme,
along with improvements in treatment for breast cancer, led
to a 21% reduction in breast cancer deaths in England and
Wales between 1990 and 1998, finds a study in this week's
BMJ.

Using national data on breast cancer deaths for 1971-89,
Blanks and colleagues were able to predict the number of
deaths for 1990-8. The effect of screening and other factors
on breast cancer deaths during this period was then estimated
by comparing observed deaths with those predicted among
women aged from 50-54 and from 75-79 years, the effect of
screening being restricted to certain age-groups.

They found that in 1998, estimated deaths from breast cancer
were 21% below that predicted in the absence of screening
or other effects in women aged 55-69. Of this fall, 6-7% was
as a direct effect of screening, and equates to 320 prevented
deaths. Other factors, such as improvements in treatment and
presentation of cancers at an earlier stage, also play major
roles in the substantial reduction in deaths from breast cancer.

Despite several limitations in projecting deaths into future
years, the authors are confident that further effects from
screening, together with improved treatments, should result in
yet further reductions in breast cancer deaths, particularly for
women aged 55-69, over the next 10 years.

Contact:

Kate Husher or Erica Boardman at Press Office, The
Institute of Cancer Research, 123 Old Brompton Road,
London SW7 3RP
E-mail: press@icr.ac.uk

(2) EUROPEANS WILL ADJUST TO GLOBAL WARMING
BUT WILL STILL DIE OF COLD

(Heat related mortality in warm and cold regions of Europe:
observational study)
http://bmj.com/cgi/content/full/321/7262/670

(Editorial : Saving lives in extreme weather in summer)
http://bmj.com/cgi/content/full/321/7262/650

Heat related deaths start at higher temperatures in hot regions
of Europe compared to cold regions, suggesting that people
have adjusted successfully to differences in summer
temperatures across Europe, and can be expected to adjust
to the global warming predicted in the next 50 years,
according to a study in this week's BMJ.

A team of European researchers calculated the average
number of deaths among men and women aged 65-74 years
at successive 3C temperature bands across seven European
regions - north and south Finland, south west Germany,
Netherlands, London, north Italy and Athens. The authors
found for each region the 3C temperature band in which there
was least mortality, and found that this band was significantly
higher in hotter regions (14-17C in north Finland and 23-26C
in Athens). As a result, when temperatures rose above these
bands, regions with hot summers did not have significantly
more heat related deaths than cold regions.

The team also found that cold related deaths were much
more numerous than heat related deaths, across all regions.
They were 78 times more numerous than heat related deaths
in London, which had the highest rate of cold related deaths
of any region.

These findings suggest that populations in Europe have
adjusted to differences in average summer temperatures
ranging from 13.5C to 24C. This gives grounds for
confidence that they would also adjust ï¿½ with little increase in
heat related deaths ï¿½ to the global warming of around 2C
predicted to occur in the next 50 years, say the authors.
However, the authors suggest that pre-emptive measures
against heat stress, such as improving ventilation in the homes
of vulnerable people, in advance of global warming should be
considered.

Their most important conclusion is that cold will continue to
cause massive mortality every winter, particularly in Britain,
unless effective steps are taken to improve protection against
cold stress.

Contact:

W R Keatinge, Professor of Physiology, Queen Mary and
Westfield College, London, UK
Email: w.r.keatinge@qmw.ac.uk

(3) WOMEN WITH EPILEPSY ARE POORLY MANAGED
DURING PREGNANCY

(Population based, prospective study of the care of women
with epilepsy in pregnancy)
http://bmj.com/cgi/content/full/321/7262/674

Guidelines for the management of women with epilepsy are
not being followed, according to a study in this week's BMJ.

Researchers in Newcastle upon Tyne interviewed 300
pregnant women with epilepsy during 1997-8 about the care
they received, advice given prior to conception and control of
their epilepsy. General practice and hospital notes were
reviewed after the women had given birth to check advice
given and assess pregnancy outcomes. The authors found that
most women (61%) were managed by a general practitioner.
Control of epilepsy was poor, with more than 70% of women
reporting ongoing seizures, and compliance with medication
was variable.

Only 38% of women recalled receiving advice prior to
conception. However, review of the notes of 25 women who
denied having received advice showed that eight had been
counselled. Malformations were more common in babies
born to mothers with epilepsy, although not all malformations
were attributable to anti-epileptic drugs, add the authors.

Most published guidelines are targeted at neurologists, say
the authors, and therefore fail to improve the management of
women under the care of their general practitioner.
Considerable expansion of epilepsy services in primary and
secondary care is needed if the guideline recommendations
are to be achieved, they conclude.

Contact:

Susan Fairgrieve, Genetic Nurse Specialist, Department of
Human Genetics, Royal Victoria Infirmary, Newcastle upon
Tyne, UK
Email: JohnBurn@newcastle.ac.uk

(4) ONSET OF FOREARM PAIN CAN BE PREDICTED

(Role of mechanical and psychosocial factors in the onset of
forearm pain: prospective population based study)
http://bmj.com/cgi/content/full/321/7262/676

The concept that forearm pain is caused purely by repetitive
movements of the arms or wrists, particularly in the
workplace, is called into question in this week's BMJ. A new
study suggests that several other factors ï¿½ such as high levels
of psychological distress and dissatisfaction with support from
colleagues at work - predict the onset of forearm pain.

Over a period of two years, researchers at the University of
Manchester obtained questionnaires from more than 1,200
individuals in Greater Manchester aged 18-65 years. The
questionnaire contained a picture of a blank manikin and
respondents were asked to shade the site of any pain
experienced during the previous month and lasting at least
one day. A detailed occupational history was obtained for all
participants and further information was collected for those
who specifically reported forearm pain.

A total of 105 participants (8.3%) reported forearm pain,
with little difference between men (8.9%) and women
(7.9%). Among these, 67% also reported shoulder pain,
65% back pain and 45% chronic widespread pain. This is
consistent with the view that forearm pain rarely occurs in
isolation from other regional pain syndromes, say the authors.
In the workplace, repetitive movements of the arms or wrists
and dissatisfaction with support from supervisors and
colleagues were associated with the highest risk of future
forearm pain. The authors also found that high levels of
psychological distress, presence of other physical symptoms
and general anxiety about health were all important predictors
of forearm pain.

This study emphasises the multifactorial nature of forearm
pain in the population, say the authors. They suggest that
misleading terms such as "repetitive strain injury" - implying a
single uniform cause - should be avoided.

Contact:

Professor Gary Macfarlane, Unit of Chronic Disease
Epidemiology, University of Manchester, Manchester, UK
Email: G.Macfarlane@man.ac.uk

FOR ACCREDITED JOURNALISTS

Embargoed press releases and articles are available from:

Public Affairs Division
BMA House
Tavistock Square
London WC1H 9JR
(contact: pressoffice@bma.org.uk)

and from:

the EurekAlert website, run by the American Association for the
Advancement of Science
(http://www.eurekalert.org)