Case-control Study In France Research Articles

Understanding regional differences in maternal mortality: a national case–control study in France

To assess the risk of postpartum maternal death associated with region, and to examine whether the quality of care received by the women who died differed by region. A national case-control study. France. Selected from recent nationwide surveys, 328 postpartum maternal deaths from 2001 through 2006 as cases; and a representative sample (n = 14 878) of women who gave birth in 2003 as controls. Crude and adjusted odds ratios (aOR) of maternal death associated with region were calculated with logistic regression, and the quality of care for women who died was compared according to region with chi-square tests or Fisher's exact tests. Risk of postpartum maternal death associated with region, and quality of care. After adjustment for maternal age and nationality, the risk of maternal death was higher in the Ile-de-France region (aOR 1.6, 95% CI 1.2-2.0) and the overseas districts (aOR 3.5, 95% CI 2.4-5.0) than in the group for the rest of continental France. In both regions, the excess risk of death from haemorrhage, amniotic fluid embolism and hypertensive disorders was significant. In continental France, after further controlling for women's obstetric characteristics, the risk of maternal death in Ile-de-France remained higher (aOR 1.8. 95% CI 1.3-2.6). The women in the cases groups received suboptimal care more frequently in Ile-de-France than in the other continental regions (64% versus 43%, P = 0.01). These results suggest that quality of care and organisation of health services may play a role in the differential risk of maternal mortality between regions in France. Research on severe maternal morbidity and its determinants is needed to clarify the mechanisms involved.

Investigation of occupational and environmental causes of respiratory cancers (ICARE): a multicenter, population-based case-control study in France.

BackgroundOccupational causes of respiratory cancers need to be further investigated: the role of occupational exposures in the aetiology of head and neck cancers remains largely unknown, and there are still substantial uncertainties for a number of suspected lung carcinogens. The main objective of the study is to examine occupational risk factors for lung and head and neck cancers.Methods/designICARE is a multi-center, population-based case-control study, which included a group of 2926 lung cancer cases, a group of 2415 head and neck cancer cases, and a common control group of 3555 subjects. Incident cases were identified in collaboration with cancer registries, in 10 geographical areas. The control group was a random sample of the population of these areas, with a distribution by sex and age comparable to that of the cases, and a distribution by socioeconomic status comparable to that of the population. Subjects were interviewed face to face, using a standardized questionnaire collecting particularly information on tobacco and alcohol consumption, residential history and a detailed description of occupational history. Biological samples were also collected from study subjects. The main occupational exposures of interest are asbestos, man-made mineral fibers, formaldehyde, polycyclic aromatic hydrocarbons, chromium and nickel compounds, arsenic, wood dust, textile dust, solvents, strong acids, cutting fluids, silica, diesel fumes, welding fumes. The complete list of exposures of interest includes more than 60 substances. Occupational exposure assessment will use several complementary methods: case-by-case evaluation of exposure by experts; development and use of algorithms to assess exposure from the questionnaires; application of job-exposure matrices.DiscussionThe large number of subjects should allow to uncover exposures associated with moderate increase in risks, and to evaluate risks associated with infrequent or widely dispersed exposures. It will be possible to study joint effects of exposure to different occupational risk factors, to examine the interactions between occupational exposures, tobacco smoking, alcohol drinking, and genetic risk factors, and to estimate the proportion of respiratory cancers attributable to occupational exposures in France. In addition, information on many non-occupational risk factors is available, and the study will provide an excellent framework for numerous studies in various fields.

NIGHT WORK AND BREAST CANCER RISK: CECILE STUDY

Background and Aims: Epidemiological studies have suggested that night shift-work may increase the risk of breast cancer. Disruption of the normal circadian rhythm may explain this association. We investigated whether working at night may influence the incidence of breast cancer in a population-based case-control study in France. Methods: The CECILE study was conducted in two administrative areas (départements). All female residents aged 25-75 years diagnosed in 2005-2007 with a cancer of the breast were eligible to the study. Population controls were frequency-matched by age group to the cases. A total of 1232 incident breast cancer cases and 1317 controls were included. An in-person interview was conducted using a standardized questionnaire to obtain information on risk factors for breast cancer, as well as on lifetime occupational history. For each job held for more than 6 months, information on night work schedules (defined as working at least one hour between 11pm and 5am) was elicited. Analyses were conducted using unconditional logistic regression adjusting for age and recognized risk factors for breast cancer. Results: Thirteen percent of the cases and eleven percent of the controls had ever worked during night shifts (OR=1.27 [0.99-1.64]). The association was more pronounced for women who worked during overnight shifts (shift work from 11 pm to 5 am: OR=1.35 [1.01-1.80]) than for women with late evening shifts (ending before 3 am: OR=1.25 [0.79-1.98]) or early morning shifts (starting after 3 am: OR=0.90 [0.36-2.21]). Women who had worked at night for 4.5 or more years had an OR of 1.40 [1.01-1.92], but no further increase of the OR was observed for longer durations. Night work of less than 3 nights per week, implying frequent changes between night and day schedules, was associated with an OR of 1.43 [1.01-2.03]). Conclusion: Our results support the hypothesis that working at night increases the incidence of breast cancer.

Occupation and head and neck cancer: a population-based case-control study in France

ObjectivesTo investigate the association between head and neck cancer (HNC) and occupation in men.MethodsAs part of a large population based case-control study conducted in France between 2002 and 2007 (the...

Abstract 3728: Night work and breast cancer risk: CECILE study

Abstract Objectives: Epidemiological studies have suggested that night shift work increases the risk for breast cancer. Disruption of the normal circadian rhythm may explain this association. We investigated the role of night work in the occurrence of breast cancer in a population-based case-control study in France. Methods: The CECILE study was conducted in two French départements (Côte d'Or, Ille-et-Vilaine) between 2005 and 2008. All female residents in these areas aged 25-75 years who were diagnosed with a breast cancer were eligible to the study. Population controls were frequency-matched by 5-year age group to the cases. A total of 1232 incident breast cancer cases and 1317 controls were included. An in-person interview was conducted using a standardized questionnaire to obtain information on recognized or suspected risk factors for breast cancer, as well as on lifetime occupational history. For each job held for more than 6 months, information on night shift work was elicited. Any work shift where the woman had to work for at least one hour between 11 pm and 5 am was defined as night work. Duration (in years) and frequency (times per week) of night shifts were also obtained. Analyses were conducted using unconditional logistic regression adjusting for age and recognized risk factors for breast cancer. Results: Thirteen percent of the cases and eleven percent of the controls had ever worked at night (OR=1.29 [1.00-1.64]). The association was more pronounced for women who had overnight shifts (full-time shift work between 11 pm and 5 am: OR=1.37 [1.03-1.83]) than for women who had late evening shifts (ending after 11 pm: OR=1.29 [0.78-2.15]) or early morning shifts (starting before 5 am: OR=1.19 [0.43-3.31]). Women who worked in overnight shifts for 3 or more years had an OR of 1.49 [1.05-1.89], but no further increase of the OR was observed for longer durations. Overnight shift work of 3 nights or less per week during overnight periods, implying frequent changes between night and day schedules, was associated with an OR of 1.59 [1.08-2.33]). Conclusion: Our results support the hypothesis of a role of overnight work in the occurrence of breast cancer. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 3728. doi:10.1158/1538-7445.AM2011-3728

Breast cancer risk by occupation and industry: Analysis of the CECILE study, a population‐based case–control study in France

It has been suggested that certain occupational exposures may play a role in breast cancer etiology. The recognition of high-risk occupations may give clues about potential mammary carcinogens in the work place. We conducted a population-based case-control study in France including 1,230 breast cancer cases and 1,315 population controls with detailed information on lifetime work history. Odds ratios for women ever employed in an occupation or industry were adjusted for well-established risk factors for breast cancer. Adjusted odds ratios were marginally increased in some white-collar occupations, as well as in textile workers (2.4; 95% CI [0.9-6.0]), rubber and plastics product makers (1.8; 95% CI [0.9-3.5]), and in women employed for more than 10 years as nurses (1.4; 95% CI [0.9-2.1]) and as tailors/dressmakers (1.5; 95% CI [0.9-2.6]). The incidence of breast cancer was increased among women employed in the manufacture of chemicals, of non-metallic mineral products, and decreased among women in agriculture. These findings suggest a possible role of occupational exposures in breast cancer, including night-shift work, solvents and endocrine disrupting chemicals and require further studies with detailed assessment of occupational exposures.

Occupational and environmental risk factors for brain cancer: a pilot case-control study in France

The increased incidence of malignant primary brain tumors (MPBT) reported in several studies could be due to environmental factors. To estimate the chemical and physical risk factors of these tumors in southeastern France, a pilot case-control study that included all new MPBT cases diagnosed in 2005 in the main brain cancer treatment centers in the western section of the Provence-Alpes-Côte d'Azur (PACA) region. Age-, sex-, and hospital-matched controls were selected from the neurosurgery department of the same hospital. An occupational physician, using a standardized questionnaire, collected information on suspected risk factors of MPBT in a face-to-face interview at the hospital of all case and control subjects. Data collected included jobs held, various exposures throughout working life, and leisure time activities. The study included 122 cases and 122 controls. No particular job was identified as a major risk factor for brain cancer. Risk was significantly higher among those who used glue (OR=17.58, 95% CI 1.75 - 176.62) during leisure activities and significantly lower among those residing near cellular telephone towers (OR=0.49, 95% CI 0.26 - 0.92). Several new hypotheses about the effects of cellular telephone towers and chemical exposure merit further analytic studies.

Occupation and Lymphoid Malignancies: Results From a French Case-Control Study

Investigating relationships between potential occupational risk factors and lymphoid malignancy (LM). We conducted a multicenter hospital-based case-control study in France between 2000 and 2004, including 824 incident cases of non-Hodgkin lymphoma (NHL), Hodgkin lymphoma (HL), multiple myeloma, and "lymphoproliferative syndrome" and 752 frequency-matched controls. Data were collected through face-to-face standardized and detailed interviews. Farming was significantly associated with NHL (odds ratio [OR] = 1.4 [1.0 to 2.0]) and, although not significantly, with lymphoproliferative syndrome and multiple myeloma. ORs were higher for longest durations of exposure. Self-declared exposure to pesticides was significantly associated with NHL (OR = 1.8 [1.2 to 2.7]) and HL (OR = 2.2 [1.0 to 4.7]). Neither solvent-related jobs nor self-reported exposure to solvents were related to LM. Systematic screening based on job titles did not evidence any other association. The results support the hypothesis that farming plays a role in most types of LM.

Pica and food craving in patients with iron-deficiency anemia: A case-control study in France

Pica, an eating disorder known since antiquity, 1 Parry-Jones B. Pagophagia, or compulsive ice consumption a historical perspective. Psychol Med. 1992; 22: 561-571 Crossref PubMed Scopus (31) Google Scholar is defined as compulsive ingestion of nonfood substances. Its association with iron deficiency is widely recognized; 2 Reynolds R.D. Binder H.J. Miller M.B. Chang W.W. Horan S. Pagophagia and iron-deficiency anemia. Ann Intern Med. 1968; 69: 435-440 Crossref PubMed Scopus (66) Google Scholar , 3 Rector Jr, W.G. Pica its frequency and significance in patients with iron-deficiency anemia due to chronic gastrointestinal blood loss. J Gen Intern Med. 1989; 4: 512-513 Crossref PubMed Scopus (45) Google Scholar , 4 Rector Jr, W.G. Fortuin N.J. Conley C.L. Non-hematologic effects of chronic iron deficiency. A study of patients with polycythemia vera treated solely with venesections. Medicine (Baltimore). 1982; 61: 382-389 PubMed Google Scholar a majority of authors postulate that pica is a consequence, rather than a cause, of iron deficiency.

Occupation and larynx and hypopharynx cancer: an international case-control study in France, Italy, Spain, and Switzerland.

To estimate risks for laryngeal/hypopharyngeal cancer associated with occupational titles and industrial activities. A multicentre population-based case-control study was conducted in the early 1980s in six southern European areas. Analyses included 1010 male cases and 2176 controls. Odds ratios (ORs) (adjusted for age, study area, tobacco consumption, and alcohol consumption) were estimated for 156 occupations and 70 industrial activities. An excess risk has been confirmed for categories of construction workers, potters (OR: 5.91, 95% confidence intervals 1.46-24.0), butchers (2.53, 1.22-5.22), barbers (2.33, 1.00-5.40), laborers not otherwise specified (1.52, 1.12-2.06), as well as for men who had been employed in railway transport (1.52, 0.97-2.39), shipbuilding (2.05, 0.89-4.94), and hotels (2.06, 0.89-4.75). An association was also found for shoe finishers (3.23, 0.75-13.9), loggers (2.07, 0.87-4.90), and some groups of metal workers. ORs for loggers, butchers, railway transport workers, laborers, and reinforced concreters increased with duration of employment. The suggestion of a risk for machine operators among woodworkers (3.10, 0.92-10.5) conflicts with previous findings. No significant excess of risk was found for categories previously reported to be associated with laryngeal and hypopharyngeal cancer, such as drivers, mechanics, welders, machinists, and painters. The present study provides additional evidence to the hypothesis of a risk of cancer of the larynx/ hypopharynx for workers engaged in jobs in the construction, metal, textile, ceramic, and food industries and in railway transport. Loggers were also found at risk; a previously unreported finding.

Occupation and larynx and hypopharynx cancer: a job-exposure matrix approach in an international case-control study in France, Italy, Spain and Switzerland.

To investigate the effect of exposure to occupational agents on the risk of hypopharyngeal/laryngeal cancer. Case-control study conducted during 1979-1982 in six centres in South Europe. An occupational history and information on exposure to non-occupational factors were collected for 1010 male cases of hypopharyngeal/ laryngeal cancer as well as for 2176 population controls. The exposure to 10 occupational agents was assessed through a job-exposure matrix. As occupational histories had been collected since 1945 major analyses were restricted to subjects aged less than 55 years (315 cases and 819 controls). Significant elevated risks adjusted for non-occupational variables (smoking, alcohol consumption and diet) and other occupational exposures were consistently found for organic solvents (odds ratio (OR) for ever-exposure: 1.7, 95% confidence interval: 1.1-2.5) and asbestos (OR: 1.6, 1.0-2.5). A significant positive trend for both probability of exposure and duration was found for exposure to solvents. A positive association between exposure to formaldehyde and laryngeal cancer was also suggested. No association was found for exposure to arsenic and compounds, chromium and compounds, and polycyclic aromatic hydrocarbons. Analyses restricted to subjects aged 55 or more did not show elevated risks, with the exception of wood dust (OR: 1.8, 1.3-2.7). In our study occupational exposure to solvents was associated with an increased risk of hypopharyngeal/laryngeal cancer. Results also provide additional evidence of an excess of risk for exposure to asbestos.

Occupational risk factors, ultraviolet radiation, and ocular melanoma: a case-control study in France.

Ultraviolet radiation has been suspected as a possible cause of ocular melanoma. Because this association is controversial, we examine the role of occupational exposure to ultraviolet radiation on the occurrence of this rare cancer. A population-based case-control study was conducted in 10 French administrative areas (départements). Cases were 50 patients with uveal melanoma diagnosed in 1995-1996. Controls were selected at random from electoral rolls, after stratification for age, gender, and area. Among 630 selected persons, 479 (76%) were interviewed. Data on personal characteristics, occupational history, and detailed information on each job held were obtained from face-to-face interviews using a standardized questionnaire. Estimates of occupational exposure to solar and artificial ultraviolet light were made using a job exposure matrix. Results show elevated risks of ocular melanoma for people with light eye color, light skin color, and for subjects with several eye burns. The analysis based on the job exposure matrix showed a significantly increased risk of ocular melanoma in occupational groups exposed to artificial ultraviolet radiation, but not in outdoor occupational groups exposed to sunlight. An elevated risk of ocular melanoma was seen among welders (odds ratio = 7.3; 95% confidence interval = 2.6-20.1 for men), and a dose-response relationship with job duration was observed. The study also showed increased risk of ocular melanoma among male cooks, and among female metal workers and material handling operators. Following the present study, the existence of an excess risk of ocular melanoma in welders may now be considered as established. Exposure to ultraviolet light is a likely causal agent, but a possible role of other exposures in the welding processes should not be overlooked.

Laryngeal and hypopharyngeal cancers and occupational exposure to formaldehyde and various dusts: a case-control study in France

OBJECTIVESA case-control study was conducted in France to assess possible associations between occupational exposures and squamous cell carcinomas of the larynx and hypopharynx.METHODSThe study was restricted to men, and included...

Risk of Stevens-Johnson syndrome and toxic epider mal necrolysis during first weeks of antiepileptic therapy: a case-control study

There is still controversy about whether all antiepileptic drugs are associated with the severe cutaneous reactions Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). We have studied the role of antiepileptic drugs in SJS and TEN, taking into account potential cofactors that might confound or modify the risk. The case-control study in France, Italy, Germany, and Portugal identified cases of SJS/TEN that developed when the patient was not in hospital and were validated by an expert committee. Controls were patients admitted to the same hospital as the case for an acute illness or an elective procedure. 73 (21%) of the 352 SJS/TEN cases and 28 (2%) of the 1579 controls reported intake of antiepileptic drugs. Among the 73 exposed SJS and TEN patients, 36 reported intake of phenobarbital, 14 of phenytoin, 21 of carbamazepine, 13 of valproic acid, and three of lamotrigine. Risk was highest in the first 8 weeks after onset of treatment. For individual antiepileptic drugs the univariate relative risk of SJS/TEN for 8 weeks or less of use was 57 (95% CI 16-360; multivariate risk 59 [12-302]) for phenobarbital; 91 (26-infinity) for phenytoin; 120 (34-infinity) for carbamazepine; 25 (5.6-infinity) for lamotrigine, and 24 (5.9-infinity) for valproic acid. The result for valproic acid was based on four case users, all of whom reported concurrent use of other associate drugs. The univariate relative risk for more than 8 weeks of use was 6.2 (2.4-17.0; multivariate risk 2.1 [0.5-9.3]) for phenobarbital, 1.2 (0-5.4) for phenytoin, 0.4 (0.02-2.1) for carbamazepine, and 7.0 (2.4-21.0; multivariate risk 2.0 [0.3-15.0]) for valproic acid. SJS and TEN are associated with short-term therapy with phenytoin, phenobarbital, and carbamazepine. The association with valproic acid seems to be confounded by concomitant short-term therapy with other causal drugs. Lamotrigine also has the potential for severe skin reactions. The period of increased risk is largely confined to the first 8 weeks of treatment.

Risk factors for Toxoplasma infection in pregnancy: a case-control study in France.

Each year an estimated 4900 cases of primary Toxoplasma infection occur in pregnant women in France, a country with a high prevalence. Since 1992 all pregnant women at risk of Toxoplasma infection have been required to undergo monthly serological testing. This case-control study, the first of its kind in France, was undertaken to identify risk factors for Toxoplasma infection during pregnancy, with a view to improving primary prevention among non-immune pregnant women. A total of 80 pregnant women who seroconverted to Toxoplasma were matched with 80 pregnant women who had repeatedly negative tests. The women were interviewed by telephone, using a standardized questionnaire, to determine socio-demographic characteristics, exposure to possible risk factors and the type of information on prevention received during pregnancy. The risk factors for Toxoplasma infection included in a multivariate analysis were poor hand hygiene (OR = 9.9; 95%CI: 0.8-125), consumption of undercooked beef (OR = 5.5; 95%CI: 1.1-27), having a pet cat (OR =4.5; 95%CI: 1.0-19.9), frequent consumption of raw vegetables outside the home (OR = 3.1; 95%,CI: 1.2-7.7) and consumption of undercooked lamb (OR = 3.1; 95%CI: 0.85-14). Receipt of documentary advice on prevention was associated with a lower risk of infection. Prevention campaigns among pregnant women in France could be improved and should focus on eating habits, hand hygiene and cats.

Alcohol Consumption and Myocardial Infarction: A Case-Control Study in France and Northern Ireland

The effect of alcohol consumption was assessed in 561 men with myocardial infarction and 643 healthy controls recruited from France and Northern Ireland between 1988 and 1991 in the ECTIM Study (Enquête Cas-Témoins de I'Infarctus du Myocarde). In total, patients consumed less wine than did controls, while non-wine-derived alcohol consumption did not differ significantly. After adjustment for cardiovascular risk factors and country of recruitment by logistic regression, alcohol consumption displayed a protective effect against myocardial infarction, the magnitude of which was comparable in both countries. This effect, which was essentially due to wine consumption in France and to nonwine consumption in Northern Ireland, was largely attenuated by the introduction of high density lipoprotein cholesterol into the model. Thus, both wine and nonwine consumption appear to exert a protective effect against myocardial infarction which is partly mediated through an increase in high density lipoprotein cholesterol.

Sexually transmitted diseases as major causes of ectopic pregnancy: results from a large case-control study in France

To evaluate the current impact of sexually transmitted diseases (STDs) and their consequences on the occurrence of ectopic pregnancy (EP). Case-control study. Fifteen maternity hospitals in the Rhône-Alpes region, France. Six hundred twenty-four women with EP diagnosed from October 1988 to December 1991 and 1,247 controls who delivered liveborn children during the same period. Information on risk factors included behavioral, clinical, and serological indicators of STDs and other known risk factors of EP. Logistic regression identified several indicators of STDs as strong and independent risk factors for EP: previously treated STD without history of salpingitis; history of probably pelvic inflammatory disease (PID) and, especially, history of confirmed PID; previous STDs of the sexual partner; and Chlamydia trachomatis seropositivity. The adjusted attributable fractions of EP for previous symptomatic STDs, symptomatic STDs of the sexual partner, and C. trachomatis seropositivity were 20%, 3.5%, and 25.2%, respectively, giving a total of 43% of EP cases attributable to infectious factors. Our findings and previous epidemiological and biological evidence suggest that STD is a major cause of EP. The evidence is particularly strong in the case of C. trachomatis infection. An effective way of dramatically reducing the EP rate would be to prevent STD through education programs sensitizing young women to the complications of STD and public health measures promoting the use of protective methods such as condoms.

Risk factors for spontaneous abortion: a case-control study in France

A case-control study was conducted in seven maternity hospitals in the Paris area in 1988 to evaluate the role of several risk factors in spontaneous abortion. A total of 279 cases and 279 controls were compared for socio-demographic characteristics, reproductive history and for conditions of conception. Prior fetal losses [odds ratio (OR) = 2.30 for n greater than or equal to 2; 95% confidence interval (CI) = 1.17-4.61] and maternal age at pregnancy (greater than 30 years) appeared to be major and independent risk factors of spontaneous abortion. Other factors associated with an increased risk of fetal loss were: geographical or ethnic origin (OR = 2.85 for North African women; 95% CI = 1.58-5.10); psychological problems at the time of conception, either related to the outcome of the pregnancy (OR = 3.08; 95% CI = 0.92-10.25) or unrelated to this outcome (OR = 3.35; 95% CI = 1.41-8.00). The following factors were not associated with spontaneous abortion: gravidity, parity, prior induced abortion, prior sexually transmitted diseases and Chlamydia trachomatis serology, menstrual cycle abnormalities, induced conception cycle and in-vitro fertilization, cigarette smoking, current or past use of combined oestrogen/progestagen pill or intrauterine device. These findings confirm the importance of two risk factors for fetal loss: maternal age and number of prior spontaneous abortions. Two risk factors, ethnic origin and psychological problems at the time of conception are also identified, which require further study.

Risk Factors for Ectopic Pregnancy: A Case-Control Study in France, with Special Focus on Infectious Factors

A case-control study was conducted in 1988 in seven Paris area maternity hospitals to evaluate the role of several risk factors, particularly infectious factors, in ectopic pregnancy. A total of 279 cases and 279 controls were compared for sociodemographic characteristics, cigarette smoking, sexual, reproductive and surgical histories, and conditions of conception. Pelvic inflammatory disease confirmed by celioscopy (odds ratio (OR) = 5.5, 95% confidence interval (CI) 2.1-13.9) and Chlamydia trachomatis seropositivity (OR = 3.9, 95% CI 2.3-6.7) appeared to be important risk factors for ectopic pregnancy. Other risk factors found to be associated with an increased risk of ectopic pregnancy were dose-related cigarette smoking at the time of conception (ORs 1.3 to 2.5), appendectomy (OR = 1.6, 95% CI 1.1-2.5), prior tubal surgery (OR = 5.1, 95% CI 1.7-15.4), induced conception cycle (OR = 3.2, 95% CI 1.1-9.3), and prior ectopic pregnancy (OR = 13.3, 95% CI 4.5-39.2). However, some of the latter risk factors, i.e., prior tubal surgery, prior ectopic pregnancy, and perhaps appendectomy, may be considered to be the results of pelvic inflammatory disease and sexually transmitted diseases. Maternal age, parity, prior induced abortion, and prior spontaneous abortion were not associated with ectopic pregnancy. Use of intrauterine device, progestagen micropill, and also combined estroprogestative pill at the time of conception were associated with a better prevention of intrauterine pregnancy than of ectopic pregnancy. These findings confirm the importance of several previously reported risk factors of ectopic pregnancy: sexually transmitted diseases, cigarette smoking, and prior ectopic pregnancy. They also identified new risk factors, appendectomy and induced conception cycle, and revealed that the combined estroprogestative pill does not prevent ectopic pregnancy as effectively as it does intrauterine pregnancy.

Oral contraceptives and breast cancer in young women. Some notes on a current controversy.

A number of studies have examined the possible association of oral contraceptive (OC) use and the risk of breast cancer in young women since a World Health Organization (WHO) scientific group stated in 1978 that there is no firm evidence in accumulated data to suggest either an adverse or a beneficial effect of OC use on breast cancer risk. The group did state that some evidence exists suggesting that OCs may increase the risk of breast cancer among certain categories of women i.e. young women women with benign breast neoplasia and women using drugs prior to giving birth to their 1st child. The group emphasized that the evidence available at that time applied only to relatively short periods of OC exposure and for a very limited period of followup and that no inference could therefore be drawn about the longterm effects of OCs on subsequent risk of breast cancer. Kalache et al. have presented a comprehensive review of the findings up to 1983. These conclusions were largely in agreement with the statement of the WHO scientific group. To the subgroups of women whose risk of developing breast cancer was heightened by using OCs Kalache et at. added very young women nulliparous women women with a positive family history and women of perimenopausal age. Since the Kalache review a few additional studies have been published. This paper summarizes the findings of some of the most recent investigations dealing with the current controversy over the safety of OCs with regard to breast cancer in young women. Pike et al. (1983) suggested a substantially increased risk of breast cancer for young women who had taken OCs for 4 years or more before age 25. The relative risk of breast cancer in relation to OC use before age 25 was 2 with 95% confidence limits for 4-6 years of OC use and 4.9 for more than 6 years of OC use. Pike et al. also analyzed the risk of breast cancer relative to the progestagen potency of OCs as defined and found that the risk increase was confined to OCs with high progestagen potency only. Shortly after the Pike et al. study McPherson et al. presented similar results from an ongoing study of 247 married women recruited since 1980 and the same number of age and hospital matched married controls. The estimated relative risk for breast cancer for women who had used OCs for 4 or more years prior to their 1st fullterm pregnancy was 3.1 and for 1-3 years of use. Le et al. reported preliminary results in 1984 from an ongoing case-control study in France; OC use was not found to be associated with increased risk of breast cancer in this study. Stadel et al. reported in 1985 for 2573 eligible cases of breast cancer in women aged 20-44 years in the US that there was no significant increase in the risk of breast cancer for OC users according to age at 1st use or duration of use before age of 25 or before 1st fullterm pregnancy.