Are cancer registries unconstitutional?

Population-based cancer registration, mandated throughout the United States, is central to quantifying the breadth and impact of cancer. It facilitates research to learn what causes cancer to develop and, in many cases, lead to death. However, as concerns about privacy increase, cancer registration has come under question. Recently, its constitutionality was challenged on the basis of 1) the vagueness of statutory aims to pursue public health versus the individual privacy interests of cancer patients, and 2) the alleged indignity of one's individual medical information being transmitted to government authorities. Examining cancer registry statutes in states covered by the US National Cancer Institute's SEER Program and the US Centers for Disease Control and Prevention's National Program of Cancer Registries, we found that cancer registration laws do state specific public health benefits, and offer reasonable limits and safeguards on the government's possession of private medical information. Thus, we argue that cancer registration would survive constitutional review, is compatible with the civil liberties protected by privacy rights in the U.S., satisfies the conditions that justify public health expenditures, and serves human rights to enjoy the highest attainable standards of health, the advances of science, and the benefits of government efforts to prevent and control disease.     

What does cancer treatment look like in consumer cancer magazines? An exploratory analysis of photographic content in consumer cancer magazines

In an exploratory analysis of several highly circulated consumer cancer magazines, the authors evaluated congruency between visual images of cancer patients and target audience risk profile. The authors assessed 413 images of cancer patients/potential patients for demographic variables such as age, gender, and ethnicity/race. They compared this profile with actual risk statistics. The images in the magazines are considerably younger, more female, and more White than what is indicated by U.S. cancer risk statistics. The authors also assessed images for visual signs of cancer testing/diagnosis and treatment. Few individuals show obvious signs of cancer treatment (e.g., head scarves, skin/nail abnormalities, thin body types). Most images feature healthier looking people, some actively engaged in construction work, bicycling, and yoga. In contrast, a scan of the editorial content showed that nearly two thirds of the articles focus on treatment issues. To explicate the implications of this imagery-text discontinuity on readers' attention and cognitive processing, the authors used constructs from information processing and social identity theories. On the basis of these models/theories, the authors provide recommendations for consumer cancer magazines, suggesting that the imagery be adjusted to reflect cancer diagnosis realities for enhanced message attention and comprehension.     

Aspirin and colorectal cancer?

This paper evaluates aspirin in the reduction of colorectal cancer risk against the nine causality criteria suggested by Bradford-Hill in 1965. Although some questions remain, the evidence is suggestive of a reduction by perhaps 20-30%. Aspirin could make important contributions to public health programmes given that it reduces cardiovascular disease risk and is relatively safe. It is appropriate for bodies such as the World Health Organisation and national governments to begin to consider the future use of aspirin for the reduction of two major sources of death and disability.     

Psychosocial care for cancer patients in primary care? Recognition of opportunities for cancer care

The paper outlines psychosocial problems experienced by cancer patients and the current barriers to service delivery. New models of psychosocial service provision are put forward, emphasizing information, communication and technology aids in an attempt to improve co-ordination of care. The management of cancer patients has evolved greatly over the past decades, and patients are well placed to benefit from the experiences of primary care professionals in the delivery of chronic illness disease management strategies.     

Do pesticides cause childhood cancer?

Objectives: Epidemiological studies have reported associations between childhood cancer and either parental or child exposure to pesticides. Reviews have been published in 1997 and 1998, where the evidence was found suggestive but not conclusive. An update of the current state of knowledge is warranted. Methods: A literature search has been conducted to identify and evaluate new research results on this topic issued between 1998 and 2004. Results: Eighteen new studies have been identified for this review. Collectively, the studies suggest an increase in the risk of different cancer types associated with exposure to pesticides. However, the evidence is conflicting with regard to cancer types as well as to causative factors across studies. The major shortcomings concern exposure assessment, where, e.g., “farming” is treated equal to “exposure to pesticides,” disregarding other possible exposures, e.g., to biological or infectious agents, and hitherto unidentified lifestyle factors. Also, many exposure questionnaires used in case–control studies are based on broad and sometimes implausible categories. In most studies exposures were categorized as “ever vs. never,” with no regard for exposure intensity or duration. Conclusions: The available literature does not allow firm conclusions with regard to pesticides and any type of childhood cancer. Investing in the acquisition and critical review of exposure information appears to be the crucial step for causal assessment in future research. However, focusing on the presence of pesticides, and not asking the question why they were used, might mask relevant associations to other causative agents.Lecture at the XXXII Medichem Congress, September 1–3, 2004, Paris, France     

General practitioners’ preferences with regard to colorectal cancer screening organisation Colon cancer screening medico-legal aspects

Objective

French health authorities put general practitioners at the heart of the colorectal cancer screening. This position raises organisational issues and poses medico-legal problems for the professionals and institutions involved in these campaigns, related to the key concepts of medical decisions and suitability of standards. The objective of our study is to reveal the preferences of general practitioners related to colorectal cancer screening organisation with regard to the medico-legal risk

How protective is cervical cancer screening against cervical cancer mortality in developing countries? The Colombian case

Background  

Cervical cancer is one of the top causes of cancer morbidity and mortality in Colombia despite the existence of a national preventive program. Screening coverage with cervical cytology does not explain the lack of success of the program in reducing incidence and mortality rates by cervical cancer. To address this problem an ecological analysis, at department level, was carried out in Colombia to assess the relationship between cervical screening characteristics and cervical cancer mortality rates.     

Vaginal cancer: an iatrogenic disease?

Presently we are witnessing two unique occurrences in the field of public health: the first demonstration of transplacental carcinogenesis in humans and the first drug-induced cancer epidemic in women under age 30. This article examines the current status of the vaginal cancer epidemic and possible reasons for the failure of governmental health agencies to recall and test the generation of females who were exposed to diethylstilbestrol (DES) in utero. Epidemiologic evidence indicates that the large majority of "DES daughters" may develop adenosis. The carcinogenicity of other estrogens in wide use is examined. It is pointed out that, although vaginal cancer in daughters exposed to DES in utero provided the clinical evidence to secure a Food and Drug Administration ban on DES as an additive to cattle feed, the FDA approved a new use of DES as a "morning-after pill" contraceptive even though the contraceptive contains 833,000 times the amount of DES banned for human consumption in beef. The lack of standards of informed consent in the testing of the morning-after pill on university women and the additional risk this presents to DES daughters are discussed. The sociopolitical and economic contributing factors to the vaginal cancer epidemic and the extent to which the scientific direction of medical care is influenced by economic factors are examined. Public health measures which might prevent the occurrence of such man-made epidemics in the future are recommended.