Clinical and demographic predictors of late-stage cervical cancer

BACKGROUND: Despite increasingly widespread use of the Papanicolaou smear, almost half of all women with invasive cervical cancer are diagnosed at a late stage (regional or distant). Little is known about factors associated with late-stage diagnosis of cervical cancer. OBJECTIVE: To examine the relationship of age, race, education level, income level, smoking, marital status, health insurance type, comorbidity, and residence in an urban or rural setting to late stage at diagnosis of cervical cancer. METHODS: Incident cases of invasive cervical cancer occurring in 1994 in Florida were identified from the state tumor registry (N = 852). Cases were linked with state discharge abstracts and the 1990 US census. Multiple logistic regression was used to determine the relationship between predictor variables (age, race or ethnicity, marital status, smoking status, education level, income level, insurance type, comorbidity, and urban vs rural residence) and the odds of late-stage diagnosis. RESULTS: Age, marital status, and insurance type were associated with late-stage diagnosis. Each additional year of age was associated with a 3% increased odds of late-stage diagnosis (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.02-1.05; P<.001). Being unmarried was associated with a 63% increased odds of late-stage diagnosis (OR, 1.63; 95% CI, 1.18-2.25; P=.003). Being uninsured was associated with a 60% increased odds of late-stage diagnosis (OR, 1.60; 95% CI, 1.07-2.38; P=.02). Having commercial health maintenance organization insurance was associated with a 46% decreased odds of late-stage disease (OR, 0.54; 95% CI, 0.30-0.96; P=.04). Race, education level, income level, smoking status, comorbidity, and urban residence were not associated with stage at diagnosis. CONCLUSIONS: Women with cervical cancer who are elderly, unmarried, and uninsured are more likely to be diagnosed at a late stage. These women should be targeted for cervical cancer education and screening programs.     

An assessment of factors related to tumor thickness and delay in diagnosis of melanoma in southern Italy

BACKGROUND: Since survival of patients with melanoma is strongly correlated with the Breslow tumor thickness of the primary lesion, factors that influence stage at diagnosis and delay in diagnosis are considered to be crucial. To test the relationship between tumor thickness and some social and clinical variables (including diagnosis/treatment delay) and the relationship between the diagnosis/treatment delay and some clinical variables, we analyzed data on 530 patients with melanoma from our Institute. METHODS: In the analysis, Breslow tumor thickness was categorized into two categories (< or =1.49, > or =1.5). Three time intervals were examined to evaluate diagnostic delay: patient delay, time from first symptom to seeking medical advice; medical delay, time from first medical consultation to hospital admission; total delay, time from first symptom to resection. The variables evaluated in the analysis were: age at diagnosis, education, occupational status, first symptom, visibility of tumor, anatomic site, and physician who made the initial diagnosis. RESULTS: A significant risk of having a Breslow tumor thickness > or =1.5 mm was noted in patients who had a low level of education (odds ratio 3.0, 95% confidence interval 1.9-5.0) or who were unemployed (odds ratio 1.7, 95% confidence interval 1.1-2.8). With respect to patient delay, a delay >3 months for anatomic locations visible to patients was associated with significant risk (odds ratio 1.7, 95% confidence interval 1.1-2.6); with respect to medical delay, a delay >3 months was associated with a higher risk in patients examined by a dermatologist (odds ratio 2.0, 95% confidence interval 1.2-3.4). CONCLUSIONS: Our results clearly indicate that in Southern Italy poorly educated and unemployed subjects are at risk of being diagnosed at a more advanced stage, and admission to an oncological hospital causes a delay (waiting list) in the time interval related to the doctor (medical delay).     

Psychopathology and attrition in the epidemiologic catchment area surveys.

This analysis shows the effect of sociodemographic variables and psychopathology on attrition in a 1-year follow-up of 10,167 household-residing respondents, aged 18-64 years, from four sites of the National Institute of Mental Health Epidemiologic Catchment Area Program. Attrition is defined in two ways: failure to locate (n = 1,035) and refusal to participate (n = 1,010). As compared with 8,122 respondents successfully interviewed after 1 year, those who are not located are more likely to be male, Hispanic, young, and unmarried. Refusers are older and more likely to be married and to have lower educational attainment than those successfully reinterviewed. After adjusting for sociodemographic variables, psychopathology had a small to moderate effect on attrition. Panic and depression were associated with failure to locate, but no diagnoses, or selected symptoms, were strongly or significantly associated with refusal to participate in the second wave.     

California Medicaid enrollment and melanoma stage at diagnosis: a population-based study

BACKGROUND: Insurance status and SES are associated with the stage of melanoma at diagnosis. However, the influence of Medicaid enrollment on melanoma stage has not been studied in detail. This study examined the effect of Medicaid enrollment status and duration on melanoma stage at diagnosis in a large, multi-ethnic California population. METHODS: California Cancer Registry records were linked with statewide Medicaid enrollment files to identify 4558 men and women diagnosed with invasive cutaneous and metastatic melanoma during 1998-1999. Multivariate logistic regression was used to evaluate the association between prediagnosis Medicaid enrollment status and late-stage diagnosis and tumor depth at diagnosis. RESULTS: Late-stage disease was diagnosed in 27% of Medicaid and 9% of non-Medicaid melanoma patients. Those enrolled in Medicaid at diagnosis and those enrolled intermittently during the year prior to diagnosis had significantly greater covariate-adjusted odds of late-stage cancer than those not enrolled in Medicaid (OR 13.64, 95% CI=4.43, 41.98, and OR 2.77, 95% CI=1.28, 5.99, respectively). Participants continuously enrolled during the previous year were not at increased odds for late-stage disease. An increased likelihood of late-stage melanoma was also associated with low SES (p<0.05) and non-Hispanic black race/ethnicity (p<0.10) after covariate adjustment. CONCLUSIONS: Men and women intermittently enrolled in Medicaid or not enrolled until the month of diagnosis had a significantly increased likelihood of late-stage melanoma. Greater education and outreach, particularly in low-SES areas, are needed to improve melanoma awareness and access to screening.     

What factors are associated with poor developmental attainment in young Canadian children?

BACKGROUND: This study was undertaken to determine the association between poor developmental attainment (PDA) and biological, home environment and socio-demographic factors in a population-based sample of Canadian children. METHODS: Cross-sectional data from two cycles (1994/95 and 1996/97) of the National Longitudinal Survey of Children and Youth were used. Children aged 1-5 years were included. PDA was defined as < or = 15th percentile for motor and social developmental skills (1-3 year olds) or Peabody Picture Vocabulary Test (4-5 year olds). Multiple logistic regression was used. RESULTS: The proportion of children with PDA varies across Canada, between males and females, and by age. Among 1 year olds in Cycle I, having a low birthweight (OR=3.3; 95% CI: 2.1-5.2), being male (OR=1.6; 95% CI: 1.2-2.2) and having a mother who is an immigrant (OR=1.6; 95% CI: 1.1-2.2) increased the odds of PDA. Similar results were observed in Cycle II. Among children aged 4-5 years in Cycle II, having a mother who is an immigrant (OR=5.3; 95% CI: 4.1-6.9) and a mother with low educational attainment (OR=2.8; 95% CI: 2.1-3.9) increased the odds of PDA. Low income was a significant predictor of PDA across all age groups. INTERPRETATION: The strong and consistent associations with living in a low-income household, having a mother with low educational attainment or a mother who is an immigrant highlight the need for targeting developmental assessments and services to this population.     

The association of race/ethnicity,socioeconomic status,and physician recommendation for mammography: who gets the message about breast cancer screening?

OBJECTIVES: This study investigated the association between physician recommendation for mammography and race/ethnicity, socioeconomic status, and other characteristics in a rural population. METHODS: In 1993 through 1994, we surveyed 1933 Black women and White women 52 years and older in 10 rural counties. RESULTS: Fifty-three percent of the women reported a physician recommendation in the past year. White women reported recommendations significantly more often than did Black women (55% vs 45%; odds ratio = 1.49). Controlling for educational attainment and income eliminated the apparent racial/ethnic difference. After control for 5 personal, 4 health, and 3 access characteristics, recommendation for mammography was found to be more frequent among women who had access to the health care system (i.e., had a regular physician and health insurance). Recommendation was less frequent among women who were vulnerable (i.e., were older, had lower educational attainment, had lower annual family income). CONCLUSIONS: Socioeconomic status, age, and other characteristics--but not race/ethnicity--were related to reports of a physician recommendation, a precursor strongly associated with mammography use. Efforts to increase physician recommendation should include complementary efforts to help women address socioeconomic and other barriers to mammography use.     

Socio-demographic factors, health behavior and late-stage diagnosis of breast cancer in Germany: a population-based study.

Late-stage diagnosis of breast cancer is associated with poor survival. Identification of individuals at high risk of late-stage diagnosis could be an effective step to reduce breast cancer mortality. We examined the association of socio-demographic factors and health behavior with breast cancer stage in a population-based sample of 380 female breast cancer patients in Saarland, Germany. Overall, 182 women (47.9%) were diagnosed with late-stage (regional or distant) breast cancer. After control for potential confounding by multivariate logistic regression, an increased risk of late-stage diagnosis was observed for older age (OR = 1.8; 95% CI 1.0-3.2), foreign nationality (OR = 3.9; 95% CI 0.7-20.8), living in large households (OR = 1.7; 95% CI 1.0-2.9), non-participation in general health check-up (OR = 1.5; 95% CI 0.9-2.4) and low interest in health care (OR = 1.6; 95% CI 1.0-2.7). The proportion of late-stage cancer was clearly decreased when tumors were detected by screening (OR = 0.4; 95% CI 0.2-0.8). Certain socio-demographic factors and characteristics of health behavior seem to represent independent risk indicators of late-stage diagnosis.     

Detailed Educational Pathways Among Females After Very Early Sexual Intercourse

CONTEXT: Although studies have shown that early sex is negatively associated with high school graduation and college enrollment, no recent study has examined the extent to which early sex affects educational attainment, and the mediating mechanisms have not been established. METHODS: Data from 4,613 female participants in the National Educational Longitudinal Study were used to examine the relationship between early sexual intercourse (i.e., first sex prior to age 15) and educational attainment. Logistic regression analyses that controlled for background characteristics, school performance, behavioral factors and academic aspirations were conducted to assess this association, as well as to explore the potential mediating role of early marriage and childbearing. RESULTS: Young women who had had early sex had reduced odds of having graduated from high school (odds ratio, 0.4) and from college (0.5). Postsecondary enrollment was positively associated with expectations of postsecondary education (1.5) and levels of academic achievement (1.4–1.5), but not with early sex. Respondents who had married before their expected high school graduation date had reduced odds of having graduated from high school (0.1), enrolled in postsecondary school (0.4) or completed college (0.1); those who had a child before their expected high school graduation date had reduced odds of having graduated from high school (0.3) or college (0.1). CONCLUSIONS: Programs that target early parenthood and marriage, and that provide hope for future educational opportunities, could lessen the impact of early sex for young women.     

Prevalence and Risk Factors for Adult Paternity Among Adolescent Females Ages 14 through 16 Years

To investigate sociodemographic factors associated with adolescent females ages 14–16 years having children fathered by males age 20 years or older and identify differences in correlates across rural, urban, and border areas. The method section was a cross-sectional study using Texas birth record data. From 2000 through 2004, there were 29,186 births to adolescent females aged 14–16 years with valid paternal age. Prevalence of and adjusted odds of paternal age of 20 years or older were identified by paternal and maternal factors. The Results section Having both parents born outside of the U.S. was associated with a 5.29 (95% CI: 4.82, 5.80) times increase in the odds of paternal age of 20 years or older as compared to having both parents born in the U.S. Parental place of birth was associated with greater odds of paternal age of 20 years or older in urban areas compared to rural or border areas. Compared to those with average or high educational attainment relative to age, low educational attainment relative to age was associated with an increase in the odds of paternal age of 20 years or older. This association was present whether maternal or paternal educational attainment was low relative to age. Messages are needed to help adolescent females avoid pregnancy with adult males. In addressing this specific prevention challenge, it is important to consider maternal/paternal place of birth and its association with adolescent births with adult males.     

Body mass index among Melanesian and Indian Fijians aged ≥ 40 years living in Fiji

To determine the distribution and sociodemographic associations of body mass index (BMI; kg/m(2)) among Melanesian and Indian Fijians aged ≥40 years living in Fiji, a population-based cross-sectional survey with multistage random sampling was conducted in 2009. Melanesians were more likely to have BMI ≥25 (odds ratio [OR] = 4.73; 95% confidence interval [CI] = 3.57-6.28; P < .001) and BMI ≥30 (OR = 3.84; 95% CI = 2.94-5.03; P < .001). Among Melanesians, gender and educational attainment were predictive of BMI ≥25 on multivariate analysis. Women were more likely to be overweight (OR = 2.03; 95% CI = 1.34-3.06) or obese (OR = 1.92; 95% CI = 1.43-2.59). Among Indians, gender and age were predictive of BMI ≥25. Again, women were more likely to be overweight (OR = 2.51; 95% CI = 1.69-3.73) or obese (OR = 3.71; 95% CI = 2.19-6.29). Gender-age-domicile-adjusted, and extrapolating across Fiji, 0.3%, 84.5%, and 51.7% of Melanesians aged ≥40 years had BMI <18.5, ≥25, and ≥30, respectively. Among Indians, these values were 5.8%, 54.2%, and 21.2%, respectively.     

Risk behaviors for sexually transmitted diseases among truck drivers in Brazil

OBJECTIVE: To evaluate the frequency of sexually transmitted diseases (STD) and associated risk factors based on self-reporting by long-haul truck drivers in Brazil. METHOD: From October 2005-October 2006, 641 long-haul truck drivers that travel federal highway BR-153, traversing the country from south to north, were interviewed. A structured interview was used to collect sociodemographic data. The truck drivers also completed a self-administered questionnaire on risk behaviors and STD history. The data were adjusted and analyzed using logistic regression. RESULTS: Of 641 drivers interviewed, 620 (96.7%) provided answers on STD history. Of these, 35.6% (95% confidence interval (CI) = 31.9-39.6) reported past or current STD. Being 30 years of age or older was statistically associated with having a history of STD. In addition, truck drivers who reported using amphetamines (odds ratio (OR) = 1.7; 95%CI = 1.1-2.6), having been incarcerated (OR = 2.2; 95%CI = 1.2-4.2), and sexual relations with sex professionals (OR = 1.9; 95%CI = 1.3-2.8) had increased odds for having a history of STD. CONCLUSION: These results confirm that Brazilian truck drivers are highly vulnerable to STD and show the importance of prevention programs targeting this specific group, one that is constantly on the move and may efficiently disseminate STD.     

Socioeconomic factors in Helicobacter pylori infection among Danish adults.

OBJECTIVES: This study examined the relationship between housing conditions, educational level, occupational factors, and serologically diagnosed acute and chronic Helicobacter pylori infection. METHODS: Immunoglobulin G and immunoglobulin M serum antibodies against H. pylori were measured in 3589 Danish adults who participated in a population study. RESULTS: Low socioeconomic status (odds ratio [OR] = 2.2, 95% confidence interval [CI] = 1.7, 3.0), short duration of schooling (OR = 2.0, 95% CI = 1.3, 2.5), lack of training/education (OR = 1.4, 95% CI = 1.2, 1.7]), unskilled work (OR = 1.7, 95% CI = 1.2, 2.5), and high work-related energy expenditure (OR = 1.4, 95% CI = 1.1, 1.9) increased the likelihood of chronic H. pylori infection. Infection was frequent in people who had lived abroad. Increased levels solely of immunoglobulin M antibodies were found more often in people who were divorced (OR = 2.3, 95% CI = 1.2, 4.4) or unmarried (OR = 2.0, 95% CI = 1.1, 3.8) or who worked long hours (OR = 2.0, 95% CI = 1.1, 4.0). CONCLUSIONS: Educational and occupational factors relate to the likelihood of chronic H. pylori infection in adults. The rate of acute infection is high in single individuals.     

The effects of physician supply on the early detection of colorectal cancer

BACKGROUND: Policymakers question whether there is a relationship between the number and distribution of physicians and the outcomes for important health conditions. We hypothesized that increasing primary care physician supply would be related to earlier detection of colorectal cancer. METHODS: We identified incident cases of colorectal cancer occurring in Florida in 1994 (n = 8,933) from the state cancer registry. We then obtained measures of physician supply from the 1994 American Medical Association Physician Masterfile and examined the effects of physician supply (at the levels of county and ZIP code clusters) on the odds of late-stage diagnosis using multiple logistic regression. RESULTS: For each 10-percentile increase in primary care physician supply at the county level, the odds of late-stage diagnosis decreased by 5% (adjusted odds ratio [OR] = 0.95; 95% confidence interval [CI], 0.92 - 0.99; P = .007). For each 10-percentile increase in specialty physician supply, the odds of late-stage diagnosis increased by 5% (adjusted OR = 1.05; 95% CI, 1.02-1.09; P = .006). Within ZIP code clusters, each 10-percentile increase in the supply of general internists was associated with a 3% decrease in the odds of late-stage diagnosis (OR = 0.97; 95% CI, 0.95 - 0.99; P = .006), and among women, each 10-percentile increase in the supply of obstetrician/gynecologists was associated with a 5% increase in the odds of late-stage diagnosis (OR = 1.05; 95% CI, 1.01 - 1.08; P = .005). CONCLUSIONS: If the relationships observed were causal, then as many as 874 of the 5463 (16%) late-stage colorectal cancer diagnoses are attributable to the physician specialty supply found in Florida. These findings suggest that an appropriate balance of primary care and specialty physicians may be important in achieving optimal health outcomes.     

Potential explanations for the educational gradient in coronary heart disease: a population-based case-control study of Swedish women

OBJECTIVES: This study examined the association between educational attainment and coronary heart disease (CHD) and the factors that may explain this association. METHODS: This population-based case-control study included 292 women with CHD who were 65 years or younger and 292 age-matched controls. RESULTS: Compared with the adjusted odds ratio for CHD associated with college education, the age-adjusted odds ratio associated with mandatory education (< or = 9 years) was 1.87 (95% confidence interval [CI] = 1.23, 2.84) and the odds ratio for high school education was 1.35 (95% CI = 0.81, 2.25) (P for trend < .01). The odds ratio for mandatory education was reduced by 82%, to 1.16 (95% CI = 0.69, 2.09), after adjustment for psychosocial stress, unhealthy lifestyle patterns, hemostatic factors, hypertension, and lipids. CONCLUSIONS: Much of the increased risk of CHD in women with low education appears to be linked to psychosocial stress and lifestyle factors. Hemostatic factors, lipids, and hypertension also contribute to a lesser extent. These factors may be considered in strategies geared to reducing socioeconomic inequalities in cardiovascular health.     

Second Births to Teenage Mothers: Risk Factors For Low Birth Weight and Preterm Birth

CONTEXT: Teenagers are more likely than older women to have a low-birth-weight infant or a preterm birth, and the risks may be particularly high when they have a second birth. Identifying predictors of these outcomes in second teenage births is essential for developing preventive strategies.
METHODS: Birth certificate data for 1993–2002 were linked to identify second births to Milwaukee teenagers. Predictors of having a low-birth-weight second infant or a preterm second birth were identified using logistic regression.
RESULTS: The same proportion of first and second infants were low-birth-weight (12%), but second births were more likely than first births to be preterm (15% vs. 12%). In analyses that adjusted for demographic, pregnancy and behavioral characteristics, the odds that a second infant was low-birth-weight or preterm were elevated if the mother smoked during pregnancy (odds ratios, 2.2 and 1.9, respectively), had inadequate prenatal weight gain (1.8 and 1.4), had an interpregnancy interval of less than 18 months (1.6–2.9 and 1.4–2.3) or was black (2.7 and 1.7). Women who had received an adequate level of prenatal care had reduced odds of both outcomes (0.6 and 0.4). Women younger than 16 also had increased odds of having a low-birth-weight second infant. Further adjustment for socioeconomic characteristics yielded largely the same results. In addition, women who were unmarried or did not identify a father were at increased risk of both outcomes (1.5 for each), and poor women were at risk of having a low-birth-weight infant (1.3).
CONCLUSIONS: Predictors of poor birth outcomes include modifiable behaviors. Prenatal interventions addressing these behaviors could help improve outcomes.     

Teenage childbearing and long-term socioeconomic consequences: a case study in Sweden

CONTEXT: Whether long-term socioeconomic problems experienced by many teenage mothers are a reflection of preexisting disadvantage or are consequences of teenage motherhood per se remains unclear. METHODS: National data on all women born in Sweden from 1941 to 1970 who were younger than age 30 when they first gave birth (N=888,044) were analyzed. The outcome measures, assessed during adulthood, were employment status, socioeconomic status, educational attainment, single motherhood, family size, receipt of disability pension and dependence on welfare. Multiple logistic regression techniques were used to adjust for maternal birth cohort and for socioeconomic background of the woman's family. RESULTS: Compared with Swedish women who first gave birth at ages 20-24, those who were teenage mothers had significantly increased odds of each unfavorable socioeconomic outcome in later life, even after the data were adjusted for family socioeconomic situation and maternal birth cohort. For example, teenage motherhood was positively associated with low educational attainment (odds ratios of 1.7-1.9, depending on the specific age during adolescence when the woman gave birth), with single living arrangements (odds ratios, 1.5-2.3), with high parity (odds ratios, 2.6-6.0), with collecting a disability pension (odds ratios, 1.6-1.9) and with welfare dependency (odds ratios, 1.9-2.6). These trends were usually linear, with the highest odds ratios corresponding to women who had had their first child at the youngest ages. CONCLUSIONS: A longitudinal analysis of record-linkage data from Sweden supports the view that childbearing during adolescence poses a risk for socioeconomic disadvantage in later life--even for adolescents from relatively comfortable backgrounds and for those who studied beyond elementary school.     

Perceived risk of chlamydial and gonococcal infection among sexually experienced young adults in the United States

CONTEXT: Understanding young adults' perceived risk of chlamydial and gonococcal infection can inform interventions to reduce the prevalence of these sexually transmitted diseases. METHODS: Bivariate and multivariate analyses, using data from Wave 3 of the National Longitudinal Study of Adolescent Health (2001-2002), were conducted to examine relationships between perceived risk and selected characteristics in two groups: a nationally representative sample of sexually experienced 18-26-year-olds and a subsample of those who tested positive for chlamydia or gonorrhea. The relationship between current infection and perceived risk was also evaluated. RESULTS: Only 14% of all respondents and 33% of infected participants reported some perceived risk of chlamydial or gonococcal infection. In the overall sample, the odds of perceiving risk were significantly elevated among blacks, Hispanics, unmarried respondents, inconsistent condom users and nonusers, respondents who reported multiple partners in the past year, those who had received a diagnosis of chlamydia or gonorrhea in the past year, and those reporting current symptoms (odds ratios, 1.5-3.3). Currently infected participants were significantly more likely than those who were not infected to perceive some risk of infection (2.4). Among infected respondents, the factors positively associated with perceived risk were being black or Hispanic, using condoms inconsistently or not using them, having exchanged money for sex, having been tested in the past year but with no diagnosis, having received a diagnosis, and reporting current symptoms (2.5-5.2). CONCLUSIONS: Interventions to increase the accuracy of young adults' risk perceptions may influence sexual and health care-seeking behaviors in a way that will reduce rates of chlamydia and gonorrhea.     

Functional health literacy and health-promoting behaviour in a national sample of British adults

OBJECTIVES: To measure the prevalence of limited functional health literacy in the UK, and examine associations with health behaviours and self-rated health. DESIGN: Psychometric testing using a British version of the Test of Functional Health Literacy in Adults (TOFHLA) in a population sample of adults. SETTING: UK-wide interview survey (excluding Northern Ireland and the Scottish Isles). PARTICIPANTS: 759 adults (439 women, 320 men) aged 18-90 years (mean age _ 47.6 years) selected using random location sampling. MAIN OUTCOME MEASURES: Functional health literacy, self-rated health, fruit and vegetable consumption, physical exercise and smoking. RESULTS: We found that 11.4% of participants had either marginal or inadequate health literacy. Multivariable logistic regression analysis indicated that the risk of having limitations in health literacy increased with age (adjusted odds ratio 1.04; 95% confidence interval 1.02 to 1.06), being male (odds ratio _ 2.04; 95% confidence interval 1.16 to 3.55), low educational attainment (odds ratio _ 7.46; 95% confidence interval 3.35 to 16.58) and low income (odds ratio _ 5.94; 95% confidence interval 1.87 to 18.89). In a second multivariable logistic regression analysis, every point higher on the health literacy scale increased the likelihood of eating at least five portions of fruit and vegetables a day (odds ratio _ 1.02; 95% confidence interval 1.003 to 1.03), being a non-smoker (odds ratio _ 1.02; 95% confidence interval 1.0003 to 1.03) and having good self-rated health (odds ratio _ 1.02; 95% confidence interval 1.01 to 1.04), independently of age, education, gender, ethnicity and income. CONCLUSIONS: The results encourage efforts to monitor health literacy in the British population and examine associations with engagement with preventative health behaviours.     

Important prognostic significance of a sentinel-node biopsy in patients with malignant melanoma

OBJECTIVE: To determine the prognostic significance of sentinel-node biopsy in patients with malignant melanoma (unlike the United States, a sentinel-node biopsy is still not routinely performed on melanoma patients in the Netherlands, as the outcomes of prospectively randomised clinical trials are being awaited). DESIGN: Retrospective. METHODS: Between 1996 and 2001 a sentinel-node biopsy and a re-excision of the scar of the diagnostic biopsy were performed on all melanoma patients who had a Breslow thickness > or = 1 mm or a Clark level > or = IV. At operation the sentinel node was identified with a gamma probe and patent blue. It was removed and sent for pathological investigation for the presence of melanoma cells. If the sentinel node was tumour positive, a dissection of the regional lymph-node basin was performed. Subsequently, these patients were put forward for the European Organisation for Research and Treatment of Cancer (EORTC) peginterferon alfa(2b) adjuvant treatment study. RESULTS: A sentinel-node biopsy was performed in 61 lymphnode basins in 57 patients (18 male and 39 female; median age: 45 years (range: 9-80)). The median Breslow thickness of the melanomas was 2.2 mm (range: 0.7-13 mm). In 10 of the 61 cases histological examination of the sentinel node demonstrated tumour cells. In 2 additional cases tumour cells were demonstrated only by immunohistochemical studies or complete dissection of the node. Eight regional lymph-node basins were dissected, two of which contained additional metastases. The median follow-up was 36 months (range: 1-68). During follow-up 12 of the 57 patients were found to have metastases, in 8 of these patients the sentinel-node biopsy contained tumour cells. The negative predictive value of a tumourless sentinel node with respect to the later occurrence of distant metastases was 92%. CONCLUSION: The patients with a tumour-positive sentinel node had a poorer prognosis with respect to distant metastases than patients with a tumour-negative node. This is the main reason for performing sentinel-node biopsy: to predict the prognosis of the disease. Therefore sentinel-node biopsy should be incorporated into the treatment of patients with malignant melanoma.