Editor's Choice | This Week in BMJ | Press releases

BMJ No 7100 Volume 315 This week in BMJ Saturday 12 July 1997 No link found between DDE in fat tissue and breast cancer "End of life decisions" are taken for 41% of mentally handicapped Dutch patients in institutions Doctors think equity of access to health care is more important than patients do Miscarriage statistics miss about a third of cases No link found between DDE in fat tissue and breast cancer Earlier studies have suggested a higher risk of breast cancer in women with high plasma concentrations of the organochlorines polychlorinated biphenyl and DDE, the main metabolites of DDT. On p 81 van 't Veer et al show that this possibility is not supported by their research, in which they examined long term adipose stores of DDE among over 250 postmenopausal women with breast cancer and over 300 controls from five European countries. In four out of five centres DDE concentrations among women with breast cancer were lower than among controls. There was a significant inverse gradient of risk at higher DDE concentrations. These results are incompatible with an increased risk of breast cancer. They cannot exclude, however, the possibility that other organochlorines could exert such an effect. HRT does not increase risk of cervical cancer Use of oral contraceptives has been linked with increased risk of cervical cancer, but few data exist on the effect of oestrogen replacement therapy. On p 85 Parazzini et al report the results of a case-control study to determine the risk of cervical cancer. They found that women who had taken oestrogen replacement had no higher risk of cervical cancer than those who had not, and the odds were lower among women who had taken it for longer periods. "End of life decisions" are taken for 41% of mentally handicapped Dutch patients in institutions Among mentally handicapped patients, decisions taken at the end of life that might hasten their death ("end of life decisions") pose complex problems, because the patients concerned are incompetent. On p 88 van Thiel et al report the prevalence of such decisions in institutions caring for mentally handicapped patients in the Netherlands, why the decisions were taken, and the decision making process. End of life decisions were taken in 41% of deaths, largely because of the patient's suffering. Beforehand, there was usually consensus between all discussants. This study is a useful basis for public debate on end of life decisions. Miscarriage statistics miss about a third of cases No one knows how many miscarriages are already treated in primary care as the only statistics published in Britain come from hospital inpatient figures. On p 32 Everett reports the results of a prospective community study of bleeding in early pregnancy. Extrapolations from live birth and population figures suggest that there may be 70,000-90,000 miscarriages every year in England and Wales, and about a third of these women are not admitted to hospital. The data also suggest that the risk of a miscarriage among women who have miscarried their previous pregnancy is not significantly higher than that for other women. Home | Current issue | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline