OBJECTIVE: To examine changes in temporal trends in breast cancer mortality in women living in 30 European countries. DESIGN: Retrospective trend analysis. Data source WHO mortality database on causes of deaths Subjects reviewed Female deaths from breast cancer from 1989 to 2006 MAIN OUTCOME MEASURES: Changes in breast cancer mortality for all women and by age group (or=70 years) calculated from linear regressions of log transformed, age adjusted death rates. Joinpoint analysis was used to identify the year when trends in all age mortality began to change. RESULTS: From 1989 to 2006, there was a median reduction in breast cancer mortality of 19%, ranging from a 45% reduction in Iceland to a 17% increase in Romania. Breast cancer mortality decreased by >or=20% in 15 countries, and the reduction tended to be greater in countries with higher mortality in 1987-9. England and Wales, Northern Ireland, and Scotland had the second, third, and fourth largest decreases of 35%, 29%, and 30%, respectively. In France, Finland, and Sweden, mortality decreased by 11%, 12%, and 16%, respectively. In central European countries mortality did not decline or even increased during the period. Downward mortality trends usually started between 1988 and 1996, and the persistent reduction from 1999 to 2006 indicates that these trends may continue. The median changes in the age groups were -37% (range -76% to -14%) in women aged or=70 year olds. CONCLUSIONS: Changes in breast cancer mortality after 1988 varied widely between European countries, and the UK is among the countries with the largest reductions. Women aged
Resistance to antibiotics is very high in the intensive care units of many countries, although there are several exceptions. Some infections are becoming extremely difficult to treat. The risk of cross-transmission of those strains is very high. This review focuses on recent data (2003 to the present) that may help understanding and dealing with this serious public health problem.
Intensive care units can be considered as 'factories' for creating, disseminating and amplifying resistance to antibiotics, for many reasons: importation of resistant microorganisms at admission, selection of resistant strains with an extensive use of broad-spectrum antibiotics, cross-transmission of resistant strains via the hands or the environment. Some national programs can be considered as failures, as in the UK and the USA. Other countries have been able to maintain a low level of resistance (Scandinavian countries, Netherlands, Switzerland, Germany, Canada). There is clearly an 'inoculum effect' above which preventive measures become poorly efficient. Several preventive measures have been proposed including preventive isolation, systematic screening at admission, local, national or international antibiotic guidelines, antibiotic prescriptions advice by infectious-disease teams, antibiotic prevention with selective digestive decontamination, antibiotic strategies such as 'cycling', or rather, for some authors, the use of an 'à la carte' antibiotic strategy which could be considered as a 'patient-to-patient antibiotic rotation'.
There is obviously an international concern regarding the level of resistance to antibiotics in the intensive-care-unit setting. A strong program including prevention of cross-transmission and better usage of antibiotics seems to be needed in order to be successful. We do not know if this kind of program will enable countries with a very high endemic level of resistance to decrease the level in future years.
Screening for prostate cancer with prostate-specific antigen (PSA), a simple blood test, is complex, controversial, intellectually challenging and ethically concerning. Sweden has contributed actively to the knowledge base for PSA screening in the last couple of years and a more informed debate is now possible. I will in this article summarize what we currently know about PSA testing. I discuss the closely related issues of the natural history of early-stage disease and the risks and benefits of radical local treatment. I propose that the mortality reduction following PSA screening is probably modest, whilst substantial harms are well documented. Furthermore, there is growing evidence that the PSA test is profoundly limited for screening purposes. I therefore concur with the growing number of health and professional agencies - notably outside the US - that advise against population screening with PSA. Through PSA screening the medical community has generated a pseudo-epidemic of over-diagnosed non-lethal prostate cancer. Molecular tools to distinguish innocent, over-diagnosed prostate cancer from lethal tumors that deserving curative treatment are necessary to improve screening test performance. To date, extensive attempts to identify molecular predictors of outcome have remained unsuccessful, and no ideal screening test is within sight.