This months Leading Edge editorial examines the recently published US Environmental Protection Agency's (EPA) 10-year in-the-making report on the toxic effects of diesel exhaust fumes from large vehicles. The report-which showed that large cities are heavily polluted with emissions that are associated with increased risk of lung cancer-has clear public-health implications for a political administration that does not appear to giving a high priority to environmental issues.
The editorial comments: 'The development of effective environmental policies should be a priority for all governments. Healthcare professionals are in great need of solid evidence-based policies rather than legislation based on economic or qualitative criteria. When a report with the strength of the EPA study presents persuasive quantitative evidence, the benefits of any resultant policies should be patently obvious and viewed as an integral part of healthcare provision, rather than isolated environmental issues.'
HORMONAL RISK FACTORS FOR BREAST CANCER - IDENTIFICATION, CHEMOPREVENTION, AND OTHER PREVENTION STRATEGIES
Breast cancer is a leading cause of female illness and death worldwide. Many hormonal and genetic risk factors have been identified and have led to the development of mathematical models that can be used in the clinic to give a woman an estimate of her individual risk of developing breast cancer. These models can also be used to identify women who might benefit from breast-cancer chemoprevention with tamoxifen or be suitable for entry into trials with new agents. This review article discusses two mathematical models (the Gale model and the Clause model) and their relative strengths in identifying a woman's breast-cancer risk. The Claus model is based mainly on family history, whereas the Gail model also includes simple markers of oestrogen exposure. The authors also explore more sophisticated measures of lifetime oestrogen exposure that can be used to improve the discriminatory ability of these models; they also appraise the four trials of breast-cancer chemoprevention, including the trial that led to the licensing of tamoxifen in the USA. The review concludes with a discussion other agents and interventions that could be used in the future to improve the efficacy and tolerability of breast-cancer risk reduction.
OTHER REVIEWS:
Neoadjuvant and adjuvant therapy for resectable hepatocellular carcinoma: review of the randomised clinical trials
Dynamism of tumour vasculature in the early phase of cancer progression: outcomes from oesophageal cancer research
Informing and involving cancer patients in their own care. Quality of life in patients undergoing systemic therapy for advanced breast cancer.
Beyond futility: to what extend is the concept of futility used in clinical decision-making about CPR?
Journal
The Lancet Oncology