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Question Under Study: Physicians play a key role in motivating women to undergo mammography screening. In 1998 we assessed Swiss physicians' attitudes to mammography screening and their prescription behaviour in this regard., Methods: All female physicians and every second male physician aged 50-69 who were either not board-certified or board-certified in general practice, internal medicine, or obstetrics/gynaecology were sent a questionnaire. The response rate was 50% and thus 738 questionnaires were included in this study. Of the study population 39% were female and 61% male physicians. The distribution of professional backgrounds was: 27% board-certified general practitioners; 23% board-certified internists; 11% board-certified gynaecologists; 39% not board-certified., Results: 55% of all study participants were in favour of a mammography screening programme for women aged over 50 in Switzerland, but breast self-examination and clinical breast examination were judged to have a more positive impact on breast cancer survival. Among clinically practising physicians, 22% reported generally prescribing biannual screening mammographies for women aged 50-69. Irrespective of other determinants, physicians from the Italian- and French-speaking parts of Switzerland prescribed screening mammographies more often than their colleagues from the German-speaking part (odds ratio [OR] 2.5; 95% confidence interval [CI] 1.5-4.2). Clinical practice in obstetrics/gynaecology (OR 2.4; CI 1.3-4.2) and a self-reported high level of knowledge concerning mammography screening (OR 1.9; CI 1.1-3.2) were also positively associated with the prescription of screening mammography., Conclusions: Since mammography screening programmes exist in only three French-speaking cantons of Switzerland (VS; VD; GE), the gap in prescription of screening mammographies between French/Italian- and German-speaking regions must be narrowed to prevent a higher prevalence of side effects from opportunistic screening among German-speaking women. There is a need to educate physicians and the political community regarding the risks and benefits of mammography screening.

We conducted a large, sigmoidoscopy-based case-control study to examine the relation of intake of macronutrients, meat, and fiber to occurrence of adenomas of the large bowel. Cases were subjects diagnosed for the first time with one or more histologically confirmed adenomas. Controls had no polyps of any type at sigmoidoscopy, had no history of polyps, and were individually matched to cases by gender, age, date of sigmoidoscopy, and Kaiser Center. The response rate was 84% for cases and 82% for controls. Complete dietary data for 488 matched pairs were available. All odds ratios are from matched analyses adjusted for energy. We observed positive associations with risk of adenomas for calories, animal fat, saturated fat, red meat, and the ratio of red meat to poultry and fish. Protective effects were observed for vegetable protein, carbohydrates, and dietary fiber. The fiber effects diminished after adjusting for fruits and vegetables. Results after mutually adjusting for the effects of saturated fat, fiber and the ratio of red meat to chicken and fish suggest that each of these variables has an effect on risk of adenomas that is independent of the other 2 exposures.

Data sparseness currently limits gene-environment interaction estimation. To improve effect estimates of gene-environment interactions, we give an overview of one approach, hierarchical modeling, and propose a two-stage hierarchical model. The first stage is a logistic model for the joint effects of the genetic and environmental factors. The second stage regresses the joint effects on genotype-specific enzymatic activity of the environmentally derived substrate. The model is illustrated using a case-control study of adenomas of the large bowel, for which NAT2 genotype and dietary data were collected. The first-stage interactions of dietary components and genotype were regressed on initial conversion rates of dietary heterocyclic amines to aryl nitrenium ions. We fit the hierarchical model by penalized likelihood. Compared to effect estimates from maximum-likelihood logistic regression, hierarchical results are more reasonable and precise. These results lend further support to previous observations that hierarchical regression is preferable to ordinary logistic regression when multiple factors and their interactions are being studied. We propose that hierarchical modeling can act as a bridge between molecular epidemiology studies and laboratory data, combining both efficiently.

Lead concentration in whole blood of a representative sample of 471 subjects aged 20 to 74 years and living in Basle was determined in 1989/90 by flame atomic absorption spectrophotometry. The participants in the cross-sectional study filled in a questionnaire on demographic factors, nutrition and drinking habits. The age-adjusted geometrical mean blood lead level was 0.38 +/- 0.19 mumol/litre of whole blood for males, and 0.29 +/- 0.17 mumol/litre for females. The average lead burden was about 30% below the mean concentration found in a comparable population in Western Switzerland five years earlier. Lead emissions in Switzerland decreased by about 40% from 1984 to 1990 through restriction of lead in petrol. This offers the most plausible explanation for the low blood lead levels found in Basle. Sex, age, occupation (employment in painting or printing, construction or the metal processing industry), smoking and alcohol intake (especially wine consumption) were identified as independent blood lead predictors in a multiple linear regression analysis. Participants who consumed alcohol daily had blood lead concentrations on average 12% higher than those of abstinent subjects. Regular smokers had an unconfounded average blood lead level 8% above that of people who never smoked. Place of residence and hourly frequency of cars in that area were not identified as independent predictors in the model. The analysis of 99 different wines on the market in Basle showed an average lead concentration of 50 +/- 17 micrograms/litre wine. Compared to an estimated 25 micrograms daily nutritional intake of lead in Switzerland the value appeared to be high.(ABSTRACT TRUNCATED AT 250 WORDS)