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In this analysis, data in relation to 259 breast malignancies detected on first round screening at the Royal Women's Hospital Breast Screening Clinic (RWHBSC), Brisbane, in the first 6 years of its function, is reviewed. A reduction in recall rate was noted when two-view mammography was adopted as the method of screening over single-view mammography plus physical examination, which was practised for the first 2 years of the Clinic's operation. The parameters of clinic performance, including a recall rate of 9.1%, an open surgical biopsy rate of 1.5%, a benign to malignancy biopsy ratio of 1.1:1, a cancer detection rate of 7.1 cancers per 1000 women screened, and a cancer detection rate for tumours

The clinical stage at presentation of 280 women with histologically proven breast cancer is reviewed over a 25 year time span from 1962 to 1987. The data from 240 unscreened patients, including 87 women from the period 1962 to 1963, 103 women from 1981 to 1982, and 50 women from 1986 to 1987 demonstrate a chronologically based improvement in the stage of disease at presentation over the 25 years. Specifically, over that period, there was a fall in the mean tumour diameter, a reduction in the proportion of patients with involved axillary nodes, and a greater percentage of patients with Stages I and II disease. A reduction in the symptomatic period was also noted over this time, and a direct relationship was found between the duration of symptoms and tumour size, nodal status and overall stage of disease. A subsequent comparison with the staging data from 40 women with breast cancer detected at a breast screening clinic (1985-87) shows that significant further advances in the earlier diagnosis of breast cancer can be achieved. Mammographic breast screening centres represent the best-known means of early breast cancer detection, and thus may hold the key to reducing breast cancer mortality.

It has been suggested that the percentage of non-protein-bound or free oestradiol (E2) is abnormally high in patients with breast cancer. In this study, the serum oestradiol profiles of a large group of women were analysed to determine whether a significant correlation could be found between serum oestradiol and various breast diseases. In addition oestradiol levels were measured in relation to sex hormone binding globulin (SHBG), albumin levels, oestrogen receptor status and family history of breast cancer. Serum samples were taken from a total of 300 women who had either no breast disease, benign breast disease or breast cancer. The percentage of free oestradiol was found to be highest in women with breast cancer, lowest in the control group and intermediate for the women with benign breast disease. These differences were most marked in post-menopausal women. The absolute values for total and free oestradiol were not statistically different in the three groups studied. There did not appear to be a correlation between oestrogen receptor (ER) concentration in breast cancer tissue and free E2 percentage levels. Women who had a family history of breast cancer did not appear to have higher percentage levels of free E2 than those with no such history. The presence of elevated proportions of free oestradiol in the serum of women with breast cancer may be significant in regard to understanding the aetiology of breast neoplasia. There also may be important implications for the use of this measurement in the earlier diagnosis and detection of breast cancer.

When an abnormality is detected in a mammogram the following questions should be answered: 1. Does a significant abnormality exist, that is, is the abnormality present in at least two views? 2. Should special imaging techniques, such as ultrasound, be used? 3. What is the conclusion of the radiologist? 4. Is the radiological abnormality clinically palpable? 5. Is the opinion of a breast specialist required? 6. Can fine needle aspirations cytology of the area be performed accurately and without trauma? 7. Should biopsy be undertaken? By posing these questions in sequence and obtaining firm answers, small cancers should not be missed and the biopsy rate will be kept to an acceptably low level.

There is some evidence that postoperative deep vein thrombosis (DVT) may be commoner in cool than in warm climates. To determine whether this complication is less common in the subtropical climate of Brisbane than in more temperate locations, the incidence of DVT after major abdominal surgery was assessed by 125I fibrinogen scanning. In order to avoid overestimating the incidence of DVT, abnormal scans were accepted as diagnostic only if the DVT was confirmed by venography or if the abnormality on the scan fulfilled more stringent criteria than have previously been applied. Thirty-six of 152 patients (24 per cent) developed a DVT; this incidence was significantly lower than in one previous study from Melbourne and higher than that found in South-East Asia and East Africa, but was not significantly different from that reported from Sydney, Japan and several centres in North America and Britain. There was no apparent seasonal variation in the incidence of the complication. The geographical variation in incidence of postoperative DVT may have been overestimated in previous reports and may be at least partly due to variations in screening technique.

Summary Four cases illustrating aspects of multiple keratoacanthoma syndromes are reported. One patient with the classical picture of the familial Ferguson Smith variety provided an additional example of an affected family from Glasgow where the majority of the early cases were studied. The second patient displayed striking susceptibility to the effect of minor trauma in provoking new tumours and provided a unique model for the observation of the development of Keratoacanthoma. The third patient demonstrated complete disappearance of tumours during an episode of exfoliative dermatitis. The fourth patient provided an example of the interaction of nodular neurodermatitis and multiple keratoacanthomas.

Investigation in the postoperative period of 75 patients by means of the radioiodinated fibrinogen uptake method, by the use of the Doppler ultrasonic flow detector, and by clinical assessment revealed an incidence of deep vein thrombosis of only 12%. This is distinctly lower than has been reported by other investigators using the same techniques both in Australia and elsewhere. It appears from this study and associated work that the Doppler ultrasonic technique is sufficiently accurate to be of value in the clinical diagnosis of significant deep vein thrombosis.