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A total of 112 white females residents of King County, Washington, aged 35-54 years, who had received a first diagnosis of invasive breast cancer between July 1977 add August 1978, were investigated concerning prior use of oral contraceptives. Their responses were compared with those of a random sample of 469 demographically comparable women from the same population. Overall, oral contraceptive use in cases and controls was similar. However, use of oral contraceptives in preparous women was more common among cases than controls, with the estimated risk of breast cancer associated with such use being 2.2 times that of nonusers (90% confidence interval = 1.1-4.6). This relationship could be explained only in part by the effect of oral contraceptives in postponing or preventing childbirth. The association of breast cancer with use of oral contraceptives prior to ever giving birth has been observed in three studies, including this one, suggesting that the susceptibility of breast tissue to hormonal factors that influence the development of malignancy may be altered by having been exposed to the events of pregnancy.

The effect of duration of symptoms and other prognostic factors on survival was studied by interview using a population-based sample of 154 colorectal cancer patients. The authors found that symptom durations of up to approximately one year before diagnosis had no effect on survival. In addition, it was found that the total number of symptoms was a statistically significant predictor of survival, although no single symptom had a significant effect. Stage, sex, and site also were found to be significant predictors of survival, whereas age, socioeconomic status, and other factors were not predictive.

The clinical management of pain could be improved if more were known about the intensity and duration of the pain. The cancer patient, however, is often unable to communicate this information to caregivers. Relying on next-of-kin to provide information about the patient's pain could help, but little has been done to verify next-of-kin responses with respect to subjective experiences. For the present study 42 pairs of cancer patients and their next-of-kin were independently surveyed in 1982 in Washington state regarding their cancer pain and various aspects of medical treatment to determine whether proxies can give reliable responses. Close agreement between subject and next-of-kin was observed for the items which were salient and had a limited choice of responses, such as the presence of pain. Agreement in the aggregate was achieved for the items having several possible responses, such as the intensity and frequency of pain. Correspondence was virtually random for those items which had a variety of listed responses. The use of proxies in obtaining information, future research directions, and difficulties with measuring agreement are discussed.

The relationship between the occurrence of female breast cancer and menopausal estrogen replacement was investigated in a population-based case-control study. One hundred and eighty-three white female residents of King County, Washington (ages 50-74) in whom breast cancer was diagnosed from July, 1977, through August, 1978, were interviewed with respect to reproductive and other factors, with emphasis on the use of estrogen-containing medication. For purposes of comparison, the same data were collected from 531 white female King County residents of the same ages without breast cancer. Use of menopausal estrogens was reported somewhat more commonly among controls than among cases (relative risk = 0.74, 95% confidence interval = 0.51-1.08) and some variation in proportions of users was present between different hysterectomy-oophorectomy subgroups. However, each of these differences could easily have been due to chance. No substantial trends in risk were apparent with increasing duration of use, time since first use, time since last use, or average dose. The findings suggest that in King County no important relationship exists between use of menopausal estrogens and the occurrence of breast cancer.

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