Objective To investigate whether size at birth and rate of fetal growth influence the risk of breast cancer in adulthood. Design Cohort identified from detailed birth records, with 97% follow up. Setting Uppsala Academic Hospital, Sweden. Participants 5358 singleton females born during 1915-29, alive and traced to the 1960 census. Main outcome measures Incidence of breast cancer before (at age < 50 years) and after (> 50 years) the menopause. Results Size at birth was positively associated with rates of breast cancer in premenopausal women. In women who weighed >4000 g at birth rates of breast cancer were 3.5 times (95% confidence interval 1.3 to 9.3) those in women of similar gestational age who weighed < 3000 g at birth. Rates in women in the top fifths of the distributions of birth length and head circumference were 3.4 (1.5 to 7.9) and 4.0 (1.6 to 10.0) times those in the lowest fifths (adjusted for gestational age). The effect of birth weight disappeared after adjustment for birth length or head circumference, whereas the effects of birth length and head circumference remained significant after adjustment for birth weight. For a given size at birth, gestational age was inversely associated with risk (P=0.03 for linear trend). Adjustment for markers of adult risk factors did not affect these findings. Birth size was not associated with rates of breast cancer in postmenopausal women. Conclusions Size at birth, particularly length and head circumference, is associated with risk of breast cancer in women aged < 50 years. Fetal growth rate, as measured by birth size adjusted for gestational age, rather than size at birth may be the aetiologically relevant factor in premenopausal breast cancer.

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Registration of cancer and mortality after the death of a spouse were assessed using data from the longitudinal study of the Office of Population Censuses and Surveys (OPCS). The study population comprised 1% of the people counted in England and Wales in the 1971 census, for whom data on subsequent vital events were linked with their census records. There was little evidence of an increase in registrations of cancer after the death of a spouse and only a slight suggestion of increased mortality from cancer. For other causes of death there was some evidence of increases in mortality during widow(er)hood.In so far as the death of a spouse is often a very stressful event, these data may be interpreted as providing little support for the hypothesis that stress is implicated in the aetiology of cancer.

Injectable contraceptives are a valid option in every family planning program. Contraceptives which are administered every 2 or 3 months, containing only progestogen agents (DepoProvera, Noristerat) have proven efficacious and do not show long-term safety problems. They differ from other contraceptives in their long lasting action and by not presenting the contraindications of the estrogens. Their most prominent side-effect is the irregularity of cyclic bleeding. Although bleeding irregularities are not life threatening, many users stop the treatment for that reason. Monthly contraceptives comprising progestogens and estrogens, maintain or improve the high efficacy of the earlier forms and have the added benefit of allowing bleeding to resemble the physiologic one. This increases acceptability and the continuation rate. There is no long-term inconvenience. At this point, the greatest experience is with the formulation known as Topasel or Perlutal. Other formulations (Cyclofem, Mesigyna) are beginning to be commercialized and their characteristics must still be confirmed through daily use. Indications, contraindications, precautions and warnings for the use of monthly injectable contraceptives are basically identical to those of the combined oral contraceptives, as are the side-effects. Efficacy, though, proves to be superior, which can be correlated to a simpler method of use and less risk of error when using it. Main motivation factors are: efficacy, simplicity in usage, reversibility and confidentiality.