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Follow-up colonoscopies in patients with adenomas should include careful examination of the proximal colon. The time interval between follow-up examinations could probably be extended beyond three years in patients who have only one or two distal adenomas.

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Knowledge of factors related to the use of preventive practices is essential in order to build strategies to decrease cancer incidence and mortality. The aim of this study is to describe the characteristics of women who periodically use cervical smear and mammography. This is a cross-sectional study based on the 2001 Balearic Health Survey, using a stratified sample of non-institutionalized population resident in the Balearic Islands. The study included 560 women, aged 20 years or over. The variables studied were age, marital status, social class, education, place of residence and birth, self-perceived health status, satisfaction with health services, job status and type of medical coverage. A multivariate analysis was performed using logistic regression models. Thirty-five per cent had regular mammography (72% between 50 and 64 years) and 54% had cervical smears. The probability of having undergone mammography is higher in women between the ages of 50 and 64 years [odds ratio (OR)=11.74; interval confidence (IC): 5.89-23.39] and in those with additional medical coverage (OR=1.97; IC: 1.19-3.27) and much lower in single women (OR=0.22; IC: 0.10-0.49). The probability of having undergone a Pap test increases according to educational level (OR=2.25; IC: 0.98-5.18 for women in the higher level) and social class (OR=1.98; IC: 0.91-4.28 for social class I) and decreases in women older than 65 years (OR=0.15; IC: 0.07-0.35) and in single women (OR=0.29; IC: 0.16-0.50). Age and marital status are factors related to both practices. Socio-economic status remains associated with cervical smear use, while having an additional medical coverage increases the probability of regular mammography.

A case-control study on dietary factors and colorectal adenomas was conducted in the island of Majorca, Spain, from April 1987 to February 1990. Subjects were interviewed using a food frequency questionnaire. Nutrient and caloric intake was estimated using local food composition tables. The risk of colorectal adenomas was related to the consumption of sugar and pastries. Consumption of vegetables was highly protective, irrespective of the cooking procedures. Analyses by nutrients identified as protective factors ftber from fruits and vegetables, magnesium and zinc, and vitamins C, B, and folk acid. No excess risk was found for alcohol drinking, intake of saturated fats or animal protein. Of the non-dietary factors, sedentariness in the workplace and urban residence were the only risk factors identified.o 1993 Wiley-Liss, Inc.Neoplastic transformation of the colonic mucosa is accepted as a multi-stage process involving celI proliferation, adenoma formation and growth, malignant transformation and invasion (Fearon and Vogelstein, 1990). Host genetic factors have been reported to be related to the neoplastic process (Vogelstein et aZ., 1988) and epidemiological studies have identified dietary risk factors for colorectal cancer and adenomas. However, it remains uncertain which dietary factors are relevant in each of the proposed intermediate stages and it has been suggested that different factors might operate in each step in the neoplastic process (Hill et al., 1978;Faivre and Boutron, 1991; Cannon-Albright et al., 1988). In the US, a prospective study on adenomas of the left colon and rectum in males revealed an increased risk associated with diets rich in saturated fats and low in fiber, with a strong protective effect of fiber irrespective of food source (Giovanucci et al., 1992). These results are consistent with the hypothesis that the same dietary factors operate in colorectal cancer and in its precursors. Meat consumption, one of the commonest described risk factors for colorectal cancer, has been linked to a lower risk of colonic adenoma in Japan (Kato et al., 1990) and to a high risk in the US (Neugut et al., 1993;Giovannucci et al., 1992).Increased risk of colonic adenomas has been linked to the consumption of sugar and sweets (Macquart-Moulin et al., 1987) and cheese (Neugut et al., 1993) and a reduction in risk has been linked to high consumption of potatoes and oil (Macquart-Moulin et al., 1987), fish (Kato et al., 1990), and fruit and vegetables (Giovannucci et al., 1992;Hoff et al., 1986; Kato et al., 1990; Neugut et al., 1993). Several studies have reported an increased risk linked to alcohol consumption (Kikendall et al., 1989;Stemmermann et al., 1988; Kato et al., 1990;Kono et al., 1990; Cope et al., 1991), although the effect has not been found consistently (Giovannucci et al., 1992; Riboli et al., 1991).Studies on dietary risk factors for colorectal adenomas serve the double purpose of describing the dietary factors involved in stages of the continuum from normal mucosa to cancer and of p...

BackgroundPrimary health care (PHC) professionals play a key role in population screening of colorectal cancer. The purposes of the study are: to assess knowledge and attitudes among PHC professionals with regard to colorectal cancer screening, as well as the factors that determine their support for such screening.MethodsQuestionnaire-based survey of PHC physicians and nurses in the Balearic Islands and in a part of the metropolitan area of Barcelona.ResultsWe collected 1,219 questionnaires. About 84% of all professionals believe that screening for colorectal cancer by fecal occult blood test (FOBT) is effective. Around 68% would recommend to their clients a colorectal cancer screening program based on FOBT and colonoscopy. About 31% are reluctant or do not know. Professionals perceive the fear of undergoing a colonoscopy as the main obstacle in getting patients to participate, and the invasive nature of this test is the main reason behind their resistance to this program. The main barriers to support the screening program among PHC professionals are lack of knowledge (nurses) and lack of time (physicians). On multivariate analysis, the factors associated with reluctance to recommend colorectal cancer screening were: believing that FOBT has poor sensitivity and is complicated; that colonoscopy is an invasive procedure; that a lack of perceived benefit could discourage client participation; that only a minority of clients would participate; thinking that clients are fed up with screening tests and being unaware if they should be offered something to ensure their participation in the programme.ConclusionsTwo in every three PHC professionals would support a population screening program for colorectal cancer screening. Factors associated with reluctance to recommend it were related with screening tests characteristics as sensitivity and complexity of FOBT, and also invasive feature of colonoscopy. Other factors were related with patients' believes.

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