Background:During 2001 to 2005, 1-year breast cancer survival was low in ethnically diverse East London. We hypothesised that this was due to low breast cancer awareness and barriers to symptomatic presentation, leading to late stage at diagnosis in women from ethnic minorities. We examined ethnic differences in breast cancer awareness and barriers to symptomatic presentation in East London.Methods:We carried out a population-based survey of 1515 women aged 30+ using the Cancer Research UK Breast Cancer Awareness Measure. We analysed the data using logistic regression adjusting for age group and level of deprivation.Results:South Asian and black women had lower breast cancer awareness than white women. South Asian women, but not black women, reported more emotional barriers to seeking medical help than white women. White women were more likely than non-white women to report worry about wasting the doctor's time as a barrier to symptomatic presentation.Conclusion:Interventions to promote early presentation of breast cancer for South Asian and black women should promote knowledge of symptoms and skills to detect changes, and tackle emotional barriers to symptomatic presentation and for white women tackle the idea that going to the doctor to discuss a breast symptom will waste the doctor's time.

The influence of smoking and social class on dietary intake in pregnancy was investigated in a random sample of smokers (greater than or equal to 15 cigarettes/d) and nonsmokers. A total of 206 subjects (94 smokers and 112 nonsmokers) completed a 7-d weighed dietary intake at 28 wk gestation and 178 completed a second assessment at 36 wk. Nonsmokers had higher intakes of almost all nutrients than did smokers and the nutrient density of their diet was greater. Energy intake was nonsignificantly higher in nonsmokers. Women in higher social classes had the highest nutrient intakes. Smokers were shorter than nonsmokers and tended to be of lower social class. After maternal height and social class were controlled for, smoking had a significant effect on intake of many micronutrients. Dietary intake was reduced in late pregnancy, particularly in smokers. These data suggest that smokers in all social classes have a poorer quality of diet.

~_ _The relationship between nutrient intake and pregnancy outcome (adjusted birth weight and gestational age) was investigated in randomly selected non-smokers (n 97) and in heavy smokers (15 + cigarettes/d) (n 72) booking for ante-natal care at a hospital in South London. Weighed dietary intakes (7 d) were obtained at 28 and 36 weeks gestation. Birth weight was adjusted for gestational age, maternal height, parity and sex of infant.Compared with non-smokers, intakes of micronutrients and fibre were lower in smokers at both 28 and 36 weeks, and smokers reduced their intakes more in late pregnancy. The babies of smokers had a lower adjusted birth weight but there was no difference in length of gestation between smokers and nonsmokers. After controlling for smoking, social class and alcohol consumption, nutrient intakes a t 28 weeks were found to have no effect on adjusted birth weight. However, intakes of protein, zinc, riboflavin and thiamin at 36 weeks, and the change in intakes of these nutrients (plus iron) between 28 and 36 weeks, had independent positive effects on birth weight. Some of the effect of smoking on birth weight appeared to be mediated through differences in nutrient intakes. Smoking explained 14.3 YO of the variance in birth weight in this population and a further 24-7.2 YO was explained by change in nutrient intakes between 28 and 36 weeks. It is recommended that women in pregnancy do not reduce their dietary intakes in late pregnancy.

This study investigated the effects of smoking and alcohol consumption in pregnancy on length, head circumference, upper arm circumference and ponderal index, of neonates born to 1513 Caucasian women who delivered at St George's Hospital, south London. All measurements were adjusted for gestational age, maternal height, parity and sex of infant. Babies of smokers were shorter, had lower ponderal index and smaller upper arm circumference than those of non-smokers. After controlling for alcohol consumption, these differences remained (but with reduced statistical significance). There was no statistically significant difference in head circumference between smokers and non-smokers. Alcohol consumption at booking had no effect on growth measurements in non-smokers but had a significant, negative effect on all measurements in smokers. Drinking later in pregnancy had less effect. Alcohol appears to enhance the growth-retarding effect of smoking. It is suggested that both smoking and alcohol also have an inhibitory effect on fat deposition in babies, which contributes to the reduction in birthweight associated with smoking and drinking.