Spain had one of the lowest breast cancer mortality (BCM) rates in Europe a decade ago but this is no longer the case. A study of the trends of breast cancer mortality in Spain during the last 30 years, and an analysis, at the ecological level, of the current and past dietary patterns associated with breast cancer mortality have been conducted. Age standardized rates and standardized mortality rates (SMR) for this period were calculated. Dietary information about 20 different groups of foods for the 50 Spanish provinces was obtained from two National Household Budget and Expenditure Surveys, conducted in 1964-1965 and 1980-1981. Simple correlation coefficients were calculated, and multiple regression (dependent variables: BCM and breast cancer SMR) with a stepwise procedure was performed. Trends of breast cancer mortality in Spain for the last 35 years indicated a 100% increase in the 35-64 years group. Results indicate important changes in food consumption patterns in Spain, departure from the traditional Spanish diet, and the association of breast cancer mortality with past (15 years period) consumption of beef and total meat and the current consumption of vegetable oils, among other features of interest. Past consumption of meat and particularly beef meat seems to be associated with current breast cancer mortality rates in Spain. However, results at ecological level need to be confirmed in individuals.

Objective-To evaluate the adequacy of reporting of results of necropsy to referring clinicians and to general practitioners. Design-Questionnaire survey of referring clinicians and general practitioners of deceased patients in four districts in North East Thames region. Patients were selected by retrospective systematic sampling of 50 or more necropsy reports in each district. Setting-One teaching hospital, one inner London district general hospital, and two outer London district general hospitals. Participants-70 consultants and 146 general practitioners who were asked about 214 necropsy reports; coroners' reports were excluded. Main outcome measures-Time taken for dispatch of final reports after necropsy, consultants' recognition of the reports, general practitioners' recognition of the reports or of their findings, and consultants' recall of having discussed the findings with relatives. Results-Only two hospitals dispatched final reports including histological findings (mean time to dispatch 144 days and 22 days respectively). 42 (60%) consultants and 83 (57%) general practitioners responded to the survey. The percentage of reports seen by consultants varied from 37% (n= 13) to 87% (n=36); in all, only 47% (39/83) of general practitioners had been informed of the findings by any method. Consultants could recall having discussed findings with only 42% (47/112) ofrelatives. Conclusions-Communication of results of necropsies to hospital clinicians, general practitioners, and relatives is currently inadequate in these hospitals. Implications and action-A report of the macroscopic findings should be dispatched immediately after necropsy to clinicians and general practitioners; relatives should routinely be invited to discuss the necroscopic findings. One department has already altered its practice.

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