Complete financial disclosures are presented at the end of this article.We especially thank Raul Murillo, MD, MPH; Lennarth Nystr€ om, PhD; and Vahit € Ozmen, MD, FACS for writing and editing.

The Breast Health Global Initiative (BHGI) brought together international breast cancer experts to discuss breast cancer in low resource countries (LRCs) and identify common concerns reviewed in this consensus statement. There continues to be a lack of public and health care professionals' awareness of the importance of early detection of breast cancer. Mastectomy continues to be the most common treatment for breast cancer; and a lack of surgeons and anesthesia services was identified as a contributing factor in delayed surgical therapy in LRCs. Where available, radiation therapy is still more likely to be used for palliation rather than for curative treatment. Tumor receptor status is often suboptimally performed due to lack of advanced pathology services and variable quality control of tissue handling and processing. Regional pathology services can be a cost-effective approach and can serve as reference, training and research centers. Limited availability of medical oncologists in LRCs often results in non-specialist providing chemotherapeutic services, which requires additional supervision and training. Palliative care is an emerging field in LRCs that requires investment in training and infrastructure development. A commitment and investment in the development of breast cancer care services by LRC governments and health authorities remains a critical need in LRCs.

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Organized national mammographic screening has been adopted as the gold standard for breast cancer early detection in western countries; however it may not be the most cost-effective approach to early detection in low and middle income countries (LMC) as it is very demanding in terms of human and financial resources. Moreover, its benefit to harm ratio has been questioned lately, particularly in women <50 years, the age group which produces the majority of breast cancer cases in LMC. In the past few years, evidence about alternatives to mammographic screening that would benefit LMC populations have been produced. They are reviewed and discussed in the present paper, together with evidence about mammographic screening relevant to LMC. Alternative screening tests (clinical breast-exam and self breast-exam) are examined, then the pro- and cons- for various strategies (opportunistic screening, population based screening and clinical downstaging) are discussed.

The overall cost of this program was

Cigarette smoking and snuff (tobacco powder with additives) intake were significantly associated with differentiated NPC but not with undifferentiated carcinoma (UCNT), which is the major histological type of NPC in these populations. As demonstrated by a stratified permutation test and by conditional logistic regression, marijuana smoking significantly elevated NPC risk independently of cigarette smoking, suggesting dissimilar carcinogenic mechanisms between cannabis and tobacco. Domestic cooking fumes intake by using kanoun (compact charcoal oven) during childhood increased NPC risk, whereas exposure during adulthood had less effect. Neither alcohol nor shisha (water pipe) was associated with risk. CONCLUSION: Tobacco, cannabis and domestic cooking fumes intake are risk factors for NPC in western North Africa.

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Previous studies have provided conflicting evidence regarding the association of the serotonin transporter (5-HTT) gene with autism. Two polymorphisms have been identified in the human 5-HTT gene, a VNTR in intron 2 1 and a functional deletion/insertion in the promoter region (5-HTTLPR) with short and long variants. 2 Positive associations of the 5-HTTLPR polymorphism with autism have been reported by two family-based studies, but one found preferential transmission of the short allele 3 and the other of the long allele. 4 Two subsequent studies failed to find evidence of transmission disequilibrium at the 5-HTTLPR locus. 5,6 These conflicting results could be due to heterogeneity of clinical samples with regard to serotonin (5-HT) blood levels, which have been found to be elevated in some autistic subjects. 7-9 Thus, we examined the association of the 5-HTTLPR and VNTR polymorphisms of the 5-HTT gene with autism, and we investigated the relationship between 5-HTT variants and whole-blood 5-HT. The transmission/disequilibrium test (TDT) revealed no linkage disequilibrium at either loci in a sample of 96 families comprising 43 trios and 53 sib pairs. Furthermore, no significant relationship between 5-HT blood levels and 5-HTT gene polymorphisms was found. Our results suggest that the 5-HTT gene is unlikely to play a major role as a susceptibility factor in autism. Molecular Psychiatry (2002) 7, 67-71. DOI: 10.1038/ sj/mp/4000923Family and twin studies indicate that autism is one of the most strongly genetic neuropsychiatric disorders. 10,11 The pattern of recurrence risk among relatives suggests that several interacting genes are likely to underlie susceptibility to autism. 11 Genetic factors predisposing to autism may also confer a risk for a broader phenotype that extends beyond strictly defined autism to include a range of related but milder behavioral deficits. Indeed, cognitive, social, and language impairments are more frequently observed among relatives of autistic probands than among relatives of controls. 12 Similarly, elevated levels of whole blood or platelet serotonin (5-hydroxytryptamine, 5-HT) have been consistently observed in about one third of autistic subjects 7 and in their first-degree relatives, 8,9,13,14 suggesting that hyperserotonemia may be a marker of genetic susceptibility to autism. Other lines of evidence also suggest that a dysregulation in serotonergic neurotransmission might be involved in the pathogenesis of autism. Short-term dietary depletion of the 5-HT precursor tryptophan results in an exacerbation of behavioral symptoms in autistic subjects. 15 Conversely, 5-HT re-uptake inhibitors, which block the re-uptake of 5-HT into the presynaptic neuron by inhibiting the 5-HT transporter (5-HTT), appear to be of some benefit in the treatment of autistic symptoms such as ritualistic behavior and aggression. 16,17 These data suggest that the 5-HTT is a compelling candidate gene for autism.Two common polymorphisms of the 5-HTT gene have been described, a variable number of tandem repeats...