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Contains fulltext : 69403.pdf (Publisher’s version ) (Open Access) INTRODUCTION: Mammographic density is known to be a strong risk factor for breast cancer. A particularly strong association with risk has been observed when density is measured using interactive threshold software. This, however, is a labour-intensive process for large-scale studies. METHODS: Our aim was to determine the performance of visually assessed percent breast density as an indicator of breast cancer risk. We compared the effect on risk of density as measured with the mediolateral oblique view only versus that estimated as the average density from the mediolateral oblique view and the craniocaudal view. Density was assessed using a visual analogue scale in 10,048 screening mammograms, including 311 breast cancer cases diagnosed at that screening episode or within the following 6 years. RESULTS: Where only the mediolateral oblique view was available, there was a modest effect of breast density on risk with an odds ratio for the 76% to 100% density relative to 0% to 25% of 1.51 (95% confidence interval 0.71 to 3.18). When two views were available, there was a considerably stronger association, with the corresponding odds ratio being 6.77 (95% confidence interval 2.75 to 16.67). CONCLUSION: This indicates that a substantial amount of information on risk from percentage breast density is contained in the second view. It also suggests that visually assessed breast density has predictive potential for breast cancer risk comparable to that of density measured using the interactive threshold software when two views are available. This observation needs to be confirmed by studies applying the different measurement methods to the same individuals.

Objective: To evaluate the effects of secondary prevention clinics run by nurses in general practice on the health of patients with coronary heart disease.

Various guidelines have been issued to doctors concerning the treatment of anxiety in primary care and particularly on the use of benzodiazepines. Little has been reported about how this advice has influenced doctors' opinions and practice. This paper describes results of interviews with 15 general practitioners and 15 general practitioner trainees on their management of anxiety problems. Most respondents admitted prescribing benzodiazepines for anxiety but reported doing so only in cases of severe distress and for short periods of time. Trainees appeared more cautious in their use of benzodiazepines than the experienced practitioners. Most doctors agreed, that counselling could be as effective as benzodiazepines in treating moderate anxiety but several respondents felt it too demanding of their time. Two-thirds of doctors were in favour of employing counsellors in general practice though many foresaw practical difflculties in doing so. Increased availability of clinical psychology services was the development which most respondents felt would improve their management of anxiety problems in primary care.