Objective To examine whether anti-inflammatory drug treatment protects against the commoner cancers in the United Kingdom. Design Case-control study using the general practice research database. Setting Practices throughout United Kingdom providing data to the database. Subjects Patients who had a first diagnosis of five gastrointestinal (oesophagus, stomach, colon, rectum, and pancreas) cancers and four non-gastrointestinal (bladder, breast, lung, and prostate) cancers in 1993-5 for whom prescription data were available for the at least the previous 36 months. Each case was matched for age, sex, and general practice with three controls. Main outcome measure Risk of cancer. Results In 12 174 cancer cases and 34 934 controls overall risk of the nine cancers was not significantly reduced among those who had received at least seven prescriptions in the 13-36 months before cancer diagnosis (odds ratio 0.98, 95% confidence interval 0.89 to 1.07). Findings were nevertheless compatible with protective effects from anti-inflammatory drugs against cancers of the oesophagus (0.64, 0.41 to 0.98), stomach (0.51, 0.33 to 0.79), colon (0.76, 0.58 to 1.00), and rectum (0.75, 0.49 to 1.14) with dose related trends. The risk of pancreatic cancer (1.49, 1.02 to 2.18) and prostatic cancer (1.33, 1.07 to1.64) was increased among patients who had received at least seven prescriptions, but the trend was dose related for only pancreatic cancer. Conclusions Anti-inflammatory drugs may protect against oesophageal and gastric cancer as well as colon and rectal cancer. The increased risks of pancreatic and prostatic cancer could be due to chance or to undetected biases and warrant further investigation.

Objectives-To investigate whether there is an excess of leukaemias in 0-15 year old children among those living in close proximity (within 100 m) of a main road or petrol station. Methods-Data for 0-15 year old children diagnosed between 1990 and 1994 in the United Kingdom West Midlands were used. Postcode addresses were used to locate the point of residence which was compared with proximity to main roads and petrol stations separately, and to both together. Odds ratios (ORs) were calculated with solid tumours as a control, and incidence ratios (IRs) with population density as a control. Results-The method based on solid tumours as a control showed ORs of 1.61 (95% confidence interval (95% CI) 0.90 to 2.87) and 1.99 (95% CI 0.73 to 5.43), for those living within 100 m of a main road or petrol station respectively. When population was used as a control, the estimated IRs for leukaemia were 1.16 (95% CI 0.74 to 1.72) and 1.48 (95% CI 0.65 to 2.93) for residence within 100 m of a main road or petrol station respectively, but neither reached significance at the 95% level. Results for residence in close proximity to both a main road and petrol station were inconsistent, but there were few. The influence of socioeconomic factors as represented by the Townsend deprivation index on leukaemia incidence was not significant and the results were not explicable on the basis of impact of social class. Conclusions-The results are suggestive of a small increase in risk of childhood leukaemia, but not solid tumours, for those living in close proximity to a main road or petrol station. This increase in risk is not, however, significant and a larger study is warranted to establish the true risk and causes of any increase in risk. (Occup Environ Med 1999;56:774-780)

Pharmacovigilance is an essential element of any drug treatment and considering the history of adverse events due to products used to treat inherited bleeding disorders, it should be an integral component of modern haemophilia treatment. Because inherited bleeding disorders and adverse events are rare, a multicentre, preferably multinational, adverse event reporting scheme for all clotting factor products is required. EUHASS is a European, prospective, multicentre adverse event reporting scheme in the field of inherited bleeding disorders.

Study objectives -Firstly, to examine relationships between the birth and death addresses of children dying from leukaemia and cancer in Great Britain, and the sites of potential environmental hazards; and secondly to measure relative case densities close to, and at increasing distances from, different hazard types. Design -Home address postcodes (PCs) and their map coordinates were identified at birth and at death in children who died from leukaemia or cancer. Potentially hazardous industrial addresses and PCs were listed from business and other directories, and map coordinates obtained from the Central Postcode Directory or else located directly on Ordnance Survey (OS) maps. Railway lines and motorways were digitised from OS maps. Numbers of deaths (and births) at successive radial distances from these hazards were counted and compared with expected numbers. The latter were based on a count of all PCs at similar distances. Relative case density ratios at successive distances from the hazards were obtained from observed and expected numbers, aggregated over similar sites. This was repeated for different hazard types and results were tested for evidence of systematic centrifugal case density gradients. Participants and setting -All 22 458 children dying from leukaemia or cancer aged 0-15 years, in England, Wales, and Scotland, between 1953 and 1980. Main results -Relative excesses of leukaemias and of solid cancers were found near the following: (1) oil refineries, major oil storage installations, railside oil distribution terminals and factories making bitumen products; (2) motor car factories, coach builders, and car body repairers; (3) major users of petroleum products including manufacturers of solvents, paint sprayers, fibreglass fabricators, paint and varnish makers, plastics and detergent manufacturers, and galvanisers; (4) users ofkilns and furnaces including steelworks, power stations, galvanizers, cement makers, brickworks, crematoria and aluminium, zinc, and iron/steel foundries; (5) airfields, railways, motorways and harbours. The findings for leukaemias and for solid cancers were indistinguishable. The hazard proximities ofbirth addresses were stronger than for death addresses. For children who had moved house between birth and death, the proximity effect was limited to the birth addresses. Conclusions -Childhood cancers are geographically associated with two main types ofindustrial atmospheric effluent namely: (1) petroleum derived volatiles and (2) kiln and furnace smoke and gases, and effluents from internal combustion engines. Our previous studies showed that childhood leukaemias and cancers occurred in small geographical clusters.'2 Among 9411 childhood registrations of leukaemia and lymphoma in Great Britain between 1966 and 1983, for whom we knew the residential postcode (PC) coordinates, there were 264 case pairs/triplets who were separated by less than 150 m; and in England and Wales there were 520 registration pairs who shared a common census enumeration district (ED). Among 22 458...