Plasminogen activator is a serine protease which exists in two forms, known as tissue-type plasminogen activator and urokinase-type plasminogen activator. Here, we show that urokinase-type plasminogen activator activity in primary breast carcinomas correlates with both size of tumor and number of axillary nodes with metastases. Patients with primary carcinomas containing high levels of urokinase-type plasminogen activator activity had a significantly shorter disease-free interval than patients with low levels of activity. It is concluded that urokinase-plasminogen activator may be a new prognostic marker in breast cancer.

Almost two-thirds of the palliative care population studied had comorbid psychiatric illness. One-third of these disorders had not been identified or treated appropriately prior to admission. Future research needs to identify effective methods of detecting and diagnosing these disorders to enable early and efficient treatment programmes be initiated.

The process of cancer invasion and metastasis is associated with tissue remodeling (Aznavoorian et al., 1993). It is now widely believed that this process is controlled by different proteases released from the primary cancer. The proteases implicated in cancer progression include urokinase-plasminogen activator (uPA), cathepsins B, D and L and various matrix metalloproteases (MMPs) (for review, see DufFy, 1992;Birkedal-Hansen, 1995). One MMP that may be involved in cancer progression is stromelysin-3 (ST3). ST3 was originally identified using subtractive hybridization of a cDNA library prepared from a human breast cancer (Basset et a/., 1990). In breast and other cancers, ST3 is specifically expressed in fibroblast-like cells immediately surrounding cancer cells (for review, see Basset et al., 1993;Rouyer et al., 1994). While almost all invasive breast carcinomas express mRNA for ST3, expression of this gene was found in only 5% of 21 fibroadenomas, 31% of in situ ductal carcinomas of the non-comedo type and in 61% of in situ ductal carcinomas of the comedo type (Wolf et al., 1993). The latter are the most aggressive sub-type of in situ ductal carcinoma and are characterized by high nuclear grade and necrosis. Furthermore, ST3 expression has been shown to promote the tumor take of breast-cancer cells in nude mice . These findings taken together suggest that ST3 may contribute to breast-cancer progression.

SUMMARYSome patients with advanced cancer express the wish for an early death. This may be associated with depression.We examined the relations between depressive symptoms and desire for early death (natural or by euthanasia or physician-assisted suicide) in 142 terminally ill patients with cancer being cared for by a specialist palliative care team. They completed the Hospital Anxiety and Depression Scale questionnaire and answered four supplementary questions on desire for early death.Only 2 patients expressed a strong wish for death by some form of suicide or euthanasia. 120 denied that they ever wished for early release. The desire for early death correlated with depression scores. Depressive symptoms were common in the whole group but few were on antidepressant therapy.Better recognition and treatment of depression might improve the lives of people with terminal illness and so lessen desire for early death, whether natural or by suicide.

SUMMARYSome patients with advanced cancer express the wish for an early death. This may be associated with depression.We examined the relations between depressive symptoms and desire for early death (natural or by euthanasia or physician-assisted suicide) in 142 terminally ill patients with cancer being cared for by a specialist palliative care team. They completed the Hospital Anxiety and Depression Scale questionnaire and answered four supplementary questions on desire for early death.Only 2 patients expressed a strong wish for death by some form of suicide or euthanasia. 120 denied that they ever wished for early release. The desire for early death correlated with depression scores. Depressive symptoms were common in the whole group but few were on antidepressant therapy.Better recognition and treatment of depression might improve the lives of people with terminal illness and so lessen desire for early death, whether natural or by suicide.