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.

Summary Parental smoking data have been abstracted from the interview records of the case-control study that first indicated that pregnancy radiographs are a cause of childhood cancer (Oxford Survey of Childhood Cancers, deaths from 1953 to 1955). Reported smoking habits for the parents of 1549 children who died from cancer were compared with similar information for the parents of 1549 healthy controls (matched pairs analysis). There was a statistically significant positive trend between paternal daily consumption of tobacco and the risk of childhood cancer (P < 0.001). This association could not be explained by maternal smoking, social class, paternal or maternal age at the birth of the survey child, sibship position or obstetric radiography. About 15% of all childhood cancers in this series could be attributable to paternal smoking.Keywords: childhood cancer; smoking; case-control study A recent review of the published literature on childhood cancer risks and parental use of tobacco concluded that 'the associations between maternal smoking during pregnancy and childhood cancer have been studied intensively, but there is no clear association overall, or for specific sites' (Tredaniel et al, 1994). The review also summarized information on paternal smoking from 13 case-control studies. Many of these studies were small in size and a total of only 1953 childhood cancers (varying diagnostic groups) formed the combined case series. The review concluded that no clear associations have been identified'.A further four case-control study reports (additional combined series of 2772 cases) are now available, which include information on paternal smoking and childhood cancer risks (Severson et al, 1993;Shu et al, 1994Shu et al, , 1996Sorahan et al, 1995). No association was found with maternal smoking in any of these reports but, in three of them, positive associations were found for paternal smoking (Shu et al, 1994Sorahan et al, 1995). In the largest of these studies, reported consumptions of alcohol and tobacco for the parents of 1641 children who died from cancer in England and Wales during the period 1977-81 were compared with similar information for the parents of 1641 healthy control children (Sorahan et al, 1995). These data were obtained from the interview records of the Oxford Survey of Childhood Cancers (OSCC) and relations between maternal consumption of cigarettes and birth weights indicated that the (maternal) smoking data were equally reliable for case and control parents. For mothers, consumption of cigarettes was not shown to be associated with an increased risk of childhood cancer, whereas there was a statistically significant positive trend (P < 0.001) between daily consumption of cigarettes by fathers and childhood cancer risks. Earlier OSCC data have, therefore, been revisited to seek further information on this topic.

Objective To determine whether obstetric and maternal factors relate to faecal incontinence at three months postpartum.Setting Maternity units in Aberdeen (Scotland), Birmingham (England) and Dunedin (New Zealand).Population All women who delivered during one year in the three maternity units.Methods Postal questionnaire at three months postpartum, to obtain information on faecal incontinence, linked to obstetric casenote data. Main outcome measures Prevalence of faecal incontinence.Results 7879 questionnaires were returned, a 71.7% response rate. The prevalence of faecal incontinence was 9.6%, with 4.2% reporting this more often than rarely. Logistic regression, con®ned to primiparae, showed that forceps delivery was a predictor of an increased risk of symptoms (OR 1.94, 95% CI 1.30 to 2.89) while vacuum extraction was not associated. Caesarean section was marginally associated with a reduced risk (OR 0.58, 95% CI 0.35 to 0.97). Older maternal age, Indian sub-continent ethnic origin and body mass index`not known' also showed signi®cant associations. No associations were found for induced labour, duration of second stage labour, episiotomy, laceration or birthweight. Conclusions Women delivered by forceps had almost twice the risk of developing faecal incontinence, whereas vacuum extraction was not associated with faecal incontinence at three months postpartum. Caesarean section appears to offer some protection.

Objectives To investigate persistent faecal incontinence (FI) 12 years after birth and association with delivery mode history and quality of life.Design Twelve-year longitudinal study.Setting Maternity units in Aberdeen, Birmingham and Dunedin.Population Women who returned questionnaires 3 months and 12 years after index birth.Methods Data on all births over 12 months were obtained from units and women were contacted 3 months, 6 years and 12 years post birth.Main outcome measure Persistent FI, defined as reported at 12 years and one or more previous contacts. SF12 assessed quality of life.Results Of 7879 women recruited at 3 months, 3763 responded at 12 years, 2944 of whom also responded at 6 years: nonresponders were similar in obstetric factors. Prevalence of persistent FI was 6.0% (227/3763); 43% of 12-year responders who reported FI at 3 months also reported it at 12 years. Women with persistent FI had significantly lower SF12 scores. Compared with only spontaneous vaginal deliveries, women who had one or more forceps delivery were more likely to have persistent FI (odds ratio [OR] 2.08, 95% confidence interval [95% CI] 1.53-2.85) but it was no less likely with exclusively caesarean births (OR 0.93, 95% CI 0.54-1.58). More obese women than normal weight women reported persistent FI (OR 1.52, 95% CI 1.06-2.17).Conclusions This longitudinal study has demonstrated persistence of FI many years after birth and shown that one forceps birth increased the likelihood, whereas exclusive caesarean birth showed no association. Obesity, which increased symptom likelihood, is a modifiable risk factor.

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