In December, 1963, the Health Insurance Plan of Greater New York (HIP), in cooperation with 23 of its 31 affiliated medical groups, launched a large-scale screening program to determine whether periodic breast cancer screening with mammography (soft-tissue X ray) and clinical examination holds substantial promise for lowering mortality from breast cancer in the female population.Two stratified random samples of about 31,000 women aged 40-64 with at least one year's membership in HIP were selected from the enrollees of these 23 medical groups. One sample is designated as the "study" group, the other the "control" group. Study group women were offered an initial screening examination and three follow-up reexaminations at annual intervals except for those women found to have breast conditions requiring earlier follow-up.A total of 31,092 study women were invited to take part in the initial screening examination, and 20,211 or 65 per cent were examined. Examinations were given at the medical group center where the women were enrolled. Women who did not have the initial screening examination 328 A.J.P.H. MARCH, 1972 were not asked to participate in the annual reexaminations, although they continued to be followed for the full study period for the detection of breast cancer outside the program and for mortality.Nearly half of all the study women, including participants and non-participants were between the ages of 40 and 49, and more than 90 per cent of them were married at the time of the initial examination or had been married at some time. About 30 per cent had at least some college training and 47 per cent had completed high school. Twentynine per cent were Protestant, 38 per cent Catholic and 33 per cent Jewish. About 20 per cent of the women in the study group were black.All women who came for examination were interviewed on various subjects including demographic characteristics, history of breast problems and family history of cancer. A twenty per cent sample of the examined women was further asked about their prior health behavior and about their views on a number of health topics. Information on health behavior was obtained for 80 per cent of the women of this subsample of women who had the initial examination. About half the non-response was a result of discontinuance of the supplementary questionnaire during the final months of the initial screening period. This is unlikely to have caused a serious systematic response bias since women entered the study in random order. Questionnaire and contact effort information is presented here for a total of 3,232 examined women in the 20 per cent subsample of examined women for whom health behavior data were obtained. Contacting WomenFrom the viewpoint of the overall requirements of the mammography study, it was important that a reasonably high response rate be obtained for the study group. The response rate of 65 per cent that was obtained largely satisfied the study requirements. In order to meet this rate, however, it was judged necessary to engage in a program o...

Nearly 1,300 adult members of a prepaid medical group plan in New York City were screened through automated multiphasic health testing in a series of test stations including a dental station, during 1971-1973. Oral status indicators were developed including a number of missing teeth, scores to measure levels of gingival and periodontal disease, Simplified Oral Hygiene Index scores, and ratios of decayed teeth. Ratios of filled teeth were calculated to measure levels of restorative care. The present paper examines the interrelationships of economic status, education and ethnic origin with each of the above oral status measures. It was found that variations in ratios of decayed and of filled teeth were primarily due to economic status while variations in a number of missing teeth, oral hygiene levels and levels of gingival and periodontal diseases were primarily due to screenees' educational level. Ethnic group differences could be explained in part by differences among these groups in economic and and educational levels. There were no consistent ethnic patterns, however, and while some differences could be explained by controlling for education and economic status, others persisted.

This paper deals with a long-term prospective study of breast cancer to determine the value of periodic screening for this condition, which also incorporates epidemiologic objectives. The methodology of the study, the variables included, and preliminary observations based on detected cases are presented. THE difficulties in conducting prospective studies on comparatively low incidence diseases are so severe that they are rarely undertaken for a specific condition. This holds for breast cancer despite the fact that an estimated 6 per cent of the women develop the disease during their lifetime and about one in five of the deaths from cancer among women is attributable to this condition. However, an opportunity has recently presented itself to incorporate epidemiological objectives related to breast cancer in a long-term prospective study whose main purpose is to investigate the value of periodic breast cancer screening. This paper presents the methodology of the study, the variables included, and preliminary observations based on the breast cancer cases detected in the early stages of the investigation. Before proceeding to this discussion, a brief review of where we are in understanding the epidemiology of breast cancer is in order. THE SEARCH FOR RISK FACTORS IN BREAST CANCERThe outstanding characteristic of the search for risk factors in female breast cancer is the lack of success in identifying specific parameters that are strongly associated with the incidence of the disease. The unifying element in these efforts is a hormonal hypothesis, whether the investigation is concerned with socio-

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