Effective prevention of skin cancer might not only reduce a significant burden of disease but it could also save considerable resources to the NHS.

The human Wilms tumour suppressor gene, WTl, encodes a zinc-finger protein which can function as a transcriptional activator or suppressor. This study reports the analysis of the human WTl gene promoter, and demonstrates that high levels of WTl expression lead to autosuppression of the WTl promoter. Deletion analyses of the promoter region implicate sequences 5' and 3' of the transcriptional start site as being crucial in WTI autosuppression. Loss or alteration of this function of WTl may be important in tumourigenesis.

This Liverpool Healthy Lung Programme is a response to high rates of lung cancer and respiratory diseases locally and aims to diagnose lung cancer at an earlier stage by proactive approach to those at high risk of lung cancer. The objective of this study is to evaluate the programme in terms of its likely effect on mortality from lung cancer and its delivery to deprived populations. Methods Persons aged 58-75 years, with a history of smoking or a diagnosis of chronic obstructive pulmonary disease (COPD) 1 according to general practice records were invited for lung health check in a community health hub setting. A detailed risk assessment and spirometry were performed in eligible patients. Those with a 5% or greater five-year risk of lung cancer were referred for a low dose CT 2 scan. Results A total of 4 566 subjects attended the appointment for risk assessment and 3 591 (79%) consented to data sharing. More than 80% of the patients were in the most deprived quintile of the index of multiple deprivation. Of those attending, 63% underwent spirometry and 43% were recommended for a CT scan. A total of 25 cancers were diagnosed, of which 16 (64%) were stage I. Comparison with the national stage distribution implied that the programme was reducing lung cancer mortality by 22%. Conclusions 1 COPD, chronic obstructive pulmonary disease; 2 CT, computed tomography 3 Community based proactive approaches to early diagnosis of lung cancer in health deprived regions are likely to be effective in early detection of lung cancer.

A surveillance program for invasive pneumococcal disease was undertaken in Puyde-Dĵme, an administrative district of the region Auvergne in France, from 1 January 1994 to 31 December 1998. A total of 214 cases were identified. The annual incidence of invasive pneumococcal disease increased (P=0.04) from 5.5 in 1994 to 9.3 cases per 10(5) person-years in 1998. The highest incidences were for children <2 years of age (59.2 cases per 10(5) person-years) and for adults > or = 65 years (18 cases per 10(5) person-years). Clinical diagnoses, available in 200 patients, included acute pneumonia (62%), meningitis (10%), sepsis without focus (20%), and others (8%). The most frequent chronic medical conditions of the patients included smoking, alcoholism, cardiovascular and pulmonary diseases, and malignancies. Thirty-one percent of the isolates were nonsusceptible to penicillin. Penicillin resistance (MIC > or = 0.1 mg/l) was more frequent (P=0.02) in cancer patients. The overall case-fatality rate was 21.5%. Risk factors for death were age, sex, and underlying diseases of the patients, along with the severity of illness. These population-based findings should convince clinicians to offer pneumococcal vaccine to patients at high risk for invasive pneumococcal disease, thereby increasing vaccination coverage levels in France.

No abstract