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Highlights of this issue CMAJ 2000;163(5):493 Population, consumption and human health
HPV infection and cervical cancer
An estimated 82% of cervical cancers in the developed world can be attributed to sexually transmitted human papillomavirus (HPV) infection. The proportion is even higher (91%) in the developing world, where physician scarcity is one limitation of screening programs. In the first of 2 articles in this issue, John Sellors and colleagues analysed the prevalence of HPV infection among Ontario women. The highest rate (24%) was among women aged 2024, and there was a strong association between HPV and abnormal cervical cytology results. In their second paper, the authors performed their analysis for HPV on vulvar, vaginal and urine specimens collected by the women themselves. The specimens proved adequate, the methods were acceptable, and 86.2% of women with biopsy-proven high-grade cervical intraepithelial neoplasia were identified through vaginal swabs. This approach may offer a viable alternative to women in the developing world and to others reluctant to present for Pap smears. Screening controversy
The results of 3 randomized trials showing a decrease in colon cancer mortality with fecal occult blood screening have prompted some provincial cancer control agencies to recommend screening. Ken Marshall dissents, citing a systematic review which demonstrates that 1000 people would need to be screened for about 10 years to prevent a single death from colon cancer. Marshall is taking the wrong perspective, according to Sidney Winawer and Ann Zauber, by whose calculations 12 325 life-years would be saved for every 100 000 people screened. Type 2 diabetes in Canada's First Nations Diabetes, once rare in Aboriginal peoples, is now a significant health problem for them, accompanied as it is by high rates of retinopathy, renal disease and infection. T. Kue Young and colleagues describe the prevalence of diabetes in Canada's First Nations and current hypotheses for its emergence, from the "thrifty genotype" to lifestyle changes. They also outline particular considerations for health care providers, including the need to ensure access for patients living in remote areas and the need for culturally appropriate education and treatment programs. Traditional medicines are a yet-unexplored source of potential therapies. Urinary tract infections in children
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