The turn of the gradient? Educational differences in breast cancer mortality in 18 European populations during the 2000s.

This study aims to investigate the association between educational level and breast cancer mortality in Europe in the 2000s. Unlike most other causes of death, breast cancer mortality tends to be positively related to education, with higher educated women showing higher mortality rates. Research has however shown that the association is changing from being positive over non-existent to negative in some countries. To investigate these patterns, data from national mortality registers and censuses were collected and harmonized for 18 European populations. The study population included all women aged 30-74. Age-standardized mortality rates, mortality rate ratios, and slope and relative indexes of inequality were computed by education. The population was stratified according to age (women aged 30-49 and women aged 50-74). The relation between educational level and breast cancer mortality was predominantly negative in women aged 30-49, mortality rates being lower among highly educated women and higher among low educated women, although few outcomes were statistically significant. Among women aged 50-74, the association was mostly positive and statistically significant in some populations. A comparison with earlier research in the 1990s revealed a changing pattern of breast cancer mortality. Positive educational differences that used to be significant in the 1990s were no longer significant in the 2000s, indicating that inequalities have decreased or disappeared. This evolution is in line with the "fundamental causes" theory which stipulates that whenever medical insights and treatment become available to combat a disease, a negative association with socio-economic position will arise, independently of the underlying risk factors.

Physiological characteristics of nationally competitive female road cyclists and demands of competition.

There are few published data describing female cyclists and the studies available are difficult to interpret because of the classification of athletes. In this review, cyclists are referred to as either internationally competitive (International Cycling Union world rankings provided when available) or nationally competitive. Based on the limited data available it appears that the age, height, body mass (BM) and body composition of women cyclists who have been selected to the US and Australian National Road Cycling Teams from 1980 to 2000 are fairly similar. Female cyclists who have become internationally competitive are generally between 21 to 28 years of age, 162 to 174 cm, 55.4 to 58.8 kg and 38 to 51 mm (sum of 7 skinfolds) corresponding to 7 to 12% body fat. The lower BM and percentage body fat are traits unique to the most competitive women. Internationally competitive women cyclists also possess a slightly superior ability to produce a high absolute power output for a fixed time period and a noticeably greater ability to produce power output relative to BM. In Women's World Cup races, successful women (top 20 places) spend more time >7.5 W/kg (11 +/- 2 vs 7 +/- 2%, p < 0.01) and less time <0.75 W/kg (24 +/- 4 vs 29 +/- 3%, p = 0.05) compared with non-top 20 placed riders. Additionally, cyclists in the top 20 produced higher average power (3.6 +/- 0.4 vs 3.1 +/- 0.1 W/kg, p = 0.01). Unlike professional men's road cycling, the physiological characteristics of internationally competitive female road cyclists and the demands of women's cycling competition are poorly understood.