Breast screening

influence mortality. With a similar aim, Case et al. studied for. two years a group of 545 men, 60 years old or younger, who had suffered a myocardial infarction. 11 Using the Jenkins' Activity Scale to determine type-A and type-B behaviour patterns, they found no statistical correlation between type-A scores' and rates of recurrence of myocardial infarction, of rehospitalization for cardiopathy, or of mortality. It is hard to describe, for the benefit of those who do not work in this field, the difficulties involved in the investigation of psychosocial influences in coronary heart disease. Depression, sleep disturbances, socioeconomic disadvantages, anxiety, neuroticism, social strata, putative job stress, lack of decision latitude, social isolation, white or blue collar work, hypochondriasis, hostility, level of education, dissatisfaction with life, inter-personal problems, cynicism and, even, being married to an educated woman12 do not exhaust the list of variables that have been scrutinized in an attempt to find meaningful correlations with coronary heart disease. The Ontario Exercise Heart Collaborative Study studied 618 post-infarction patients for three years in an attempt to predict reinfarction." Many parameters were investigated, including personality types. The characteristics which were predictive at a statistically significant level were only smoking and blue collar occupation, but not type-A personality. The National Heart Blood and Lung Institute Review Panel accepts a relationship between type-A behaviour and clinical heart disease. It does so, however, with several caveats, the most important of which is the statement "There is no evidence, even suggestive, that type-A behaviour contributes directly or indirectly to the primary event, the formation of atheroma"." It is possiblethat type-A behaviour may make a difference in the clinical presentation of coronary heart diseasebetween type-A and type-B persons with similar degrees of constitutional coronary atheroma. The exaggerated tendency to complain and the urgent lifestyle of type-A individuals renders them more likely to develop symptoms, perhaps, than their more complacent type-B counterparts. This view was put forward by the Review Panel when it indicated "the possibility that type-A patients have more symptoms at a given extent of their arterial pathology". Others have related psychosocial stress to angina, but not to infarction.":" Type-B patients do get atherosclerotic heart disease. The