Background The effect of risk-reducing salpingo-oophorectomy (RRSO) on breast cancer risk for BRCA1 and BRCA2 mutation carriers is uncertain. Retrospective analyses have suggested a protective... Show moreBackground The effect of risk-reducing salpingo-oophorectomy (RRSO) on breast cancer risk for BRCA1 and BRCA2 mutation carriers is uncertain. Retrospective analyses have suggested a protective effect but may be substantially biased. Prospective studies have had limited power, particularly for BRCA2 mutation carriers. Further, previous studies have not considered the effect of RRSO in the context of natural menopause. Methods A multi-centre prospective cohort of 2272 BRCA1 and 1605 BRCA2 mutation carriers was followed for a mean of 5.4 and 4.9 years, respectively; 426 women developed incident breast cancer. RRSO was modelled as a time-dependent covariate in Cox regression, and its effect assessed in premenopausal and postmenopausal women. Results There was no association between RRSO and breast cancer for BRCA1 (HR = 1.23; 95% CI 0.94-1.61) or BRCA2 (HR = 0.88; 95% CI 0.62-1.24) mutation carriers. For BRCA2 mutation carriers, HRs were 0.68 (95% CI 0.40-1.15) and 1.07 (95% CI 0.69-1.64) for RRSO carried out before or after age 45 years, respectively. The HR for BRCA2 mutation carriers decreased with increasing time since RRSO (HR = 0.51; 95% CI 0.26-0.99 for 5 years or longer after RRSO). Estimates for premenopausal women were similar. Conclusion We found no evidence that RRSO reduces breast cancer risk for BRCA1 mutation carriers. A potentially beneficial effect for BRCA2 mutation carriers was observed, particularly after 5 years following RRSO. These results may inform counselling and management of carriers with respect to RRSO. Show less
On 16 December 1961, an underground army commanded by Nelson Mandela,known as Umkhonto we Sizwe, publicly announced its presence in South Africa with a series of bomb explosions and the publication... Show moreOn 16 December 1961, an underground army commanded by Nelson Mandela,known as Umkhonto we Sizwe, publicly announced its presence in South Africa with a series of bomb explosions and the publication of a manifesto. Umkhonto we Sizwe was later adopted by the African National Congress as its armed wing, run jointly by the South African Communist Party (SACP). This article, using newly opened archives, demonstrates the degree to which Umkhonto we Sizwe was a SACP creation. It also examines in detail the circumstances in which Mandela joined the SACP central committee. Show less
There is increasing international concern about the growth of organized crime in Africa. Important criminal organizations and professional criminals are present in Africa, but we argue that the... Show moreThere is increasing international concern about the growth of organized crime in Africa. Important criminal organizations and professional criminals are present in Africa, but we argue that the term "organized crime" is not a very useful description of their activity, since what we are actually witnessing is a reformulation of politics and crime into networks that transcend the state/non-state boundary in ways that are hardly subsumed in standard concepts of organized crime. Similar processes are taking place in various parts of the world, and thus African countries are not exceptional in this regard. The process, however, does take particular forms in Africa that arise out of the histories of individual countries. The article describes the evolution in countries as diverse as Libya, Guinea-Bissau, and Zimbabwe of a market for protection, as business people - legitimate and otherwise - seek protection for their activities and their personnel. This market for protection is created by making private arrangements, often with state officials working in private capacities. The implications are profound: they could amount to a new mode of governance connecting Africa to international markets and institutions in which the distinctions between licit and illicit economic activity become difficult to detect. Show less
