How complete can cervical screening be? The outcome of a call screening programme for women aged 20–60 years in Perth and Kinross

In this paper a computer system for cervical screening call and recall based on the Community Health Index (CHI) population data-base is described. It allows the unscreened population to be identified and located on an individual general practice basis. The results of the call programme on 9517 women aged 20-60 years listed on the CHI and with no record of a cervical smear is described. There was a 24% smear uptake in the call programme which meant that after the call programme the total population cover had risen from 71% to 78%. In addition, if women with a valid reason are excluded, and the data-base corrected for women no longer in the area, the true cover rises to 88%. An analysis of the percentage cover in each GP practice is described with the implications for implementation of screening targets for primary care.     

Cervical cytology screening and government policy.

OBJECTIVE--To assess the coverage of cervical cytology screening in one general practice surgery according to the criteria in the new Scottish general practitioner contract and to explore the difficulties of defining performance in such screening. DESIGN--Review of annual analysis of uptake of screening during 1984-8. SETTING--Suburban general practice surgery in Glasgow serving 3000 patients. PATIENTS--All women aged 35-64 registered in 1984 increasing in 1988 to all women aged 20-64. MAIN OUTCOME MEASURE--Assessment of uptake of smear tests and reasons for smear not being taken and of the effect of these outcomes on the new general practitioner contract. RESULTS--The numbers and percentages of women having a smear test in the previous five and three years were recorded, and the reasons why a smear was not taken were defined in the remainder (hysterectomy, test not offered, risk not known, test declined, patient moved away, and patient unaccounted for). In 1988, 85% (608/719) of the women aged 30-64 and 80% (693/870) of those aged 20-64 had had a smear test in the previous five years. An appropriate or irreducible reason for the lack of a smear test was defined in all the others. CONCLUSIONS--The population studied contained a substantial number of women in whom cervical smear was unnecessary, inappropriate, or refused. These factors and the likely demographic variation in the uptake of smear tests have important implications for the setting and achieving of the government''s targets for cervical cytology screening.     

Job stress,satisfaction, and mental health among general practitioners before and after introduction of new contract.

OBJECTIVE--To compare measures of job stress, job satisfaction, and mental health among general practitioners before and after the introduction of the new contract in April 1990. DESIGN--Cross sectional postal questionnaire survey in July 1990. Comparison of results with those obtained in previous survey in November 1987. SETTING--General practice in United Kingdom. SUBJECTS--1500 general practitioners randomly selected from general medical services lists, 917 of whom (61%) returned questionnaires usable for statistical analysis. MAIN OUTCOME MEASURES--Aspects of job causing stress, job satisfaction (Warr, Cook, and Wall scale), and mental health (Crown-Crisp experiential index). RESULTS--Compared with 1987, in 1990 doctors experienced more stress from night calls (mean score 3.83 in 1990 v 3.45 in 1987), emergencies during surgery hours (3.72 v 3.48), and interruption of family life by telephone (3.58 v 2.73; p less than 0.001 for all three variables). Scores for somatic anxiety and depression were higher in both men and women in 1990 (men: somatic anxiety 3.12 v 2.36; depression 3.80 v 2.94; women: somatic anxiety 3.56 v 2.65; depression 4.02 v 3.37; p less than 0.001). Job satisfaction had also decreased in 1990 (5.23 v 4.26; p less than 0.001). CONCLUSIONS--Doctors experienced more stress, less job satisfaction, and poorer mental health in 1990 than in 1987. These changes may have resulted from the introduction of the new contract.     

Evolution of poliovirus since introduction of attenuated vaccine.

Genetic marker tests were performed on 997 strains of poliovirus isolated from patients with neurological disease and from healthy people in England and Wales. Before the introduction of live attenuated vaccine most strains could multiply at raised temperatures. Now, however, many strains isolated from cases of poliomyelitis or from healthy persons with no known contact with vaccine cannot grow above 37 degrees C, and in this respect resemble the vaccine strains. The three serotypes are also much more evenly represented. Hence probably to a limited extent the vaccine-like strains have established themselves in the community.     

Changes in incidence of and mortality from breast cancer in England and Wales since introduction of screening. United Kingdom Association of Cancer Registries.

OBJECTIVE--To assess the impact of the NHS breast screening programme on the incidence of and mortality from breast cancer. DESIGN--Comparison of age specific incidence and mortality before and after the introduction of screening in the late 1980s. SETTING--England and Wales. SUBJECTS--Women aged over 30 years. RESULTS--In 1992 the age standardised incidence of breast cancer was 40% higher than in 1979. After the introduction of screening in 1988 recorded incidence rates rose steeply in the screened age group (50-64 year olds) but not in others. In 1992 the rates levelled off at about 25% higher than in 1987. Total mortality from breast cancer has increased steadily since the 1950s; the rates increased earlier in the younger age groups. By the mid-1980s rates had begun to fall in the younger age groups; but total mortality was still among the highest in the world. Age standardised mortality in the 55-69 age group changed little during the first three years of screening but then fell steeply and in 1994 was 12% lower than in 1987. CONCLUSIONS--Since the introduction of screening there have been pronounced increases in recorded incidence in the screened age group. Cancer registries have an essential role in assessing screening programmes and cancer services. The steep decrease in mortality in 55-69 year olds which began three years after screening started is unlikely to be due to screening. The widespread adoption of treatment with tamoxifen during this period may be important. With the reduction in mortality already observed and the expected additional benefits from screening, the Health of the Nation target should be achieved.