Alwyn Smith

DELAY IN BREAST CANCER AND THE NATURE OF PRESENTING SYMPTOMS

Abstract A detailed examination of the nature and sequence of symptoms of women with breast cancer has shown that these have an important effect on delay. Women whose initial symptoms do not include a lump are slower in consulting a doctor about their symptoms and their doctor is more likely to delay referring them for specialist opinion. The important factor in both delay phases is the absence of a lump rather than the presence of other symptoms.

How district health authorities organise cervical screening

OBJECTIVES--To examine how district health authorities organised cervical screening with respect to Department of Health guidelines and to determine their assessment of the problems encountered. DESIGN--Postal questionnaire sent to all 190 district health authorities in England in 1989. PARTICIPANTS--190 District health authorities in England. MAIN OUTCOME MEASURES--Population coverage of screening, quality of smear testing, and follow up of abdominal test results in comparison with national guidelines for district cervical screening services, and problems encountered by districts. RESULTS--Replies were received from 178 (94%) of districts, in 143 of which the person named as responsible for cervical screening contributed. All districts implemented a computer managed scheme, 150 by the target date of 31 March 1988, but not all of these conformed with the guidelines. At the time of the survey only just over half called women in the target age group of 20-64 and only 70% expected to meet the target date of 13 March 1993 for completing the call. Considerable variation was evident among the schemes with regard to how they dealt with issues related to population coverage, quality of testing, and follow up of abnormal results. The problems most commonly identified by the districts (n = 174) were laboratory workload (107, 61%), computer software (104, 60%), availability of resources (78, 45%), non-attendance (77, 44%), rate of opportunistic screening (62, 36%), and investigation and treatment (60, 34%). CONCLUSIONS--Current practice in running cervical screening schemes needs to be examined to determine the extent to which it contributes to the goal of reducing mortality from cervical cancer.

Threat of Nuclear War

A brief report is provided on recent actions by groups of physicians concerned with the danger of nuclear war. Activities described include motions presented at a July meeting of the British Medical Association, a July conference in London organized by the Medical Campaign Against Nuclear Weapons, the World Assembly for Peace and Life meeting held in Prague in June, and an address to London pediatricians in June by a representative of Physicians for Social Responsibility.

Trends in the organization of cervical cancer screening.

CERVICAL CYTOLOGICAL screening has been available in the UK for several decades, but has not achieved a significant reduction in the incidence of and mortality from cervical cancer. In this paper we describe past problems of cervical screening, discuss the impact of recent innovations to computerize call and recall, and suggest further improvements for the future.