Amanda Herbert

Desquamative interstitial pneumonia in an aluminum welder.

Chronic interstitial pneumonia of predominantly desquamative pattern in an electric arc welder is described. Large amounts of finely divided particulate matter (0.02 to 0.2 μ m particle diameter) were detected in the lung, particularly in alveolar macrophages and focal perivascular collections of interstitial macrophages. Phagocytosis of the particles by type 1 alveolar epithelial cells was also observed. Electron microprobe analysis showed that the particulate matter contained abundant aluminum.

Is cervical screening working? A cytopathologist's view from the United Kingdom

This article considers the NHS cervical screening program and the controversies which have attended the introduction of comprehensive screening in a partially screened population of women in whom the underlying risk of disease was unknown. The increase in screening coverage which has taken place since 1988 has coincided with a period of high prevalence of cervical cancer and its precursors among women in the screening age group, against which background the recent fall in mortality and incidence of the disease has been a far greater achievement than generally recognized. The success of the program is considered in the context of the expectations and limitations of the test itself, and the high standards required for screening to be effective.

Relation between the Incidence of Invasive Cervical Cancer and the Screening Interval: Is a Five Year Interval Too Long?

Objective –To examine the incidence of invasive cervical cancer per 100 000 women years at risk and relative risk according to screening history among eligible women aged 25–69 in Southampton and South West Hampshire during the three years after completion of the first round of comprehensive screening. Results –There was a significantly higher incidence of invasive cervical cancer in women who had not been screened during the preceding 0.5–5.5 years than in those who had been screened (relative risk (RR) 2.6; 95% confidence interval (CI) 1.6 to 4.3). Among the latter group of women (with interval cancers) there was a significantly higher incidence in those with a long interval of 3.5–5.5 years since their most recent smear than in those with a short interval of 0.5–3.5 years (RR 2.2; 95% CI 1.3 to 3.8). Among women with non-interval cancers, there was a significantly higher incidence among those who had no cytology record than among those who had been screened but were overdue for a smear (RR 3.0; 95% CI 1.2 to 7.3). When screen detected cancers were excluded from the figures the relative risks for all the comparative groups described above were greater, though the 95% confidence limits were wider because the numbers were smaller. The most pronounced difference in incidence was between symptomatic cancers in women with a short screening interval (5.8 per 100 000 women years at risk) and in women with no cytology record (71.3 per 100 000 years at risk). Most cancers were interval cancers (76%) because of the high screening coverage: 89.2% of eligible women aged 25–69 had been screened during the preceding 0.5–5.5 years. The overall incidence per 100 000 women years at risk approached that of interval cancers, and was nearer to that observed in the short than the long interval because 74.7% of women had been screened within 3.5 years. Conclusion –The results confirm the effectiveness of screening but suggest that a five year screening interval may be too long, at least during the early rounds of screening.

Invasive Cervical Cancer in Southampton and South West Hampshire: Effect of Introducing a Comprehensive Screening Programme

A study of invasive cervical cancer in Southampton and South West Hampshire is reported, covering three consecutive three year periods during which the screening coverage increased from an estimated 60% to a recorded 87% of eligible women aged 20–64. From the first to the third periods of the study in that age group registrations of fully invasive squamous cell carcinoma (stage Ib and above) fell from 64 to 30 (53%), which was largely counteracted by an increase in microinvasive squamous cell carcinoma (linear trend: P<0–0001). In the same age group registrations of adenocarcinoma rose slightly, which resulted from an increase in the number diagnosed at a depth of invasion of less than 3 mm. There were no significant changes in the numbers of stage III and IV cancers or among cancers in women aged 65 and over. A strong inverse association was found between stage of both histological types of cancer and their likelihood of being screen detected rather than symptomatic: 91% of screen detected cancers were diagnosed at stage I compared with 38% of symptomatic cancers. There was a slight downward trend in the incidence of cancer per 100 000 total female population across the three periods of the study with a significant trend towards low stage disease, which is likely to reduce mortality in years to come. The trend towards screen detected cancers and cancers of less than 3 mm depth of invasion is presented as a positive outcome to be expected in early rounds of increasing the screening coverage.

Investigation of the effect of occult invasive cancer on progress towards successful cervical screening

Objectives To describe the effect of occult invasive disease on progress towards meeting the Health of the Nation target for reducing the incidence of cervical cancer, and to investigate the possible effect of a higher risk of cervical cancer in women born since 1940. Setting Southampton and South West Hampshire (SSWH), with a total female population of 218 549 in 1990, the midpoint of a study period covering 1985 to 1995. Methods Incidence was calculated per 100 000 women years at risk in overlapping three year periods for symptomatic and screen detected cancers. The same method was used for cohorts of women born before and after 1940. Screen detected stage Ia1 cancers were identified as a subgroup. Results The incidence of invasive cervical cancer fell by 27.4%, from 16.8 to 12.2 per 100 000 women years at risk between 1985–87 and 1993–95, which was a significant linear trend (χ2=4.494, df=1, p=0.034). The corresponding figures adjusted for age in a standardised European population were 16.3 and 11.5: a fall greater than required to meet the Health of the Nation target set for the year 2000. Incidence remained relatively high until screen detected cancers, more than one third of which were stage Ia1, had passed a peak in 1992. When screen detected stage Ia1 cancers were excluded, incidence fell by 41.2%, from 16.5 to 9.7 per 100 000 women years at risk: a highly significant linear trend (χ2=12.391, df=1, p<0.001). The incidence in the first three years of the study was higher in women born between 1940 and 1954 than in those born between 1925 and 1939, though the reverse would be expected by age and the natural history of the disease. In the 1940–54 birth cohort 44% (23/52) of screen detected cancers were stage Ia1, with a peak in 1992. When these were excluded, incidence fell by 57.1%, from 31.7 to 13.6 per 100 000 women years at risk: a highly significant linear trend (χ2=13.704, df=1, p<0.001), whereas an increase would be expected for a cohort aged from 30–45 to 40–55. In the 1925–39 cohort only 24% (8/33) of screen detected cancers were stage Ia1. When these were excluded, incidence fell by 35.3%, from 24.9 to 16.1, which was not a significant linear trend (χ2=0.409, df=1, p=0.522). Conclusion An overall decline in incidence was not achieved until prevalent occult invasive disease had been detected by improved screening. The data confirm the effectiveness of screening, particularly in a high risk cohort of women born between 1940 and 1954.