BMJ 1999;318:904 (full) ( 3 April )

Papers

Four papers appear in the print BMJ this week in abridged form. The full and abridged versions are both available here on our website. The editorial by Delamothe et al explains why we are doing this, and we welcome readers' reactions. The paper by Whitehead (p. 908) appears in two abridged versions, one much shorter than the other; again we welcome readers' reactions on which they prefer, and why.

Effect of screening on incidence of and mortality from cancer of cervix in England: evaluation based on routinely collected statistics

Editorial by Delamothe et al

Mike Quinn, director,  Penny Babb, senior cancer epidemiologist,  Jennifer Jones, cancer epidemiologist,  Elizabeth Allen, cancer epidemiologist, 

National Cancer Registration Bureau, Office for National Statistics, Demography and Health Division, London SW1V 2QQ

Correspondence to: Dr Quinn mike.quinn{at}ons.gov.uk

Objective: To assess the impact of screening on the incidence of and mortality from cervical cancer.
Design: Comparison of age specific incidence and mortality before and after the introduction of the national call and recall system in 1988.
Setting: England.
Subjects: Women aged over 19 years.
Results: From the mid-1960s, the number of smears taken rose continuously to 4.5 million at the end of the 1980s. Between 1988 and 1994, coverage of the target group doubled to around 85%. Registrations of in situ disease increased broadly in parallel with the numbers of smears taken. The overall incidence of invasive disease remained stable up to the end of the 1980s, although there were strong cohort effects; from 1990 incidence fell continuously and in 1995 was 35% lower than in the 1980s. The fall in overall mortality since 1950 accelerated at the end of the 1980s; there were strong cohort effects. Mortality in women under 55 was much lower in the 1990s than would have been expected.
Conclusions: The national call and recall system and incentive payments to general practitioners increased coverage to around 85%. This resulted in falls in incidence of invasive disease in all regions of England and in all age groups from 30 to 74. The falls in mortality in older women were largely unrelated to screening, but without screening there might have been 800 more deaths from cervical cancer in women under 55 in 1997.

Key messages The coverage of the NHS cervical screening programme has increased greatly but several problems remain Rates of in situ cervical cancer have continued to rise in women aged 20-29 Improvements in the screening programme have led to a 35% fall in incidence of invasive disease Reductions in mortality over the past 40 years in women aged over 54 are not related to screening, but in women under 55 screening may have prevented 800 deaths in 1997

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Rapid Responses:

Read all Rapid Responses

Cost-effectiveness of cancer screening

Barry A Groves
bmj.com, 5 Apr 1999 [Full text]

There is a good reason to continue screening

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