Press Releases Saturday 3 April 1999
No 7188 Volume 318
Please remember to credit the BMJ as source when publicising
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(1) CERVICAL SCREENING
HAS REDUCED INCIDENCE AND
MORTALITY
FROM CERVICAL CANCER
(2) REDUCTION IN MORTALITY
OF BABIES BORN TO SINGLE
MUMS
IS DOWN TO HEALTHCARE NOT SOCIO-ECONOMIC
IMPROVEMENTS
(3) SURVEYS TO ELICIT PUBLIC
OPINION ON PRIORITY
SETTING
MAY BE FLAWED
(4) FUTURE CHLAMYDIA SCREENING
SHOULD TAKE
ACCOUNT
OF POSSIBLE DISADVANTAGES FOR WOMEN
(1) CERVICAL SCREENING
HAS REDUCED INCIDENCE AND
MORTALITY
FROM CERVICAL CANCER
(Effect of screening on incidence
of and mortality from cancer of cervix
in England: evaluation based on
routinely collected statistics)
http://www.bmj.com/cgi/content/full/318/7188/904
The large rise in the number of women having
smear tests has reduced
the incidence of invasive cervical cancer
in England by more than one
third (35 per cent) claim researchers
in this week's BMJ. Dr Mike
Quinn and colleagues from the Office of
National Statistics report that
the coverage of women attending for a
smear test has doubled to 85 per
cent following the introduction of a national
call and recall system in
1988.
Screening for cervical cancer began in
Britain in the 1960s, but for over
20 years had little effect on mortality,
say the authors. From 1950 to
1987, total mortality from cervical cancer
fell steadily by just over 1.5
per cent each year (from 2,500 deaths
in 1950 to 1,800 deaths in
1987). The rate of fall then trebled and
by 1997 the number of deaths
was 1,150. These deaths represented two
per cent of all cancer deaths
in women and 0.4 per cent of all deaths
in women say the authors.
Quinn et al also report that screening
might have prevented 800 deaths
from cervical cancer in 1997 in women
aged 25-54. The reduction was
estimated by comparing the projected and
actual mortality. Reductions
in mortality over the last 40 years in
women aged over 54 years,
however, are not related to the screening
programme, say the authors,
as few of these women would have been
screened.
Contact:
Dr Mike Quinn, Director, National Cancer
Registration Bureau,
Office for National Statistics, Demography
and Health Division, London
Email: mike.quinn{at}ons.gov.uk
(2) REDUCTION IN MORTALITY
OF BABIES BORN TO SINGLE
MUMS IS DOWN
TO HEALTHCARE NOT SOCIO-ECONOMIC
IMPROVEMENTS
(Narrowing social inequalities in
health? Analysis of trends in mortality
among babies of lone mothers)
http://www.bmj.com/cgi/content/full/318/7188/908
An analysis of infant death rates from
1975 to 1996 in this week's BMJ
indicates that the mortality of babies
born to lone mothers as opposed to
couples, has decreased to one third of
its 1975 level, suggesting positive
progress in the reduction of inequalities.
However, the analysis shows
that this reduction was largely due to
an increase in the survival of babies
during the neonatal period (i.e. the first
month after birth) and therefore
may be more a reflection of advances in
healthcare than an improvement
in lone mothers' social and economic circumstances.
Dr Margaret Whitehead from the King's Fund
and Frances Drever from
the Office of National Statistics also
found that infant mortality in general
has fallen over the 21 year period, although
it is still more than fifty per
cent (52-67 per cent) higher in the lower
social classes than those in
classes I-II.
According to the authors, the proportion
of babies born to lone mothers
increased from five per cent of births
in 1975 to eight per cent in 1996.
In 1975 infant mortality in babies born
to lone mothers was 79 per cent
higher than those born to couples, but
this gap had fallen to 33 per cent
in 1996 finds the study. However, the
authors conclude that the lack of
improvement in mortality differentials
beyond the neonatal phase adds to
concerns that for high risk groups, insufficient
progress is being made.
Contact:
Dr Margaret Whitehead, Visiting Fellow,
Policy and Development
Division, King's Fund, London
Email: margaret{at}ashmagna.demon.co.uk
(3) SURVEYS TO ELICIT
PUBLIC OPINION ON PRIORITY
SETTING MAY
BE FLAWED
(Effect of discussion and deliberation
on the public's views of priority
setting in health care: focus group
study)
http://www.bmj.com/cgi/content/full/318/7188/916
Public participation in healthcare rationing
decisions may be of limited
value if people are not allowed time to
reflect on their opinions, say
researchers in this week's BMJ. It is
NHS policy that the views of the
public should play a greater role in setting
healthcare priorities and the
most common (and cheapest) approach of
determining the public view
has been by means of a straightforward
questionnaire. However, Dr
Paul Dolan and colleagues from the University
of York find that once
someone has had the opportunity to discuss
an issue in a group format,
their feelings may be quite different,
thus rendering the opinions
expressed in a questionnaire unreliable.
In their study the authors found that initially
over half of the 60 people
surveyed wanted to give lower priority
to smokers, heavy drinkers and
illegal drug users, yet after reflection
and discussion many people no
longer favoured this discrimination. Dolan
et al say that when people
discuss the complex issues involved in
priority setting, they realise that
things may not be as straightforward as
they had imagined. It also makes
them more sympathetic towards the role
that managers play in the
rationing of healthcare services, say
the authors.
They conclude that if patients' considered
opinions are to be included in
the priority setting process, it should
be noted that the value of surveys
that do not allow the time or opportunity
for reflection may be in doubt.
Contact:
Dr P Dolan, Senior Lecturer in Health Economics,
Sheffield Health
Economics Group, University of Sheffield
Email: P.Dolan{at}sheffield.ac.uk
(4) FUTURE CHLAMYDIA
SCREENING SHOULD TAKE
ACCOUNT OF
POSSIBLE DISADVANTAGES FOR WOMEN
(Sexuality and health: the hidden
costs of screening for Chlamydia
trachomatis)
http://www.bmj.com/cgi/content/full/318/7188/931
Any plans to introduce a predominantly
woman-centred chlamydia
screening programme into the UK should
take account of the potential
down sides as well as benefits that such
an initiative may have, say Dr
Barbara Duncan and Professor Graham Hart
of the Medical Research
Council in this week's BMJ. Such screening
can have negative
psychological effects on women and also
by not screening men, the
programme could further reduce men's responsibility
for sexual and
reproductive health, say the authors
They argue that there are lessons to be
learnt from other
woman-centred programmes, such as cervical
screening. Some women
associate cervical abnormalities with
perceptions of promiscuity and
deviant sexual practices, leaving them
with feelings of contamination,
which in turn impact negatively on self-perceptions
of attractiveness and
sexual functioning.
Duncan and Hart also suggest that social
changes have generated a
popular belief in men and women that it
is women who bear sole
responsibility for contraception and avoidance
of pregnancy. They say
that the strategy of involving men peripherally
in a chlamydia screening
programme (only as contacts of infected
women) may reinforce these
existing inequalities.
As little is known about men's beliefs
and attitudes to sexual and
reproductive health, the authors believe
that if they were to be included
in the chlamydia screening programme,
as well as the obvious gains for
detecting infection, health professionals
would also have the opportunity
to investigate and ultimately address
men's understanding of their sexual
behaviour.
Duncan and Hart conclude that these issues
should be fully considered
to ensure any future screening programme
does not have the unintended
consequence of implying that women are
to blame for sexually
transmitted infections and of neglecting
men's sexual health needs. Public
and professional education to increase
awareness and reduce stigma is
an essential prerequisite of a successful
screening programme, say the
authors.
Contact:
Dr Barbara Duncan PhD, Research Associate,
MRC Social and Public
Health Sciences Unit, University of Glasgow
Email: barbara.d{at}msoc.mrc.gla.ac.uk
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