>-----Original Message-----
>From: [log in to unmask]
>[mailto:[log in to unmask]]On Behalf Of Michael Durham
>Sent: 29 July 1998 11:07
>I would be fascinated to hear from anybody who can tell me why these
>screening catastrophes always seem to occur in cervical cancer
>screening.......and if there are any other areas of health
>which might be similarly prone to clinical errors/differences.
I guess like all things it is multifactorial.
1. There are relatively few National "screening programmes" - cervical,
breast, myxoedema/phenylketonuria in babies, and child health. There are
some screening programmes within practices, such as hypertension, urinalysis
for diabetes and renal problems, antenatal care, cholesterol, perhaps rectal
cancer (faecal occult bloods) and prostatic cancer (PSA blood test).
2. Few (if any) screening programmes have been shown to be unequivocally
beneficial. I understand that Cervical screening (at a cost of circa 123
million UKP) saves perhaps 800 lives per year. It doesn't save another
1,200 women who still die of the disease.
3. Of the National programmes, the babies ones are based on very definite
blood results, but breast, cervical and child health are often based on
"clinical interpretation".
4. Only cervical smears seem to have got a mystique of infallibility, such
that if someone is screened, found negative and subsequently gets cervical
cancer, then "something must have gone wrong". This is not usually true (an
exception may be Kent and Canterbury), and many years of careful assessment
of the cervical screening programme have confirmed that it is useful test,
but not infallible. Some cervical cancers are not detected by current
screening.
5. Cervical screening is probably the most closely monitored of the
screening programmes, with assessments of smear quality, quality of lab
assessment, quality of treatment, and some measure of outcome. Any failure
or suspected failure in any part of this process logically requires a
process of repeating and recalling. This process is very public. It will
be interesting to see if the overall outcome measures from St George's are
significantly different from the National average.
An interesting topic, and the lessons in monitoring and audit may well
inform monitoring and audit in other NHS areas in the years to come. It is
a pity that such opprobrium should fall on those who have the courage to
question or be questioned about their own practice.
--
Dr Jon Rogers Southmead Health Centre Bristol BS10 6DF
GP and member NW Bristol PCG, Vice Chair Avon LMC, Treasurer BCS PHCSG
Chair GP SWG Read Codes, Member Path Report Implementation Panel,
Medical Advisor AAH Meditel, Member RCGP Health Informatics Task Group
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
|