Objective To determine the frequency of different outcomes in women participating in cervical screening. Design Analysis of screening records from 348 419 women, and modelling of cases of cervical cancer and deaths with and without screening. Setting Cervical screening programme in Bristol. Results For every 10 000 women screened from 1976 to 1996, 1564 had abnormal cytology, 818 were investigated, and 543 had abnormal histology. One hundred and seventy six had persistent abnormality for two years or more. In the absence of screening 80 women would be expected to develop cancer of the cervix by 2011, of whom 25 would die. With screening 10 of these deaths would be avoided. Comparison of cumulative abnormality rates with numbers expected to develop cancer in the absence of screening suggests that at least 80% of high grade dyskaryosis and of high grade dysplasia would not progress to cancer. The lifetime risk of having abnormal cytology detected could be as high as 40% for women born since 1960. Conclusions Screening is labour and resource intensive. It involves treatment for many women not destined to develop invasive cancer. The increased intervention rate for cervical abnormality in England is due to change in practice, not a cohort effect, and is probably the reason for the marked fall in incidence and mortality during the 1990s. For other cancers there is scope for major iatrogenic harm from screening because of invasive tests and treatments.

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Objective-To determine laboratory workload and rates of referral for colposcopy in a three district cervical screening programme during 1983-9 to assess the feasibility of accommodating call up of all women at risk, recall at three year intervals (now five year intervals), and investigation of women with all degrees of abnormality.Design-Analysis of computerised screening histories dating back to 1977 of women screened in the Avon cervical screening programme.Setting-Three district health authorities covering the population of Bristol and Weston-super-Mare, comprising 800 000 people, of whom 250 000 were female residents aged 20 to 64.

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BackgroundMental health problems are increasing in prevalence within the paediatric population. Paediatricians are expected to work alongside CAMHS teams to assess and support these children, often with little training. In rare cases a child may require sectioning under the Mental Health Act.This issue was previously raised in RCPCH consultation ‘Looked after children: knowledge, skills and competences of health care staff’.AimsWe wanted to examine the experience and training of paediatricians in managing children with mental health problems, particularly with sectioning children.MethodsAn online questionnaire was sent to paediatricians across one training deanery. Information was gathered on frequency and experience of sectioning children. We also looked at knowledge regarding available support and training.Results27 paediatricians responded: 13 (48%) consultants, 12 (44.5%) registrars, and 2 (7.5%) other doctors.With regard to managing children with acute mental health issues, 79% of registrars were involved at least weekly, with 85% of consultants involved monthly.Only 3 doctors (11%) had sectioned a child. Reasons for sectioning were suicidal ideation, food refusal, and acute mental health issues.All staff surveyed had received support from CAMHS or the hospital crisis team. All of the doctors involved in sectioning children had found the situation difficult and stressful.78% of doctors surveyed felt that further training on sectioning patients should be available. Those respondents who said disagreed or were unsure about this gave the suggestion that this should be the responsibility of the CAMHS team. There were, however, concerns raised about the availability of urgent expert CAHMS assessment and advice.ConclusionsChildren with mental health issues are increasingly presenting acutely to paediatric units. Paediatric registrars appear to be more frequently involved than consultants in their acute treatment. The experience of sectioning a child is rare and usually directed by CAMHS. This is recognised to be a difficult process for paediatricians, who have limited knowledge and confidence in this process.This survey demonstrates that the vast majority of paediatricians would welcome further training and support in this area.