BackgroundBreast screening uptake in London is below the Government's target of 70% and we investigate whether ethnicity affects this. Information on the ethnicity for the individual women invited is unavailable, so we use an area-based method similar to that routinely used to derive a geographical measure for socioeconomic deprivation.MethodsWe extracted 742,786 observations on attendance for routine appointments between 2004 and 2007 collected by the London Quality Assurance Reference Centre. Each woman was assigned to a lower super output (LSOA) based on her postcode of residence. The proportions of the ethnic groups within each LSOA are known, so that the likelihood of a woman belonging to White, Black and Asian groups can be assigned. We investigated screening attendance by age group, socioeconomic deprivation using the Index of Deprivation 2004 income quintile, invitation type and breast screening service. Using logistic regression analysis we calculated odds ratios for attendance based on ethnic composition of the population, adjusting for age, socioeconomic status, the invitation type and screening service.ResultsThe unadjusted attendance odds ratios were high for the White population (OR: 3.34 95% CI [3.26-3.42]) and low for the Black population (0.13 [0.12-0.13]) and the Asian population (0.55 [0.53-0.56]). Multivariate adjustment reduced the differences, but the Black population remained below unity (0.47 [0.44-0.50]); while the White (1.30 [1.26-1.35]) and Asian populations (1.10 [1.05-1.15]) were higher. There was little difference in the attendance between age groups. Attendance was highest for the most affluent group and fell sharply with increasing deprivation. For invitation type, the routine recall was higher than the first call. There were wide variations in the attendance for different ethnic groups between the individual screening services.ConclusionsOverall breast screening attendance is low in communities with large Black populations, suggesting the need to improve participation of Black women. Variations in attendance for the Asian population require further investigation at an individual screening service level.

Objectives-To find out whether a false positive breast screening result has a negative eVect on subsequent screening attendance. Also considered was the proportion of women who had ever failed to reattend for screening, having previously attended routinely. Design-The study was a retrospective cohort design. Setting-Data from the call and recall records of the Central and East London Breast Screening Service (CELBSS) were used. Participants-Women who had been invited to attend for breast screening by the CELBSS during 1997. Main outcome measures-Subsequent attendance or non-attendance for the next routine breast screen, after a false positive screening result. Results-A substantial number of women failed to reattend for a breast screen during their screening history, having attended for their previous routine breast screen. No diVerences in the rates of reattendance were found between those who had previously received a false positive result and those who had not. Conclusion-From the results obtained in the present study it would seem that the experience of a false positive breast screen does not deter women from reattending in the future. However, many women living in inner city areas who attend for an initial breast screen are failing to attend for subsequent routine mammograms. This may have a deleterious eVect for these women in terms of the benefits of attendance for regular screening. (J Med Screen 2001;8:145-148)

The workload of emergency general surgery in the elderly is becoming more complex. This challenge is already being addressed with improvements in outcomes. The data presented here reinforces the need for new models of care with increased multidisciplinary geriatric care input into elderly surgical patient care in the perioperative period.

Background:The weekend effect describes excess mortality associated with hospital admission on Saturday or Sunday. This study assessed whether a weekend effect exists for patients admitted for emergency general surgery. There was no significant mortality difference for patients admitted at the weekend in adjusted Cox models (hazard ratio (HR) 1⋅00 for Saturday and 0⋅90 for Sunday, versus Wednesday). There was a significantly higher mortality for operations undertaken at the weekend (HR 1⋅15 for Saturday and 1⋅40 for Sunday; P = 0⋅021 and P < 0⋅001 respectively). The significantly increased mortality that was evident for emergency surgery at the weekend compared with weekdays in 2000-2004 (HR 1⋅46 for Saturday and 1⋅55 for Sunday; both P < 0⋅001); had reduced by 2010-2014, when the adjusted mortality risk was not significant (HR 1⋅18 for Saturday and 1⋅12 for Sunday).Conclusion: During the past 15 years there has been a weekend effect in patients undergoing emergency general surgery based on day of operation, but not day of admission. Overall mortality for emergency general surgery has improved significantly, and in the past 5 years the increased mortality risk of weekend surgery has reduced.