The NHS BCSP provides high-quality colonoscopy, as demonstrated by high caecal intubation rate, ADR and comfort scores, and low adverse event rates. Quality is achieved by ensuring BCSP colonoscopists meet a high standard before starting screening and through ongoing quality assurance. Measuring total adenoma detection (MAP and MAP+) as adjuncts to ADR may further enhance quality assurance.

HE PROVISION OF SCREENING mammography differs greatly between the United States and the United Kingdom. In the United States, screening is provided in diverse settings, such as private practice, health maintenance organizations, and academic medical centers 1 ; whereas in the United Kingdom, a single organized screening program run by the National Health Service provides virtually all mammographic screening for women aged 50 years or older. 2,3 There are also differences between the ages of women screened; the recommended interval between mammographic examinations; the proportion of women recalled for additional imaging examinations, such as diagnostic mammography or ultrasound; and the methods used to further evaluate findings considered suspicious for cancer. 4-6 However, it is not clear if there are actual differences in the performance and outcomes of screening mammography between the 2 countries. Comparing the performance of screening mammography between the 2 countries may suggest methods to improve mammography practice. We compared recall (the percentage of mammograms in which there is a recommendation for prompt additional testing, clinical evaluation, or percutaneous biopsy), surgical biopsy, and cancer detection rates for screening mammography among similarly aged women between the United States and the United Kingdom.

This is the largest study focusing on polyp-specific risk factors. We have confirmed that the greatest risk factor for both post-polypectomy bleeding and perforation is polyp size. This is the first demonstration of substantial and significantly increased risk for both noteworthy bleeding (requiring transfusion) and perforation from cecal polypectomy for a given polyp size, compared with elsewhere in the colon.

Objective To assess the impact of the NHS breast screening programme on mortality from breast cancer in women aged 55-69 years over the period 1990-8. Design Age cohort model with data for 1971-89 used to predict mortality for 1990-8 with assumption of no major effect from screening or improvements in treatment until after 1989. Effect of screening and other factors on mortality estimated by comparing three year moving averages of observed mortality with those predicted (by five year age groups from 50-54 to 75-79), the effect of screening being restricted to certain age groups. Setting England and Wales. Subjects Women aged 40 to 79 years. Results Compared with predicted mortality in the absence of screening or other effects the total reduction in mortality from breast cancer in 1998 in women aged 55-69 was estimated as 21.3%. Direct effect of screening was estimated as 6.4% (range of estimates from 5.4-11.8%). Effect of all other factors (improved treatment with tamoxifen and chemotherapy, and earlier presentation outside the screening programme) was estimated as 14.9% (range 12.2-14.9%). Conclusions By 1998 both screening and other factors, including improvements in treatment, had resulted in substantial reductions in mortality from breast cancer. Many deaths in the 1990s will be of women diagnosed in the 1980s and early 1990s, before invitation to screening. Further major effects from screening and treatment are expected, which together with cohort effects should result in further substantial reductions in mortality from breast cancer, particularly for women aged 55-69, over the next 10 years.