Characteristics of genetics-related news content in Black weekly newspapers.

UNLABELLED: BACKGROUND/AIMS/OBJECTIVES: The media are an important source of health information, especially for those with less access to regular health care. Black news outlets such as Black newspapers are a source of health information for African Americans. This study characterized media coverage of genetics-related information in Black weekly newspapers and general audience newspapers from the same communities. METHODS: All health stories in a sample of 24 Black weekly newspapers and 12 general audience newspapers from January 2004 to December 2007 were reviewed for genetics-related stories. These stories were further coded for both journalistic and public health variables. RESULTS: Of all health-related stories identified, only 2% (n = 357) were considered genetics related. Genetics-related stories in Black newspapers - compared to those in general audience newspapers - were larger, more locally and racially relevant, and more likely to contain recommendations or action steps to improve health or reduce disease risks and to mention the importance of knowing one's family history. Stories in general audience newspapers were more likely to discuss causes of disease, mention genetic testing or therapy, and suggest a high/moderate degree of genetic determinism. CONCLUSIONS: Black newspapers are a viable communication channel to disseminate findings and implications of human genome research to African American audiences.

Gender comparisons in psychological characteristics of obese, binge eaters.

OBJECTIVE: To investigate differences between male and female, obese binge eaters in levels of depression, anxiety and self-esteem. In addition, to make comparisons in these psychological characteristics, for both genders, between obese, binge eaters and obese nonbingers. METHOD: Participants consisted of 48 female (26 binge eaters and 22 nonbingers) and 13 male (4 binge eaters and 9 nonbingers) outpatients in a hospital weight-loss program. Participants completed the following: Questionnaire on Eating and Weight Patterns--Revised, Beck Depression Inventory, Beck Anxiety Inventory and the Coopersmith Self-Esteem Inventory. RESULTS: Females had a significantly higher level of depression (p<0.003) than males. No other significant gender differences were found. However significant differences between binge eaters and nonbingers were found, for both genders, in depression (p<0.0001) and anxiety (p<0.008) with the binge eaters having higher scores than the nonbingers, and in self-esteem (p<0.0001) with the binge eaters having lower scores than the nonbingers. CONCLUSION: Females have higher levels of depression compared to males, but no gender differences were found in anxiety or self-esteem. In both genders, binge eaters have higher levels of depression and anxiety and lower levels of self-esteem compared to nonbingers.

Current trends in bladder cancer in England and Wales.

PURPOSE: We examined trends in bladder cancer (BC) incidence, mortality and survival in England and Wales during a 30-year period. MATERIALS AND METHODS: Age standardized incidence and mortality rates for BC, cohort incidence ratios, and 1 and 5-year relative survival from BC were calculated, and current trends were assessed. RESULTS: Between 1971 and 1998 the total number of cases of BC increased by 57% from around 7,200 to almost 11,400. Between 1971 and 1998 directly age standardized incidence increased by 16% in males and 37% in females. Directly age standardized mortality decreased by 26% in males and showed little change in females during the same period. Five-year relative survival improved by around 15% points in the 1970s and early 1980s. However, there was less improvement in survival thereafter in that 5-year relative survival for patients diagnosed in 1993 to 1995 was 67% in men and 58% in women. CONCLUSIONS: With an almost 60% increased incidence during the last 3 decades, BC incidence remains much higher in men but has increased more rapidly in women. There have been steady decreases in mortality rates, more marked in men than in women. Unusually, women have a significantly lower survival rate than men. Reasons for these patterns and trends are unclear. The trends in bladder cancer incidence by birth cohort suggest that the relationship with smoking may not be that strong and that other factors may be involved. Further research should focus on reasons for the recent increase in bladder cancer incidence in younger female birth cohorts.

Comparison of psychological characteristics of binging and nonbinging obese, adult, female outpatients.

OBJECTIVE: This study compared levels of depression, anxiety and self-esteem in binging and nonbinging obese, adult females in a hospital weight-loss program. METHOD: Participants (n=43; mean age=43.5 yrs) completed the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Coopersmith Self-Esteem Inventory (CSEI) upon entering the program (Week 0). A subgroup (n=15) completed the same inventories on Week 4 and Week 8. RESULTS: Binge eaters had significantly higher levels of depression (p<0.002) and lower levels of self-esteem (p<0.001) on Week 0. For the subgroup that remained in the program through Week 8, significantly higher depression levels (p<0.01) and anxiety levels (p<0.05) persisted for the binge eaters. DISCUSSION: Results indicate that obese binge eaters have more psychological distress than nonbingers, and that these differences tend to persist even during weight loss.

Outcomes of screening to prevent cancer: analysis of cumulative incidence of cervical abnormality and modelling of cases and deaths prevented.

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.

Trends in oesophageal and gastric cancer incidence, mortality and survival in England and Wales 1971-1998/1999.

BACKGROUND: In England and Wales, 7% of cancers diagnosed in 1997 were oesophageal or gastric cancer. AIM: To review the epidemiology of these cancers in England and Wales using cancer registration data from 1971 to 1998 and mortality data from 1971 to 1999. METHODS: We calculated age-specific and age-standardised incidence and mortality rates; crude and relative survival by age group; age-standardised relative survival; and relative survival by socio-economic status. RESULTS: The age-standardised incidence of oesophageal cancer increased from 7.6 to 12.8 per 100,000 men and from 4.2 to 5.7 per 100,000 women. The incidence of gastric cancer decreased from 31.8 to 18.9 per 100,000 men and from 15.1 to 7.3 per 100,000 women. For both cancers, the 1- and 5-year age-standardised relative survival improved for men and women from 1971-1975 to 1992-1994; the 5-year age-standardised relative survival was significantly higher in women than in men diagnosed in 1992-1994; for some periods from 1971-1975 to 1986-1990, the 1-year relative survival was significantly higher in the least deprived men than in the most deprived men. CONCLUSIONS: Survival improved for both cancers over the study period, but there were unexplained differences related to sex and deprivation.

Trends in the subsite and morphology of oesophageal and gastric cancer in England and Wales 1971-1998.

BACKGROUND: The incidence of adenocarcinoma of the oesophagus and gastric cardia has increased in many countries. AIM: To describe the trends in the subsite and morphology of oesophageal and gastric cancer using cancer registry data from 1971 to 1998. METHODS: We calculated the overall age-standardised incidence in each year; the age-standardised incidence by subsite, by morphology and by subsite and morphology; and the ratio of the rates in men and women in 1971 and 1998. RESULTS: The incidence of oesophageal adenocarcinoma increased from 1.5 to 7.0 per 100,000 men and from 0.4 to 1.5 per 100,000 women. The incidence of cancer at the cardia also increased, from 2.0 to 5.4 per 100,000 men and from 0.6 to 1.4 per 100,000 women, but the incidence of gastric cancer without a specified subsite decreased markedly from 21.3 to 9.3 per 100,000 men and from 10.7 to 4.2 per 100,000 women. CONCLUSIONS: Although some of the increase in the incidence of adenocarcinoma of the gastric cardia is probably real, this interpretation is limited by the proportion of cancers without specified subsites or morphologies.

Cancer prevalence in the UK: results from the EUROPREVAL study.

BACKGROUND: Cancer incidence, mortality and survival statistics for the UK are routinely available; however, data on prevalence, which is generally regarded as an important measure for health planning and resource allocation, are relatively scarce. MATERIALS AND METHODS: Eight cancer registries in the UK, covering more than half the population, provided data based on >1.5 million cases of cancer. Total prevalence was calculated using methods developed for the EUROPREVAL study, based on modelling incidence and survival trends. The prevalence of cancers of the stomach, colon, rectum, lung, breast (in females), cervix uteri, corpus uteri and prostate, melanoma of skin, Hodgkin's disease, leukaemia and all malignant neoplasms combined, was estimated for the UK for the end of 1992. RESULTS: Overall, approximately 1.5% of males and 2.5% of females in the UK population at the end of 1992 were living with a diagnosis of cancer. These proportions increased steeply with age, with approximately 7.5% (7.3% and 7.8%, in males and females, respectively) of people aged > or =65 years living with a diagnosis of cancer. Of the individual cancers, by far the highest prevalence (almost 1%) was seen for breast cancer in females; more than one in three of all living female cancer patients had been diagnosed with breast cancer. For males, around half of prevalent cases had been diagnosed >5 years previously and 30% >10 years previously; for females, these figures were both higher, at approximately 60% and 40%, respectively. CONCLUSIONS: The estimates of prevalence presented here comprise: recently diagnosed patients in need of treatment and monitoring; long-term survivors, some of whom will nevertheless eventually die from the cancer, while others may be cured of the disease; and patients in the terminal phase who are dying from the cancer. Further work should attempt to identify the proportions of patients in the different phases of care in order to optimise the use of prevalence estimates in health care planning.

Classification and incidence of cancers in adolescents and young adults in England 1979-1997.

Cancer patients aged 15-24 years have distinct special needs. High quality cancer statistics are required for service planning. Data presented by primary site are inappropriate for this age group. We have developed a morphology-based classification and applied it to national cancer registration data for England 1979-1997. The study included 25,000 cancers and 134 million person-years at risk. Rates for each diagnostic group by age, sex and time period (1979-83, 1984-87, 1988-92, 1993-1997) were calculated. Overall rates in 15-19 and 20-24-year-olds were 144 and 226 per million person-years respectively. Lymphomas showed the highest rates in both age groups. Rates for leukaemias and bone tumours were lower in 20-24 year olds. Higher rates for carcinomas, central nervous system tumours, germ-cell tumours, soft tissue sarcomas and melanoma were seen in the older group. Poisson regression showed incidence increased over the study period by an average of 1.5% per annum (P<0.0001). Significant increases were seen in non-Hodgkins lymphoma (2.3%), astrocytoma (2.3%), germ-cell tumours (2.3%), melanoma (5.1%) and carcinoma of the thyroid (3.5%) and ovary (3.0%). Cancers common in the elderly are uncommon in adolescents and young adults. The incidence of certain cancers in the latter is increasing. Future studies should be directed towards aetiology.

Patterns and trends in prostate cancer incidence, survival, prevalence and mortality. Part I: international comparisons.

The international patterns and trends in prostate cancer incidence, survival, prevalence and mortality were examined. Age-standardized incidence and death rates among men in a variety of countries worldwide were obtained from various sources, survival rates from European sources and elsewhere, and prevalence estimates from the EUROPREVAL study. Results from many published studies were summarized. The incidence of prostate cancer varies widely around the world, with by far the highest rates in the USA and Canada. There has been a gradual increase in the incidence of prostate cancer since the 1960s in many countries and in most continents; there were large increases in the late 1980s and early 1990s in the USA, but increases have also occurred in countries with comparatively low incidence, e.g. India. Survival from prostate cancer improved during the 1970s and 1980s; further increases in the 1990s may be largely a result of earlier diagnosis. There were wide differences in survival across Europe, with rates in the UK well below the average, but all European rates were far below those in the USA. There was wide variation in the prevalence of prostate cancer in Europe; in some countries with high incidence and high life-expectancy, prostate cancers formed approximately 15% of all prevalent cancers in men. Mortality from prostate cancer has also increased in many countries, but to a lesser extent than incidence; this is consistent with the observed trends in survival. Mortality decreased slightly in the mid to late 1990s in several countries, including the USA, Canada, England, France and Austria. Part of the apparent increases in the incidence of prostate cancer has been associated with diagnostic artefacts (particularly detecting preclinical tumours through the increased use of transurethral resection) which may also have had an effect on death certification through the incorrect attribution of prostate cancer as the underlying cause of death. However, the greatest effect on the registration of new cases of prostate cancer has been the increased availability of prostate specific antigen testing during the early- to mid-1990s. Possibly, in addition to the effect of attribution bias, the earlier diagnosis of prostate cancers has contributed to the recent slight decreases in mortality. However, this is unlikely to account for much of the reduction, given the slow development of the disease from onset to death. Changes in disease management are probably more important. There are many strong arguments against introducing population-based screening for prostate cancer.

Trends in testicular carcinoma in England and Wales, 1971-99.

OBJECTIVES: To examine incidence, mortality and survival trends in England and Wales for testicular cancer, using the recently developed national cancer and national mortality databases. METHODS: The directly age-standardized incidence rates for testicular cancer in England and Wales were calculated for the period 1971-97 and age-standardized mortality for years 1971-99. Trends in the data were then assessed, including the influence of social deprivation on testicular cancer incidence and survival. RESULTS: The number of newly diagnosed cases of testicular carcinoma in 1971-97 in England and Wales increased from almost 650 to 1400. The age-standardized rates were 2.9 per 100000 cases in 1971 and 5.4 per 100000 in 1997, an increase of 88% over 26 years. There was a large decrease in mortality since the mid-1970s, with an age-standardized mortality of < 0.5 per 100000 since 1985. For men with testicular carcinoma diagnosed in 1991-93, the 1-year relative survival was almost 98% and 5-year relative survival almost 95%, compared with 82% and 69%, respectively, for men diagnosed during 1971-75. There is a 'deprivation gap' for the 5-year survival of > 6% in favour of the most affluent socio-economic group, with no significant change over recent years. CONCLUSIONS: The incidence of testicular cancer is increasing in England and Wales, consistent with the trend documented in other developed countries. The reduction in mortality has been marked since the mid-1970s, reflecting improved cancer management, in particular the introduction of platinum-based chemotherapy regimens for advanced disease. Survival rates in England and Wales are as good as in other European countries. Further developments in chemotherapy are unlikely to produce such a marked improvement in survival rates again, and minimizing the effect of social status on survival rates should be an important target of future care.

Socioeconomic inequalities in cancer survival in England and Wales.

BACKGROUND: Cancer survival often has been reported as lower for the poor than the rich, but, to the authors' knowledge, systematic national estimates of deprivation gradients in survival over long periods of time have not been available. METHODS: The authors estimated national population-based survival rates for almost 3 million people who were diagnosed with 1 of 58 types of cancers (47 in adults, 11 in children) in England and Wales during the 20-year period 1971-1990 and followed through December 31, 1995. Cancer patients were assigned by their address at diagnosis to 1 of 5 categories (quintiles of the national distribution) of material deprivation by using a standard index derived from census data on unemployment, car ownership, household overcrowding, and social class that was available for all 109,000 census tracts in Great Britain. The authors used relative survival rates: the ratio of observed survival among the cancer patients to the survival that would have been expected if they had had the same background mortality as the general population. Background mortality differed widely among socioeconomic categories, and the authors constructed life tables from raw national mortality data by gender, single year of age, calendar period of death, and socioeconomic category to adjust for it. The authors used variance-weighted least squares regression to estimate both time trends in age standardized survival and socioeconomic gradients in survival. The number of avoidable deaths was estimated from the observed mortality excess compared with the expected mortality in each group of patients. RESULTS: Survival rose steadily for most cancers over 25 years to 1995 in England and Wales, but inequalities in survival between patients living in rich and poor areas were geographically widespread and persistent over this period of time. These patterns existed for 44 of 47 adult cancers examined but not for 11 childhood cancers. These inequalities in survival represented more than 2500 deaths that would have been avoided each year if all cancer patients had had the same chance of surviving up to 5 years after diagnosis as patients in the most affluent group. CONCLUSIONS: The largest national cancer survival study has provided strong evidence of systematic disadvantage in outcome among patients who lived in poorer districts compared with those who lived in wealthier districts.

Current trends in colorectal cancer: site, incidence, mortality and survival in England and Wales.

The objective was to examine trends in colorectal cancer (CRC) incidence and mortality in England and Wales over the last 30 years. Age-standardized incidence, mortality and survival rates for CRC, based on data from the National Cancer Intelligence Centre at the Office for National Statistics, were calculated and trends assessed. Between 1971 and 1997 the total number of cases of CRC increased by 42%, from 20,400 to 28,900. The site distribution of CRC between 1971 and 1994 was: rectum 38%, sigmoid 29%, caecum 15%, transverse colon and flexures 10%, ascending colon 5%, and descending colon 3%. Between 1971 and 1997 the direct age-standardized incidence increased by 20% in males and by 5% in females. The direct age-standardized mortality fell by 24% in males and by 37% in females. Age-standardized relative 5-year survival in adults improved from 22%-27% for patients diagnosed during 1971-1975 to over 40% for those diagnosed during the period 1991-1993. In conclusion, the incidence of CRC in England and Wales has been steadily rising. It is more common in males and has increased more rapidly in males than in females. The reasons for these trends remain unclear. Five-year survival has improved substantially, but rates are still below those in comparable countries elsewhere in Europe and in the USA.

Effect of NHS breast screening programme on mortality from breast cancer in England and Wales, 1990-8: comparison of observed with predicted mortality.

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.

Trends in prostate cancer incidence, mortality and survival in England and Wales 1971-1998.

OBJECTIVES: To examine trends in prostate cancer incidence and mortality in England and Wales between 1971 and 1998, using a newly developed and validated national cancer database and the national mortality database. METHODS: Age-standardized incidence and death rates were calculated directly and trends in relative survival rates among men with prostate cancer registered during 1971-1990 were examined. RESULTS: The annual number of new cases of prostate cancer registered in England and Wales increased by 179% between 1971 and 1993, from 6174 to 17 210. Directly age-standardized incidence rates increased by 104% between 1971 and 1993, from 29 to 59 per 100 000. The number of deaths from prostate cancer increased by 113% between 1971 and 1998, from 4027 to 8570. Directly age-standardized death rates increased by 49% between 1971 and 1995 and then decreased by 8% between 1995 and 1998, an overall increase of 38% (20 to 27 per 100 000) between 1971 and 1998. The relative survival rate for prostate cancer among men diagnosed during 1986-1990 was 77% at 1 year and 42% at 5 years, compared with 67% and 33%, respectively, for cases diagnosed during 1971-1975. The increase in survival rates was confined to men diagnosed with prostate cancer up to 1985 and no increase was seen for cases diagnosed after 1985. CONCLUSIONS: Prostate cancer is becoming a growing burden on the health service. The explanation for the large increase in prostate cancer incidence and mortality is unclear and needs further investigation. The lack of any improvement in survival rates in cases diagnosed after 1985 is of concern, and suggests that the current management of prostate cancer in both primary and secondary care may need to be reviewed.

How many deaths have been avoided through improvements in cancer survival?

OBJECTIVE: To estimate how many deaths from cancer have been avoided in England and Wales because of recent improvements in survival. DESIGN: Analysis of national statistics. SETTING: England and Wales. SUBJECTS: 1.5 million adults with diagnosis of one of 47 different cancers during 1981-5 or 1986-90. MAIN OUTCOME MEASURES: Reduction in number of cancer deaths within five years of diagnosis among patients with cancer diagnosed during 1986-90 compared with patients with cancer diagnosed during 1981-5. RESULTS: 17 041 deaths were avoided within five years of diagnosis among patients with cancer diagnosed during 1986-90. This represents 3.3% of the cancer deaths that would have been expected if survival had been the same as for patients with cancer diagnosed during 1981-5. Two thirds of the avoided deaths arose from improvements in survival for just five cancers: female breast cancer (4822), cancers of the colon (2560), rectum (1090), and bladder (1157), and melanoma of the skin (1098). The largest proportionate reductions in excess deaths were for melanoma of the skin (23%) and cancers of the testis (17%) and bone (17%). About 12 000 (70%) of the avoided deaths arose among adults aged under 75 at death. Improvements in survival from cancers of lung, prostate, stomach, ovary, and brain were small: they accounted for 33% of all cancers but only 11% of avoided deaths. CONCLUSIONS: Small gains in survival from common cancers save more lives than larger gains for uncommon cancers. If recent rates of improvement in cancer survival continue, about 24 000 deaths within five years of diagnosis would be avoided in patents aged under 75 by the year 2010, representing about a quarter of the government's overall target of 100 000 fewer cancer deaths.

Preliminary report on high thoracic epidural analgesia: relationship between its therapeutic effects and myocardial blood flow as assessed by stress thallium distribution.

OBJECTIVES: To extend the duration of high thoracic epidural analgesia (HTEA) treatment compared with the authors' previous studies, to test the hypothesis that the mechanism by which HTEA reduces angina during long-term treatment includes an improvement in myocardial blood flow distribution and a reduction in stress-induced ischemia, and to show that new myocardial infarctions are not masked or missed in patients receiving HTEA. DESIGN: Prospective consecutive study. SETTING: Department of Veteran's Affairs medical center and university-affiliated hospital. PARTICIPANTS: Six consenting adult patients. INTERVENTIONS: Patients were evaluated before HTEA catheter insertion and >2 months after HTEA catheter insertion with stress thallium tests. MEASUREMENTS AND MAIN RESULTS: Two of 6 patients had improvement but not resolution of stress-induced ischemia at 8 and 12 months. The remaining 4 patients had no change in stress-induced ischemia. None of the 6 patients had any new areas of ischemia or infarction as determined by stress thallium tests. CONCLUSIONS: The authors previously showed that HTEA is safe and effective in relieving refractory angina pectoris. The current study shows that this therapeutic effect persists and does not appear to be related to a change in myocardial blood flow; rather the improvement in symptoms probably results, in part, from an anesthetic effect. HTEA does not mask the development of new myocardial infarctions.

Measuring aspects of women's life and work for the study of variations in health.

BACKGROUND: Studies of occupation and health commonly examine only men. This paper draws on reviews of inequalities in health carried out by the Office for National Statistics in London which in recent years have focused more on women. METHODS: Many sources of official statistics such as censuses, surveys, vital registration and health service records are used to explore different ways of measuring and monitoring economic activity, education, socio-economic, and family status and their impact on fertility and health among women. RESULTS: Taking a life cycle approach we first look at fertility and family formation, the time around childbirth, age 15-49, and finally 50+. Some relevant health issues are used to illustrate how we use available data to describe and monitor inequalities in health. CONCLUSIONS: In Britain, there is a wealth of information and linked data sources which enable us to analyze patterns and trends in fertility, morbidity, and mortality. Nevertheless, none of the traditional data sources or methods of analysis are suitable for all purposes nor for keeping up with changes in society. Sources of official statistics and ways of linking and analyzing need then to be continuously developed.

Effect of screening on incidence of and mortality from cancer of cervix in England: evaluation based on routinely collected statistics.

OBJECTIVE: To assess the impact of screening on the incidence of and mortality from cervical cancer. DESIGN: Comparison of age specific incidence and mortality before and after the introduction of the national call and recall system in 1988. SETTING: England. SUBJECTS: Women aged over 19 years. RESULTS: From the mid-1960s, the number of smears taken rose continuously to 4.5 million at the end of the 1980s. Between 1988 and 1994, coverage of the target group doubled to around 85%. Registrations of in situ disease increased broadly in parallel with the numbers of smears taken. The overall incidence of invasive disease remained stable up to the end of the 1980s, although there were strong cohort effects; from 1990 incidence fell continuously and in 1995 was 35% lower than in the 1980s. The fall in overall mortality since 1950 accelerated at the end of the 1980s; there were strong cohort effects. Mortality in women under 55 was much lower in the 1990s than would have been expected. CONCLUSIONS: The national call and recall system and incentive payments to general practitioners increased coverage to around 85%. This resulted in falls in incidence of invasive disease in all regions of England and in all age groups from 30 to 74. The falls in mortality in older women were largely unrelated to screening, but without screening there might have been 800 more deaths from cervical cancer in women under 55 in 1997.