In 1971 the Aberdeen cytology service handled 22,291 cervical smears--threequarters from women participating in a screening programme and the rest from women with symptoms who were referred to hospital. As a result of screening, 56 preclinical cases of cancer of the cervix uteri were treated in hospital; 13 others were classified as less than preclinical. Of the gynaecological patients 20 had clinical cancer and 29 had less than preclinical lesions. From estimates of the costs of running the cytology service and of hospital inpatient costs it is possible to derive figures for detecting and treating preclinical cases and investigating and treating clinical cases. The cost to the Health Service of detecting and treating each preclinical case was slightly less (445 pounds) than that for impatient treatment of each clinical case (487 pounds). However, if mass screening were abandoned cytology would almost certainly continue for women referred to hospital with symptoms, and, if the costs of taking and examining these smears is taken into account, the cost per clinical case treated nearly doubles to 835 pounds. Had outpatient and other follow-up costs been included, the difference in service costs would be even greater. Comparison of these figures assumes the controversial point that preclinical cancer will always progress to invasive carcinoma if left untreated and takes no account of inflation and discounting.

Carcinoma in Situ↗

PubMedDate not supplied

Lumbar spondylolysis. A study of natural progression in athletes.

We examined the natural course of athletically active young people with back pain and a diagnosis of spondylolysis (stress fracture of the pars interarticularis of the facet joint of the lumbar spine). We limited the study to those with "subtle" fractures (normal radiographs and positive bone scans) and used computed tomography scanning to further characterize this lesion and to determine whether we could demonstrate healing in this population. The study group included 40 patients with low back pain and a diagnosis of spondylolysis by nuclear medicine study. Computed tomography scans were performed with both traditional cuts and reverse-gantry angled cuts to help determine long-term treatment and prognosis. Forty-five percent of patients (18) demonstrated chronic nonhealing fractures, 40% (16) demonstrated acute fractures in various stages of healing, and 15% (6) demonstrated no obvious fractures. With the diagnosis of spondylolysis being fairly common in young athletes with low back pain, primary care physicians need to have a high index of suspicion in making the diagnosis. Computed tomography scans can play a very important role in diagnosis, assessment of the defect, short-term and long-term management decisions, and in determining prognosis.

Adolescent↗