Saturday, August 01, 2009

Cervical smear surgery 'given needlessly' to women with borderline results

Many women with borderline results are given invasive treatment which increases their chances of suffering complications in future pregnancies

Hundreds of women may undergo unnecessary surgery after cervical smear tests, it has emerged. Many women with borderline results are given invasive treatment which increases their chances of suffering complications in future pregnancies. A study in the British Medical Journal found many of these treatments are entirely pointless, as there may be no tumour, or it may so small that it would disappear naturally.

Some 2,700 women are diagnosed with cervical cancer every year, and around 1,000 die.

The NHS screens women aged 25 and above for signs of pre-cancerous cells that may develop into tumours. It claims screening saves around 4,500 lives a year. Many women with positive results are referred for a procedure known as a 'colposcopy' to carry out a more detailed investigation. In many cases lesions are found, and the patients are sent for an operation to remove abnormal tissue - even though it may not be cancerous.

Some doctors argue the operation should only happen if a biopsy proves it is cancerous. The BMJ research found that for those whose tests reveal only mild changes or borderline results, invasive treatment can do more harm than good.

The study concluded that while the colposcopy detected more serious lesions (known as cervical intraepithelial neoplasia or CIN) it could lead to overtreatment, because they could sometimes return to normal of their own accord.

The study of more than 4,000 British women aged 20-59 whose results showed borderline or mild abnormalities also revealed a higher rate of after-effects. These included pain, bleeding and complications in later pregnancies.

The study's authors stated: 'We conclude that there is no clear benefit of a policy of immediate colposcopy as although it detects more CIN grade II or more severe disease, it leads to a large number of referrals with no high-grade CIN, overtreatment with associated after effects in young women, and no clear psychological benefit.'


Australia: Fad-laden food religion well-entrenched at a major Melbourne hospital

FAST food giant McDonald's has been given the green light to sell Big Macs in Melbourne's new Royal Children's Hospital. But it will have to meet strict Australian-first menu guidelines.

The hospital's retail food policy revealed to the Herald Sun paves the way for several fast food chains to operate in the $1 billion hospital. They will be subject to a "traffic light" system where half their menu is made up of "green" healthy food such as fruit, vegetables and water. "Red" food, including chips, cannot form more than a fifth of the food on offer.

The decision follows a report revealing RCH staff were split over McDonald's, which opened in the existing hospital amid controversy in 1991. Many doctors believed the presence of McDonald's sent a bad health message, while others felt it was a boost for sick children.

But RCH chairman Tony Beddison said the policy - a first at an Australian hospital - encouraged healthy eating and allowed families to make their own choices. "It provides choice, it provides great variety for children and their families, but it also gives a very clear message about healthy eating," he said. [A totally misleading message, more like it. Does he know the huge amounts of fat and red meat that Eskimos eat and how they almost never get cardiovascular disease?]

"There is going to be no retailer excluded from the tender. "It will be up to the individual retailer to come forward with their plan. But those plans must comply with the traffic-light green, amber, red policy and they need to comply regardless of who they are. "Sick kids need to be nurtured and looked after, guided and helped. But above all, we need to think about their wellbeing. "As a hospital we need to provide leadership to the community. We will not be endorsing any of the tenants, but they will need to meet this policy." To earn a place in the hospital, restaurant menus must feature:

* At least 50 per cent "green" food, such as lean meat, fish, chicken, fruit, vegetables and plain water.

* No more than 30 per cent "amber" food, including ice cream, muesli and snack bars, canned fruit, diet drinks and fruit juice.

* "Red" foods - such as chips, deep fried foods, chocolate bars, lollies, chips and soft drinks - to make up no more than 20 per cent.

At least three food stores will operate in the new hospital, but there could be room for up to nine depending on the mix of plans received when the tender process opens next month. The hospital will conduct twice-yearly audits to enforce the rules.

The hospital did not want to tell families what to eat [except that they do], but Mr Beddison said the hospital policy could be adopted far more widely. "There is no doubt this policy has extensions into other parts of the community, particularly where children eat, such as tuck shops," he said.

He would not speculate on who the likely tenderers would be, but said no restaurants were involved in developing the policy.


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