- Email: [email protected]
Medical future for Hong Kong
Value of 40-49
mammography
for
women
aged
perplexed by Greenberg’s Nov 12 Washington perspective (p 1353) in which he seemed to conclude that the US National Cancer Institute (NCI) was at fault by emphasising that there are no unequivocal data to show that mammography for women under age 50 reduces causespecific mortality. The NCI’s position is a clear statement of the current position. The fact that it fails to reinforce the prejudice of many special interest groups in the USA is no cause to SIR-I
was
blame the NCI but a reason to re-examine motives of the screening zealots, who include large numbers of private radiologists who make a modest living out of this potentially damaging intervention. Far from the NCI breaking ranks with the health organisations they have, in fact, joined most European groups, which not only included the advisory committee on breast cancer screening in the UK but also the consensus of the European Society of Mastology which was arrived at in a public meeting in Paris in January, 1993. Furthermore, the Swedish authorities have just abandoned mammographic screening as part of government policy for this younger age group. I believe that the onus is now on the proponents of screening women under the age of 50 in the USA to justify their position. To continue screening inappropriate age groups without meaningful informed consent has to be regarded as unethical.’1
A K C Li, *Robert Shields Hong Kong College of Surgeons; and *Royal College Edinburgh EH8 9DW, UK
Trends in
Michael Baum
1 Jatoi I, Baum M. American and European recommendations for screening mammography in younger women: a cultural divide. BMJ 1993; 337: 1481-83.
Hong Kong
SiR-Your Oct 29 editorial contains errors in fact and flaws in reasoning. Quite properly, you allude to the strong links between Hong Kong and the UK. The present situation will inevitably change, with the establishment of the Hong Kong Academy of Medicine and its constituent colleges, but postgraduate training and education within the UK is undergoing major change (post-Calman), and for that reason we do not agree that the Hong Kong postgraduate systems will inevitably break away from those of Britain. The Royal College of Surgeons of Edinburgh has had long associations with Hong Kong. The first of the postgraduate examinations in surgery began 25 years ago, the successful candidates being awarded a fellowship of the Royal College of Surgeons of Edinburgh. However, radical changes are taking place in surgical education and training in the UK. It is likely that, in the near future, the fellowship of the Royal Colleges will be awarded at the end of higher training, as a result of an intercollegiate examination, around or slightly before, the time of award of the certificate of completion of specialist training. Basic surgical training and general professional education will occupy the first two years of surgical training and it is likely that the Senate of the Royal Colleges in the UK will approve similar, but probably not identical, programmes of training in accredited posts and hold examinations for UK and other European Union trainees. Similar arrangements will be required for overseas trainees-ie, non-UK and other European Union graduates who have undergone training abroad-and it will be one of the aims of the Edinburgh college, which is international in
of Surgeons of
Edinburgh,
gynaecological surgery
SiR-Further
Coulter’s report (Nov 12, p 1367) we wish the inference that increasing use of endometrial ablation/resection has not had an impact on hysterectomy rates. In her analysis Coulter does not differentiate between patients needing surgical treatment for menorrhagia and those with other gynaecological conditions needing hysterectomy. Her data do not therefore support the inference that endometrial ablation is creating an additional demand for surgery. Furthermore, her results could reflect the finding of the Royal College of Obstetricians and Gynaecologists’ UK survey (MISTLETOE) that laser ablation is a less effective technique than combined endometrial resection and rollerball diathermy (TCRE) for the treatment of menorrhagia. to
Institute of Cancer Research, Royal Marsden Hospital NHS Trust, London SW3 6JJ, UK
Medical future for
its outlook, to develop training and assessment schemes for these overseas graduates. In addition, the Hong Kong colleges and the Edinburgh college will strengthen their links in higher specialist training with mutually agreed high standards leading to double diplomas with a specialist fellowship of the Royal College of Surgeons of Edinburgh and fellowship of the Academy of Medicine. Although surgical colleges in Hong Kong and the UK need to look closely at the other colleges such as the Australasian colleges, and at training programmes in other countries such as the USA, Canada, Singapore, and China, there is every possibility that the links between the College of Surgeons of Hong Kong and the Royal College of Surgeons of Edinburgh will be strengthened and endure for many years ahead. You consider whether these links will continue, especially after 1997. We are convinced that they will, but it is most important the colleges concentrate on education and training of surgeons, on the maintenance of standards of the practice of surgery, and on the quality of care that our profession delivers, without becoming involved in politics.
comment
to
on
Table:
Hysterectomy and endometrial resection (TCRE), Liverpool Women’s Hospital, 1989-93
Local experience at this hospital has shown a significant decline over 5 years in the overall number of hysterectomies done for menorrhagia in the same consultant firm, with a stable referral pattern (table). Our analysis is of patients under age 55, thus excluding most operations for indications other than menorrhagia. Our customer satisfaction surveys show a 32% amenorrhoea rate and 86% of patients satisfied with the outcome of endometrial resection, with a minimum of 2 years’ follow-up. Our data strongly suggest that endometrial resection has replaced hysterectomy in a substantial proportion of patients needing surgical treatment for menorrhagia after failed medical management. *James Armatage, Siobhan
Quenby, Kath Granger,
Roy Farquharson Liverpool Women’s Hospital, Catharine Street, Liverpool L8 7NJ, UK
129
mammography
for
women
aged
perplexed by Greenberg’s Nov 12 Washington perspective (p 1353) in which he seemed to conclude that the US National Cancer Institute (NCI) was at fault by emphasising that there are no unequivocal data to show that mammography for women under age 50 reduces causespecific mortality. The NCI’s position is a clear statement of the current position. The fact that it fails to reinforce the prejudice of many special interest groups in the USA is no cause to SIR-I
was
blame the NCI but a reason to re-examine motives of the screening zealots, who include large numbers of private radiologists who make a modest living out of this potentially damaging intervention. Far from the NCI breaking ranks with the health organisations they have, in fact, joined most European groups, which not only included the advisory committee on breast cancer screening in the UK but also the consensus of the European Society of Mastology which was arrived at in a public meeting in Paris in January, 1993. Furthermore, the Swedish authorities have just abandoned mammographic screening as part of government policy for this younger age group. I believe that the onus is now on the proponents of screening women under the age of 50 in the USA to justify their position. To continue screening inappropriate age groups without meaningful informed consent has to be regarded as unethical.’1
A K C Li, *Robert Shields Hong Kong College of Surgeons; and *Royal College Edinburgh EH8 9DW, UK
Trends in
Michael Baum
1 Jatoi I, Baum M. American and European recommendations for screening mammography in younger women: a cultural divide. BMJ 1993; 337: 1481-83.
Hong Kong
SiR-Your Oct 29 editorial contains errors in fact and flaws in reasoning. Quite properly, you allude to the strong links between Hong Kong and the UK. The present situation will inevitably change, with the establishment of the Hong Kong Academy of Medicine and its constituent colleges, but postgraduate training and education within the UK is undergoing major change (post-Calman), and for that reason we do not agree that the Hong Kong postgraduate systems will inevitably break away from those of Britain. The Royal College of Surgeons of Edinburgh has had long associations with Hong Kong. The first of the postgraduate examinations in surgery began 25 years ago, the successful candidates being awarded a fellowship of the Royal College of Surgeons of Edinburgh. However, radical changes are taking place in surgical education and training in the UK. It is likely that, in the near future, the fellowship of the Royal Colleges will be awarded at the end of higher training, as a result of an intercollegiate examination, around or slightly before, the time of award of the certificate of completion of specialist training. Basic surgical training and general professional education will occupy the first two years of surgical training and it is likely that the Senate of the Royal Colleges in the UK will approve similar, but probably not identical, programmes of training in accredited posts and hold examinations for UK and other European Union trainees. Similar arrangements will be required for overseas trainees-ie, non-UK and other European Union graduates who have undergone training abroad-and it will be one of the aims of the Edinburgh college, which is international in
of Surgeons of
Edinburgh,
gynaecological surgery
SiR-Further
Coulter’s report (Nov 12, p 1367) we wish the inference that increasing use of endometrial ablation/resection has not had an impact on hysterectomy rates. In her analysis Coulter does not differentiate between patients needing surgical treatment for menorrhagia and those with other gynaecological conditions needing hysterectomy. Her data do not therefore support the inference that endometrial ablation is creating an additional demand for surgery. Furthermore, her results could reflect the finding of the Royal College of Obstetricians and Gynaecologists’ UK survey (MISTLETOE) that laser ablation is a less effective technique than combined endometrial resection and rollerball diathermy (TCRE) for the treatment of menorrhagia. to
Institute of Cancer Research, Royal Marsden Hospital NHS Trust, London SW3 6JJ, UK
Medical future for
its outlook, to develop training and assessment schemes for these overseas graduates. In addition, the Hong Kong colleges and the Edinburgh college will strengthen their links in higher specialist training with mutually agreed high standards leading to double diplomas with a specialist fellowship of the Royal College of Surgeons of Edinburgh and fellowship of the Academy of Medicine. Although surgical colleges in Hong Kong and the UK need to look closely at the other colleges such as the Australasian colleges, and at training programmes in other countries such as the USA, Canada, Singapore, and China, there is every possibility that the links between the College of Surgeons of Hong Kong and the Royal College of Surgeons of Edinburgh will be strengthened and endure for many years ahead. You consider whether these links will continue, especially after 1997. We are convinced that they will, but it is most important the colleges concentrate on education and training of surgeons, on the maintenance of standards of the practice of surgery, and on the quality of care that our profession delivers, without becoming involved in politics.
comment
to
on
Table:
Hysterectomy and endometrial resection (TCRE), Liverpool Women’s Hospital, 1989-93
Local experience at this hospital has shown a significant decline over 5 years in the overall number of hysterectomies done for menorrhagia in the same consultant firm, with a stable referral pattern (table). Our analysis is of patients under age 55, thus excluding most operations for indications other than menorrhagia. Our customer satisfaction surveys show a 32% amenorrhoea rate and 86% of patients satisfied with the outcome of endometrial resection, with a minimum of 2 years’ follow-up. Our data strongly suggest that endometrial resection has replaced hysterectomy in a substantial proportion of patients needing surgical treatment for menorrhagia after failed medical management. *James Armatage, Siobhan
Quenby, Kath Granger,
Roy Farquharson Liverpool Women’s Hospital, Catharine Street, Liverpool L8 7NJ, UK
129