Our conclusion is that despite good organisation of the service, much of our effort in Bristol is devoted to limiting the harm done to healthy women and to protecting our staff from litigation as cases of serious disease continue to occur. The real lesson from 30 years' cervical screening is that no matter how obvious the predicted benefit may seem for any screening test, introduction should never take place without adequate prior evaluation of both positive and negative effects in controlled trials. Database records for screenings, performed from 1987 to June 1994, were utilized. Analysis of distance to the screening site, median family income, county physician population, and education levels indicated that distance and then education correlated best with participation. Distance and education correlated with participation.
Expenses compare favorably with diagnostic procedures for other diseases.
Menopause is the physiologic state that is a consequence of the cessation of ovarian function. A large number of vasomotor, psychological and gynecological symptoms have been associated with menopause. Hormonal replacement therapy is effective in treating these conditions. The use of estrogens and progestins including dosages, routes of administration and their advantages and disadvant- ages are reviewed in this article. In addition, hormonal replacement therapy may reduce the risk of atherosclerosis and prevent the osteoporosis of climateric women.