Health Check: Spotting cancer with beginner's luck

Here is a puzzle. More women than ever are being screened for breast cancer, and more cancers are being detected, according to the annual review of the NHS cancer screening service published last week.

Here is a puzzle. More women than ever are being screened for breast cancer, and more cancers are being detected, according to the annual review of the NHS cancer screening service published last week.

Yet there is a national shortage of radiographers. How has the NHS managed to square that circle?

You have to burrow into the report to find the answer. In the past, radiographers alone were responsible for taking mammograms, but a woman going along for an appointment today will as likely find she is in the hands of an "assistant practitioner".

In other words the NHS is pulling people off the street and training them up to fill the vacancies left by the shortage of radiographers. The report speaks of a "new way of working" based on "skills and experience" rather than profession.

Should women be alarmed? Screening is, after all, about detecting cancer, not selling potatoes. No one, given the choice, would willingly to place their health in the hands of someone less qualified.

But before you organise a protest outside your local breast cancer screening unit, take a look at the statistics in the back of the report.

More than 10,000 cancers were detected, five per cent up on the previous year. This is mostly because there were more older women being screened. But the standardised detection rate, corrected for age, also improved, indicating an increase in quality.

In other words, the newly trained junior staff appear to be doing a better job than the radiographers they replaced. The NHS is, as we know, short of professional staff at every level. Is there a lesson here?

* Raise a glass to the catalytic converter, 30 years old this month. It has saved thousands of lives around the world - not just by cutting pollution but by reducing suicides. Gassing yourself in the car by running a hose from the exhaust used to be a favoured way of ending it all. But it is almost impossible to sign out this way in a car with a catalytic converter, which extracts the lethal carbon monoxide from the exhaust gases. There have even been some Gothic tales of despairing individuals dragged from their cars and revived after as much as five hours spent breathing fumes they thought were noxious but turned out not to be. In 1979, there were 508 deaths from poisoning by carbon monoxide and other gases. In 2002 that number had fallen to 310. Evidence suggests that removing a method of suicide is an effective way of cutting the overall rate. The despairing take time to find other methods, if they ever do.

* What does it take to operate on a Prime Minister? The cardiologist who threaded the catheter in through Tony Blair's groin and up to his heart to correct his atrial flutter last month will have needed more than a steady hand. He will also have needed the confidence, in the presence of his illustrious patient, not to dwell on the consequence of a wobble.

It is what hospital specialists are trained for. But I recall Richard Smith, the former editor of the British Medical Journal, describing many years ago what happened during his own vasectomy.

The snipping had begun when the surgeon tried to engage his patient in conversation. After the initial banter came the inevitable question: what did he do for a living? "I edit the BMJ," came the reply. The surgeon lapsed into silence. Then, in Dr Smith's eye-watering account, beads of sweat started to stand out on the poor man's brow and a procedure that should have taken 10 minutes lasted half an hour.

But then, given the choice between a prime minister and a BMJ editor for a patient, I suspect most surgeons would regard the former as the softer option.