There are some topics that the British just don’t like to talk about, and bottoms, bowel habits, and anal sex fall firmly into that category—even when the conversation is with their GP.

But these conversations are necessary. The latest statistics from Cancer Research UK show that rates of anal cancer in the UK have increased dramatically since the mid-1970s, quadrupling in women and tripling in men, reports Jacqui Wise. So what is behind the rise? Apparently it is anal sex.

In recent years, the British have become a lot more relaxed about anal sex and are engaging in a heck of a lot more of it. While pregnancy and traditional sexually transmitted diseases might seem like less of a risk with this activity, participants should still be advised to use condoms.

An estimated 90% of anal cancer cases in the UK are linked to human papillomavirus (HPV), which can be transmitted through unprotected rear penetration. Vaccination of teenage girls against HPV, introduced primarily to protect against cervical cancer, is expected to help reduce rates of all types of HPV related cancers. The Joint Committee on Vaccination and Immunisation is considering whether to extend the vaccination programme to boys, and rising rates of anal cancer across both sexes adds weight to the case that it should.

In other news, which doctors will find heartening but greet with a healthy dose of cynicism, NHS England’s chief executive, Simon Stevens, called for service redesign to be tested as rigorously as new therapies in his first speech to the annual NHS Confederation conference, reported by Tom Moberly, editor of BMJ Careers. “We do too many pilots that are not rigorously conceptualised and effectively managed,” Stevens said. Perhaps we will see the National Institute for Health and Care Excellence or another body assessing the evidence base in the future?

If they do, I hope they make the full data available so that researchers can do their own independent evaluations, unlike with the European Medicines Agency’s current “transparency” plans for clinical trial reports. The European Ombudsman is not happy with the EMA’s backtracking, and has formally asked the European Commission, which must approve the agency’s plans, for its view. It has also launched an investigation into how the agency handled requests for access to clinical trial reports about the approval of the drug Humira, which is produced by AbbVie—a company that took legal action last year against the agency to prevent the release of documents related to its products.

Ingrid Torjesen is a freelance news reporter for The BMJ.