In January, Boyd et al¹ drew attention to the shortcomings of the National Congenital Anomaly System (NCAS), and Archives now carries a complementary paper (page 368) examining the functionality of the system, measured against the standards suggested by the USA Center for Disease Control. In both reports, NCAS is found wanting. Can it be fixed, should it be fixed, or should it be abolished?

The problems with NCAS are well described in these two papers: very poor ascertainment, and no data on antenatally diagnosed cases, except when fed data by the regional congenital anomaly registers; massively incomplete data fields; and consequently a severely limited capacity to fulfil the role for which it was set up in the wake of the thalidomide disaster. Yet congenital anomaly remains a leading cause of death and disability, perinatally and in infancy. It continues to pose challenges to public health, neonatal medicine, and surgery. Environmental pollutants, prescription drugs, assisted reproduction technologies, and changes in diet and lifestyle all have actual or potential effects on the risk for congenital anomaly, so continuous, accurate anomaly monitoring is of great importance nationally and internationally.

A great strength of the regional registers in England …