Screening Dr Helen Raison Consultant, Public Health Royal Borough of Kingston
What is screening? Screening is a process of identifying apparently healthy people who may be at increased risk of a disease or condition. They can then be offered information, further tests and appropriate treatment to reduce their risk and/or any complications arising from the disease or condition.
UK Population Screening Programmes Antenatal and Newborn sickle cell and thalassaemia fetal anomaly infectious diseases in pregnancy newborn and infant physical examination newborn blood spot newborn hearing Young Person and Adult diabetic eye abdominal aortic aneurysm breast cancer cervical cancer bowel cancer Have to meet strict criteria to be introduced as a managed screening programme by National Screening Committee
Antenatal And Newborn Screening Programmes
Adult Screening Programmes
Adult Screening Programmes
Diabetic Retinopathy Screening Programme Diabetes can lead to diabetic eye disease. Early identification and treatment of diabetic eye disease can reduce sight loss. The main treatment for diabetic retinopathy is laser surgery. All people with known type 1 and type 2 diabetes aged 12 or over are invited for screening People already under the care of an ophthalmology specialist for the condition are not invited for screening. The programme offers pregnant women with type 1 or type 2 diabetes additional tests because of the risk of developing retinopathy 79.4% of those offered a test attended and had digital screening
Abdominal Aortic Aneurysm Screening Programme https://www.gov.uk/guidance/abdominal-aortic-aneurysm-screeningprogramme-overview
Breast Cancer Screening Programme Women age 50-70 automatically invited every 3 years Some older and younger women are invited as part of a screening study Women over 70 can continue to have breast screening every 3 years but have to request it Finds small cancers which cannot yet be seen or felt Main risk is that some women will be diagnosed and treated for a breast cancer that would never otherwise have been found or caused them harm 66.2% eligible women screened in last 3 years in South West London. Lower than target of 70% coverage Screening leaflets https://www.gov.uk/government/collections/ breast-screening-information-leaflets.
Bowel Cancer Screening Programme Offered every 2 years to all men and women aged 60 to 74 Information letter sent, followed by posted faecal occult blood sampling kit. The kit includes simple instructions for taking sample at home and sending to lab The sample is then processed and the results sent to the individual within 2 weeks. Colonoscopy for those with abnormal screening result (to look at bowel lining) 53.9% eligible people been screened in past 2.5 years in SWL. Working to increase this. A bowel scope screening programme is being introduced for all men and women in England aged 55
Cervical Cancer Screening Programme https://www.gov.uk/guidance/cervical-screening-programmeoverview
Why some screening tests are not run as screening programmes? National Screening Committee makes recommendations on 109 conditions Reviews every 3 years Uses evidence to decide if population screening should be introduced, changed or stopped Examples of conditions where NSC has recommended no in 2017 include: Asymptomatic bacteriuria Antenatal carriage of Group B streptococcus Ovarian Cancer Duchenne Muscular Dystrophy
Prostate Cancer PSA screening test Second leading cause of cancer-related death in UK men Risk of prostate cancer increases with age, family history, in black men, in overweight and obese men NSC does not recommend universal screening (2016) Slow growing prostate cancer is common, may not cause symptoms or shorten life Abnormal PSA test may mean a man has cancer, but it may mean he does not (3 in 4 men wont) PSA test cannot distinguish fast-growing from slow-growing cancers Prostate cancer screening can reduce prostate cancer deaths by 21% but it can also lead to major harms caused by treating men who incorrectly testing positive. NSC concluded that harms outweigh the benefits. Work is ongoing to increase the accuracy of the PSA test Information on PSA test: https://patient.info/health/prostate-and-urethraproblems/prostate-specific-antigen-test-psa NHS/PHE Prostate Cancer Risk Management Programme guidance for GPs and patients to decide whether to do a PSA test
Who is who in screening? UK National Screening Committee advises ministers and the NHS in the 4 UK countries about all aspects of screening and supports implementation of screening programmes Royal Borough Kingston Public Health Team assures local programmes, holds PHE/NHSE to account, supports work to reduce inequalities in access to screening Helen Raison, Screening Assurance Lead PHE Screening and NHSE England PHE lead the national population screening programmes, and advise NHSE Screening Commissioners who commission the programmes NHS, GPs, Hospitals deliver the screening programmes at screening centres, maternity units, GP surgeries, local clinics