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The Nottingham Bowel Cancer Screening trial showed that biennial Faecal Occult Blood testing reduced bowel cancer mortality by 16%. As a consequence of this trial, the Department of Health launched two screening pilots and introduced a National Bowel Cancer Screening Programme (NBCSP), achieving national coverage in 2010. Since 2008, this has sent out almost 18 million invitations and detected 16,000 bowel cancers, of which 21.6% were early cancers with a 95% chance of cure. It is estimated that the NBCSP saves around 3,500 lives each year in the UK. International screening programmes modelled on the UK system will save many more.
The UK Faecal Occult Blood Test Screening Programme, based on Dundee-led research (Steele), offers bowel cancer screening through mailed test kits followed up with colonoscopy when faecal blood is detected. It is estimated to prevent about 2,000 UK deaths annually. Steele's Screening Research Unit also trialled immunological faecal occult blood testing, which was subsequently incorporated into the Scottish screening algorithm. In addition to demonstrating a 27% reduction in bowel cancer deaths through participation in Faecal Occult Blood screening, the Unit has researched the incidence of interval cancers and the impact of repeated invitations, development of new tests, and strategies for increasing participation. All of these drive the National Screening Programme, and will further reduce mortality.
Essex contributed to the independent evaluation of the UK NHS Bowel Cancer Screening Pilot programme by conducting the psychosocial aspects of this research. The evaluation recommended full roll-out, and was used to inform the programme's subsequent development and implementation. Nationwide screening for 60-69 year olds, using the Faecal Occult Blood test, began in 2006 and in 2010 the programme was extended to include adults up to their 75th birthday. Since July 2006 over 17 million screening episodes have been completed and 15,000 cancers detected. It is estimated that the programme is on track to cut deaths by 16%.
Our evidence that a single flexible sigmoidoscopy (FS) dramatically reduced bowel cancer mortality and incidence, combined with evidence of high public acceptability in our pilot programme, led the Prime Minister to announce in late 2010 that once-only FS would be included in the UK National Bowel Cancer Screening Programme. The new FS screening programme started in March 2013 in six pilot centres, and is being progressively implemented nationally, with full roll-out expected by 2016. All eligible adults will be invited for screening around the time of their 55th birthday using the invitation and bowel preparation protocols developed for the trial. If uptake rates similar to those in the pilot are achieved, bowel cancer rates could be cut by a quarter, and deaths by a third, giving the UK the best colorectal cancer (CRC) outcomes in the world.
There are currently 2 million cancer survivors in the UK. This is predicted to become 6 million by 2050 — by which time more than 50% of the UK population are expected to have experienced a cancer diagnosis. Our research and expertise have been central to the creation of the Department of Health's National Cancer Survivorship Initiative (NCSI), and framing policy more widely to respond to this challenge. It has provided evidence of the wide-ranging impact of the disease following cancer treatment, and has led to new models of cancer aftercare being implemented across the UK and internationally. Our research has linked directly to policy and practice through Professor Jessica Corner's membership of the NCSI Steering Group, as co-chair of the Department of Health's Cancer Patient Experience Advisory Group, and through our partnership with Macmillan Cancer Support.
Professor Peter Sasieni's team at Queen Mary showed that the efficacy of cervical screening was age-dependent. Their recommendations were adopted as policy in England in 2003 and led many other countries, including the USA, to raise the recommended age of first screening. This research was central to the 2009 re-evaluation of the most appropriate age for first screening in England, resulting in some 300,000 fewer screening tests per year in women aged 20-24, with a cost saving to the NHS of some £15 million annually. Annually, 45,000 fewer women now have an abnormal cervical screening test, of which an estimated 8,500 would have received unnecessary surgical treatment. The estimated annual saving to the NHS is £17.5 million.
School dental screening was a statutory function of the NHS. University of Manchester (UoM) research demonstrated that the national screening programme was ineffective and likely to increase inequalities in health and service utilisation. As a direct result of UoM research, the National Screening Committee recommended that the national programme should stop. This changed Departments of Health policy resulting in new guidance to the NHS, which stopped the screening programme and redirected resources to treatment services for vulnerable groups and prevention programmes. In 2010 in England the costs of a national screening programme were estimated to be £17m per year; money released for reallocation to other dental services.
Research at UCL developed a `screen and treat' model for dealing with mental health problems in the aftermath of disasters. This was successfully implemented after the London bombings in 2005. The strategy was shown to be very effective in detecting individuals in severe psychological need, and those screened and referred within the programme benefited substantially from evidence-based treatment. Since then, the model has been adopted in planning for major incidents in the UK and abroad. The screening instrument developed at UCL is in widespread use around the world.
As a result of research at Queen Mary, an estimated 2,500-3,000 additional women per year in UK have a breast cancer detected early through two-view mammography at the NHS Breast Screening Programme, and similar country-wide benefits have occurred abroad. From 1988 the NHS Breast Screening Programme offered women aged 50-64 three-yearly one-view mammography. In 1995, results from the UKCCCR Randomised Trial of One and Two View Mammography (led by Queen Mary researchers) showed that including a second view increased breast cancer detection by 24% and reduced recall rate by 15%. On the basis of this evidence, the Department of Health immediately issued an Executive Letter requiring all breast screening units to move to two-view mammography for the prevalent screen. Changes were rapidly and widely implemented. By 2004, two-view mammography had become the policy at all screens, prevalent and incident. Two-view mammography remains national policy and its benefits continue to the present day.
Abdominal aortic aneurysms (AAAs) affect more than 4% of British men aged 65-74 and are responsible for over 6,800 deaths annually. The MASS trial showed that screening could reduce AAA-related mortality by 42%, and the Health Economics Research Group (HERG) demonstrated, through the MASS trial, that AAA screening was cost-effective. HERG thus helped inform the policy announced by UK ministers in 2008 to introduce a national screening programme for all men reaching 65. By Spring 2013 it was fully introduced in England — offering screening to 300,000 men annually; the latest Annual Report (2011-12) claimed an uptake rate of 75%. In 2008 the DH estimated the health gain from a screening programme would be at least 130,000 QALYS over 20 years. Internationally, MASS is the most significant trial of AAA screening, and provides the most robust evidence-based model of its cost-effectiveness. It extensively influenced AAA screening guidelines, policies and services, including in the USA and Europe.