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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.
Three national, multicentre randomised controlled trials and associated studies during a 20-year research programme on abdominal aortic aneurysm (AAA) led by Imperial College researchers have altered international practice. The United Kingdom Small Aneurysm Trial (UKSAT) set the threshold for intervention at 5.5cm to repair AAAs. Population screening programmes and guidelines in Europe (UK, Sweden and Europe as a whole), Australia and the United States are based on these data. The results from EndoVascular abdominal Aortic Repair (EVAR) trials have informed international audits, guidelines (including NICE) and task forces in the same countries.
Research undertaken by Professor Atkin has identified a feasible, acceptable and cost-effective method of reducing colorectal cancer incidence and mortality rates, which involves a once-only flexible sigmoidoscopy screening for all men and women at around age 60. The supporting research involved publishing the evidence, developing a fail-safe, efficient, patient-friendly delivery system, developing a surveillance strategy following adenoma-removal, and testing in multicentre randomised trials. After 11 years, incidence and mortality rates were reduced profoundly in the trials, with no observed attenuation of effect. The entire screening strategy was rolled out in a national programme from 2013, with complete population coverage expected by 2016.
The Institute of Sound and Vibration Research (ISVR) has played an influential role in transforming testing for child deafness in Europe, North America and elsewhere. In England, the NHS drew on its findings in deciding to replace traditional testing methods with universal newborn hearing screening programmes. This form of testing is more accurate, cost-effective and can be conducted at an earlier age. In England alone more than four million babies will be screened between 2008 and 2013, with around 6,000 identified as having hearing impairments. Earlier clinical intervention has benefited children's language development and overall quality of life.
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.
The results of two major randomised trials and a cohort study based at the University of Manchester (UoM) have had a major impact on cervical screening in the UK and influenced thinking internationally. These trials evaluated two technologies which had the potential to improve cervical screening. As a result HPV primary screening has moved to a large national pilot study. HPV as a test of cure following treatment of cervical precancerous lesions has now been adopted as standard across the National Screening Programme. Automation assisted technology, which was shown to be inferior to manually read cytology, will not be adopted.
Research by Professor Judith Stephenson and colleagues at the UCL Institute of Women's Health into the effectiveness of chlamydia screening has led to guidance to health policy makers in the EU about national strategies for chlamydia control, and has influenced NICE guidelines on the subject. In particular, our work has informed debate on the value for money of the National Chlamydia Screening Programme (NCSP). Stephenson advised the National Audit Office on this topic, and a resulting report led to the NCSP focusing on chlamydia testing in sexual health services and primary care rather than screening in low risk groups. These changes are expected to make considerable cost savings to the NHS.
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.
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.
Impact: Health and welfare; a UK clinical trial of uterine artery embolisation (UAE), with five-year follow-up, defined the risk- and cost-benefit of UAE versus surgery.
Significance: The trial informed guidelines/recommendations internationally and changed clinical practice. Women worldwide can now make an informed choice about their treatment; economic factors have been quantitated.
Beneficiaries: Uterine fibroid patients, the NHS, healthcare providers.
Attribution: G. Murray, UoE, developed and delivered innovative trial methodology; clinical aspects led by University of Glasgow.
Reach: UK guidelines; worldwide (Australia, USA, Europe) effect on clinical practice that will impact up to 25% of women.