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.
IOE researchers have helped the NHS to maximize the number of babies in
the UK who are
screened for a range of serious but treatable conditions when they are
about a week old. This
means that more children with one of the screened-for conditions can start
a course of treatment
quickly. The fruits of the IOE team's work — a suite of training materials
for healthcare staff and
information leaflets for parents — have had another important consequence.
They have enabled
parents in the UK and in other countries to make much more informed
decisions on screening than
they could in the past.
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
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.
Antenatal screening aims to identify genetic carriers of sickle
cell/thalassaemia in order to provide prospective parents with "informed
choice". Throughout the period January 2008-July 2013, the NHS in England
has used a Family Origins Questionnaire in connection with sickle
cell/thalassaemia screening derived from our research programme. The
original policy issue concerned whether or not it is possible/desirable to
target antenatal screening for sickle cell/thalassaemia by means of an
ethnicity question. The policy problem was that socially constructed
"ethnicity" categories correspond imperfectly and to an unknown degree
with actual prevalence of genetic carriers. The screening question based
on our research now guides the offer of initial screening and/or further
laboratory tests for all pregnant mothers in England.
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.
Karl Atkin participated in a research programme that explored ways of
best supporting those with or at-risk of sickle cell and thalassaemia from
the perspective of patients, families, practitioners and policy makers.
The findings have had an accumulated impact on: care standards for a range
of health care professional and national policy bodies; public outreach;
ante-natal care and screening policy; and have informed the training and
education of doctors and nurses on how best to communicate with those at
risk of inherited blood disorders. Findings have also contributed to the
evidence base on social care and education, including providing practical
guidance to teachers.
University of Glasgow researchers have played a pivotal role in
developing and evaluating the pioneering Childsmile oral health
improvement programme. By the late 1990s, more than 50% of 5-year-olds in
Scotland showed evidence of dental decay. Since implementation of Childsmile
in 2006, this has decreased to 33% and, within this population dental
decay in children from the most severely deprived backgrounds has
experienced a striking reduction (from 79% to 55%). In 2011, Childsmile
was formally incorporated into the primary care dental contract and
subsequently in 2012, into the universal child health surveillance
programme in Scotland. Since its introduction Childsmile's
community-based, preventive approach has revolutionised dental healthcare
from birth for all children up to 12 years of age in Scotland resulting in
delivery of Childsmile to over 730,000 children per year.
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.
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
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
was shown to be inferior to manually read cytology, will not be adopted.