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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.
King's College London research identified the feasibility of implementing newborn screening for sickle cell disease, which was advocated. King's research also demonstrated the feasibility of antenatal screening for sickle cell disease early in pregnancy. A new national NHS Programme for antenatal and newborn screening for haemoglobin disorders was rolled out, with the national Programme Centre based at King's, resulting in increasing numbers of women and newborn infants being tested for sickle cell disease and trait. The screening programme enables informed choices for carrier individuals, and contributed to earlier diagnosis and better care for those with disease. King's research identified important problems in the delivery of treatment services for patients with sickle cell disease. The research informed the decision to designate specialist NHS services in order to address deficiencies in care.
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 16%.
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 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.
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.
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.
A series of projects focusing on the medical, social, and emotional experience of pre-pregnancy, pregnancy, and early motherhood have been undertaken since 2006 at Plymouth University. The impact of these projects is wide ranging covering both policy and practice. The research has: changed the physical environment of the antenatal clinic specifically to suit the needs of pregnant women with pre-existing diabetes; developed an online leaflet for women with Polycystic Ovary Syndrome (PCOS); developed training programmes for health and social care professionals; provided baseline information to inform practitioners and patients involved in UK screening programmes; and, informed screening strategies for Downs Syndrome.