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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.
Research undertaken at the University of Sheffield in 2005 to evaluate the cost-effectiveness and resource implications of potential screening programmes for colorectal cancer informed the decision to launch a national colorectal cancer screening programme in England. Upon their 60th/61st birthday, all individuals in England are now invited to participate in biennial bowel cancer screening using faecal occult blood testing (FOBT) until the age of 74. The programme identifies individuals with less advanced colorectal cancer and there is emerging evidence that it has led to an overall improvement in prognosis. Projections suggest that the programme is on course to reduce colorectal cancer deaths by 16%.
Amongst others, follow-on research includes an options appraisal of screening in Ireland that has informed national policy and a re-appraisal of colorectal screening options following publication of a pivotal trial of flexible sigmoidoscopy (FSIG) screening for NHS Cancer Screening Programmes.
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.
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.
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.
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.
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.
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.
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.