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Permanent childhood hearing impairment (PCHI) is common and adversely affects language acquisition. Early identification enables effective early interventions including hearing aids and cochlear implants. Research at Southampton was central to the case accepted by policymakers in the UK, USA and across several continents to recommend universal newborn screening (UNS) for PCHI. From 2008-13 more than three million babies in the UK were screened and over 5,000 cases of PCHI were identified with benefit to family functioning, literacy, academic achievement, social-emotional well-being, employment, wider society and the UK economy.
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.
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.
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.
Abdominal aortic aneurysm (AAA) is a major cause of death in older men, in the UK and elsewhere. A large UK trial led by the University of Cambridge evaluated the long-term benefits of ultrasound screening for AAA in men aged 65-74 years. This provided the basis for the introduction of a UK national AAA screening programme in men aged 65; this was announced in 2008, initiated in 2009, and achieved full coverage of England in 2013. Similar screening has started in Sweden, New Zealand and in parts of Italy, and is being actively discussed in Denmark, Norway and Finland.
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.
Congenital heart defects are a leading cause of infant death, accounting for more deaths than any other type of malformation and up to 7.5% of all infant deaths. Timely diagnosis is crucial for the best possible outcome for these children. However, the accuracy of current methods for screening for critical congenital heart defects (CCHD) before birth is variable and currently only detects these defects in between 35-50% of cases. Although around a third of remaining cases are picked up after birth, up to a third of children with a CCHD are sent home, where they may become unwell or die. Research led by Dr Andrew Ewer at the University of Birmingham has demonstrated that pulse oximetry is a rapid, safe, non-invasive, painless method of detecting the low blood oxygen levels associated with CCHD, and is also a cost-effective approach. As a result of Dr Ewer's research, Pulse Ox was recommended for adoption across the US in 2011 by the Secretary for Health and Human Services, and Dr Ewer has been instrumental in this screening approach being taken up worldwide. This research prompted a national UK review of screening for these conditions.