L14- Screening in practice Flashcards
NSC def of screening
‘The process of identifying healthy people who may have an increased chance of a disease or condition”
screening in the uk
for large target groups e.g. cervical cancer screening for all women aged between 25 and 64
targeted or risk stratified screening
for people at higher risk of disease
o E.g. targeted screening for women have a family history of breast cancer
NHS helaht checks for all between
40 and 74
opportunistic screening
recommended for certain groups, which doesn’t involve them being actively invited for screening
o E.g. screening young sexually active people for chlamydia when they come for the pill
organizations involved ins screening
- UK national screening committee- advices
- Department of health and social care- funds
- NHS England- commissions
- Public health England- advice and commissions
- Screening service providers- provides screening services (e.g. GPs)
- IT providers - providers
name 5 national screening programmes
- AAA screening
- Breast screening
- Cervical screening
- Diabetic eye screening
- Bowel cancer screening
AAA screening
- Targeted at men only
- Aged 65
- One-off scan
outcomes for AAA screening
- Less than 3cm- reassure
- 3cm-4.4cm- invited for annual scan
- 4.5cm-5.4cm- quarterly scan
- 5.5cm and over-refer to vascular surgeon within 2 weeks
why AAA screening
1 in 70 mean will have an AAA
when AAA screening
automatic in your 65th year
what is AAA
weakening of artery wall
how is AAA carried out
ultrascan
breast screening offered to
- Offering women aged 50 to 64 triennial screening appointments
- Current trial looking at extending age range 47-73
cervical screening
- Offered to women aged 25 to 64 (every 3 years)
- Started as a smear test, progressed to liquid based cytology and is now transitioning to primary HPV testing
- Est. to save around 5,000 livers per year
- 71.4% uptake
diabetic eye screening
- Invites all people with diabetes aged 12 years and over for an annual screen of the back of their eye (retina and macula)
- Those found to have retinopathy are either recalled sooner than one year, or if severe, referred to hospital eye services for further assessment and treatment
- 82.7% uptake
bowel cancer screening
- Offered to men and women aged 60 to 74
- Another one off screening test offered to those age 55 in some areas
- Saves 2,400 lives per year
bowel cancer screening low uptake due to
o Feeling healthy
o Fear of outcome
o Lack of time
o Disgust at the idea of handling stools
o Concern about posting samples in the mail
o Misunderstanding instructions
o Past negative experience or fear of colonoscopy
new test- faecal immunochemical test
- Better sensitivity
- Simple to use- better acceptability
- Extension of the bowl screening programme agreed in principle in NHS long term plan
- Workforce implications
participation rates are measured through
Uptake
coverage
iptale
he proportion of those invited who take up the invitation to participate
coverage
the proportion of the eligible population who have been screened within a given time period
factors effecting screening uptake
- Acceptability of the test
o Non-invasive vs invasive - Awareness of the benefits of the screening and corresponding risk of mortality/ morbidity
- Convenience- most screening programmes are not organised to promote convenience for patients
- Accessibility e.g. for those with disabilities
- Reminders and endorsements
inequalities in screening
Demographic factors and levels of affluence affect uptake and coverage across the programmes
- Efforts should be made in areas of low uptake to encourage participation
when screening goes wrong
- When people aren’t invited for screening when they are eligible e.g. breast and cervical screening
causes of problem with screening
- Initially attributed to a computer algorithm error meaning women aged 71 did not receive their final routine screening invitation
- Full investigation found error due to unclear programme spec and inconsistent interpretation across centres
- Screening programmes rely on complex and ageing NHS IT system to identify who to invite
developments in screening
- More targeted screening techniques- targeting those at higher risk
- Possible new population screening programmes
- New biomarkers
- The genomic revolution: polygenic risk score
- Artificial intelligence
