L14- Screening in practice

Question 1

NSC def of screening

Answer 1

‘The process of identifying healthy people who may have an increased chance of a disease or condition”

Question 2

screening in the uk

Answer 2

for large target groups e.g. cervical cancer screening for all women aged between 25 and 64

Question 3

targeted or risk stratified screening

Answer 3

for people at higher risk of disease

o E.g. targeted screening for women have a family history of breast cancer

Question 4

NHS helaht checks for all between

Answer 4

40 and 74

Question 5

opportunistic screening

Answer 5

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

Question 6

organizations involved ins screening

Answer 6

• 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

Question 7

name 5 national screening programmes

Answer 7

• AAA screening
• Breast screening
• Cervical screening
• Diabetic eye screening
• Bowel cancer screening

Question 8

AAA screening

Answer 8

• Targeted at men only
• Aged 65
• One-off scan

Question 9

outcomes for AAA screening

Answer 9

• 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

Question 10

why AAA screening

Answer 10

1 in 70 mean will have an AAA

Question 11

when AAA screening

Answer 11

automatic in your 65th year

Question 12

what is AAA

Answer 12

weakening of artery wall

Question 13

how is AAA carried out

Answer 13

ultrascan

Question 14

breast screening offered to

Answer 14

• Offering women aged 50 to 64 triennial screening appointments
• Current trial looking at extending age range 47-73

Question 15

cervical screening

Answer 15

• 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

Question 16

diabetic eye screening

Answer 16

• 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

Question 17

bowel cancer screening

Answer 17

• 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

Question 18

bowel cancer screening low uptake due to

Answer 18

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

Question 19

new test- faecal immunochemical test

Answer 19

• Better sensitivity
• Simple to use- better acceptability
• Extension of the bowl screening programme agreed in principle in NHS long term plan
• Workforce implications

Question 20

participation rates are measured through

Answer 20

Uptake

coverage

Question 21

iptale

Answer 21

he proportion of those invited who take up the invitation to participate

Question 22

coverage

Answer 22

the proportion of the eligible population who have been screened within a given time period

Question 23

factors effecting screening uptake

Answer 23

• 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

Question 24

inequalities in screening

Answer 24

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

Question 25

when screening goes wrong

Answer 25

• When people aren’t invited for screening when they are eligible e.g. breast and cervical screening

Question 26

causes of problem with screening

Answer 26

• 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

Question 27

developments in screening

Answer 27

• More targeted screening techniques- targeting those at higher risk
• Possible new population screening programmes
• New biomarkers
• The genomic revolution: polygenic risk score
• Artificial intelligence