Screening In Practice

Question 1

What is screening

Answer 1

Process of identifying healthy people who may have an increased chance of disease
Secondary intervention

Question 2

Screening in the UK examples

Answer 2

Can be national, targeted or aimed at higher risk groups
NHS health checks for people between 40-74
Lung health checks - current/ex smokers
Opportunistic screening - doesn’t involved being invited

Question 3

Screening timelines

Answer 3

Pregnancy, newborn, diabetic eye, cervical, breast, bowel cancer, abdominal aortic aneurysm

Question 4

Organisations involved in screening

Answer 4

IT providers, screening service providers, NHS England, Public Health England, UK National Screening Committee, Department of Health and Social Care

Question 5

Abdominal aortic aneurysm

Answer 5

Men only over 65
one off ultrasound scan
Less 3cm - reassure
5.5 - vascular surgeon within 2 weeks

Question 6

Breast screening

Answer 6

Ages 50-70
May be changing to 47-73
1 fewer death per 200 women

Question 7

Cervical screening

Answer 7

Was Smear but now primary HPV testing

Every three years for women 25-49

Question 8

Diabetic eye screening

Answer 8

All people with diabetes aged over 12

Recalled sooner or referred to hospital eye services

Question 9

Bowel cancer screening

Answer 9

Faecal occult blood test
In post
Capture poo, smear on sheet
2 poos
2 smears for each

Question 10

Issues with faecal occult blood test

Answer 10

Uptake affected by:
Feeling healthy
Fear of outcome
Lack of time
Disgust
Concern about posting
Misunderstanding instructions
Past negative experiences or fear of colonoscopy

Question 11

New bowel cancer test

Answer 11

Faecal immunochemical test
Better sensitivity
Simpler
But if diagnose more, more work and infrastructure is needed to treat them

Question 12

Participation rates of screening are measured by

Answer 12

Uptake - those who take up invite

Coverage - proportion of eligible population who have been screened

Question 13

Factors affecting screening uptake

Answer 13

Acceptability of test - non invasive
Awareness of benefits
Convenience
Accessibility (eg those who are disabled less access, or speak different language)
Reminders and endorsements 
Peers taking party

Question 14

Inequalities in screening

Answer 14

More deprived = less uptake

Question 15

Developments in screening

Answer 15

Targeted
New population screening programs
New bio markers (eg PSA in prostate not useful)
Genomic revolution: polygenic risk scores (multi gene overview)
Artificial intelligence to read results and interpret