Screening Horizon Scanning Volume 5 Issue 1

Screening Horizon Scanning.

The latest edition of the Screening Horizon Scanning is out and available. Produced by NHS Libraries North West, Horizon Scanning is : “Bringing together best practice, innovation and future risks to support the commissioning process and service redesign.

Cervical cancer screening age in Scotland to be increased

The age at which women in Scotland receive their first cervical screening test will be raised from 20 to 25.

via BBC News – Cervical cancer screening age in Scotland to be increased.

Bowel-cancer screening pilot to begin in England

Health Secretary Jeremy Hunt is to announce pilots of a bowel-cancer screening programme that could save 3,000 lives a year.

via BBC News – Bowel-cancer screening pilot to begin in England.

Boltons Health Matters Evidence Summary: NHS Bowel Cancer Screening Programme – Evidence and Evidence Gaps. A Snapshot

The concept of this search was to see what research has been done, to then find gaps where further research could be undertaken. Please bear this in mind.

Boltons Health Matters Evidence Summary NHS Bowel Cancer Screening Programme Evidence Evidence Gaps A Snapshot

An evidence summary produced by NHS Bolton Library. Please click on the link to view. This is an original piece of work. Please contact the library if you wish to re-use in any format.

Electronic cancer decision support tool initiative planned for 2013

Plans to pilot an electronic cancer decision support tool to help GPs detect cancer earlier have been sent out in a letter to trust chief executives. Cancer networks are now recruiting general practices to take part and are working with local trusts to prepare for the initiative which is expected to be fully rolled out from March 2013 for 6 months.

via Electronic cancer decision support tool initiative planned for 2013 | Department of Health.

Looking ahead to the Be Clear on Cancer campaigns for 2013

The department is running regional and local pilot Be Clear on Cancer campaigns in January 2013 to improve public awareness of cancer symptoms. The campaign is set to encourage those people with symptoms to see their GP earlier and uses TV, radio, public events, press and poster advertising.

via Looking ahead to the Be Clear on Cancer campaigns for 2013 | Department of Health.

European cost-effectiveness analysis of cervical screening strategies for women not vaccinated for HPV: in many scenarios primary HPV screening is preferable to primary cytology screening in women aged over 30 years

European cost-effectiveness analysis of cervical screening strategies for women not vaccinated for HPV: in many scenarios primary HPV screening is preferable to primary cytology screening in women aged over 30 years — Denny and Kim 16 (1): 8 — Evidence-Based Nursing.

No abstract is available. An NHS Athens account may be required to view this article in full.

Screening Horizon Scanning Volume 4 Issue 7

Screening Horizon Scanning.

The latest edition of the Screening Horizon Scanning is out and available. Produced by NHS Libraries North West, Horizon Scanning is : “Bringing together best practice, innovation and future risks to support the commissioning process and service redesign.

Primary care factors associated with cervical screening coverage in England

Primary care factors associated with cervical screening coverage in England.

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Abstract

Background The National Health Service Cervical Screening Programme was established to decrease the incidence and mortality of cervical cancer in England.

To nudge or not to nudge: cancer screening programmes and the limits of libertarian paternalism

To nudge or not to nudge: cancer screening programmes and the limits of libertarian paternalism — Ploug et al. 66 (12): 1193 — Journal of Epidemiology & Community Health.

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Abstract

‘Nudging—and the underlying idea ‘libertarian paternalism’—to an increasing degree influences policy thinking in the healthcare sector. This article discusses the influence exerted upon a woman’s choice of participation in the Danish breast screening programme in light of ‘libertarian paternalism’. The basic tenet of ‘libertarian paternalism’ is outlined and the relationship between ‘libertarian paternalism’ and informed consent investigated. Key elements in the process of enrolling women into the Danish mammography screening programme are introduced.

Development of a pre-notification leaflet to encourage uptake of cervical screening at first invitation: a qualitative study

Development of a pre-notification leaflet to encourage uptake of cervical screening at first invitation: a qualitative study.

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Abstract

Cervical screening attendance among women aged 25–29 years in England is lower than at older ages. There is some evidence that pre-notification leaflets motivate women who have not yet considered their response to a health intervention. We aimed to identify key information to motivate young women at their first cervical screening invitation. Six focus groups were conducted, five with young women aged 17–25 registered with a General Practice in Manchester, UK, and one with Practice nurses. Some women took part in two further groups to discuss leaflet design.

Breast screening is beneficial, panel concludes, but women need to know about harms

Breast screening is beneficial, panel concludes, but women need to know about harms | BMJ.
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UK women invited to attend screening for breast cancer are three times as likely to be treated for a cancer that would never have harmed them as they are to have their lives saved, an expert panel has concluded

Breast cancer screening does ‘more good than harm’

Breast cancer screening saves the lives of two women for every one patient who receives unnecessary treatment, according to a major European revie

via BBC News – Breast cancer screening does ‘more good than harm’.

Expert group advises separating risk and benefit information from cancer screening invitations

via Expert group advises separating risk and benefit information from cancer screening invitations | BMJ.

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The public in England should be given more balanced information explaining the risks as well as the benefits of cancer screening, and this information should be separate from an invitation to be screened, an expert group has recommended in a consultation report.

The full report can be downloaded by clicking here

 

Mammography screening has little or no effect on breast cancer deaths, Swedish data indicate

via Mammography screening has little or no effect on breast cancer deaths, Swedish data indicate | BMJ.

 

This article is available freely via Open Access. Please click on the above link to view it fully.

Mammography screening has little or no effect on mortality from breast cancer in women aged 40-69, shows an analysis of Swedish figures published this week. But commentators argue that trends in breast cancer deaths cannot be used to evaluate screening in isolation from developments in diagnostic methods and treatment.

 

Pilot study will assess whether HPV test should replace smears to screen for cervical cancer

via Pilot study will assess whether HPV test should replace smears to screen for cervical cancer | BMJ.

 

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A pilot scheme is to be set up in the United Kingdom to assess the value of using human papillomavirus (HPV) testing as the primary screening test for cervical cancer rather than the currently used cytology or smear test.

 

Comparative effectiveness research in cancer screening programmes

via Comparative effectiveness research in cancer screening programmes | BMJ.

 

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Large scale cancer screening programmes are not amenable to generating or responding to new evidence about their effectiveness. The authors outline a new approach in Norway intended to overcome these drawbacks by means of comparative effectiveness research

 

Performance indicators for participation in organized mammography screening

Performance indicators for participation in organized mammography screening.

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Abstract

Background A population’s acceptance of a screening programme is reflected by its participation. Participation can be measured by cross-section, in an individual screening round, or by cumulative examination rate, which covers participation in numerous rounds at a pre-specified frequency. To establish an informed overview of programme performance, the relationship between these measures was analysed.

Primary care factors associated with cervical screening coverage in England

Primary care factors associated with cervical screening coverage in England.

An NHS Athens account may be required to view this in full.

 

 

Abstract

 

Background The National Health Service Cervical Screening Programme was established to decrease the incidence and mortality of cervical cancer in England.

 

Evaluation of the bowel cancer awareness pilot in the south west and east of England: 31 January to 18 March 2011

Evaluation of the bowel cancer awareness pilot in the south west and east of England: 31 January to 18 March 2011 : Department of Health – Publications.

This report, commissioned by the Department of Health, provides an independent evaluation of the two regional pilots aimed at raising public awareness and promoting earlier diagnosis of bowel cancer. It brings together information from a wide range of sources including:

·         A campaign-specific survey of public awareness of the key symptoms of bowel cancer and of the acceptability of such campaigns.

 

·         A bespoke study of attendance at GP practices before and during the campaign to assess changes in the public’s behaviour resulting from the campaign and any effect on GP workload.

 

·         Analysis of urgent referrals to secondary care for suspected colorectal cancer both in the two pilot regions and elsewhere.

 

·         Analysis of the impact on lower gastrointestinal endoscopy activity.

 

·         Analysis of the impact of the campaign on the uptake of bowel cancer screening.

 

·         Analysis of numbers of cancers diagnosed and (where available) stage at diagnosis, through cancer registries.

 

Psychosocial consequences of allocation to lung cancer screening: a randomised controlled trial

Psychosocial consequences of allocation to lung cancer screening: a randomised controlled trial — Aggestrup et al. 2 (2) — BMJ Open.

This article is available freely via Open Access. Please click on the above link to view it fully.

 

Abstract

Objective To examine the psychosocial consequences of being allocated to the control group as compared with the screen group in a randomised lung cancer screening trial.

Screening and cervical cancer cure: population based cohort study

Screening and cervical cancer cure: population based cohort study | BMJ.

This article is available freely via Open Access. Please click on the above link to view it fully.

Abstract

Objective To determine whether detection of invasive cervical cancer by screening results in better prognosis or merely increases the lead time until death.

Don’t flush away your toilet worries

News : NDS.

The Government’s first ever national cancer campaign to raise awareness of the symptoms of bowel cancer will be launched today by Care Services Minister Paul Burstow.

Confusion regarding cervical cancer screening and chlamydia screening among sexually active young women

Confusion regarding cervical cancer screening and chlamydia screening among sexually active young women — Ogbechie et al. 88 (1): 35 — Sexually Transmitted Infections.

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Abstract

Objective The American Congress of Obstetricians and Gynecologists (ACOG) recently recommended that cervical cancer screening begin at 21 years of age and occur biennially for low-risk women younger than 30 years. Earlier studies suggested that women may have limited understanding of the differences between cervical cancer screening and chlamydia screening. This study assessed the knowledge of chlamydia and cervical cancer screening tests and schedules in younger women.

Methods A survey regarding knowledge of chlamydia and cervical cancer screening was administered to 60 younger women aged 18–25 years in an obstetrics and gynaecology clinic at an urban community health centre.

Results The majority of respondents recalled having had a Pap smear (93.3%) or chlamydia test (75.0%). Although many respondents understood that a Pap smear checks for cervical cancer (88.3%) and human papillomavirus (68.3%), 71.7% mistakenly believed that a Pap smear screens for chlamydia. No respondent correctly identified the revised cervical cancer screening schedule, and 83.3% selected annual screening. Few respondents (23.3%) identified the annual chlamydia screening schedule and 26.7% were unsure.

Conclusion Many younger women in an urban community health centre believed that cervical cancer screening also screens for chlamydia and were confused about chlamydia screening schedules. As there is limited knowledge of the revised ACOG cervical cancer screening guidelines, there is a risk that currently low chlamydia screening rates may decrease further after these new guidelines are better known. Obstetrician gynaecologists and primary care providers should educate younger women about the differences between chlamydia and cervical cancer screening and encourage sexually active younger women to have annual chlamydia screening.

Identifying women with suspected ovarian cancer in primary care: derivation and validation of algorithm

Identifying women with suspected ovarian cancer in primary care: derivation and validation of algorithm | BMJ.

This article is available freely via Open Access. Please click on the above link to view it fully.

 

Abstract

Objective To derive and validate an algorithm to estimate the absolute risk of having ovarian cancer in women with and without symptoms.

Design Cohort study with data from 375 UK QResearch general practices for development and 189 for validation.

Participants Women aged 30-84 without a diagnosis of ovarian cancer at baseline and without appetite loss, weight loss, abdominal pain, abdominal distension, rectal bleeding, or postmenopausal bleeding recorded in previous 12 months.

Main outcome The primary outcome was incident diagnosis of ovarian cancer recorded in the next two years.

Methods Risk factors examined included age, family history of ovarian cancer, previous cancers other than ovarian, body mass index (BMI), smoking, alcohol, deprivation, loss of appetite, weight loss, abdominal pain, abdominal distension, rectal bleeding, postmenopausal bleeding, urinary frequency, diarrhoea, constipation, tiredness, and anaemia. Cox proportional hazards models were used to develop the risk equation. Measures of calibration and discrimination assessed performance in the validation cohort.

Results In the derivation cohort there were 976 incident cases of ovarian cancer from 2.03 million person years. Independent predictors were age, family history of ovarian cancer (9.8-fold higher risk), anaemia (2.3-fold higher), abdominal pain (sevenfold higher), abdominal distension (23-fold higher), rectal bleeding (twofold higher), postmenopausal bleeding (6.6-fold higher), appetite loss (5.2-fold higher), and weight loss (twofold higher). On validation, the algorithm explained 57.6% of the variation. The receiver operating characteristics curve (ROC) statistic was 0.84, and the D statistic was 2.38. The 10% of women with the highest predicted risks contained 63% of all ovarian cancers diagnosed over the next two years.

Conclusion The algorithm has good discrimination and calibration and, after independent validation in an external cohort, could potentially be used to identify those at highest risk of ovarian cancer to facilitate early referral and investigation. Further research is needed to assess how best to implement the algorithm, its cost effectiveness, and whether, on implementation, it has any impact on health outcomes.

Performance measures in three rounds of the English bowel cancer screening pilot

Performance measures in three rounds of the English bowel cancer screening pilot — Moss et al. 61 (1): 101 — Gut.

This article is available freely via Open Access. Please click on the above link to view it fully.

 

Abstract

Objectives To compare performance measures across all three rounds of the English bowel cancer screening faecal occult blood test pilot and their relation to social deprivation and ethnicity.

Methods In each round in three primary care trusts, data for a restricted population of over 48 500 aged 60–69 years were analysed. Individual-based data included postcode linked to area-based data on the Index of Multiple Deprivation (IMD) 2004, and ethnicity. Outcomes were the rates of screening and colonoscopy uptake, positivity and detection of neoplasia (adenomas or bowel cancer) and bowel cancer, and the positive predictive values (PPVs) of a positive test for neoplasia and bowel cancer. Sensitivity was calculated by the proportional incidence method using data on interval cancers identified from cancer registrations.

Results The overall uptake rate was 61.8%, 57.0% and 58.7% in the first, second and third rounds, respectively. Although the PPV for cancer decreased over the course of the three rounds (10.9% in the 1st round, 6.5% in 3rd round), the PPV for all neoplasia remained relatively constant (42.6% in 1st round, 36.9% in 3rd round). Deprivation and non-white ethnic background (principally Indian subcontinent in the pilot region) were associated with low screening and colonoscopy uptake rates, and this changed little over the three screening rounds. Uptake was lower in men, although differences in uptake between men and women decreased over time. Non-participation in previous rounds was a strong predictor of low uptake.

Conclusions Performance measures are commensurate with expectations in a screening programme reaching its third round of screening, but a substantial ongoing effort is needed, particularly to address the effects of deprivation and ethnicity in relation to uptake.

NHS cancer diagnosis waiting times down, figures show

NHS cancer diagnosis times across the UK have come down significantly in recent years, official figures show.

via BBC News – NHS cancer diagnosis waiting times down, figures show.

CDC panel recommends HPV shot for boys

A US government medical committee has recommended the human papillomavirus vaccine for boys, to tackle the spread of the sexually-transmitted virus.

via BBC News – CDC panel recommends HPV shot for boys.

Observations: Breast Screening

The NHS breast screening programme needs independent review

An independent review is under way — Richards 343 — bmj.com.

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The BMJ has published several articles over the past few years raising concerns about the accuracy and transparency of information provided to women about the benefits and harms of mammography screening for breast cancer. Last month the professor of complex obstetrics Susan Bewley sent us for publication an open letter to England’s cancer tsar. Here we publish the letter and Mike Richards’s response

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Should we use total mortality rather than cancer specific mortality to judge cancer screening programmes? Head to Head

No: Should we use total mortality rather than cancer specific mortality to judge cancer screening programmes? No — Steele and Brewster 343 — bmj.com.

Yes: Should we use total mortality rather than cancer specific mortality to judge cancer screening programmes? Yes — Penston 343 — bmj.com.

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James Penston believes all cause mortality is a more reliable measure of the effectiveness of screening, but Robert Steele and David Brewster think it is too stringent