Cervical screening coverage rates in England fall

This report presents information about the NHS Cervical Screening Programme in England in 2016-17. It includes data on the call and recall system, on screening samples examined by pathology laboratories and on referrals to colposcopy clinics | NHS Digital

Key Facts:

• At 31 March 2017, the percentage of eligible women (aged 25 to 64) who were recorded as screened adequately within the specified period was 72.0 per cent. This compares with 72.7 per cent at 31 March 2016 and 75.4 per cent at 31 March 2012.

• A total of 4.45 million women aged 25 to 64 were invited for screening in 2016-17, representing an increase of 5.6 per cent from 2015-16 when 4.21 million women were invited.

• In total, 3.18 million women aged 25 to 64 years were tested in 2016-17, an increase of 2.9 per cent from 2015-16 when 3.09 million women were tested.

• Of samples submitted by GPs and NHS Community Clinics, 94.8 per cent of test results were returned Negative.

• 8.8 per cent of patients did not attend colposcopy appointments and gave no prior warning.

Full detail at NHS Digital: Cervical Screening Programme, England – 2016-17

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Reducing the socioeconomic gradient in uptake of the NHS bowel cancer screening Programme

The aim of this study was to determine whether a supplementary leaflet providing the ‘gist’ of guaiac-based Faecal Occult Blood test (gFOBt) screening for colorectal cancer could reduce the socioeconomic status (SES) gradient in uptake in the English NHS BCSP | BMC Cancer

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The trial was integrated within routine BCSP operations in November 2012. Using a cluster randomised controlled design all adults aged 59–74 years who were being routinely invited to complete the gFOBt were randomised based on day of invitation. The Index of Multiple Deprivation was used to create SES quintiles. The control group received the standard information booklet (‘SI’). The intervention group received the SI booklet and the Gist leaflet (‘SI + Gist’) which had been designed to help people with lower literacy engage with the invitation. Blinding of hubs was not possible and invited subjects were not made aware of a comparator condition. The primary outcome was the gradient in uptake across IMD quintiles.

In November 2012, 163,525 individuals were allocated to either the ‘SI’ intervention (n = 79,104) or the ‘SI + Gist’ group (n = 84,421). Overall uptake was similar between the intervention and control groups (SI: 57.3% and SI + Gist: 57.6%; OR = 1.02, 95% CI: 0.92–1.13, p = 0.77). Uptake was 42.0% (SI) vs. 43.0% (SI + Gist) in the most deprived quintile and 65.6% vs. 65.8% in the least deprived quintile (interaction p = 0.48). The SES gradient in uptake was similar between the study groups within age, gender, hub and screening round sub-groups.

Providing supplementary simplified information in addition to the standard information booklet did not reduce the SES gradient in uptake in the NHS BCSP. The effectiveness of the Gist leaflet when used alone should be explored in future research.

Full reference: Smith, S.G. et al. (2017) Reducing the socioeconomic gradient in uptake of the NHS bowel cancer screening Programme using a simplified supplementary information leaflet: a cluster-randomised trial. BMC Cancer. 17:543

Interactive dashboard provides new insight into cervical screening coverage

GPs and health organisations will be able to improve cervical screening rates thanks to an innovative new online data tool | NHS Digital

It is hoped that the interactive dashboard will help identify areas where screening levels could be improved and encourage work to boost coverage.

The dashboard will provide more detailed and timely information about cervical screening and will help Clinical Commissioning Groups (CCGs), GP practices and local authorities to improve coverage rates for the potentially lifesaving test, which are currently falling.

NHS Digital, Public Health England (PHE) and Jo’s Cervical Cancer Trust have collaborated on the initiative, which aims to provide easier access to the latest data about cervical screening3. This is part of a PHE-led project to empower GP practices and CCGs to improve cervical screening attendance and coverage rates.

Household screening could reduce tuberculosis transmission in England

Screening people who live in the same household as a person diagnosed with tuberculosis (TB) for the disease could help reduce its transmission in low-incidence countries, such as England | OnMedica

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If screening is limited to those that have come into contact with pulmonary TB cases – as recently recommended in UK guidelines – one quarter of TB cases could be missed, researchers at Public Health England suggest.

The research team looked at all TB cases notified in 2010-12 in England that were likely to be caused by recent transmission from another person living in the same household, to see whether the same strain that caused the disease in index and subsequent cases.

The researchers found that 7.7% (1,849 out of 24,060) of all TB cases reported between 2010 and 2012 shared a house with at least one other TB case. However, 25% of these cases had discordant strains of the TB bacterium, which means that they were not transmitted by the infected person living in the home. In total, 3.9% of TB cases in England were estimated to be due to recent household transmission. However, strain data were unavailable for 67% (1,242) of household pairs.

Benefits and harms of breast cancer screening in women aged 40-49 years

Early detection of breast cancer through screening can lower breast cancer mortality rates and reduce the burden of this disease in the population | International Journal of Cancer

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In most western countries, mammography screening starting from age 50 is recommended. However, there is debate about whether breast cancer screening should be extended to younger women. This systematic review provides an overview of the evidence from RCT’s on the benefits and harms of breast cancer screening with mammography in women aged 40 to 49 years. The quality of the evidence for each outcome was appraised using the GRADE approach.

Four articles reporting on two different trials, the Age trial and the Canadian National Breast Screening Study-I (CNBSS-I), were included. The results showed no significant effect on breast cancer mortality (Age trial: RR 0.93, 95% CI 0.80-1.09; CNBSS-I: HR 1.10 (95% CI 0.86-1.40) nor on all-cause mortality (RR 0.98, 95% CI 0.93-1.03) in women aged 40 to 49 years offered screening. Among regularly attending women the cumulative risk of experiencing a false-positive recall was 20.5%. Overdiagnosis of invasive breast cancer at five years post cessation of screening for women aged 40to 49 years was estimated to be 32%; 20 years post cessation of screening 48%. Including ductal carcinoma in situ, these numbers were 41% and 55%.

Based on the current evidence from randomised trials, extending mammography screening to younger age groups cannot be recommended. However there were limitations including relatively low sensitivity of screening and screening attendance, insufficient power, and contamination, which may explain the non-significant results.

Full reference: van den Ende, C. et al. (2017) Benefits and harms of breast cancer screening with mammography in women aged 40-49 years: A systematic review. International Journal of Cancer. DOI: 10.1002/ijc.30794

Clinics should choose women’s breast screening appointment times to improve attendance

For women who miss a breast screening appointment, giving a fixed date and time for a new appointment could improve poor attendance and be a cost-effective way to shift national participation trends | ScienceDaily

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In England, participation in breast cancer screening has been falling in the last ten years, getting close to the national minimum standard of 70 per cent, with screening particularly low in areas of socioeconomic deprivation.

The NHS Breast Screening Programme (NHSBSP) invites women aged 50-70 to mammographic screening every three years. The usual practice for those who don’t attend their first offered appointment is to issue them with a second invitation letter. Some centres supply ‘open’ invitations, asking women to telephone to make an appointment, while others send an invitation with a fixed date and time, requiring no effort from the invitee to book an appointment.

Read the full overview via ScienceDaily here

Read the original research article here