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Screening

Evidence

This section contains a brief overview of the research carried out in this area. The evidence is divided into the settings listed here.

View overview

Screening has the potential to save lives or improve quality of life through early detection of serious disease. It is targeted at apparently healthy people, who are given the opportunity to make informed choices about improving their health.

The vast majority of people take part in a screening programme believing that ‘prevention is better than cure’ and expecting to be given a clean bill of health. Those who have disease detected as a result of screening usually believe this is a good thing, and that they have been saved from a more serious condition by early intervention. 1 2 Although screening reduces the risk of developing a condition or its complications, it cannot offer a guarantee of protection. 3

The screening test should be reliable, cheap and acceptable, but it is not a diagnostic. Therefore, each screening test needs to be followed by further investigation and prompt treatment for those with abnormal results. The whole process from identification of an eligible population to treatment is complex, involving different health professionals. Good communication, both within the team and with the person being screened, is vital.

Good uptake is important for a successful screening programme, but this must be based on informed decisions to take part.

References

  1. Milburn K, MacAskill S. Cervical screening: continuing concerns in the 1990s. Health Educ J. 1994;53:201-213.
  2. Webster P, Austoker J. Women’s knowledge about breast cancer risk and their views of the purpose and implications of breast screening - a questionnaire survey. J Public Hlth 2006;28:197-.202. External Link
  3. UK National Screening Committee. Chapter 1 of Second Report of the UK National Screening Committee. OctoberLondon: Department of Health, 2000. External Link (accessed 12 Apr 2007)

Interventions to increase uptake of screening programmes

View Methodology

Topics searched

We searched for studies looking at interventions to improve the uptake of screening in groups of people that are hard to reach. We included six screening tests. The unique populations for each screening test and the tests are described in the table below.

Screening condition Setting Who is hard to reach? Tests
Down’s syndrome Prenatal (pregnant women of all ages) All pregnant women, deprived people, late-bookers in particular Serum screening, triple test (α fetoprotein (AFP), human chorionic gonadotrophin (hCG) and unconjugated oestriol (uE3)), nuchal thickness, nuchal translucency, ultrasound
Sickle cell and thalassaemia Prenatal (pregnant women of all ages) Black people, and visible minorities Prenatal diagnosis, genetic screening
Hearing Newborn (aged 0–6 months) Deprived people, travellers, visible minorities, teenage mothers Otoacoustic emissions test (OAE), automated auditory brainstem response test (AABR)
Cervical cancer Adults (18–49 years) Young women in their late 20s, early 30s, deprived, visible minorities Cytology, liquid based cytology (LBC), smear, Papanicolaou smear (Pap test), cervical cancer screening, vaginal smears
Diabetic retinopathy Adults (18–49 years), older people (50 years and older) Adults or older people with diabetes Retinal photography, retinal screening, digital photography
Bowel cancer Older people (50 years and older) Aged 60+, men, visible minorities, and deprived people in particular Faecal occult blood test (FOBT), colonoscopy, endoscopy, flexible sigmoidoscopy

Dates and study types searched

We searched for systematic reviews published from 1990 until November 2006 and randomised controlled trials published from 2001 until November 2006.

Databases searched

We searched Medline, Embase, and the Cochrane Library for relevant studies. We also searched DARE, NHS EED, Trip database, the National Library for Health, Health evidence.ca, and the WHO Health Evidence Network (HEN).

Search strategies

These are searches that have been conducted on Ovid Medline (http://gateway.ovid.com/). The other searches have been adapted from this one to accommodate the search engine of each specific database.

Bowel cancer

  1. Mass Screening/
  2. exp Colonoscopy/
  3. Occult Blood/
  4. (FOBT or fecal occult blood test$ or faecal occult blood test$ or sigmoidoscop$ or endoscop$ or colonoscop$).ti,ab.
  5. exp Intestinal neoplasms/
  6. ((bowel or colon$ or rect$ or intestin$) adj2 (cancer$ or neoplas$ or tumour? or tumor?)).ti,ab.
  7. (Uptake or accept$ or declin$ or refus$ or prefer$ or satisf$ or coverage or response or allow$).ti,ab.
  8. Aged/
  9. (older adj2 (adult$ or person$ or people$ or man or men or woman or women)).ti,ab.
  10. or/1-4
  11. or/5-6
  12. or/8-9
  13. 7 and 10 and 11 and 12

Cervical cancer

  1. Mass Screening/
  2. (screen$ or diagnos$).ti,ab.
  3. Vaginal Smears/
  4. (pap$ smear$ or pap$ test$ or cervical smear$ or cervical cancer screening).ti,ab.
  5. Uterine Cervical Neoplasms/
  6. Cervical Intraepithelial Neoplasia/
  7. ((cervix or cervical) adj1 (cancer$ or neoplas$ or tumo$ or dysplasi$)).ti,ab.
  8. (Uptake or accept$ or declin$ or refus$ or prefer$ or satisf$ or coverage or response or allow$).ti,ab.
  9. or/1-4
  10. or/5-7
  11. 8 and 9 and 10

Diabetic retinopathy

  1. Mass Screening/
  2. (screen$ or diagnos$).ti,ab.
  3. exp Vision Tests/
  4. Fluorescein Angiography/
  5. (fluorescein angiograph$ or vision test$ or visual test$ or imaging).ti,ab.
  6. (photograph$ adj2 retina$).ti,ab.
  7. Diabetic Retinopathy/
  8. (diabet$ adj2 (retinopath$ or retina$ or visual loss or vision loss)).ti,ab.
  9. (Uptake or accept$ or declin$ or refus$ or prefer$ or satisf$ or coverage or response or allow$).ti,ab.
  10. or/1-6
  11. or/7-8
  12. 9 and 10 and 11

Down’s syndrome

  1. Down Syndrome/
  2. (down$ syndrome or trisomy 21).ti,ab.
  3. (triple test$ or alpha fetoprotein or human chorionic gonadotrophin or unconjugated estriol).ti,ab.
  4. Ultrasonography, Prenatal/
  5. (ultrasound or ultrasonograp$).ti,ab.
  6. (screen$ or diagnos$).ti,ab.
  7. (prenatal or antenatal or pregnan$).ti,ab.
  8. or/1-2
  9. or/3-6
  10. 7 and 8 and 9

Hearing

  1. Mass Screening/
  2. Neonatal Screening/
  3. (screen$ or diagnos$).ti,ab.
  4. exp Hearing Tests/
  5. (hearing adj2 test$).ti,ab.
  6. (hearing or deaf$ or auditory).ti,ab.
  7. (otoacoustic emissions or OAE or automated auditory brainstem response or AABR).ti,ab.
  8. Hearing Impaired Persons/
  9. exp Hearing Loss/
  10. Infant, Newborn/
  11. (newborn? or neonat$).ti,ab.
  12. (Uptake or accept$ or declin$ or coverage or response or number?).ti,ab.
  13. or/1-5
  14. or/6-9
  15. or/10-11
  16. 12 and 13 and 14 and 15

Thalassaemia

  1. exp Thalassemia/
  2. exp Anemia, Sickle Cell/
  3. (thalassaemia or thalassemia or sickle cell).ti,ab.
  4. exp Mass Screening/
  5. exp Prenatal Diagnosis/
  6. (screen$ or diagnos$).ti,ab.
  7. Pregnancy/
  8. (prenatal or antenatal or pregnan$).ti,ab.
  9. (number? or uptake or accept$ or refus$ or declin$ or coverage or response or aware$).ti,ab.
  10. exp Health Promotion/
  11. or/1-3
  12. or/4-6
  13. or/7-8
  14. or/9-10
  15. 11 and 12 and 13 and 14

Filter

The following filter was used to include only randomised controlled trials or systematic reviews:

  1. ("review" or "review academic" or "review tutorial").pt.
  2. (medline or medlars or embase).tw,sh
  3. (scisearch or psychinfo or psycinfo).tw,sh.
  4. (psychlit or psyclit).tw,sh.
  5. cinahl.tw,sh.
  6. ((hand adj2 search$) or (manual$ adj2 search$)).tw,sh.
  7. (electronic database$ or bibliographic database$ or computeri?ed database$ or online database$).tw,sh
  8. (pooling or pooled or mantel haenszel).tw,sh.
  9. (peto or dersimonian or der simonian or fixed effect).tw,sh.
  10. or/2-9 47239
  11. 1 and 10
  12. meta-analysis.pt.
  13. meta-analysis.sh.
  14. (meta-analys$ or meta analys$ or metaanalys$).tw,sh.
  15. (systematic$ adj5 review$).tw,sh.
  16. (systematic$ adj5 overview$).tw,sh.
  17. (quantitativ$ adj5 review$).tw,sh.
  18. (quantitativ$ adj5 overview$).tw,sh.
  19. (quantitativ$ adj5 synthesis$).tw,sh
  20. (methodologic$ adj5 review$).tw,sh.
  21. (methodologic$ adj5 overview$).tw,sh.
  22. (integrative research review$ or research integration).tw.
  23. or/12-22
  24. 11 or 23
  25. exp Randomized controlled trials/
  26. "randomized controlled trial".pt.
  27. "controlled clinical trial".pt.
  28. (random$ or placebo$).ti,ab,sh.
  29. ((singl$ or double$ or triple$ or treble$) and (blind$ or mask$)).tw,sh.
  30. or/25-29
  31. (animals not humans).sh.
  32. 30 not 31