Policies, Targets and Guidelines
Policies and guidelines
Before 1996, there were only four national screening programmes in the UK: phenylketonuria and congenital hypothyroidism screening in newborns, and breast cancer and cervical cancer screening in adults. By 2007, there are 13 recommended programmes screening for over 20 different conditions.
The UK National Screening Committee (UKNSC) regularly reviews the evidence for a wide range of conditions. 1 Indeed, the UKNSC has found nearly 300 different unevaluated and unregulated screening practices within the NHS. 2 For up-to-date information on the UKNSC policy on screening: see External Link
Once screening is established, the national advisory group and programme team of the individual screening programme provide ongoing guidance and policy, and develop national information leaflets. There are currently 12 recommended programmes screening for over 20 different conditions. More information on these programmes is available on the individual programme websites [see Tables 1, 2 and 3].
Table 1. National newborn and antenatal screening programmes in the UK.
| Target population | Disease | Year introduced as national programme (if recent) | Screening test | Link to website |
| Antenatal | Down’s syndrome | 2001 | Serum screening and nuchal thickness ultrasound in 1st or 2nd trimester | External Link |
| - | Fetal anomalies | 2005 | Ultrasound at 2nd trimester | External Link |
| - | Sickle cell disease and thalassaemia | 2001 | Blood tests for anaemia and prenatal diagnosis in 1st trimester | External Link |
| - | Infectious diseases: syphilis HIV, hepatitis B, rubella | 2003 for HIV | Blood tests | External Link |
| Newborn | Hearing | 2002 | Oto-acoustic emissions | External Link |
| - | Newborn bloodspot: sickle cell disease, cystic fibrosis, MCADD (in addition to phenylketonuria and congenital hypothyroidism) | 2001 2005 2007 | Dried blood spot on Guthrie card | External Link External Link External Link External Link |
| - | Physical examination of the newborn | 2006, as organised programme | Physical examination by paediatrician at birth & by GP at 6-8 weeks | External Link |
Adult screening programmes
Cancer screening programmes
The breast and cervical screening programmes were modernised in 2003. The age range of breast cancer screening was extended and an additional view (a second X-ray of each breast taken at a different angle) added to all screens in order to detect more small cancers. 3 4 Cervical screening has moved from a conventional smear to liquid-based cytology and women under 25 years are no longer invited routinely for cervical cancer programmes. 5 6 See Table 2 for the national cancer screening programmes in the UK.
Table 2. National cancer screening programmes in the UK.
| Target population | Disease | Year introduced | Screening test | Link |
| Men and women aged 60-69 years | Bowel cancer | 2005 (England) | Bi-annual faecal occult blood test | External Link |
| Women aged 50-70 | Breast cancer | 1988 for women aged 50-64 | Mammography every 3 years | External Link |
| Women aged 25-64 | Cervical cancer | 1988 (originally 20-64) | Cervical cytology: 3- yearly aged 25-49 then 5-yearly aged 50-64 | External Link |
Vascular screening programmes
Screening people aged over 40 years for vascular risk is one of the more recent programmes introduced in the UK. The screening programme for diabetic retinopathy aims to detect a complication of diabetes in those already diagnosed with this condition. See Table 3 for vascular screening programmes in the UK.
Table 3. Vascular screening programmes in the UK.
| Target population | Disease | Year introduced | Screening test | Link |
| People with diabetes aged over 12 years | Diabetic retinopathy | 2003 | Digital photography of the retina in people with diabetes | External Link |
| Men and women aged 40 years or more | Vascular risk | 2007 | Risk assessment which could include measurement of risk factors such as blood pressure, cholesterol and glucose. | External Link |
Opportunistic screening programmes
Chlamydia screening of young women aged less than 25 years is done opportunistically when the women access other health services, using urine samples or vaginal swabs. For more information see
Recommended but not implemented screening programmes
The UKNSC is currently preparing a national action plan on screening men aged 65 for abdominal aortic aneurysm (AAA). For the latest position on AAA screening see External Link
Screening programmes not recommended
Prostate cancer
In 1997, the UKNSC advised against the introduction of a national screening programme for prostate cancer because of the poor performance of the prostate-specific antigen (PSA) test and the likelihood that most cancers detected would never be life-threatening. There are also uncertainties about the effectiveness of different treatments for prostate cancer, and complications of current treatments for prostate cancer. Instead, there is a national risk management programme where men aged over 50 years can request a PSA test after discussion of the benefits and risks with their GP. 7
Other types of screening that can do more harm than good include whole body scanning by computed tomography or magnetic resonance imaging, and exercise electrocardiograms, which may be advertised by independent sector providers. 8
Other screening tests
The UKNSC regularly reviews other screening options. Screening is not recommended for a wide range of diseases affecting people of all ages, including various cancers, mental health conditions such as Alzheimer’s disease, and a range of chronic and genetic conditions. Latest guidance on conditions where screening is not recommended can be found at External Link
Targets
General targets may be set by:
- The Department of Health, as in the National Service Framework for Diabetes target for screening for diabetic retinopathy; 1 or
- the UKNSC in establishing the programme; or
- the individual screening programme will set detailed quality standards for the service. 2 3
Author
Dr Linda Garvican
References:
- UK National Screening Committee Policy Positions. July 2006. Available from External Link
- UK National Screening Committee. First Report of the UK National Screening Committee. Health Departments of the United Kingdom, April 1998.
- Moss SM, Brown J, Garvican L, Coleman DA, Johns LE, Blanks RG, et al. Routine breast screening for women aged 65-69: results from evaluation of the demonstration sites. Br J Cancer 2001;85:1289-1294. External Link
- Blanks RG, Given-Wilson RM, Moss SM. Efficiency of cancer detection during routine repeat (incident) mammographic screening: two versus one view mammography. J Med Screen. 1998;5:141-145. External Link
- National Institute for Health and Clinical Excellence. Liquid-based cytology for cervical screening, (review). NICE Technology appraisal 69. London: NICE, 2003. Available at: External Link
- Sasieni P, Adams J, Cuzick J. Benefit of cervical screening at different ages: evidence from the UK audit of screening histories. Br J Cancer 2003;89:88-93. External Link
- Melia J, Paul Hewitson P, Austoker J. Review of screening for prostate cancer. BJU Int 2005; 95 Suppl 3:1-32. External Link
- Raffle AE. Types of screening that can do more harm than good. External Link