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Advisors back changes to screening for bowel cancer and Down’s

  • Comment
  • Chances to screening for cancer, diabetes and Down’s syndrome
  • Charities welcome updates to cancer screening techniques
  • But screening for seven other conditions rejected by committee

Government advisors have backed changes to a number of NHS screening programmes, with charities welcoming improved tests for bowel cancer and Down’s syndrome.

The UK National Screening Committee has today published a number of recommendations following its latest meeting on 19 November.

“These changes would help identify more people who would benefit from early treatment”

Anne Mackie

The independent group of experts made 11 recommendations, including improvements to screening programmes for Down’s syndrome, cervical and bowel cancer, and diabetic retinopathy.

The committee recommended that the faecal immunochemical test (FIT) should replace the guaiac faecal occult blood test (gFOBt) as the first test used in the NHS Bowel Cancer Screening Programme.

Replacing the current gFOBt with FIT provides the opportunity to “detect and prevent more cancers and is easier to use”, said the committee.

The committee also recommended that non-invasive prenatal testing (NIPT) be introduced as an additional test into the NHS Fetal Anomaly Screening Programme (FASP) for Down’s syndrome and the related conditions Edwards’ syndrome, or Patau’s syndrome.

It said NIPT should be introduced gradually as part of an evaluation, with ongoing monitoring and evaluation meaning the test is rolled out in “such a way that the screening programme can be altered if necessary in light of any real life findings”.

The new test is more accurate than FASP, meaning that fewer women will need unnecessary diagnostic tests, which can potentially mean a small risk of losing their baby, said the committee.

In addition, the committee recommended the introduction of primary screening for human papillomavirus.

“Research shows that the changes to these new tests will make them even more effective”

Harpal Kumar

Currently the NHS Cervical Screening Programme uses cytology testing to look for abnormal cells that could be the first sign of cancer, with HPV testing used as a secondary measure in women needing further investigation.

However, the committee said evidence suggested that screening for HPV first would be a more effective way to let women know whether they are at risk of developing cervical cancer.

Meanwhile, the committee also backed changing the frequency of diabetic eye screening appointments.

It recommended that diabetes patients at low risk of sight loss only needed to attend eye screening tests every two years, rather than annually, after evidence showed it was “safe to do so”.

The screening interval for people with a high risk of diabetic retinopathy should remain yearly, as now, it noted.

At the same meeting, it did not recommend introducing screening programmes for the following conditions after “careful consideration of the evidence”.

  • Congenital Adrenal Hyperplasia (CAH) in newborns
  • Glaucoma
  • Hearing loss in older adults
  • Mucopolysaccharidosis type I (MPS I)
  • Neuroblastoma in children
  • Oral cancer
  • Prostate cancer

The committee said it would review all the recommendations again in three years or earlier if significant new evidence becomes available.

Dr Anne Mackie, director of programmes for the UK National Screening Committee, said: “The latest recommendations, which propose changes to existing screening programmes, would bring about considerable improvements.

“All recommendations made by the committee are based on internationally recognised criteria and a rigorous evidence review and consultation process,” she added.

“I would urge all the governments of the UK to commit to rolling them out as quickly as possible”

Harpal Kumar

The Department of Health and relevant arm’s-length bodies, including Public Health England, will now decide whether to accept the recommendations and, if so, how to implement them.

Health minister Ben Gummer said via the social media website Twitter that the government was considering “carefully” the committee’s support for NIPT, noting that the recommendation had the ”potential to transform antenatal screening”.

Mervi Jokinen, practice and standards professional advisor at the Royal College of Midwives, said she welcomed non-invasive testing in pregnancy.

“It will support and improve the already established screening tests which women are familiar with anyway such as scans and blood tests provided in early pregnancy,” she said.

“The [committee]’s recommendation has the potential to transform antenatal screening”

Ben Gummer

She added: “What is different is that the new blood test provides choice and reduces the need for diagnostic testing of fetal DNA through obtaining fetal cells in amniotic fluid for abnormalities.”

Sir Harpal Kumar, chief executive of the charity Cancer Research UK, described the UK National Screening Committee’s recommendations on cancer screening methods as both “very important and positive”.

“These changes to the bowel and cervical screening programmes were strongly recommended by the independent taskforce behind the new NHS cancer strategy for England, which I published in the summer,” he said.

“Now I would urge all the governments of the UK to commit to rolling them out as quickly as possible, as Scotland has already pledged to do with the new bowel screening test FIT,” he added.

Deborah Alsina, chief executive of Bowel Cancer UK, said: “We have long called for the introduction of FIT into the bowel screening programme. The introduction of the new test will save lives – it is proven to be more accurate and easier for people to complete.”

 

Key conclusions from the meeting include:

Introducing Faecal Immunochemical Testing

The Faecal Immunochemical Test (FIT) should replace the current first test used in the NHS Bowel Cancer Screening Programme. Replacing the current guaiac faecal occult blood test (gFOBt) with FIT provides the opportunity to detect and prevent more cancers and is easier to use.

Introducing Non-Invasive Prenatal Testing

Non-Invasive Prenatal Testing (NIPT) should be introduced as an additional test into the NHS Fetal Anomaly Screening Programme (FASP) as part of an evaluation. Ongoing monitoring and evaluation will mean that the test is rolled out across England in such a way that the screening programme can be altered if necessary in light of any real life findings. FASP offers screening to women in pregnancy to find out how likely it is that their baby has Down’s syndrome, Edwards’ syndrome, or Patau’s syndrome. The new test is more accurate, meaning that fewer women will need unnecessary diagnostic tests, which can potentially mean a small risk of losing their baby.

Introducing HPV Primary Screening

Currently the NHS Cervical Screening Programme uses cytology testing to look for abnormal cells that could be the first sign of cancer. Human Papillomavirus (HPV) testing is used as a secondary measure in women needing further investigation. Evidence suggests that screening for HPV first will be a more effective way to let women know whether they are at risk of developing cervical cancer.

Fewer diabetic eye screening appointments

People with diabetes at low risk of sight loss only need to attend eye screening tests every two years rather than annually, after evidence showed it was safe to do so. The screening interval for people with a high risk of sight loss should remain yearly as now.

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