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GPs buried under trusts' workload dump

NHS screening programmes to adopt new tests for cervical and bowel cancer

The NHS in England could soon start routinely offering a test for HPV instead of a cervical smear as the initial screening test for cervical cancer, after experts ruled the change in approach would help to pick up cancers more effectively.

The National Screening Committee (NSC) has advised the screening programme in England ‘should adopt HPV as a primary screen test as it is a more accurate screening test’.

Under the new approach, women will only undergo cytology if they test positive for high-risk HPV, with further investigations if they have a positive cytology result. It is hoped the move will mean that overall, women will in future undergo screening less frequently over their lifetime.

The NSC also recommended the bowel cancer screening programme should introduce the newer, more accurate faecal immunohistochemical test (FIT) instead of faecal occult blood tests (FOBTs). Evidence has shown the FIT test is more accurate and increases uptake as the home testing is much simpler to carry out.

In other recommendations, the interval for screening patients with diabetes for diabetic retinopathy is to be extended from one to two years.

However, NSC experts have again ruled out a population based screening programme for prostate cancer. They said the PSA test is ‘still a poor test for prostate cancer and a more specific and sensitive test is needed’.

The changes to the bowel and cervical screening programmes have already been backed by the Government’s independent cancer taskforce, which forms the basis of NHS England’s new cancer strategy.

Sir Harpal Kumar, chief executive of Cancer Research UK and head of the taskforce, said: ‘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.’

Dr Andrew Green, chair of the GPC’s clinical and prescribing subcommittee, said the move to screening for diabetic retinopathy every two years ‘should free up significant capacity, as well as preventing patients from unnecessary attendances’.

Dr Green added that, in light of the ruling on PSA tests, ‘I would like to see all patients having this test done on a private basis to be properly consented, which should include the specific information that the test is not recommended by the UK National Screening Committee’.

Readers' comments (5)

  • Surely they also need to make it compulsory for all privately completed retinopathy conducted by optoms to be included in the national programme to prevent duplication, and ensure that the data of those who don't attend the national screening as a result of having it privately is included.

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  • Vinci Ho

    Would also like FIT to be available in GP's routine tests for symptomatic patients which at least answers to the 'contentious' NICE recommendations on early cancer detection , e.g. FOB in any form of anaemia ( including non-microcytic type) in elderly patients ...

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  • Vinci Ho

    Professor Fraser, are you out there? Your opinion ?

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  • Yes, thank you, Dr Ho, you are absolutely correct.

    The use of FIT as THE "test for the presence of blood in faeces" would indeed satisfy the contentious statements in NG12 regarding use of such tests to triage low risk patients presenting in primary care with lower abdominal symptoms. FIT represent ONE test that can be used in TWO very dissimilar clinical settings. The advantages outlined in the documentation from the UK National Screening Committee for FIT, and others merits, also hold for FIT in assessment of those with symptoms.

    As I have documented here before, FIT at low faecal haemoglobin concentration cut-off (much lower than applied in asymptomatic population screening) have very good diagnostic accuracy. FIT have very high clinical sensitivity (often shown to be 100%) for colorectal cancer, so that a positive test result should stimulate rapid referral for colonoscopy. Moreover and, probably more importantly, FIT in this context has very high negative predictive value for detection of significant colorectal diseases well worthy of detection, namely, cancer plus advanced adenoma (sometimes precursors of cancer) and inflammatory bowel disease (IBD): in consequence, a negative test result provides considerable reassurance that colonoscopy is not required urgently or even at all.

    Thus, although no test is perfect and there will be some false positive and false negative results, FIT have many merits and its adoption undoubtedly could help GP in particular to direct the scarce colonoscopy resource to those who would most benefit, enhancing patient satisfaction and safety.

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  • A brilliant refresher from Prof. Fraser. Cudos!. i hope our CCGs would take it on board.

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