More targeted screening is necessary but may face resistance, experts say

BMJ 2014; 348 doi: (Published 27 June 2014) Cite this as: BMJ 2014;348:g4293
  1. Adrian O’Dowd
  1. 1London

Changes to make national screening programmes more targeted at people with a higher risk of developing conditions and diseases may be unpopular with the general public, experts have told MPs.

Witnesses at a 25 June evidence session of the House of Commons science and technology committee’s inquiry into national health screening said that changes were needed but that they might not be universally welcomed.

MPs asked how difficult it would be to introduce more targeted, stratified screening if the general public was concerned that not everyone would be screened—possibly failing to detect problems in some people.

Hilary Burton, director of the PHG Foundation, an independent think tank focusing on genomics and other emerging health technologies, giving evidence, said, “One of the problems is that in the past we have portrayed screening as being a good thing that you should take up because it will be ‘good for your health,’ and we have not necessarily always given balanced messages about that.

“We have to rebalance that so the public understand that there are risks and benefits to screening or prevention. When you can get across to people that we do not want to inconvenience or harm them by offering unnecessary screening, one would hope that gradually they would start to accept it, but it is a difficulty.”

A fellow witness, Owen Sharp, chief executive of Prostate Cancer UK, said, “I think it’s a challenge. Whilst there would be a job to explain it and be clear that screening programmes of whatever shape or form are not absolute, they do give you a better sense of where your risks lie. The public are probably a lot more open to that than we consider them to be.”

MPs asked whether genomic information could be used to target cancer screening programmes for people most at risk. Burton argued that it could, saying, “With breast cancer, you can use known genetic susceptibilities, and there have been large studies lately that have looked at a number of variants that increase the risk of cancer.

“If you can then use that information to target, for example, a breast screening programme, you are able to optimise the benefit:harm ratio better because you screen fewer women and detect a similar number of cases.”

Ian Jacobs, vice president at the University of Manchester and dean of medicine and health with a research programme into ovarian cancer research, also giving evidence, agreed. “With ovarian cancer, the nirvana would be that you put together genetic predisposition with demographic social differences and epidemiological differences into an algorithm, which allows you to accurately define which women are at very low risk, which are at intermediate risk, and which are at very high risk,” he said. Different approaches would then be taken with women depending on their risk, rather than having blanket screening for all women.

MPs asked other witnesses how well equipped the UK National Screening Committee was to adapt to new and changing technologies.

Anne Mackie, director of the screening committee, giving evidence, said, “Pretty well, I think. Each of our existing screening programmes has got a large advisory committee. One of their roles is horizon scanning.

“Either we do evaluative work within the NSC [National Screening Committee] or we ask outfits like the Health Technology Assessment Agency or the MRC [Medical Research Council] to undertake pieces of research for us.”


Cite this as: BMJ 2014;348:g4293

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