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Cancer screening: more convenient access will boost early diagnosis, says review

BMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l6059 (Published 16 October 2019) Cite this as: BMJ 2019;367:l6059
  1. Gareth Iacobucci
  1. The BMJ

The NHS should provide more convenient access to cancer screening services to increase early diagnosis and improve survival rates, a major government commissioned review has recommended.1

Women should be able to access screening for breast, cervical, and other cancers at health centres or other locations close to their work, and local screening services should provide extra evening and weekend appointments, says the review by Mike Richards, a leading cancer expert.

The report was commissioned2 by Simon Stevens, NHS chief executive, and Matt Hancock, England’s health and social care secretary, to recommend how to overhaul national screening programmes. This is to help achieve the goal, set out in the NHS long term plan,3 of saving an extra 55 000 lives a year by 2028 by diagnosing three quarters of all cancers early.

Patient choice

Richards, formerly NHS cancer director and the Care Quality Commission’s chief inspector of hospitals, said that giving people greater choice over when and where they are screened was crucial to reaching people early and improving survival rates.

“People live increasingly busy lives, and we need to make it as easy and convenient as possible for people to attend these important appointments,” he said. Social media campaigns and text reminders should also be tested and deployed to improve uptake if successful, his report adds.

Richards also recommends a major overhaul of screening programmes, citing current upgrades to the cervical screening programme that will reduce the number of cervical smears that NHS labs need to review.

He supports the government’s £200m (€231m; $255m) investment to upgrade and replace older mammography and diagnostic imaging equipment, and he predicts increased use of artificial intelligence to develop blood tests to screen for a range of cancers, as well as more personalised screening using genetics.

In the shorter term he recommends that patients should receive results within a standard time frame throughout all screening programmes and says that NHS England should assume sole responsibility for commissioning and delivering screening services.

He added that a single agency should advise the government on what tests it should commission nationally. These functions are currently carried out by the UK National Screening Committee, which advises ministers on population screening, and the National Institute for Health and Care Excellence, which issues guidance on screening people at elevated risk of serious conditions.

Breast screening providers should aim to invite people at 34 month intervals after their previous appointment so that all participants can be screened within 36 months, the report advises.

More tailored approach

Stevens said, “I’m grateful to Sir Mike for taking on this important assignment. His sensible recommendations keep all that is good about NHS screening services, while rightly setting out a blueprint for more convenient access, upgraded technology, and progressively more tailored approaches to early diagnosis.”

Hancock also welcomed the report, adding, “After careful consideration, I can announce that Public Health England will host world class scientific and expert advice on screening, building on its current role as host of the UK National Screening Committee. This expert advice will inform the delivery of national screening services by the NHS.”

The Department of Health and Social Care said that commissioning and delivery of cancer screening was currently split between Public Health England and NHS England but that this would change so that NHS England would be responsible for commissioning and delivery, while Public Health England would host expert advice and recommendations.

References

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