UK NSC challenges and vision
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Transcript of UK NSC challenges and vision
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UK NSC – Challenges and
Vision
Prof. Bob Steele
Professor of Surgery, University of Dundee
Independent Chair, UK NSC
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UK NSC Chair
• Who I am and how I came to be involved
• Thoughts on Screening and the UK NSC
• Challenges
• Vision for the future
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1990
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Key Areas in Health Screening
Sir Muir Gray• Systems thinking and quality assurance
• Harm vs Benefit
• Importance of evidence
• Efficacy vs effectiveness and importance of pilots
• Cost effectiveness
• Efficacy and quality relative value
• Importance of the individual’s perspective
• Evidence base for communicating risk
• Informed choice
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UK National Screening
Committee
• Advises ministers and NHS
– Introducing, continuing, modifying and withdrawing
screening programmes
• Meets 3 times a year
– New recommendations and updates existing ones
– Supported by FMRG and ARG
• Keeps abreast of new evidence
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Screening in the
UK
Each UK health
department responsible
for setting screening
policy, taking account of
advice from UK NSC
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To whom do we offer
screening?
• Pregnant women
• Newborn babies
• Children and adults defined by
age or risk
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What do we screen for?
www.gov.uk/uknsc
(or put “UKNSC” into Google!)
From a wide range of conditions under
consideration(100) there are 30 for which
there is firm evidence that the benefits of
screening outweighs the harm.
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How is screening kept up to
date?
• By regular review of evidence
– existing proposals
• By responding to new evidence
– existing proposals
– existing programmes
– new programmes
• By evaluating new proposals
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With whom does UK NSC
work?
• PHE and Health Departments
• Research Funders (e.g. HTA)
• Stakeholders
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Stakeholders
• National groups representing patients and
carers
• Organisations representing healthcare
professionals
• Standard setting and guideline developing
bodies
– e.g. NICE, SIGN
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How can stakeholders
contribute?
• Annual call for new proposals
• Suggesting modifications or early updates
• Annual stakeholder meeting
• Consultation on evidence review
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Why is the work of UK NSC
important?
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Screening is Popular
• Most people have a negative test
• A few people have a false positive test
• A few people are cured
• A few people are harmed by investigation or
treatment
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Advising on Screening Policy
• Starting screening
• Stopping screening starting
• Changing screening
• Stopping screening
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We have to careful with the
interpretation of screening
data
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Lead-time Bias
Screening
Disease
Progression
Symptoms
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Length Bias
Screen Screen
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Selection Bias
Individuals accepting screening tend
to be health conscious
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Screening RCTs
Population
No screening
offered
Screening
Offered(including those who
choose not to participate
and those developing
interval disease)
Compare numbers of deaths from disease
(and number of cases)
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Criteria for Screening
• Effective treatment
• Treatment at early stage better
• Diagnostic and treatment facilities
available
• Suitable test
– Sensitive
– Specific
– Acceptable
• Economically viable
• Benefit outweighs harm
Modified from Wilson
and Jungner,
1968
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Colorectal
Cancer
Screening
Test Development
(FOBT)
Observational
Clinical Studies
Small-
Scale
RCTs
Population –based
demonstration
pilots
Government
Policy
Decisions
Population
Screening
Implemented
Ongoing research
-improving the test
-improving uptake
Time scale = 25 years
Sensitivity
Specificity
Effectiveness
provenFeasibility
proven
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What are the challenges for
UK NSC?• Communication
– Public, Politicians and invitees
• Evidence review
– Existing portfolio
– New proposals
• Working with researchers
• Working with patient groups
• Estimating value
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No screening Screening
Cost
Harm
Cost and harm
of treating
disease not
detected
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Vision for UK NSC• To continue to provide high quality, evidence-based
independent advice to Government
• To promote the introduction of new, high value programmes
• To ensure that screening in the UK produces net benefit to
the population
• To be responsive to the public and the professions
• To work to ensure that participation in screening in based on
truly informed choice
• To promote good practice in screening internationally
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Thanks to:
• PHE
• The UK NSC Secretariat
• The Evidence Review Team
• The Committee Members