Chair of the Committee, Andrew Miller MP, said:
"Like any medical intervention, screening carries both benefits and risks, whether that is for breast cancer, for aneurisms or hypothyroidism in newborns. However, health screening is seen in such a positive light by the public that it can be challenging to convey the negative side of the equation.
While screening can increase the likelihood of curing, preventing or delaying the progression of disease for some patients, for others it may lead to false results, misdiagnosis and unnecessary treatment. More needs to be done to ensure that both the benefits and risks are clearly, and even-handedly, communicated so that people can make an informed choice about whether screening is right for them."
Providing balanced, high-quality information to all potential screening participants must be a well-resourced and nationally supported priority, not an afterthought undertaken on an ad-hoc basis, the MPs argue. A recently revised breast cancer screening leaflet for the 50-70 age group – with its more explicit focus on helping women make an ‘informed choice’ about whether screening is right for them – marks a step in the right direction. However, the inquiry found that the principles followed to revise this leaflet have not been applied to the communications developed by other NHS screening programmes.
The Committee recommends that steps are immediately taken by the Government’s advisor on screening, the UK National Screening Committee (UK NSC), to devise and implement a standard process for producing information that facilitates informed choice. It also recommends a clarification of what ‘informed choice’ means for potential screening participants so that different screening programmes can be more effectively evaluated on their delivery of it. MPs are also calling on the Office for National Statistics to validate the statistics presented in NHS screening information to resolve disagreement and confusion over their accuracy.
Andrew Miller MP said:
"Producing accurate, concise and accessible public information on screening will always be challenging, but the UK National Screening Committee must ensure there is standard process across the NHS for achieving this and facilitating informed choice. Ministers must also do more to ensure that all front-line health care professionals delivering screening programmes receive regular training to refresh their communication skills.
Poor communication of the risks and benefits is not a problem confined to the NHS, however. Concerns were raised during our inquiry about the poor quality of information provided by private health companies offering commercial screening tests. While the NHS must remedy the problems identified by its own screening tests, it also has to deal with those of private companies that effectively privatise the goods of screening and nationalise the bads."
The evidence base for screening programmes
It is the UK NSC’s responsibility to ensure that screening programmes are only offered where there is robust, high-quality evidence that they will do more good than harm, and at a reasonable cost. MPs agree that all screening programmes should be grounded in robust evidence and the evidential barrier to entry should remain high. However, if the UK NSC is to remain an authoritative source of advice, it must become more transparent in the way it makes decisions and evaluates the evidence. The NHS Health Check programme - which aims to prevent heart disease, stroke, diabetes, and kidney disease - was introduced without a rigorous evidence base and was not reviewed by the UK NSC. The MPs are concerned that the Health Check programme is wasting resources at time when the NHS can ill-afford to do so and recommend that the UK NSC scrutinise the programme, retrospectively, to ascertain its value.
Looking to the future
Andrew Miller MP concluded:
"Developments in genetic science mean that it should soon become possible to target screening programmes directly at those most of risk of certain diseases. It is imperative that the UK National Screening Committee develops its capacity for horizon scanning and ensures that proven developments in screening are supported and implemented across the NHS."
Health screening is the process of testing a defined population for one of a range of serious diseases or conditions. Usually, its aim is to detect disease among apparently healthy people so that it can be treated at an early stage. The National Health Service (NHS) offers screening for a range of conditions and diseases covering all life stages, from antenatal and newborn screening through to adulthood. Each year approximately 11 million people in England are invited to participate in a screening programme at a total annual cost of around £348 million for the breast, cervical and bowel cancer screening programmes, with an additional £400 million spent on a suite of non-cancer screening programmes. The UK National Screening Committee advises Ministers and the NHS across the UK about all aspects of screening and makes recommendations on the introduction, modification or withdrawal of screening programmes.