UK NSC – Challenges and

Vision

Prof. Bob Steele

Professor of Surgery, University of Dundee

Independent Chair, UK NSC

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

1990

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

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

Screening in the

UK

Each UK health

department responsible

for setting screening

policy, taking account of

advice from UK NSC

To whom do we offer

screening?

• Pregnant women

• Newborn babies

• Children and adults defined by

age or risk

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.

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

With whom does UK NSC

work?

• PHE and Health Departments

• Research Funders (e.g. HTA)

• Stakeholders

Stakeholders

• National groups representing patients and

carers

• Organisations representing healthcare

professionals

• Standard setting and guideline developing

bodies

– e.g. NICE, SIGN

How can stakeholders

contribute?

• Annual call for new proposals

• Suggesting modifications or early updates

• Annual stakeholder meeting

• Consultation on evidence review

Why is the work of UK NSC

important?

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

Advising on Screening Policy

• Starting screening

• Stopping screening starting

• Changing screening

• Stopping screening

We have to careful with the

interpretation of screening

data

Lead-time Bias

Screening

Disease

Progression

Symptoms

Length Bias

Screen Screen

Selection Bias

Individuals accepting screening tend

to be health conscious

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)

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

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

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

No screening Screening

Cost

Harm

Cost and harm

of treating

disease not

detected

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

Thanks to:

• PHE

• The UK NSC Secretariat

• The Evidence Review Team

• The Committee Members