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29.10.14

More needs to be done to highlight risks of NHS screening

More needs to be done to highlight the risks alongside the benefits of screening for diseases such as cancer, according to a new report from the Science and Technology Select Committee.

While screening is helpful for diagnosing diseases at early stages it also leads to “false results, misdiagnosis and unnecessary treatment”.

The committee’s report on national health screening, published today, said it was concerned that health professionals can struggle with screening terminology and concepts, particularly with tests for rarer conditions.

The bill for breast, cervical and bowel cancer programmes comes in at around £348m, while a further £400m is spent on non-cancer testing, with about 11 million patients in England are invited for some form of screening every year. However the committee found that while there were benefits to screening, public perception of the practice was so positive that it was difficult to convey the downsides.

Committee chair 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.”

The committee calls on the UK National Screening Committee (NSC), which assesses the effectiveness of NHS screening programmes, to “step up its education programme” and ensure all health professionals dealing with the public “receive regular training to refresh their communication skills, as well as their understanding of available screening programmes and their associated benefits and risks”.

A recently revised breast cancer screening leaflet for the 50-70 age group – with 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.

"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,” Miller said. “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.”

Prof Kevin Fenton, director of health and wellbeing at Public Health England, which oversees the NHS screening programmes, said that PHE welcomed the report and would not consider its recommendations in full.

Dr Richard Vautrey, deputy chair of the British Medical Association’s GP committee, said: “As the BMA has repeatedly warned, it is vitally important that people being invited for screening fully understand the pros and cons of the procedure. Patients must also be aware that there is a risk that false positive results could lead to unnecessary and potentially harmful further investigations.

“The BMA would welcome a full review of the benefits of the current NHS Health Check programme as many GPs have doubts as to its benefit and cost effectiveness. More also needs to be done to protect patients from companies promoting inappropriate health screening when in fact the evidence of benefit is often lacking.”

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