Cancer screening: informed consent

Public Health England has updated the Cancer Screening: Informed consent guidelines.

These guidelines give commissioners, providers and healthcare professionals in cancer screening information on consent to screening and procedures.

The document covers information and advice on:

  • breast screening
  • cervical screening
  • bowel cancer screening
  • mental capacity and consent

It also provides several template letters for patients withdrawing from programmes.

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Making cervical screening more accessible

Attendance for cervical screening has been falling year on year. This professional resource from Public Health England aims to address this decline in attendance by presenting recommendations that can help increase access to screening and awareness of cervical cancer.

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Image source: http://www.gov.uk

Download the infographics, references and a shorter version of this publication here

Reducing the socioeconomic gradient in uptake of the NHS bowel cancer screening Programme

The aim of this study was to determine whether a supplementary leaflet providing the ‘gist’ of guaiac-based Faecal Occult Blood test (gFOBt) screening for colorectal cancer could reduce the socioeconomic status (SES) gradient in uptake in the English NHS BCSP | BMC Cancer

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The trial was integrated within routine BCSP operations in November 2012. Using a cluster randomised controlled design all adults aged 59–74 years who were being routinely invited to complete the gFOBt were randomised based on day of invitation. The Index of Multiple Deprivation was used to create SES quintiles. The control group received the standard information booklet (‘SI’). The intervention group received the SI booklet and the Gist leaflet (‘SI + Gist’) which had been designed to help people with lower literacy engage with the invitation. Blinding of hubs was not possible and invited subjects were not made aware of a comparator condition. The primary outcome was the gradient in uptake across IMD quintiles.

In November 2012, 163,525 individuals were allocated to either the ‘SI’ intervention (n = 79,104) or the ‘SI + Gist’ group (n = 84,421). Overall uptake was similar between the intervention and control groups (SI: 57.3% and SI + Gist: 57.6%; OR = 1.02, 95% CI: 0.92–1.13, p = 0.77). Uptake was 42.0% (SI) vs. 43.0% (SI + Gist) in the most deprived quintile and 65.6% vs. 65.8% in the least deprived quintile (interaction p = 0.48). The SES gradient in uptake was similar between the study groups within age, gender, hub and screening round sub-groups.

Providing supplementary simplified information in addition to the standard information booklet did not reduce the SES gradient in uptake in the NHS BCSP. The effectiveness of the Gist leaflet when used alone should be explored in future research.

Full reference: Smith, S.G. et al. (2017) Reducing the socioeconomic gradient in uptake of the NHS bowel cancer screening Programme using a simplified supplementary information leaflet: a cluster-randomised trial. BMC Cancer. 17:543

Flexible new method for early cancer diagnosis

Earlier discovery of cancer and greater precision in the treatment process are the objectives of a new method recently developed. | ScienceDaily

Screening of at-risk groups for certain types of cancer, leading to earlier diagnosis, is being described as an area with major potential, both with regard to saving lives and saving money within healthcare. No tissue samples are needed for the method, and the tumor does not even need to be located. Investments are now being made to roll out this innovation across healthcare and broaden the scope of the research in this field.

The technique was created based on the fact that people with cancer also have DNA from tumor cells circulating in the blood, molecules that can be discovered in a regular blood sample long before the tumor is visible via imaging such as tomography, MRI, X-ray and ultrasound.

The researchers have now increased the sensitivity of detecting tumor DNA in blood thousand-fold by eliminating the background noise from the measurements using “DNA barcoding.”

Full story at ScienceDaily

Link to the research: Anders Ståhlberg, et al. Simple multiplexed PCR-based barcoding of DNA for ultrasensitive mutation detection by next-generation sequencing.  Nature Protocols, 2017; 12 (4): 664

Benefits and harms of breast cancer screening in women aged 40-49 years

Early detection of breast cancer through screening can lower breast cancer mortality rates and reduce the burden of this disease in the population | International Journal of Cancer

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In most western countries, mammography screening starting from age 50 is recommended. However, there is debate about whether breast cancer screening should be extended to younger women. This systematic review provides an overview of the evidence from RCT’s on the benefits and harms of breast cancer screening with mammography in women aged 40 to 49 years. The quality of the evidence for each outcome was appraised using the GRADE approach.

Four articles reporting on two different trials, the Age trial and the Canadian National Breast Screening Study-I (CNBSS-I), were included. The results showed no significant effect on breast cancer mortality (Age trial: RR 0.93, 95% CI 0.80-1.09; CNBSS-I: HR 1.10 (95% CI 0.86-1.40) nor on all-cause mortality (RR 0.98, 95% CI 0.93-1.03) in women aged 40 to 49 years offered screening. Among regularly attending women the cumulative risk of experiencing a false-positive recall was 20.5%. Overdiagnosis of invasive breast cancer at five years post cessation of screening for women aged 40to 49 years was estimated to be 32%; 20 years post cessation of screening 48%. Including ductal carcinoma in situ, these numbers were 41% and 55%.

Based on the current evidence from randomised trials, extending mammography screening to younger age groups cannot be recommended. However there were limitations including relatively low sensitivity of screening and screening attendance, insufficient power, and contamination, which may explain the non-significant results.

Full reference: van den Ende, C. et al. (2017) Benefits and harms of breast cancer screening with mammography in women aged 40-49 years: A systematic review. International Journal of Cancer. DOI: 10.1002/ijc.30794

Clinics should choose women’s breast screening appointment times to improve attendance

For women who miss a breast screening appointment, giving a fixed date and time for a new appointment could improve poor attendance and be a cost-effective way to shift national participation trends | ScienceDaily

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In England, participation in breast cancer screening has been falling in the last ten years, getting close to the national minimum standard of 70 per cent, with screening particularly low in areas of socioeconomic deprivation.

The NHS Breast Screening Programme (NHSBSP) invites women aged 50-70 to mammographic screening every three years. The usual practice for those who don’t attend their first offered appointment is to issue them with a second invitation letter. Some centres supply ‘open’ invitations, asking women to telephone to make an appointment, while others send an invitation with a fixed date and time, requiring no effort from the invitee to book an appointment.

Read the full overview via ScienceDaily here

Read the original research article here