New insights on self-sampling for cervical cancer screening

Drysdale, H. et al. (2022). Self-sampling for cervical screening offered at the point of invitation: A cross-sectional study of preferences in England. Journal of Medical Screening. https://doi.org/10.1177/09691413221092246

A study funded by Cancer Research UK has published the results of its qualitative study which assessed intentions (motivational stage) to provide an upper estimate of how many women might select self-sampling over clinician screening if they were offered a choice. The research team also examined associations between demographic factors and past screening behaviours and preferences for self-sampling, as well as reasons for women’s choices.

Abstract

Objectives

This study assessed preferences for human papillomavirus (HPV) self-sampling if offered as an alternative to clinician-based screening at the point of invitation for cervical screening.

Setting and Methods

An online questionnaire was completed by screening-eligible women living in England (n equal to  3672). Logistic regressions explored associations between demographic characteristics and screening preferences, stratified by previous screening attendance. Reasons for preferences were also assessed.

Results

Half of participants (51.4 per cent) intended to choose self-sampling, 36.5 per cent preferred clinician screening, 10.5 per cent were unsure, and less than 2 per cent preferred no screening. More irregular and never attenders chose self-sampling, compared with regular attenders (71.1 per cent and 70.1 per cent vs. 41.0 per cent respectively). Among regular attenders, self-sampling was preferred more frequently by the highest occupational grade, older and lesbian, gay and bisexual women, and those with experience of blood self-tests. In the irregular attender group, older women and those with experience of blood self-tests were more likely to choose self-sampling. In ‘never attenders’, self-sampling was less popular in ethnic minority groups.

Conclusions

If offered a choice of screening, around half of women in England may choose self-sampling, but a substantial proportion would still opt for clinician screening. Screening providers will need to manage a high take-up of self-sampling if many regular attenders switch to self-sampling.

Cancer Research UK New insights on self-sampling for cervical cancer screening

Self-sampling for cervical screening offered at the point of invitation: A cross-sectional study of preferences in England [paper]

Hundreds of people diagnosed with cancer early through life-saving NHS lung checks

NHS England | 19 April 2022 | Hundreds of people diagnosed with cancer early through life-saving NHS lung checks

Hundreds of people have been diagnosed with lung cancer earlier through NHS mobile trucks, as part of the biggest programme to improve early lung cancer diagnosis in health service history.

Today, NHS cancer chiefs are urging those most at risk of lung cancer to come forward as soon as they are invited for a life-saving health check, to help even more people benefit from early diagnosis.

The call comes as new figures show only a third (35 per cent) of patients go to their lung health check when invited by the NHS.

A further 20 NHS lung truck sites are due to go live shortly with the capacity to invite 750,000 more people at increased risk for a check, in efforts to catch thousands more cancers at an earlier stage.

So far, the 23 existing truck sites have issued up to 25,000 invitations every month.

Hundreds of people diagnosed with cancer early through life-saving NHS lung checks

In the news

Guardian NHS urges people to attend vital lung cancer check-ups in England

Severe mental illness: inequalities in cancer screening uptake

Public Health England | September 2021 | Severe mental illness: inequalities in cancer screening uptake

This report from PHE highlights that people with a recorded diagnosis of SMI are more likely than the general population to experience poor physical health and to die prematurely.

People with SMI in England:

• die on average 15 to 20 years younger than the general population
• are 4.7 times more likely to die under the age of 75 than people without SMI

• cancer is the leading cause of premature mortality among adults with SMI

While international research suggests that the incidence of most cancers is similar among people with and without SMI. However, among people with a cancer diagnosis, those who also have SMI are more likely to die from the cancer (the case fatality is higher).

Comparing the uptake of NHS bowel, breast and cervical cancer screening services between people with and without severe mental illness.

Severe mental illness (SMI): inequalities in cancer screening uptake report

New screening pathways could improve NHS England’s bowel cancer programme

NIHR | 13 September 2021 | New screening pathways could improve NHS England’s bowel cancer programme

 NHS England’s Bowel Cancer Screening Programme aims to find warning signs in people aged 60 to 74. This population are invited to take a faecal immunochemical test (FIT) every two years. FIT measures blood in faeces and people with levels above a certain threshold are invited to have their bowel tissue examined for signs of cancer. Growths which could become cancerous (polyps) are removed and cancers prevented.

The research team set out to

1. Explore the relationship between FIT results and bowel pathology using truncated regression, in both a univariate and multiple regression model, with demographic factors including age, sex and area-based socioeconomic status; and
2. Use these results to estimate proportions of bowel abnormalities the screening programme would fail to diagnose at different FIT thresholds (false negative rates);
3. Generate hypotheses for fuller exploitation of quantitative FIT measures.

Researchers were surprised to find that the FIT threshold for further investigation is set at a point that may miss more than half of bowel cancer cases. This highlights a need to improve the NHS screening programme.

They suggest that the programme could make better use of FIT’s ability to provide the exact concentration of blood in faeces (rather than only whether it is above or below a cutoff level).

A new, multi-threshold strategy would mean referring people different follow-up according to their results. Screening intervals could be varied, and different ways of examining the bowel could be used (for example, sigmoidoscopy examines only the lower bowel). This could reduce the number of cancers missed while minimising the demand on services (Source: NIHR & Li et al, 2021).

Full details are available from NIHR

Primary paper Faecal immunochemical testing in bowel cancer screening: Estimating outcomes for different diagnostic policies

Li, S.J. et al | 2021| Faecal immunochemical testing in bowel cancer screening: Estimating outcomes for different diagnostic policies| Journal of Medical Screening | 28 | 3 P .277-285. doi:10.1177/0969141320980501

Abstract

Objectives

The National Health Service Bowel Cancer Screening Programme (NHS BCSP) in England has replaced guaiac faecal occult blood testing by faecal immunochemical testing (FIT). There is interest in fully exploiting FIT measures to improve bowel cancer (CRC) screening strategies. In this paper, we estimate the relationship of the quantitative haemoglobin concentration provided by FIT in faecal samples with underlying pathology. From this we estimate thresholds required for given levels of sensitivity to CRC and high-risk adenomas (HRA).

Methods

Data were collected from a pilot study of FIT in England in 2014, in which 27,238 participants completed a FIT. Those with a faecal haemoglobin concentration (f-Hb) of at least 20 µg/g were referred for further investigation, usually colonoscopy. Truncated regression models were used to explore the relationship between bowel pathology and FIT results. Regression results were applied to estimate sensitivity to different abnormalities for a number of thresholds.

Results

Participants with CRC and HRA had significantly higher f-Hb, and this remained unchanged after adjusting for age and sex. While a threshold of 20 μg/g was estimated to capture 82.2 per cent of CRC and 64.0 per cent of HRA, this would refer 7.8 per cent of participants for colonoscopy. The current programme threshold used in England of 120 μg/g was estimated to identify 47.8 per cent of CRC and 25.0 per cent of HRA.

Conclusions

Under the current diagnostic policy of dichotomising FIT results, a very low threshold would be required to achieve high sensitivity to CRC and HRA, which would place further strain on colonoscopy resources. The NHS BCSP in England might benefit from a diagnostic policy that makes greater use of the quantitative nature of FIT.

1. Exploring the relationship between FIT results and bowel pathology using truncated regression, in both a univariate and multiple regression model, with demographic factors including age, sex and area-based socioeconomic status; and
2. Using these results to estimate proportions of bowel abnormalities the screening programme would fail to diagnose at different FIT thresholds (false negative rates);
3. Generating hypotheses for fuller exploitation of quantitative FIT measures.

NIHR: UK lung cancer trial shows screening at-risk groups lowers mortality rates

NIHR | September 2021 | UK lung cancer trial shows screening at-risk groups lowers mortality rates

This NIHR Alert summarises the findings of a piece of recent screening trial in the UK, the trial looked at the first lung cancer computed tomography (CT) screening trial in the UK.

This paper enhances our knowledge of lung cancer CT screening, including effects on mortality (lung cancer mortality and all-cause mortality), as well as on stage of the disease and on pulmonary nodule classification. As the UK lung cancer screening trial (UKLS) had only a single screen, this study adds considerably to knowledge of the pattern of lung cancer incidence and mortality post-screening. The associated meta-analysis, which includes the UKLS trial, provides the most up to date international view of lung cancer mortality in lung cancer CT screening studies (Source: Field et al, 2021).

NIHR UK lung cancer trial shows screening at-risk groups lowers mortality rates

Primary paper Lung cancer mortality reduction by LDCT screening: UKLS randomised trial results and international meta-analysis

Be Clear on Cancer: first national ‘Cervical Screening Saves Lives’ campaign

Public Health England | July 2021 | Be Clear on Cancer: first national ‘Cervical Screening Saves Lives’ campaign

This online publication evaluates the first national ‘Cervical Screening Saves Lives’ campaign which ran in 2019 from 5 March 2019 to 30 April 2019 in England, as part of the wider Be Clear on Cancer initiative.

Full details from Public Health England

Breast cancer screening: women with poor mental health are less likely to attend appointments

NIHR | 21 June 2021| Breast cancer screening: women with poor mental health are less likely to attend appointments

This Alert from National Institute for Health Research (NIHR) highlights the findings of recent research that looked at resaons why women chose not to attend breast screening appointments. This research was conducted in Northern Ireland and included nearly 60 000 women between the ages of 50 and 70. They were all eligible for routine NHS screening for breast cancer. One in ten of the sample reported poor mental health. This group was almost a quarter (23 per cent) less likely to attend breast screening than women without mental health problems.

In the last decade evidence suggests that women who live in less affluent or urban areas, and those who are not married, are less likely to attend screening.

The researchers used data from the Northern Ireland Longitudinal Study includes data on one in four (28 per cent) of the Northern Ireland population. It includes women’s responses to questions on mental health in the 2011 Northern Ireland Census. The authors linked this information to women’s records on breast cancer screening. 

Their investigation into the factors that impacted on a woman’s likelihood not to attend a screening appointment were:

• women with mental illness were less likely to attend screening than women who did not report mental health conditions
• not being married or living in an urban area were each linked to a similar reduction (23 per cent less) in attendance
• the effect of social deprivation was greater, and women in this group were 34 per cent less likely to attend breast screening
• mental health had an impact across all groups of women, regardless of social deprivation, urban living or marital status.

The authors of the study call for health services to explore targeted interventions, such as more frequent appointment reminders. This could encourage women with mental illness to attend screening appointments. 

[Abstract] Does poor mental health explain socio-demographic gradients in breast cancer screening uptake? A population-based study.

If you’d like access to this paper, please request it from the Library

Cancer won’t wait: building resilience in cancer screening and diagnostics in Europe based on lessons from the pandemic #covid19rftlks

IQVIA Institute | March 2021  | Cancer won’t wait: building resilience in cancer screening and diagnostics in Europe based on lessons from the pandemic

This report, from The IQVIA Institute for Human Data Science, highlights some of the approaches already being taken to address the  ongoing impact of COVID-19 on health services across Europe has in most cases led to significant reductions in cancer screening, testing and diagnosis. The resultant delays in diagnosis are impacting cancer treatment and survival. The publication also makes a number of suggestions for what should be done going forward. It considers different stakeholders – from local pharmacies to national and international organisations – and their roles, as well as multi-stakeholder collaboration and cooperation. It aims to highlight initiatives adopted in some countries that can be shared more widely. It is also intended to provide a platform for additional activity during 2021 focused on specific types of cancer and expanded local, country-specific initiatives.

Reduced screening and testing causes

Source: IQVIA Institute for Human Data Science

Key points

• Reduced screenings and testing can be attributed to both health system issues and patient concerns
• Re-prioritisation of health system resources has caused a reduction in capacity and significant disruption to the provision of health services
• Patient attitudes and concerns about engaging with the health system, especially for asymptomatic conditions and preventative measures, have also triggered the steep decline in screenings and testing

Recommendations

• The response to the COVID-19 pandemic has already shown that much can be achieved by embracing innovation and adapting quickly
• There is an ongoing need for collaboration at all levels and for organisations to learn quickly and share good practice
• There is a shared responsibility to take action, which will require leadership, flexibility and cultural change in order for the lessons from this pandemic to be learned and to achieve greater resilience going forward

Registration required to download the report Cancer won’t wait: building resilience in cancer screening and diagnostics in Europe based on lessons from the pandemic

Breast Cancer UK: Almost one million women in UK miss vital breast screening due to COVID-19

Breast Cancer UK| September 2020| Almost one million women in UK miss vital breast screening due to COVID-19

Close to a million women in the UK have missed potentially lifesaving NHS breast screening due to COVID-19, the leading UK breast cancer charity has warned on the eve of Breast Cancer Awareness Month.

Breast Cancer Now estimates that around 986,000 women missed their mammograms due to breast screening programmes being paused in March 2020, in a bid to reduce the risk of COVID-19 spreading and to free up emergency resource for the NHS.

Although the charity says screening for breast cancer is now beginning again, it cautions that this varies across the UK, with availability of appointments being significantly reduced to enable social distancing, and the programme has recommenced at different paces across England.

 Breast Cancer Now  Almost one million women in UK miss vital breast screening due to COVID-19

Screening restart: Guidance for safe service provision during Covid-19 pandemic and post pandemic phase

Screening restart: Guidance for safe service provision during Covid-19 pandemic and post pandemic phase | The Society and College of Radiographers | Royal College of Radiologists

The Society and College of Radiographers (SCoR), in collaboration with the Royal College of Radiologists (RCR), has produced this joint guidance to support the restarting of screening services involving imaging during the COVID-19 pandemic. This document offers guidance to members and providers. It supports ‘paused’ or ‘stopped’ services to recommence safely, protecting staff and clients.

The guidance within this document is to inform local policy decisions with regard to the delivering of screening services, to ensure that providers meet government recommendations, while still providing client-centred care within the challenging environments of the COVID-19 pandemic and post pandemic (endemic) stage. All staff should work to the same local policy, to provide a consistent service to clients.

Full document: Screening restart: Guidance for safe service provision during Covid-19 pandemic and post pandemic phase