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Cancer screening services need major overhaul to halt ‘worrying decline’, report warns

Harry Cockburn
Cancer screening must be made much more accessible, major report commissioned by government says: Getty

Patients must have greater availability of cancer screening services in order to halt a “worrying decline” in the number of people attending, a government-ordered review has said.

Professor Sir Mike Richards, the former national cancer tsar, said patients need to be given more choice over where they go for tests, including for cervical or breast screening, and that evening and weekend options in locations close to their home or work must be available.

He has lead a study examining the NHS screening programmes for abdominal aortic aneurysm, bowel cancer, breast cancer, cervical cancer and diabetic eye screening.

His report also highlighted how existing services are not well equipped to serve trans people and gender diverse populations.

It recommended outdated IT systems used for screening must be overhauled as they are currently too fragmented and lead to errors, risking patient safety.

It also criticised delays in introducing new types of screening – such as a delay of over a decade in bringing in the new bowel cancer test. It said such delays end up costing lives.

The study pointed to “substantial” evidence that people would be more likely to accept invitations for screening if appointments were available at convenient times and locations – either near home or their place of work.

Some women also prefer to be screened at sexual health clinics, while GPs must be “incentivised” to provide convenient appointments and ensure people take up screening, it said.

Text message reminders could also be sent to increase uptake of appointments, although current IT systems hinder access to mobile phone numbers.

More should also be made of social media campaigns to raise awareness of the importance of screening, the report said.

The study said trans people are “currently poorly served by screening services” and this must be improved.

It said: “Transmen may have a cervix and thus be at risk of cervical cancer.

“However, their gender may be recorded as male and thus they would not be routinely called for cervical screening.

“Transwomen are at an increased risk of breast cancer compared to cisgender men if using hormones, but are only invited for screening if registered as female.”

The report welcomed the government’s new funding to replace MRI machines, CT scanners and breast screening equipment, saying some equipment was hugely outdated, with some mobile vans for breast screening “at least 17 years old” and had “leaking roofs”.

And while most patients get the results of their screening on time, just 23.2 per cent of women received their cervical screening results within the recommended two weeks in April 2019 due to a changeover to a new system.

The report said the current screening service saves over 10,000 lives a year but there is a sense “that we are now slipping” and each screening service could “do better”.

It was also unclear who is accountable for the screening service – with Public Health England (PHE) and NHS England both having key roles – and the report said responsibility must be transferred to NHS England.

“The current system lacks clear leadership and accountability,” the report said.

“The rationale for dividing responsibilities across PHE and NHSE is often unclear and creates confusion, delays and risks to patient safety.”

On IT, the study said the current systems used for screening “are woefully out of date and long due for replacement”, leading “to inefficiencies and errors”.

It added: “Some of the systems – particularly those for breast and cervical screening – are old and liable to fail.”

Sir Mike welcomed the work being done by bodies including NHSX to upgrade the systems, adding that this process must continue.

The report said: “A modern IT system should enable patients to make or change their own appointments for screening, to be able to access information on their own screening records and to see when their various screenings are next due.

“None of these functions are currently available.”

Simon Stevens, NHS chief executive, welcomed the report and said the recommendations were “sensible”, while Health Secretary Matt Hancock accepted that NHS England would take on overall responsibility for screening.

Sara Hiom, Cancer Research UK’s director of early diagnosis, said: “Thousands of premature deaths are avoided every year in the UK thanks to our cancer screening programmes, but there are still many things holding them back.”

She said a “lack of funding has led to an archaic NHS infrastructure – especially IT systems – making it virtually impossible to optimise our country’s screening programmes.”

She added: “The Department of Health and Social Care must take urgent action to ensure the review’s recommendations are implemented so that no lives are needlessly lost to cancer.”

Robert Music, chief executive of Jo’s Cervical Cancer Trust, said there needed to be “quick and decisive action as a result of the recommendations”.