Screening and earlier diagnosis
NHS cancer screening programmes can help to diagnose cancer or risk of cancer earlier and improve the likelihood of successful treatment. There are three national cancer screening programmes in England.
If you are eligible, please make every effort to have your screening test. Screening tests can detect a problem early, before you have any symptoms. Finding out about a problem early can mean that treatment is more effective.
The NHS cervical screening programme in England is offered to people with a cervix aged from 25 to 64. Routine screening is offered every three years up to 49 years of age and every five years from 50 to 64 years of age. Depending on the result of the screen, people may be recalled earlier than these routine intervals.
As part of the NHS Cervical Screening Programme, all samples taken at cervical screening appointments are now being tested for high risk Human Papillomavirus (HPV) in the first instance. This is the virus which causes nearly all cervical cancers. Samples that test positive for HPV will then go on to be further analysed with Liquid Based Cytology to detect cell abnormalities. The new test will identify more people at risk of cervical cancer earlier and could prevent around 600 additional cancers a year.
HPV is a very common virus which effects around 8 in 10 people; it is nothing to be embarrassed about, and in many cases, your immune system will naturally get rid of HPV.
For more information on the cervical screening programme, please visit the NHS cervical screening pages. Alternatively, visit the gov.uk website or Jo’s Cervical Cancer Trust’s website.
About 1 in 8 women in the UK are diagnosed with breast cancer during their lifetime. If it’s detected early, treatment is more successful and there’s a good chance of recovery.
Breast screening uses an X-ray test called a mammogram that can spot cancers when they’re too small to see or feel.
Breast screening is offered to women aged 50 to their 71st birthday in England. You’ll first be invited for screening within three years of your 50th birthday
There is also currently a trial to examine the effectiveness of offering some women one extra screen between the ages of 47 and 49, and one between the ages of 71 and 73.
You may be eligible for breast screening before the age of 50 if you have a very high risk of developing breast cancer.
If you are 71 or over, you will stop receiving screening invitations. You can still have screening once you are 71 or over if you want to and can arrange an appointment by contacting your local screening unit.
If you’re worried about breast cancer symptoms, such as a lump or an area of thickened tissue in a breast, or you notice that your breasts look or feel different from what’s normal for you, do not wait to be offered screening. See a GP.
Bowel cancer survival is improving and has more than doubled in the last 40 years in the UK. If diagnosed early, more than 90% of bowel cancer cases can be treated successfully.
Screening programmes test to see if people show any early signs of cancer. By detecting bowel cancer at an early stage, treatment has a better chance of working.
As part of the NHS Bowel Cancer Screening Programme, men and women aged 60-74 are sent a home testing kit every two years to collect a small sample of poo to be checked for tiny amounts of blood which could be caused by cancer. In 2019, the home testing kit was changed from the guaiac Faecal Occult Blood Test (gFOBT) to the Faecal Immunochemical Test (FIT) because it is:
- more accurate – it can detect smaller signs of blood hidden in poo samples, which can be an early sign of bowel cancer.
- easier to use – only one sample is required. The gFOBt required three samples to be taken on three different days.
As part of the NHS Long Term Plan, there is also a commitment to lower the bowel screening age to 50 and improve the sensitivity of the screening test further. With support from Public Health England and Health Education England, the NHS is working on plans to safely implement these significant changes, which will include needing extra staff to be trained to undertake extra colonoscopies and other investigations.
For more information on the bowel cancer screening test, please visit the nhs.uk bowel cancer screening pages. You can also find information on the signs and symptoms of bowel cancer on the nhs.uk website.
Review of screening services in England
Professor Sir Mike Richards’ Review of Adult Screening Programmes in England was commissioned in November 2018 as a response to the increased scrutiny that cancer screening programmes were under from national screening incidents. The remit was “to assess current strengths and weaknesses in the current commissioning and delivery arrangements for the national cancer screening programmes in England, in view of the current available evidence.’’
Following publication of the interim report in March 2019 and the Public Accounts Committee session on adult screening, the review scope was extended to include all screening programmes which target the adult population and require people to be actively called and recalled for screening:
- Abdominal aortic aneurysm
- Bowel cancer
- Breast cancer
- Cervical cancer
- Diabetic eye screening (this also extends to young people).
The report of the review was published in October 2019 on the NHS England website.
The report states that these programmes save around 10,000 lives a year through prevention and early diagnosis. As a country, they give us much to be proud of and this is in large part due to the expertise and dedication of staff across the NHS and Public Health England (PHE). However, the report states that these services are far from realising their full potential.
We will be working closely with government and PHE to consider the 22 recommendations in full as part of existing work which is already underway:
- NHS England and NHS Improvement have developed plans to improve uptake in all three of the adult cancer screening programmes, with actions being implemented at both a national and local level. These, together with new service improvements now implemented such as the roll-out of primary human papillomavirus testing in cervical screening and the new faecal immunochemical test in bowel screening, which spots signs of cancer earlier, will save more lives as well as increasing screening uptake.
- NHS England and Improvement have already strengthened the governance of NHS screening programmes with wider participation including PHE, enhanced information on trends and performance and has worked to build accountable structures at regional level. NHS England and NHS Improvement will now go further, in line with the recommendations, to publish individual programme annual reports and strengthen support to its regional teams in their oversight of service delivery and their work with local systems, including Cancer Alliances and Primary Care Networks to integrate screening with symptomatic and other diagnostic services.
- Work is now being taken forward by NHSX, in collaboration with NHS Digital, PHE and NHS England and Improvement to transform the digital components of our screening programmes, beginning with cervical and breast cancer screening as a priority. This work will both ensure that the programmes are as safe and as efficient as possible and provide a better service for people.
- There will be a £200m investment in cancer screening equipment, to ensure that all x-ray mammography machines and MRI and CT scanners more than 10-years old are replaced as a matter of urgency. This will support the ability of the NHS to diagnose cancer and support the commitment in the NHS Long Term Plan to ensure more people survive cancer each year.
Whilst this review considers some aspects of diagnostic capacity that are directly related to screening, its scope does not extend to diagnostic capacity more generally. This will be covered in a separate report for later publication.