Screening on the agenda

Every blood test, biopsy sample, cancer screening test or search for infection will involve a pathology team. Some screening tests such as the heel prick test are only offered to newborn babies, while others such as breast screening and abdominal aortic aneurysm screening are only offered to adults. The heel prick test carried out on newborn babies allows blood to be tested for diseases such as sickle cell anaemia and cystic fibrosis, as well as various inherited metabolic diseases.

Review of national cancer screening programmes in England

Early in 2019, the College hosted a working conference to contribute to Professor Sir Mike Richards’ review of national cancer screening programmes in England. The review examined breast, bowel and cervical screening programmes. The event brought together doctors, nurses, policy experts, representatives from public health, the charity sector and patient groups.

Feedback from the participants raised a number of issues about the screening programmes. In particular, the problems caused by the age and complexity of IT systems in use; a highly committed workforce faced with increasing demand and a lack of robust workforce planning; the need to make screening more convenient and acceptable to those being screened; and the complex and multi-layered arrangements for accountability and governance, which can mean that when incidents do occur, it is not always obvious which organisation should take the lead on investigating.

Prof Sir Mike Richards’ screening report was published in October 2019. Professor Jo Martin, President of the Royal College of Pathologists responded to the report:

‘Screening programmes are key to detecting cancer early. The sooner a diagnosis is made the easier the cancer is to treat and pathologists are critical to the diagnosis of cancer.

‘We welcome the drive to increase the uptake of screening, but without the right IT support and investment in the workforce, pathologists will not be able to continue to keep pace with increasing demand. 

‘We are pleased to see that our some of our main concerns have been recognised. Making sure the recommendations become reality is crucial. We look forward to Professor Sir Mike Richards’ more detailed report on diagnostic capacity. Ensuring that we can deliver a world-class screening programme depends on having the right number of pathology staff with the right expertise in the right places.’

Cervical screening programme

Changes to the UK’s cervical screening programme so that samples are first tested for the presence of human papillomavirus (HPV), which causes most cases of cervical cancer, could lead to 600 fewer cancers a year. This programme has been implemented in Wales and will be rolled out in England and Scotland in 2019 and 2020 respectively.

This new system has meant a major restructuring of services and a significant reduction in the number of laboratories. Once the new centres are established, there will be greater stability for staff but the intervening period is one of great uncertainty.

The College, along with the British Association of Cytopathology and Institute of Biomedical Science, worked with NHS England, NHS Improvement and Public Health England to suggest ways to mitigate potential risks to services. We pressed for improvements in commissioning, workforce planning and IT to support our cytopathology colleagues. Lessons learned were fed into the review of national cancer screening programmes.

Making the transition safe and ensuring that future staffing is secure is paramount. Cervical screening is a key service for cancer prevention and we will work to ensure that the programme works well for women.

Figures released by NHS Digital in November 2019 show that the lack of capacity in laboratories has impacted turnaround times for cytology screening since 2017-18. To reduce the backlog and stabilise service delivery, a national mitigation plan has been in place whereby the HPV pilot sites have increased the amount of HPV Primary screening to release cytology capacity.

Faecal Immunochemical Test (FIT)

FIT is a type of faecal occult blood test for bowel cancer screening which uses antibodies that specifically recognise human haemoglobin (Hb). It is used to detect, and can quantify, the amount of human blood in a single stool sample and is carried out in clinical biochemistry departments. FIT has been shown to have higher participation rates by the population and the switch is expected to increase screening uptake by around seven to eight percentage points in England. Whilst we welcome higher uptake in testing and the benefits of earlier diagnosis, this will increase pathology demand, both as a result of increased initial testing and because positive results lead to further testing.

Also on the agenda