What health screening options are available? Who is at risk?
NHS screening programmes
Within the NHS there are a number of screening programmes in place that are designed for both targeted populations and the general population, depending on their risk. These are put in place by the UK National Screening Committee (UK NSC), which assesses large amounts of data and evidence in order to make recommendations. Generally, screening schemes are designed to identify people who appear healthy but may have a high risk of developing a condition. However, these screening tools are not sufficient to fully diagnose a condition, and a positive screening test result may mean that you would need further investigations for confirmation. This often means that conditions can be treated early, however, there are also chances of getting false positive results, meaning that you may undergo additional testing unnecessarily.
Screening programmes have been shown in large studies to save lives, and often allow people to make well-informed decisions regarding their own healthcare. However, it is important to be aware of the risks and ramifications of undergoing screening, as well as its limitations. It is also important to be aware that, whilst a negative screening result means that you are a lower risk of developing a condition, it does not mean that you will not develop that condition in the future. Many of the screening programmes take this into account, and you will be invited to multiple screenings over an appropriate time frame.
If you are registered with a GP, you should receive appropriate screening invitations for conditions that you may be at an increased risk of. This may depend on your age, sex and any other medical conditions you may have. Screening is advised but not compulsory, and if you would not like to attend for screening it is best to let your GP practice know so that you can ‘opt out’.
Whilst the NHS provides a number of free screening programmes, it is possible to pay for specific screening with private healthcare companies. It is important to carefully consider the risks and benefits of having screening, as well as any further investigations that may be invasive and unnecessary.
Here are some of the screening programmes currently available on the NHS:
AAA – ‘AAA’ stands for Abdominal Aortic Aneurysm. This refers to the main blood vessel in the body that helps to get blood from the heart to the other organs and tissues, known as the aorta. Sometimes, particularly in older males, this blood vessel can become enlarged at a certain point where the wall of the vessel has become weakened (known as an aneurysm). This puts that person at a slightly increased risk of that vessel rupturing. Whilst this is not a common occurrence, it can be severe, so there is a one-time screening programme for men aged 65. Men aged over 65 can request to have a screening. The test takes roughly 10 minutes and uses an ultrasound scan (similar to that used in pregnancy) to look at the aorta and measure how wide it is. You will get the results at the end of the scan. Around 1 in 1,000 men screened will have what is known as a ‘large AAA’. These men will then be referred to a surgeon to discuss the best next steps. If you have a smaller aneurysm present, you may be invited back for further screening over the next few years to keep an eye on the enlarged vessel.
Bowel cancer – Screening for bowel cancer in the UK is offered to men and women aged 60 to 74, every 2 years. You will be sent a kit for a test known as ‘faecal occult blood test’. This is a test that you can complete at home (instructions are sent with the packs) and post; the results normally take around 2 weeks to come back. If you have an abnormality detected in the test, you will be offered a colonoscopy; a camera test to look inside the bowels. If you are aged over 74, you can request to opt-in for screening. The government is currently making some changes to this screening programme, including the offer of a one-off colonoscopy (camera test) for men and women at the age of 55, and also extending screening to those aged 50 to 74. These may be available in some parts of the UK.
Breast cancer screening – Generally breast screening is offered every 3 years to all women aged 50 to 71, although in some areas this is extended to those aged 47 to 73. After the normal age of offered screening, it is possible to request to have continued screening every 3 years. The test involves a mammogram; an X-ray image is taken of the breast tissue, which can help to identify if there are any early changes in the tissues. The results should be sent to you within 2 weeks of having the mammogram. Detecting breast cancer early can prevent the need for less radical treatment later on.
Cervical Smear – Cervical screening is a test for abnormal cells in the cervix. These cells can potentially become cancerous later on. The advantage of this screening programme is that these abnormal cells can be treated before they progress to cancer. Cervical smear testing is offered every 3 years for women aged 25 to 49, and then every 5 years for women aged 50 to 64. This test involves obtaining a sample of cells form the cervix, looking at them under a microscope for any abnormalities (cytology), and testing them for the human papilloma virus (HPV), which is linked to an increased risk of developing cervical cancer. You should receive notification of your smear results within 2 weeks. If there are any abnormalities detected, you may be offered further assessment and treatment options.
Diabetic Eye – All patients with type 1 or type 2 diabetes over the age of 12 are invited for yearly eye screening. A complication of diabetes is a process called ‘diabetic retinopathy’. This is where the small blood vessels in the eye become damaged and can cause visual disturbance and eventually leads to blindness. This screening involves having some special eye drops, then a qualified clinician will look into the eye with a light and take a picture of the back of the eye. The eye drops needed for this test may temporarily affect your vision, so you won’t be able to drive home from your appointment. After the image is taken, it can take up to 6 weeks for the results to come through. Patients with signs of retinopathy will be followed up by their GP or specialist to discuss further treatment options.
Fetal Anomaly – All pregnant women in the UK are offered a 20-week fetal anomaly scan (usually carried out between 18 and 21 weeks). This is an ultrasound scan (the same type used for dating the pregnancy) and can be used to identify a number of structural abnormalities in the baby, including spina bifida and cardiac problems. This scan can also be used to identify the presence of some chromosomal diseases such as Edward’s and Patau’s syndrome. You may also opt to have extra testing for Down’s syndrome. This scan is offered to all pregnant women but is optional. If any abnormalities are detected during the scan, you will be offered a follow-up appointment to discuss further options and management.
Infectious Diseases in Pregnancy – Pregnant women in the UK are all offered a single blood test for Hepatitis B, HIV and syphilis. This test is generally offered in early pregnancy, although it will be re-offered at 20 weeks if initially refused. This is because these infections can all be transmitted to the baby throughout pregnancy or birth and can cause serious health problems for the mother and the baby. Although this test is recommended, it is not compulsory. Presence of any of these infections may indicate the need for certain precautions and treatments to keep both the baby and the mother healthy and safe. Acute Hepatitis B is a notifiable disease in England and Wales, meaning that it must be reported to Public Health England.
Newborn and Infant Physical Examination – All babies will receive a full physical examination from a trained clinician at both 72 hours, and again at 6-8 weeks. This examination particularly focuses on conditions relating to the heart, hips, eyes and testes (in boys). This examination can be carried out in hospital, at your GP practice or at home by a community practitioner such as a midwife. Whilst most baby checks are normal, it is good to screen for any potential problems early so that treatment can be started as soon as possible to prevent any long-term adverse effects.
Newborn Blood Spot – All babies are offered a blood test for a set of nine inherited conditions, including cystic fibrosis and sickle cell anaemia. Early treatment of these conditions is essential to preventing further complication and disability. The blood test involves a small prick to the baby’s heel to collect a few drops of blood, usually when they are around 5 days old. This test is not compulsory but is highly recommended. All the test results should be available by the time your baby is 6-8 weeks old.
There is also a specific test done for sickle cell anaemia for both pregnant women and fathers-to-be where screening shows that the mother is a carrier of the sickle cell gene. This special screening can also be done for other genetic diseases affecting the blood, such as thalassaemia.
Newborn Hearing – Screening for hearing in newborns is essential as hearing difficulties or deafness can seriously affect development if not addressed early. Again, although not compulsory, this screening comes highly recommended. Ideally, this testing is done within the first 4-5 weeks but can be done up to 3 months. Also known as the Automated Otoacoustic Emission (AOAE) test, this involves placing some small, soft earpieces into the baby’s ear to play some quiet clicking noises. If any abnormalities are detected, a repeat test can be done or a further assessment can be done to determine the cause.