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Adult screening programmes

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Introduction

Screening is an activity which identifies apparently healthy people from a defined population who may be at increased risk of a disease or condition. The idea behind screening is early detection of risk factors or early disease; beneficial for both clinical and health outcomes for a population. The non-cancer screening programmes delivered by the NHS are:

The NHS offers a range of free health checks such as the NHS Health Check and NHS screening programmes which are designed to spot early signs of certain diseases or see how likely you are to develop them. Cancer screening information is available in the breast cancer and cervical cancer sections of the JSNA.

 

Facts and figures

Diabetic eye screening

Diabetic retinopathy is one of the most common causes of sight loss among people of working age. It is is caused by high blood sugar levels damaging blood vessels in the eye. They may become blocked, have excess fluid or leak, causing blurred visions, and in worst case, blindness.

Diabetic eye screening seeks to reduce the risk of sight loss amongst those with diabetes by early identification and treatment of diabetic retinopathy. The programme is offered every year to all people over the age of 12 who have been diagnosed with diabetes. The screen involves a digital photograph of the retina (back of the eye) followed by a two- or three- image grading process, identifying any changes in the retina. Risk factors are continued high glucose levels, blood pressure, fatty foods and smoking. Regular screening allows prompt identification and effective treatment if necessary of sight threatening diabetic retinopathy. The NHS Diabetic Eye Screening Programme is essential for identifying retinopathy at an early stage.

Diabetic eye screening services in Blackpool are now provided by the Cumbria, North Lancashire, Blackpool, Fylde and Wyre Screening Programme and it is currently not possible to separate Blackpool's results from the total for the programme.  Figure 1 shows the coverage (proportion of eligible people screened within the relevant time scale) of diabetic eye screening for the three programmes across Lancashire1.

Figure 1: Trend in diabetic eye screening coverage across the three Lancashire screening programmes

Diabetic Eye screening KPI result chart
Source: PHE, NHS Screening Programmes: KPI reports 2013/14 to 2015/16

While some people with diabetes may choose to decline an offer of screening, the level of uptake is an important measure of programme performance. Low uptake may indicate that: - those offered screening are not accepting the test (for example, because they do not understand its importance, or because it is inconvenient, or because they have had a bad screening experience in the past) - those accepting the test are not being tested (for example, because they attend but do not receive screening by digital photography)

Diabetic eye screening data was previously collected as part of the Quality and Outcomes Framework (QOF) and figures for 2013/14 show that 82.4% (8,420) of people in Blackpool who have been diagnosed with diabetes had an eye screen in the previous 12 months.  This is the same as the national average.  Diabetic eye screening is not part of the QOF now due to the national screening programme.

For further information on sight loss or diabetes see the Eye Health and Sight Loss and Diabetes sections.

Abdominal Aortic Aneurysm (AAA) screening

The NHS AAA Screen­ing Pro­gramme aims to reduce deaths from the con­di­tion among men aged 65 and over by up to 50 per cent by detect­ing aneurysm­s early and offer­ing appro­pri­ate mon­i­tor­ing or treat­ment. Men aged 65 and over are most at risk from the con­di­tion and invi­ta­tions for screen­ing are sent to men in Lan­cashire and Cum­bria in the year they turn 65.

This is a relatively new programme that began rollout across Cumbria and Lancashire in 2013. Rollout is now complete and across Lancashire and Cumbria 100% of the eligible population (men aged 65) were invited for screening in 2014/151. Figure 2 shows the coverage  (% screened of those eligible) and uptake (% screened of those offered) across the Lancashire and Cumbria programme for 2013/14 and 2014/15.

Data for Blackpool is only available for 2014/15 and shows:

    • 833 men aged 65 were offered screening, 100% of those eligible
    • 578 (69.4%) were screened, significantly lower than the national average of 79.5%
    • Of those screened in Blackpool, 14 (2.4%) were identified with an aorta >=3cm (Figure 3)

Figure 2: Uptake of AAA screening, England, Cumbria and Lancashire and Blackpool

AAA screening uptake chart
 Source: PHE, Abdominal aortic aneurysm screening: 2014 to 2015 data

Scans which identify a small (3.0-4.4cm) or medium (4.5-5.4cm) aneurysm won't need any treatment at this stage but will be monitored in case it gets bigger.  Because aneurysms grow so slowly, men with a small or medium aneurysm may never need treatment. An AAA 5.5cm or larger will lead to a referral to a vascular surgeon who may recommend an operation.

Figure 3: % identified with an aorta >=3cm

AAA screening-% aneurysm
Source: PHE, Abdominal aortic aneurysm screening: 2014 to 2015 data

Risk factors for an AAA

It's not known exactly what causes the aortic wall to weaken, although increasing age and being male are known to be the biggest risk factors. One study found that people aged over 75 are seven times more likely to be diagnosed with an AAA than people under 55 years old. Men are around six times more likely to be diagnosed with an AAA than women2.

However, there are other risk factors that you can do something about – the most important of which is smoking.

National and local guidance

An overview of the NHS diabetic eye screening programme, its services, and contact information

The Royal College of Ophthalmologists Diabetic Retinopathy Guidelines provide evidence-based, clinical guidance for the best management of different aspects of diabetic eye disease.

How the NHS abdominal aortic aneurysm screening-programme works: who is eligible, what it does, how to find out more

 


[1] PHE, NHS screening programmes: KPI reports 2014 to 2015

[2] NHS Choices, Abdominal aortic aneurysm