The National Institute for Health and Care Excellence’s (NICE) clinical guideline on familial breast cancer, published in June 2013, recommends that women with breast or ovarian cancer should be offered genetic testing if their combined BRCA1 and BRCA2 mutation carrier possibility is 10% or more.

NICE clinical guidelines represent best practice and we expect National Health Service organisations in England to take them fully into account in designing services to meet the needs of their local populations.

The UK National Screening Committee makes recommendations on whole population screening programmes. It is for the National Institute for Health and Care Excellence or its accredited guideline producing bodies to recommend care and testing of people at high risk.

NHS England has commissioning arrangements in place for carrier testing for Tay Sachs disease for at risk populations. Genetic testing will be undertaken where there is a known family history, which indicates a risk of the specific condition or in response to the individual’s clinical symptoms. In the absence of a family history or clinical symptoms it is the responsibility of clinical commissioning groups based on their local needs as to whether they fund referrals to clinical genetics for carrier screening for Tay Sachs disease.

Genomics offers a great opportunity to improve our insight into genetic diseases. It is for this reason that the Government launched a world-leading project to sequence 100,000 genomes from National Health Service patients and established Genomics England, a subsidiary of the Department, to deliver the project.

The UK National Screening Committee makes recommendations on whole population screening programmes. It is for the National Institute for Health and Care Excellence or its accredited guideline producing bodies to recommend care and testing of people at high risk.

NHS England has commissioning arrangements in place for carrier testing for Tay Sachs disease for at risk populations. Genetic testing will be undertaken where there is a known family history, which indicates a risk of the specific condition or in response to the individual’s clinical symptoms. In the absence of a family history or clinical symptoms it is the responsibility of clinical commissioning groups based on their local needs as to whether they fund referrals to clinical genetics for carrier screening for Tay Sachs disease.

Genomics offers a great opportunity to improve our insight into genetic diseases. It is for this reason that the Government launched a world-leading project to sequence 100,000 genomes from National Health Service patients and established Genomics England, a subsidiary of the Department, to deliver the project.

The UK National Screening Committee makes recommendations on whole population screening programmes. It is for the National Institute for Health and Care Excellence or its accredited guideline producing bodies to recommend care and testing of people at high risk.

NHS England has commissioning arrangements in place for carrier testing for Tay Sachs disease for at risk populations. Genetic testing will be undertaken where there is a known family history, which indicates a risk of the specific condition or in response to the individual’s clinical symptoms. In the absence of a family history or clinical symptoms it is the responsibility of clinical commissioning groups based on their local needs as to whether they fund referrals to clinical genetics for carrier screening for Tay Sachs disease.

Genomics offers a great opportunity to improve our insight into genetic diseases. It is for this reason that the Government launched a world-leading project to sequence 100,000 genomes from National Health Service patients and established Genomics England, a subsidiary of the Department, to deliver the project.

The UK National Screening Committee makes recommendations on whole population screening programmes. It is for the National Institute for Health and Care Excellence or its accredited guideline producing bodies to recommend care and testing of people at high risk.

NHS England has commissioning arrangements in place for carrier testing for Tay Sachs disease for at risk populations. Genetic testing will be undertaken where there is a known family history, which indicates a risk of the specific condition or in response to the individual’s clinical symptoms. In the absence of a family history or clinical symptoms it is the responsibility of clinical commissioning groups based on their local needs as to whether they fund referrals to clinical genetics for carrier screening for Tay Sachs disease.

Genomics offers a great opportunity to improve our insight into genetic diseases. It is for this reason that the Government launched a world-leading project to sequence 100,000 genomes from National Health Service patients and established Genomics England, a subsidiary of the Department, to deliver the project.

Screening arrangements at London Heathrow and the other ports remain under constant review.

Information for 2014-15 is not available.

The NHS Bowel Cancer Screening Programme holds data for the number of men and women screened aged 75 and over, observing that nearly 15,000 men have self-referred to be screened for bowel cancer and just over 13,000 women. A table showing the number of screenings in each centre in England is attached.

Further, at the end of January 2015, nearly 25 million Faecal Occult Blood test (FOBt) kits had been sent out to men and women aged 60-74 to self-sample at home. Over 15 million kits have been returned by post to one of five regional laboratories (programme hubs). Since the Programme began in 2006, over 21,000 cancers have been detected and over 122,000 patients have been managed for polyps, including polyp removal.

A smear test is primarily used for screening purposes, and is unlikely to be appropriate when a woman has gynaecological issues that are symptomatic of cancer.

In such cases the National Institute for Health and Care Excellence Referral Guidelines for Suspected Cancer (2005) are available to help general practitioners (GPs) assess when it is appropriate to refer patients for suspected cancer, including cervical cancer. The Guidelines make clear recommendations in relation to gynaecological cancer, and state that:

“A patient who presents with symptoms suggesting gynaecological cancer should be referred to a team specialising in the management of gynaecological cancer, depending on local arrangements.”

In relation to cervical cancer the guidelines make clear that a smear test is not required before referral:

“In patients found on examination to have clinical features that raise the suspicion of cervical cancer, an urgent referral should be made. A cervical smear test is not required before referral, and a previous negative cancer smear result is not a reason to delay referral.”

Therefore, when a woman is experiencing gynaecological problems which are symptomatic of gynaecological cancer, their GP would be expected to refer them to the appropriate specialist without needing to conduct a smear test.

NHS England has advised that decisions taken by screening panels are made in accordance with its interim commissioning policy on individual funding requests, which is available at:

www.england.nhs.uk/wp-content/uploads/2013/04/cp-03.pdf

Its individual funding request screening panels are skilled, experienced and trained in their role and NHS England does not consider that any decisions are made in error.

Arrangements are already in place locally to enable general practitioners to have direct access to appropriate tests to support the primary investigation of disease in all areas of diagnostic tests.

A significant proportion of the work undertaken by pathology laboratories and imaging services is associated with direct access from primary care.

The Department's National Institute for Health Research welcomes funding applications for research into any aspect of human health, including tests for biological markers of brain diseases. These applications are subject to peer review and judged in open competition, with awards being made on the basis of the importance of the topic to patients and health and care services, value for money and scientific quality.

A leaflet sent out with every invitation for cervical screening provides women with clear, honest and balanced information about the benefits and limitations of cervical screening in order to ensure women are able to make an informed decision as to whether to have a cervical screening test or not.

Improving Outcomes: A Strategy for Cancer (January 2011) makes clear the important role that cervical screening plays in preventing cervical cancer. The strategy also notes that some groups and communities are not accessing cancer screening services. Public Health England (PHE) is working with NHS England via the Public Health Section 7A agreement to develop a system of performance improvement through the use of performance floors, and strengthened governance for screening. The aims of the performance floors are:

- Improving performance and equity of service over time by reducing the range of variation at a local level.

- Enabling easy identification of poor performance and the setting of objectives and plans for local action, to reduce variation and improve performance.

PHE will look at research provided by the STRATEGIC study (Strategies to increase cervical screening uptake at first invitation) to identify methods to help increase uptake among women. The STRATEGIC study will be publishing findings in May 2016, more details of this can be found at:

http://www.nets.nihr.ac.uk/projects/hta/0916401

The cervical cancer screening programme was established on the basis that it would prevent, and lead to the early diagnosis of, cervical cancer reducing the number of premature deaths.^[1]

No assessment has been made of the financial consequence to the NHS on the low uptake of cervical screening. However, cost-effectiveness is a key criteria of the UK National Screening Committee recommending whether or not screening for a particular condition should take place. For example, a cost-effectiveness evaluation of the current pilot of human papillomavirus (HPV) testing as primary cervical screening is being undertaken alongside the clinical evaluation of the pilot. Cancer Research UK has estimated that, when fully implemented, HPV testing as primary screening could prevent an additional 600 cancers a year.^[2]

[1] Peto et al, The cervical cancer epidemic that screening has prevented in the UK, Lancet 2004; 364: 249-56

[2] http://msc.sagepub.com/content/early/2013/06/10/0969141313492313

A leaflet sent out with every invitation for cervical screening provides women with clear, honest and balanced information about the benefits and limitations of cervical screening in order to ensure women are able to make an informed decision as to whether to have a cervical screening test or not.

Improving Outcomes: A Strategy for Cancer (January 2011) makes clear the important role that cervical screening plays in preventing cervical cancer. The strategy also notes that some groups and communities are not accessing cancer screening services. Public Health England (PHE) is working with NHS England via the Public Health Section 7A agreement to develop a system of performance improvement through the use of performance floors, and strengthened governance for screening. The aims of the performance floors are:

- Improving performance and equity of service over time by reducing the range of variation at a local level.

- Enabling easy identification of poor performance and the setting of objectives and plans for local action, to reduce variation and improve performance.

PHE will look at research provided by the STRATEGIC study (Strategies to increase cervical screening uptake at first invitation) to identify methods to help increase uptake among women. The STRATEGIC study will be publishing findings in May 2016, more details of this can be found at:

http://www.nets.nihr.ac.uk/projects/hta/0916401

The cervical cancer screening programme was established on the basis that it would prevent, and lead to the early diagnosis of, cervical cancer reducing the number of premature deaths.^[1]

No assessment has been made of the financial consequence to the NHS on the low uptake of cervical screening. However, cost-effectiveness is a key criteria of the UK National Screening Committee recommending whether or not screening for a particular condition should take place. For example, a cost-effectiveness evaluation of the current pilot of human papillomavirus (HPV) testing as primary cervical screening is being undertaken alongside the clinical evaluation of the pilot. Cancer Research UK has estimated that, when fully implemented, HPV testing as primary screening could prevent an additional 600 cancers a year.^[2]

[1] Peto et al, The cervical cancer epidemic that screening has prevented in the UK, Lancet 2004; 364: 249-56

[2] http://msc.sagepub.com/content/early/2013/06/10/0969141313492313