Does individual programme size affect screening performance? Results from the United Kingdom NHS breast screening programme

Blanks, R. G.; Bennett, R. L.; Wallis, M. G.; Moss, S. M.
March 2002
Journal of Medical Screening;Mar2002, Vol. 9 Issue 1, p11
Academic Journal
Objective: The size (number of women screened) of the 95 individual NHS breast screening programmes (NHSBSPs) varies by a factor of 10. This study investigates the impact of size on the performance of individual programmes. Method: Data were collated from the 95 United Kingdom screening programmes on the standard statistical returns for the past 5 years (1 April 1995–31 March 2000). Additional information was obtained from questionnaires. The number of women screened between 1 April 1999 and 31 March 2000 determined the size of a programme. The bottom 25% were defined as small, the middle 50% as medium, and the top 25% as large. On average large programmes screened about four times as many women as small programmes and medium programmes about twice as many. Performance was evaluated using cancer detection rates, referral rates for assessment, and positive predictive value (PPV) of assessment using PPV referral diagrams. Results: The performance of smaller programmes was shown to be marginally poorer than medium and large sized programmes in that they detected fewer cancers and had a lower PPV. The smallest 25% of programmes had an invasive cancer detection rate 13% less than the medium and large programmes. However, if these programmes had an equivalent detection rate to the medium/large programmes the national detection rate would only increase by about 2%. This is because the 75% of programmes described as medium and large screen about 90% of all women. It is therefore important to place the clinical importance of these findings in context when considering any envisaged possible solutions. Conclusions: Although the performance of smaller programmes was shown to be poorer than that of the larger programmes, it is not clear from this study exactly why this is so. A likely contributory factor based on experience of evaluating the NHSBSP is that performance problems in larger programmes have been easier to detect by quality assurance staff. The size of the small programmes and the few screen detected cancers (and inherent statistical instability in detection rates) mean that problems are difficult to identify. As a consequence small programmes which are genuinely performing marginally below specific standards are likely to receive less attention than larger programmes, and even under close scrutiny the causes are less likely to be found.


Related Articles

  • Breast screening controversy triggers DoH review. Robinson, Stephen // GP: General Practitioner;11/4/2011, p19 

    The article informs that an independent panel will review the breast cancer screening programme of the National Health Service (NHS) after doubts over whether its benefits outweigh potential harm. Professor Mike Richards, England's national cancer director, said that screening programmes should...

  • A comparison of cancer detection rates achieved by breast cancer screening programmes by number of readers, for one and two view mammography: results from the UK National Health Service breast screening programme. Blanks, R G; Wallis, M G; Moss, S M // Journal of Medical Screening;Dec1998, Vol. 5 Issue 4, p195 

    Objective To determine the increased cancer detection rate, if any, of programmes in the UK National Health Service breast screening programme (NHSBSP) using more than single reading of mammograms. Design Information on the detection of cancers by individual screening programmes from annual...

  • An Implementation Intentions Intervention to Increase Uptake of Mammography. Steadman, Liz; Field, Stuart; Rutter, D. R.; Quine, Lyn // Annals of Behavioral Medicine;2006, Vol. 32 Issue 2, p127 

    Background and Purpose: This study tested an implementation intentions intervention to increase uptake in the United Kingdom's National Health Service Breast Screening Programme. The intervention asked women to plan how they would overcome up to 3 previously identified barriers to attending....

  • Monitoring and evaluating the UK National Health Service Breast Screening Programme: evaluating the variation in radiological performance between individual programmes using PPV-referral diagrams. Blanks, R. G.; Moss, S. M.; Wallis, M. G. // Journal of Medical Screening;Mar2001, Vol. 8 Issue 1, p24 

    A high quality breast cancer screening programme can be defined as one offering both a high cancer detection rate and a low referral rate of women for further investigation. Such a programme will have as few women as possible undergoing further investigations who do not have a final diagnosis of...

  • Five year survival rate of women whose cancer is detected by screening has risen to 96.4%. Mayor, Susan // BMJ: British Medical Journal (International Edition);6/21/2008, Vol. 336 Issue 7658, p1398 

    The author reports on the survival rate of women whose breast cancer was discovered through a detection program by the National Health Service (NHS) in Great Britain. The increase in the five year survival rate of patients who were detected as having breast cancer by the NHS screening program in...

  • Cervical smear tests 'should focus on age'. Polak, Monika // GP: General Practitioner;10/27/2003, p2 

    The frequency of cervical screening should depend on a woman's age, the NHS Cervical Screening Programme has said. Until now, at least one smear every five years has been recommended for women aged between 20-64 years, although the interval has varied between three to five years in different...

  • Translation of an Efficacious Cancer-Screening Intervention to Women Enrolled in a Medicaid Managed Care Organization. Dietrich, Allen J.; Tobin, Jonathan N.; Cassells, Andrea; Robinson, Christina M.; Reh, Meredith; Romero, Karen A.; Flood, Ann Barry; Beach, Michael L. // Annals of Family Medicine;Jul/Aug2007, Vol. 5 Issue 4, p320 

    The article cites a study which evaluated the impact of a streamlined prevention care management (PCM) delivered through a Medicaid managed care organization (MMCO) in New York City. It was found that the abbreviated PCM telephone intervention was feasible to deliver through a MMCO and improved...

  • Should the practice of medicine be a deontological or utilitarian enterprise? Garbutt, Gerard; Davies, Peter // Journal of Medical Ethics;May2011, Vol. 37 Issue 5, p267 

    There is currently an unrecognised conflict between the utilitarian nature of the overall NHS and the basic deontology of the doctor-patient interaction. This conflict leads to mistrust and misunderstanding between managers and clinicians. This misunderstanding is bad for both doctors and...

  • Cardiology: the development of a managed clinical network. Baker, C D; Lorimer, A R // BMJ: British Medical Journal (International Edition);11/04/2000, Vol. 321 Issue 7269, p1152 

    Presents an overview of the managed clinical network system used as a means of providing acute services by the National Health Service (NHS) in Scotland. Details of the organizing principles of such networks; Methods used by networks in the coordination of primary, secondary, and tertiary care;...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics