The UK National Screening Committee (UK NSC) has today (9 June 2015) upheld its recommendation against screening adults in the UK for bladder cancer, concluding that the available test is not accurate enough for identifying who would be at risk of the disease.
This followed a review of the available evidence which led to the recommendation being made at the March meeting of the UK NSC.
At the same meeting, recommendations against introducing national screening programmes were also made for depression in adults and screening newborn babies for amino acid metabolism disorders, fatty-acid oxidation disorders and galactosaemia.
Dr Anne Mackie, Director of Programmes for the UK NSC, said:
While health screening can have real benefits, it also has the potential to harm people and that is why the recommendation to start a screening programme is subject to the highest level of scrutiny.
In the majority of cases, the UK NSC recommends against screening for a particular condition due to concerns about the accuracy of the test, the treatment involved or because there isn’t enough understanding of how the condition develops.
For some conditions and some people, there would be no benefit in the early identification screening may provide, and indeed, this can cause harm.
The latest screening recommendations were made at the UK NSC committee meeting on 19 March 2015, the minutes of which are published today.
Screening adults for bladder cancer
Bladder cancer is a very serious disease and is the seventh most common cancer in the UK. The UK NSC recommended against screening for bladder cancer, as current testing options for identifying the disease early have high false positive rates. This means that many people would be told they might have bladder cancer when they do not. This can lead to unnecessary anxiety and uncomfortable testing.
Screening adults for depression
Depression affects people in different ways and it has a wide variety of symptoms which vary in severity. The UK NSC reviewed the available tests for identifying a person’s risk of depression. The UK NSC recommended against a national screening programme for depression in the general adult population as the questionnaire-based tests are not reliable, leading to many people wrongly being identified as depressed. There is also insufficient evidence that early treatment would prevent the development of more severe forms of depression in the long term. There is national guidance available to identify and support these groups of people.
The UK NSC recommended against screening for 3 rare amino acid metabolism disorders in newborn babies. The disorders cause problems with breaking down certain proteins and cause a build-up of toxins which can damage vital parts of the body including the liver. The review of the evidence highlighted that the test is not reliable enough to be used to identify babies with Citrullinaemia. The test for Argininosuccinate lyase deficiency will come too late to help the baby. For Tyrosinaemia type 1, the UK NSC found that currently not enough was known about it in the UK.
Screening newborn babies for fatty-acid oxidation disorders
Carnitine uptake defect (CTD) and Very long chain acyl CoA dehydrogenase deficiency (VLCADD) are types of fatty-acid oxidation disorders. These rare inherited conditions lead to problems breaking down certain types of fat to produce energy. The UK NSC found there was currently not enough known about these conditions and no way to distinguish babies who would be severely affected from those who would not. Also, it is not clear how accurate the screening tests would be for newborn babies. Therefore the committee recommended against a screening programme.
Screening newborn babies for Galactosaemia
Galactosaemia, an inherited condition, causes excessive amounts of galactose, a type of sugar, to accumulate in the blood. This can cause illness and a small number of deaths every year. The UK NSC recommended against screening as it is not clear whether screening would help more babies than the current treatment and diagnosis service offered when babies become ill. There are also concerns regarding the accuracy and timeliness of the test. The UK NSC noted that some babies are already identified with the disease through the existing newborn screening programmes.
The full minutes from the UK NSC meeting in March 2015 are available on the UK NSC website.
The UK National Screening Committee is independent of, but supported by, Public Health England.
Detailed summaries of the recommendations for all of the conditions mentioned can be found in the relevant sections of the UK NSC website.
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