Corporate report

NHS screening programmes in England: 2018 to 2019

Updated 16 February 2023

Applies to England

1. Introduction

This data report covers the screening year from 1 April 2018 to 31 March 2019. During this period:

• 3.4 million women were screened for cervical abnormalities
• 2.2 million women were tested for abnormalities in breast tissue
• 500,000 tests were carried out for fetal anomalies during pregnancy
• 2.7 million people were screened for bowel cancer
• 240,000 men were screened for an abdominal aortic aneurysm
• 680,000 women were screened for conditions in their unborn baby (hepatitis B, human immunodeficiency virus (HIV), syphilis, sickle cell disease and thalassaemia)
• 630,000 babies were screened for 15 conditions*
• 2.3 million people with diabetes had routine eye screening
• 430,000 people need further testing and treatment following their screening results

*The 15 newborn conditions screened for were:

• congenital cataracts
• congenital heart disease
• developmental dysplasia of the hip
• cryptorchidism (undescended testes)
• permanent deafness
• sickle cell disease
• cystic fibrosis
• congenital hypothyroidism
• phenylketonuria (PKU)
• medium-chain acyl-CoA dehydrogenase deficiency (MCADD)
• maple syrup urine disease (MSUD)
• isovaleric acidaemia (IVA)
• glutaric aciduria type 1 (GA1)
• homocystinuria (HCU)
• thalassaemia^†

^†There is no routine screening for babies for beta thalassaemia major, but most cases are detected and reported during newborn screening.

2. NHS Abdominal Aortic Aneurysm (AAA) Screening Programme

AAA screening is offered to men when they turn 65 (cohort). Men aged 65 and over are most at risk of AAAs, and screening can help spot a swelling in the aorta at an early stage. Men aged over 65 who have not had AAA screening can contact their local service to arrange a test (self-referrals).

Measure	Value
Eligible for screening (2018 to 2019 cohort [footnote 1])	292,875
Offered screening	292,631
Tested (2018 to 2019 cohort [footnote 1])	238,167
Coverage (2018 to 2019 cohort [footnote 1])	81.3%
Tested (self-referrals)	10,646
Coverage (self-referrals)	97.6%
AAAs detected (cohort)	2,318
Incidence (cohort)	0.97%
AAAs detected (self-referrals)	337
Incidence (self-referrals)	3.17%
Men on surveillance at end of year	15,673
Referrals to surgery	883
Elective AAA repairs	616
Deaths from elective repairs	11
Ruptures	25
Deaths from rupture	24

Data source: AAA SMaRT

Data extracted: 9 July 2019

3. NHS Bowel Cancer Screening Programme

Bowel cancer screening is offered to men and women aged 60 to 74 (cohort), every 2 years. People over the invitation age range are not invited, but can request screening every 2 years (self refer). Bowel cancer screening looks for polyps and early stage cancer. Removing polyps reduces the risk of bowel cancer developing.

Note that this data relates to screening using the guaiac faecal occult blood test (gFOBt).^{[footnote 2]}

Measure	Value
Number of people invited [footnote 3]	4,604,583
Number of people adequately screened [footnote 4]	2,783,503
Number of people definitively requiring further tests following gFOBt [footnote 5]	37,307
Uptake [footnote 6]	60.45%
Positivity [footnote 7]	1.34%
Number of people diagnosed with cancer [footnote 8]	2,821
Number of people diagnosed with high risk adenomas [footnote 8]	3,579
Number of people diagnosed with intermediate risk adenomas [footnote 8]	4,178
Number of people diagnosed with low risk adenomas [footnote 8]	6,306
Number of people diagnosed with irregular findings, after further tests [footnote 8] [footnote 9]	8,173
Number of people with a usual finding, after further tests	4,161

This data relates to the invited population only. Episodes which originate from requests for screening or attendance at programme surveillance tests are excluded.

Data source: Bowel Cancer Screening System (BCSS), using the reporting tool OBIEE.

Data extracted: 19 November 2019.

4. NHS Breast Screening Programme

Breast screening is offered to women between the ages of 50 up to their 71st birthday (cohort), every 3 years. Women over the invitation age range are not invited, but can request screening every 3 years by contacting their local screening service (self refer). Breast screening detects cancers at an early stage, when effective treatment is more likely.

Measure	Value
Number of women tested (all ages)	2,234,523
Uptake of screening (all ages)	70.8%
Screening round length (50 to <71 year olds) [footnote 10]	86.5%
Number of women referred to assessment (all ages)	84,559
Number of women diagnosed with cancer (all ages)	19,558
Number of women diagnosed with small invasive cancer (all ages)	7,888

NHS Digital is responsible for publishing official statistics for the NHS Breast Screening Programme.

5. NHS Cervical Screening Programme

Cervical screening is offered to women from the ages of 25 to 64 (cohort). Women aged 25 to 49 are invited every 3 years, and women aged 50 to 64 are invited every 5 years. Cervical screening detects types of human papillomavirus (HPV) which can cause abnormal cells in the cervix. Removing these abnormal cells can prevent cervical cancer developing.

Measure	Value
Number of eligible women [footnote 11]	15,190,682
Number of women invited for screening in year	4,412,229
Number of women tested	3,428,327
Coverage [footnote 12]	71.90%
Number of screen positive women [footnote 13]	188,090
Referrals to colposcopy/gynaecology	182,304

NHS Digital is responsible for publishing official statistics for the NHS Cervical Screening Programme.

6. NHS Diabetic Eye Screening Programme

Diabetic eye screening is offered yearly to people aged 12 or over who have diabetes (cohort). Screening detects diabetic retinopathy, which can cause sight loss if left undiagnosed and untreated.

Measure	Value
Eligible people with diabetes known to programme	3,379,473
Offered screening (routine digital screening)	2,800,952
Tested (routine digital screening)	2,313,762
Uptake	82.6%
New registrations to programmes	296,018
Urgent referrals (R3A)	9,053
Routine referrals (R3SM1, R2M1, R2M0, R1M1)	83,137

Data source: programme performance reports and quarter 4 quarterly submission.

Data collected: June 2019.

R1 = Background retinopathy, R2 = Pre-proliferative retinopathy, R3A = Active proliferative retinopathy, R3S = stable treated proliferative retinopathy, M0 = No maculopathy, M1= Maculopathy.

Note: quarter 4 data for North East Manchester diabetic eye screening service was not available, so quarter 3 data have been used instead.

7. NHS Fetal Anomaly Screening Programme

Fetal anomaly screening is offered to eligible pregnant women at various points during pregnancy (cohort). The tests are to detect the presence or chance of a range of conditions.

Measure	Value
Number of tests performed	509,368
Number of women at higher chance of the condition screened for	15,812
Number of sonographers going through DQASS [footnote 14]	2,424
DQASS % red flags	1.6%
DQASS % red4 flags	1.3%
DQASS % amber flags	34.0%
DQASS % green flags	60.7%
DQASS % no flags	2.4%

Data source: Down’s syndrome Screening Quality Assurance Support Service (DQASS).

8. NHS Infectious Diseases in Pregnancy Screening Programme

Infectious diseases in pregnancy screening is offered to pregnant women (cohort), to detect HIV, hepatitis B and syphilis. Detection and treatment reduces the chance of passing on an infection to the baby, a partner or other family members.

8.1 Human immunodeficiency virus (HIV)

Measure	Value
Eligible women [footnote 15]	678,604
Tested women [footnote 15]	676,542
Coverage [footnote 15]	99.7%
Results reported within 8 working days [footnote 16]	99.3%
Number of positive results [footnote 16]	860
Screen positive women attending screening assessment within 10 working days [footnote 16]	89.3%

8.2 Hepatitis B

Measure	Value
Eligible women [footnote 15]	678,629
Tested women [footnote 15]	676,620
Coverage [footnote 15]	99.7%
Results reported within 8 working days [footnote 16]	99.3%
Number of positive results [footnote 16]	2,640
Women with hepatitis B (new positive or high infectivity) seen within 6 weeks (%) [footnote 15]	86.2%
Screen positive women attending screening assessment within 10 working days [footnote 16]	80.0%
Babies born to hepatitis B positive women received first dose of vaccination <24 hours [footnote 16]	98.9%
Babies born to hepatitis B positive women receiving immunoglobulin (if required) <24 hours [footnote 16]	96.6%

8.3 Syphilis

Measure	Value
Eligible women [footnote 15]	678,621
Tested women [footnote 15]	676,582
Coverage [footnote 15]	99.7%
Results reported within 8 working days [footnote 16]	99.3%
Number of positive results [footnote 16]	1,037
Screen positive women attending screening assessment within 10 working days [footnote 16]	81.2%

Data source: maternity services (England).

9. NHS Newborn and Infant Physical Examination (NIPE) Programme

Newborn and infant physical examination screening is offered for babies at 72 hours, and again between 6 and 8 weeks of age (cohort). The examination looks for problems with the baby’s eyes, heart, hips and testes.

Measure	Value	Percentage
Eligible babies [footnote 17]	612,235	N/A
Eligible babies tested by 72 hours [footnote 17]	589,940	N/A
Coverage by 72 hours [footnote 17]	N/A	96.40
Number of babies with suspected abnormalities of eyes (proportion of eligible) [footnote 17] [footnote 18] [footnote 19]	955	0.2
Timely assessment of eye referrals (proportion of referred) [footnote 17]	165	17.3
Number of babies with suspected developmental dysplasia of the hip (DDH) (proportion of eligible) [footnote 17] [footnote 18] [footnote 19]	1762	0.3
Timely assessment of intervention for DDH (proportion of referred) [footnote 17]	1,125	63.8
Number of babies with hip risk factors (proportion of eligible) [footnote 17] [footnote 18] [footnote 19]	41,988	6.9
Timely assessment of babies with hip risk factors (proportion of referred) [footnote 18]	12,338	29.4
Eligible male babies tested [footnote 17]	272,818	N/A
Number of babies with suspect bilateral undescended testes (proportion of tested males) [footnote 18]	1,083	0.4
Timely assessment of babies with suspect bilateral undescended testes (proportion of referred) [footnote 18]	69	6.4
Number of babies with suspect unilateral undescended testes (proportion of tested males) [footnote 18]	3,245	1.2
Number of babies with suspect heart abnormalities (proportion of eligible) [footnote 17] [footnote 18] [footnote 19]	8,529	1.5

Data source: KPI reports and NIPE SMART. Data should be viewed with caution as there are issues with data quality and completeness. (The data is incomplete as not all post referral outcomes are entered on to the NIPE IT system. Only data for providers using the NIPE IT system are included in this report. The NIPE programme team has published the data for this period to demonstrate a baseline for comparison in the future.)

10. NHS Newborn Blood Spot Screening Programme

Newborn blood spot screening is offered for babies up until their first birthday, with the exception of testing for cystic fibrosis which is only offered up until 8 weeks of age (cohort). Screening takes place for 9 conditions (see tables in sections 10.1 to 10.9 below, and data for sickle cell disease in section 12 below). Newborn blood spot screening identifies conditions which can be treated to improve a baby’s health, and can help prevent severe disability or even death.

10.1 Cystic fibrosis

Measure	Value
Babies tested	621,687
Total screened positive (including babies clinically diagnosed before screening)	264
Screened positive 1st sample (excludes 43 babies clinically diagnosed before screening)	128
Babies for whom age is recorded at appointment	101
Screened positive 1st sample and 1st appointment within 28 days	94
Screened positive 2nd sample (excludes 4 babies clinically diagnosed before screening)	89
Babies for whom age is recorded at appointment	50
Screened positive 2nd sample and 1st appointment within 35 days	41
Carriers detected by the screening pathway	156

10.2 Congenital hypothyroidism (CHT)

Measure	Value
Babies tested	630,960
Total screened positive (including babies clinically diagnosed before screening†)	504
Screened positive 1st sample (excludes 7 babies clinically diagnosed before screening)	271
Babies for whom we have age at appointment data	253
Screened positive 1st sample and 1st appointment within 14 days	231
Screened positive 2nd sample	225
Babies for whom age is recorded at appointment	203
Screened positive 2nd sample and 1st appointment within 21 days	167

^†Excluding 34 pre-term babies

10.3 Phenylketonuria (PKU)

Measure	Value
Babies tested	630,912
Babies screened positive (excludes 8 babies clinically diagnosed before screening)	77
Babies for whom age is recorded at appointment	64
Screened positive and 1st appointment within 14 days	62

10.4 Medium-chain acyl-CoA dehydrogenase deficiency (MCADD)

Measure	Value
Babies tested	630,912
Babies screened positive (excludes 7 babies clinically diagnosed before screening)	59
Babies for whom age is recorded at appointment	56
Screened positive and 1st appointment within 14 days	54

10.5 Isovaleric acidaemia (IVA)

Measure	Value
Babies tested	630,912
Babies screened positive (excludes 1 baby clinically diagnosed before screening)	12
Babies for whom age is recorded at appointment	12
Screened positive and 1st appointment within 14 days	12

10.6 Glutaric aciduria type 1 (GA1)

Measure	Value
Babies tested	630,912
Babies screened positive (excludes 1 baby clinically diagnosed before screening)	11
Babies for whom age is recorded at appointment	11
Screened positive and 1st appointment within 14 days	11

10.7 Homocystinuria (HCU)

Measure	Value
Babies tested	630,912
Babies screened positive	4
Babies for whom age is recorded at appointment	3
Screened positive and 1st appointment within 17 days	2

10.8 Maple syrup urine disease (MSUD)

Measure	Value
Babies tested	630,912
Babies screened positive (excludes 1 baby clinically diagnosed before screening)	7
Babies for whom age is recorded at appointment	6
Screened positive and 1st appointment within 14 days	5

10.9 Coverage

Measure	Value
% of babies tested and recorded on the Child Health Information System at 17 days	97.8%

Data source: Newborn Screening Laboratories and Child Health. Data is a snapshot of the annual data returns. Every attempt has been made to provide the most correct, up to date information. Percentage coverage based on the annual KPI data for England: NB1 – Coverage (CCG responsibility at birth).

11. NHS Newborn Hearing Screening Programme

Newborn hearing screening is offered to babies ideally within the first 4 to 5 weeks after birth (cohort). The test can be carried out up to the age of 3 months. Screening identifies permanent moderate, severe and profound deafness, and hearing impairment. Early detection enables interventions to improve language, speech and communication skills as the baby develops.

Measure	Value	Percentage
Number of eligible babies (babies born or resident outside of England have been excluded from the report)	619,631	N/A
Number of babies for whom screening is complete by 3 months of corrected age (proportion of eligible)	616,112	99.4
Number of babies for whom the screening process is complete by 4 weeks corrected age (hospital programmes-well babies, NICU babies) or by 5 weeks corrected age (community programmes-well babies) (proportion of eligible)	612,415	98.8
Number of babies for whom the screen is declined (proportion of eligible)	400	0.07
Number of well babies who do not show a clear response in one or both ears at AOAE1: hospital model (proportion of eligible)	127,374	23.0
Number of well babies who do not show a clear response in one or both ears at AOAE1: community model (proportion of eligible)	3,551	13.9
Total number of babies referred for diagnostic audiological assessment (hospital and community) (proportion from eligible)	14,534	2.3
Number referred for diagnostic audiological assessment from hospital screening model (proportion of eligible)	14,187	2.4
Number referred for diagnostic audiological assessment from community screening model (proportion of eligible)	410	1.5
Number offered audiological assessment within 4 weeks of screen completion or by 44 weeks gestational age (proportion of referrals) [footnote 20]	14,159	97.4
Number attended audiological assessment within 4 weeks of screen completion or by 44 weeks gestational age (proportion of referrals) [footnote 20]	13,100	90.1
Number of babies with a confirmed hearing impairment in both ears by 6 months of age born 2018/19	534	N/A

Data source: SMaRT4Hearing (S4H).

Data collected: 29 November 2019.

12. NHS Sickle Cell and Thalassaemia Screening Programme

Sickle cell and thalassaemia screening includes antenatal screening for pregnant women (ideally at 10 weeks’ gestation) and screening for fathers (if the baby’s mother is a genetic carrier). Sickle cell screening via newborn blood spot screening for babies takes place one week after birth (cohort). Antenatal SCT screening means parents can find out if they are carriers of the sickle cell or thalassaemia gene, and may therefore have passed it on to their baby.

There is no routine screening for babies at risk of inheriting thalassaemia major. However, most cases of beta thalassaemia major should be detected during newborn screening, but beta thalassaemia carriers are not.

12.1 Antenatal screening

Measure	Value
Tested women [footnote 21]	676,218
Coverage [footnote 21]	99.7%
Women tested by 10 weeks [footnote 21]	57.3%
Screen positive pregnant women [footnote 22]	13, 347
Rate of screen positive women [footnote 22]	1 in 50
Percentage of fathers tested [footnote 22]	68.9%
At risk couples detected [footnote 22]	818

12.2 Prenatal diagnostic (PND) testing

Measure	Value
PND tests performed [footnote 23]	340
Affected fetal results [footnote 23]	74

12.3 Newborn screening

Measure	Value
Newborn babies screened [footnote 24]	626,655
Screen positive babies [footnote 24] [footnote 25]	290
Rate of screen positive babies [footnote 24]	1 in 2,161
Carrier results [footnote 24]	7,936

Data source: see notes in tables above.

1. Men registered with a GP in England and born between 1 April 1953 and 31 March 1954 and who have not already been treated for an AAA. ↩ ↩² ↩³

2. gFOBt is the guaiac faecal occult blood test used in the bowel cancer screening programme. ↩

3. One invite sent per screening subject episode. A subject can have multiple episodes during their ‘bowel cancer screening lifetime’. Number of people invited does not include requests for screening such as over-age self-referrals, later responders or opt back-in episodes. ↩

4. Of those invited, the number reaching a definitive gFOBt outcome from potentially multiple gFOB test kits. Subjects can receive and return more than one test kit within an episode. ↩

5. Of those invited and adequately screened, the number reaching a definitive gFOBt outcome of ‘further tests needed’ from potentially multiple gFOB test kits. People who reach a definitive gFOBt outcome of ‘further tests needed’ are then referred for a colonoscopy fitness assessment. ↩

6. Percentage of people adequately screened (iii) out of those invited (ii) for gFOBt screening. No adjustment is made for undelivered letters and/or test kits. ↩

7. Percentage of people with a definitive gFOBt outcome of ‘further tests needed’ (iv) out of those who were adequately screened (iii) via gFOBt screening. Positivity is calculated from the invited (ii) population only. No adjustment is made for undelivered letters and/or test kits. ↩

8. The episode outcomes presented here are for the invited (ii) population only (for the specified fiscal year). Specifically, those invited (ii) who adequately participated and were found to need further tests (iv), who went on to have a diagnostic test (one or more) within the episode. It is important to note that episode outcomes are calculated from the findings of potentially multiple endoscopic or radiological tests within the episode. A patient can only have one episode outcome per episode. ↩ ↩² ↩³ ↩⁴ ↩⁵

9. Abnormal findings can be for non-neoplastic diagnosis (such as diverticular disease, haemorrhoids, inflammatory bowel disease), non-adenomatous polyp (such as hyperplastic, inflammatory, Peutz-Jeghers polyp), non-adenomatous polyp and non-neoplastic diagnosis or people who have polyps seen at a radiological test only, so no histological confirmation is possible. ↩

10. % of women aged 50 to <71 invited within 36 months of previous screening, or previous invitation if did not attend. ↩

11. Registered female population for ages 25 to 64 minus any women ceased for clinical reasons. ↩

12. % of eligible women screened adequately within the previous 3.5 years for women aged 25 to 49 and 5.5 years for women aged 50 to 64. ↩

13. Number of adequate tests minus number of negative samples. ↩

14. DQASS is the Down’s syndrome Screening Quality Assurance Support Service. Flags are assigned to a dataset of nuchal translucency (NT) and crown rump length (CRL) measurements. Flags indicate bias of the dataset. Green flag: NT bias ≤ 0.10mm. Amber flag: NT bias 0.11mm - 0.40mm. Red flag: NT bias > 0.40mm. Red4 flag: assigned if fewer than 25 paired measurements over 4 cycles. No flag: trainee sonographer has < 25 paired measurements. ↩

15. Figures based on key performance indicator (KPI) data. Exclusions made where completed data was not submitted for all 4 quarters. ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸ ↩⁹ ↩¹⁰

16. Figures based on annual standards data. Exclusions were made when data was incomplete or missing, not where trusts could not account for their whole cohort. ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸ ↩⁹ ↩¹⁰ ↩¹¹

17. Data source: screening KPI reports. ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸ ↩⁹ ↩¹⁰

18. Data source: NIPE SMART (data should be viewed with caution as there are issues with data quality and completeness). ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸

19. Proportion of eligible babies is likely to be a minor underestimate relative to proportion of those tested but accurate data on number of babies tested was available for 2018 to 2019 from NIPE SMART. ↩ ↩² ↩³ ↩⁴

20. Excludes babies who have not reached 4 weeks post screen or 44 weeks gestational age. ↩ ↩²

21. Based on KPI data. Exclusions made where completed data was not submitted for all 4 quarters. ↩ ↩² ↩³

22. Based on provisional antenatal laboratory data (138 of 145 expected returns). Figures may differ to those published in the programme-specific data report for 2018 to 2019. ↩ ↩² ↩³ ↩⁴

23. Based on data submitted by PND laboratories and compiled by the National Congenital Anomaly and Rare Disease Registration Service (NCARDRS). ↩ ↩²

24. Based on provisional newborn laboratory data. May differ to programme-specific data report for 2018 to 2019. ↩ ↩² ↩³ ↩⁴

25. Screen positive results include babies identified with FS, FSC, FS-other and FE. ↩