Evidence-based screening in the United Kingdom

Objective: To review the assessment of screening in the United Kingdom, foc using on three methods: mammography for breast cancer, screening for prosta te cancer, and routine use of ultrasound in pregnancy. Method: To review policy documents and published papers dealing with preven tion and screening in the United Kingdom. Results: Indicate that the United Kingdom has an active policy concerning t he assessment of screening methods. Generally speaking, this assessment pol icy is part of the national program for health technology assessment (HTA). The government has given HTA an important place within health care in the United Kingdom, and prevention and screening is no exception to this genera l rule. The assessment of screening is now implemented through the National Screening Committee, established in 1997. The three issues reviewed in thi s paper have all been assessed within the context of the Department of Heal th. In the case of mammography, the assessment was done more than 10 years ago and was followed by a rational implementation of a national screening p rogram for breast cancer. In the case of prostate cancer screening, two sys tematic reviews have concluded that screening should not be carried out. In general, this recommendation has been accepted in the United Kingdom. Use of ultrasound in pregnancy has been assessed by the National Screening Comm ittee. This complex technology is difficult to assess. and the screening pr ocedure is deeply embedded in clinical practice in the United Kingdom, so a ssessment has not had much impact on the frequency of screening. Conclusion: HTA and the assessment of screening are well established in the United Kingdom. Policy is generally based on the assessments done, and pra ctice generally follows the results of assessment. Assessment of screening is expected to become increasingly important in the United Kingdom during t he next years.