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New screening programmes for Ireland – how are they introduced?

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The National Screening Advisory Committee (NSAC), Ireland was established in 2019. It is an independent advisory committee tasked with advising on all new proposals for population-based screening programmes and any proposed revisions to existing programmes. In short, it is the NSAC that advises the Minister for Health on whether a new screening programme should be introduced into Ireland.

There are five national screening programmes in Ireland. The National Screening Service in the HSE screens for breast, cervical and colon cancers and diabetic retinopathy through its BreastCheck, CervicalCheck, BowelScreen and Diabetic RetinaScreen programmes. The National Newborn Bloodspot Screening Programme (NNBSP) is responsible for the ‘heel-prick’ test for babies when they are between 3 and 5 days old.

The National Screening Advisory Committee does not have any operational role in the day-to-day running of any screening programmes. That remains the responsibility of the Health Service Executive (HSE).

NSAC Annual Call

The NSAC announced its first Annual Call for topics in December 2021 and received more than 50 applications for either new programmes or changes to Ireland’s existing screening programmes. The Annual Call is an opportunity for anyone – individuals or organisations – to submit proposals for potential new screening programmes or new technologies. These included proposals for extending breast cancer screening and to incorporate breast density measurement; and the introduction of prostate and targeted lung cancer screening.  There were also proposals for a number of non-cancer related screening programmes.

The bar for introducing new screening programmes is high and the NSAC has published the 20 criteria it uses for appraising the viability, effectiveness, and appropriateness of a new screening programme. These are well established public health principles and are based on the pioneering work of Wilson and Jungner. They cover the many ethical, legal, social, medical, organisational and socio-economic aspects to be considered before decisions can be made on the actual implementation of population health screening programmes.

Independent advisory bodies such as NSAC and its UK equivalent, the UK National Screening Committee, want to be reassured that organised screening programmes will work.

They want to know that organised screening programmes have:

  • quality assurance at all levels 
  • clear information about benefits and risks
  • adequate resources for screening
  • follow-up with confirmatory diagnostic procedures, and 
  • the necessary treatment pathways of those with a positive screening test, where required.

Next steps

The NSAC has been considering the proposals submitted at its February, May and September meetings in 2022. The next step is a rapid evidence ‘scoping review’ to determine whether the proposal for a new topic or programme modification should proceed to a more detailed Health Technology Assessment (HTA) that would include an economic assessment. When it is completed the HTA will then be considered by the NSAC.

If the NSAC makes a recommendation to the Minister for Health to introduce a new programme or programme modification it will then fall to the HSE to begin the business planning process that will signal the implementation of the new programme or programme modification.

This process ensures that Ireland has a robust way to consider screening programmes and provide independent advice to the Minister for making decisions on screening. It also allows the HSE and National Screening Services to make evidence-based plans for current and future programmes.

For additional information you can read the European Commission Council Recommendation on strengthening prevention through early detection: A new EU approach on cancer screening, here


 

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