Screening

Evidence and Practice

Second Edition

Angela E. Raffle, Anne Mackie, and J. A. Muir Gray

First edition Highly Commended at the BMA Medical Book Awards
Provides an evidence-based 'how-to' guide from expert authors, covering all aspects of health screening across the globe
Full of real-life examples and fascinating case studies, illustrating how screening actually works in the real, messy world of politics, big business, and media
Written in jargon-free language, with clear illustrations and a detailed glossary, making the content accessible to any reader, irrespective of whether or not they have a clinical background
Each chapter concludes with a summary and self-test questions, enabling the reader to consolidate their knowledge and experience at each stage
Introductory chapter charts the history of health screening, providing essential context for the rest of the book

New to this Edition:

Includes a brand new case study on abdominal aortic aneurysm screening
Contains new information about the updated UK National Screening Committee Criteria
Covers a carefully researched case study on the events surrounding one of the earliest, and most damaging public investigations into screening practice, with clear lessons for evidence-based policy making
Includes a new section on CONSORT, Cochrane and what we mean by 'sound science'
Contains additional material on the concept of 'best value' and on the ground breaking work of W. Edwards Deming
Case studies on overdiagnosis in breast screening and prostate screening have been updated to take account of new evidence
Improved language, diagrams, and conceptual frameworks throughout

Screening

Evidence and Practice

Second Edition

Angela E. Raffle, Anne Mackie, and J. A. Muir Gray

Description

Screening programmes involve the systematic offer of testing for populations or groups of apparently healthy people to identify individuals who may be at future risk of a particular medical condition or disease, with the aim of offering intervention to reduce their risk.

For many years, screening was practised without debate, and without evidence, but in the 1960s serious challenges were raised about many of the screening procedures then being practised. Benefits and harms of screening must be measured in high quality trials, and the benefits of screening must be weighed alongside the negative side-effects. Concerns were raised about potential and actual harm arising when people without a health problem received dangerous and unnecessary investigations and treatments as a result of routine screening tests. Controversy raged, and it took some 50 years to achieve widespread recognition that evidence-based and quality assured programme delivery was essential, coupled with provision of balanced informed to enable informed choice for potential participants. Commercially motivated provision of poor quality and non-evidence based screening tests is increasing and screening remains a highly contested topic that has relevance in all health systems including for the general public and media.

This book serves as a practical and comprehensive guide to all aspects of screening. Following the international success of the first edition, this second edition brings extensive updates and new case study material. The first section deals with concepts, methods, and evidence, charts the story of screening back to 1861, and covers all aspects of a screening programme and how to research the full consequences. The second section is a practical guide to sound policy-making and to high quality delivery of best value screening. The controversies, paradoxes, uncertainties, and ethical dilemmas of screening are explained, and each chapter is packed with examples, real-life case histories, helpful summary points, and self-test questions. Reference is made to the NHS, a leader in screening, but the primary focus is on universal principles, making the book highly relevant across the globe.

Screening

Evidence and Practice

Second Edition

Angela E. Raffle, Anne Mackie, and J. A. Muir Gray

1:How screening started
2:What screening is, and is not
3:What screening does
4:Measuring what a screening programme does
5:Implementing screening programmes
6:Quality assuring screening programmes
7:Day-to-day management of screening progammes for public health practitioners and managers
8:Making policy on screening programmes

Screening

Evidence and Practice

Second Edition

Angela E. Raffle, Anne Mackie, and J. A. Muir Gray

Author Information

Angela E. Raffle, Consultant in Public Health, the NHS Screening Programmes, and Honorary Senior Lecturer, University of Bristol Medical School: Population Health Sciences, UK, Anne Mackie, Director of Programmes, UK National Screening Committee, and Director of Screening Programmes, Public Health England, UK, and J. A. Muir Gray, Programmes Director, UK National Screening Committee 1996-2007, and Founding Director, the Oxford Centre for Triple Value Healthcare

Dr Angela Raffle has practised as a Consultant in Public Health in Bristol since 1990. Her involvement in local programme delivery for cervical screening began in 1986 whilst she was still in training. Data since 1977 for her Bristol area programme revealed the extent of the barely recognised yet growing overdiagnosis issue within cervical screening. With the support of colleagues in Bristol and nationally, she successfully published on this issue, despite strong opposition from those who regarded this as 'too controversial'. An advocate for honesty and informed consent, Angela has worked part time for the UK National Screening Programmes since it began, combining this with her Bristol-based public health work. In 1997 she was awarded the Skrabanek Prize for contribution to medical ethics.

Professor Anne Mackie lives in London, and fulfilled senior public health roles in the NHS before taking over from Muir Gray in 2007 as Programmes Director for the UK National Screening Programmes. Under her leadership, UK screening has become known for its high quality and robust policy making processes, and the public health ethos of screening is now firmly embedded in NHS culture. Despite continual NHS upheaval she has ensured that within screening there has been continual strengthening of processes for transparent policy making and review, quality assurance and measures, information provision for participants, and universal training and education for screening staff. Anne has also played a role in fostering international collaboration within public health focused screening.

Sir Muir Gray lives in Oxford and has worked in the British National Health Service since 1972, holding many senior positions during his career. He was instrumental in leading the transformation of NHS screening from a disorganised mess in the 1980s, into high quality, evidence based, nationally managed programmes based on informed choice. He was Programmes Director from 1996 when the UK National Screening Programmes were established, through to 2007. Muir also created the National Library of Health, was a key supporter of the Cochrane Collaboration when it was in its infancy, and he continues to influence the NHS through his work with Better Value Healthcare.

Screening

Evidence and Practice

Second Edition

Angela E. Raffle, Anne Mackie, and J. A. Muir Gray

Reviews and Awards

"This is the best textbook I have ever read on all facets of an often hotly debated topic and "aha" experiences are guaranteed. If only everyone involved in the many screening debates had read this book, we would be having more constructive and useful discussions, and take better decisions." - Matthias Egger, University of Bern, Switzerland

"A readable, yet encyclopaedic guide to screening: its history, its key design elements, its implementation and its policy challenges. A must read for clinicians, managers, and policy-makers who would like to assist Raffle, Mackie, and Gray in achieving their goal: "to sort out the mess"." - H. Gilbert Welch, Dartmouth College, USA

"Essential reading for anyone touched by screening, the new edition is not just a superficial update, it has been radically revised, and I commend it to all, whether or not they are familiar with the original." - Bob Steele, UK National Screening Committee

"This welcome second edition contains new and updated material, and rigorous emphasis throughout ... I commend this book for academics as well as practitioners, and for those in clinical specialties as well as public health." - Iain Chalmers, James Lind Library, UK