Restoration and recovery of paused screening programmes
The following population screening programmes in Northern Ireland were temporarily paused from the second week in March 2020:
• Abdominal aortic aneurysm screening and surveillance monitoring.
• Routine breast screening.
• Bowel cancer screening.
• Cervical screening.
• Routine diabetic eye screening and surveillance monitoring.
This was in response to COVID-19 so that Health and Social Care (HSC) staff and resources could be redeployed and to reduce the risk of exposure to the corona virus for the public and HSC staff.
In its Strategic Framework for Rebuilding HSC Services, the Department of Health has now called for the phased restoration of these paused programmes. This has begun and the current position is as follows:
• In March 2020, abdominal aortic aneurysm screening was paused for initial screening appointments and surveillance of men with small AAA. Surveillance scanning restarted on a phased basis in July 2020 for men with medium AAAs and in November 2020 for men with small AAAs. A phased return of initial screening was planned for January 2021 but has been delayed due to rising rates of coronavirus infections. This decision will be reviewed in early February 2021. Men with a large AAA continue to be managed by the regional Specialist Vascular Team.
• Routine breast screening restarted from 20 July 2020.
• Bowel cancer screening backlogs in follow up tests are being cleared and screening invites will recommence from mid-August 2020.
• Cervical screening invitations recommenced from end June 2020.
• Routine diabetic eye screening and surveillance monitoring to recommence in a phased manner, initially focusing on patients at higher risk of sight threatening retinopathy, from August 2020.
The four month pause to date has resulted in a backlog of people awaiting screening. In addition the screening programmes will not be able to screen the same number of people as they did before the Covid-19 pandemic. This is due to the need for social distancing and appropriate infection control measures. It will therefore take many months to get population screening programmes up and running at normal levels.
While the above programmes were paused due to Covid-19, screening continued to be offered to people who required:
• Higher risk breast screening - all eligible women continued, and are continuing, to be screened at the higher risk screening unit in Antrim Area Hospital. Women who require mammography only may have their screening at their local breast screening unit. This option was paused as part of the response to Covid-19, but was reinstated from September 2020.
• Diabetic eye screening for pregnant women (sight saving laser treatments and urgent intravitreal injections continued, and are continuing, to be provided).
• Infectious diseases in pregnancy screening
• Newborn blood spot screening
• Newborn hearing screening
There programmes were not paused and continue to be provided.
Population screening programmes have a key role to play in early detection of disease and a range of programmes are currently available in Northern Ireland. The PHA has responsibility for commissioning, coordinating and quality assuring these programmes.
However, screening is not suitable for every condition. Organised screening programmes are only established on the recommendation of the UK National Screening Committee and according to the best available evidence. Any condition being considered as a screening programme must meet a number of stringent criteria before it is recommended by the Committee.
In Northern Ireland the PHA operates the following screening programmes: