Evidence-based screening in the United Kingdom.
OBJECTIVE
To review the assessment of screening in the United Kingdom, focusing on three methods: mammography for breast cancer, screening for prostate cancer, and routine use of ultrasound in pregnancy.


METHODS
To review policy documents and published papers dealing with prevention and screening in the United Kingdom.


RESULTS
Indicate that the United Kingdom has an active policy concerning the assessment of screening methods. Generally speaking, this assessment policy 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 general rule. The assessment of screening is now implemented through the National Screening Committee, established in 1997. The three issues reviewed in this paper have all been assessed within the context of the Department of Health. 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 program for breast cancer. In the case of prostate cancer screening, two systematic 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 Committee. This complex technology is difficult to assess, and the screening procedure is deeply embedded in clinical practice in the United Kingdom, so assessment has not had much impact on the frequency of screening.


CONCLUSIONS
HTA and the assessment of screening are well established in the United Kingdom. Policy is generally based on the assessments done, and practice generally follows the results of assessment. Assessment of screening is expected to become increasingly important in the United Kingdom during the next years.
Gray
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JA
National Screening Committee Program.
D001943:Breast Neoplasms / Q000175:diagnosis / Q000517:prevention & control; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D005260:Female; D006291:Health Policy; D006801:Humans; D008297:Male; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000458:organization & administration / Q000706:statistics & numerical data*; D019982:Organizational Case Studies; D011247:Pregnancy; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000517:prevention & control; D013673:Technology Assessment, Biomedical; D016216:Ultrasonography, Prenatal / Q000706:statistics & numerical data*; D006113:United Kingdom
D017430:Prostate-Specific Antigen