I feel very honoured to have been appointed Chair of the UK National Screening Committee (UK NSC).
I first became interested in screening as a very junior surgeon in Edinburgh in the early 1980s working for Sir Pat Forrest whose work laid the foundation for the national breast screening programme in the UK.
After a period as a lecturer in surgery at the Chinese University of Hong Kong I moved to Aberdeen where I saw and treated many patients with colorectal cancer, most of whom presented at an advanced stage.
In 1990, I moved to Nottingham to work for Jack Hardcastle when the Nottingham trial of faecal occult blood test (FOBt) screening for colorectal cancer was under way. There, instead of encountering advanced disease, most colorectal cancer patients had tumours that could be cured by surgery alone. It was extremely motivating to experience the direct clinical effects of a public health intervention. Ever since then, screening has been a central clinical and research interest of mine.
When I moved to Dundee in 1997 I led a successful bid to host the Scottish arm of the demonstration pilot of FOBt screening. I was also fortunate enough to be asked to chair the executive group that oversaw the day-to-day running of the pilot. When a decision was taken to roll out FOBt screening across the UK, I was appointed clinical director of the Scottish Bowel Screening Programme, a post I still hold today. My interest in colorectal cancer screening has gradually extended into other areas of health screening. I find it a fascinating and stimulating area, so I had no hesitation in applying when the opportunity arose to chair the UK NSC.
The committee's biggest achievement is ensuring that population screening programmes are introduced only on the basis of robust evidence, so that health screening is used responsibly within the NHS. I am also extremely impressed by the UK NSC's open and inclusive approach to all suggestions for future screening programmes. In the next few years I should really like the committee to grapple with the evidence relating to 3 of our major causes of cancer death – lung cancer, prostate cancer and ovarian cancer – all of which may be candidates for screening programmes in the future. I also think it will be very important to look seriously at evidence relating to screening in cardiovascular disease, diabetes and psychiatric disorders.
As incoming chair of the UK NSC I am following my distinguished colleague Professor David Walker (pictured right), whose outstanding contribution has included reviewing the committee structure and processes and establishing an annual stakeholder conference.
As a result, the UK NSC has the strong governance and breadth of experience it needs to rise to the challenges it will face from future proposals.
I hope to build on this work by:
- developing an ongoing and fruitful dialogue with all stakeholders
- ensuring all proposals receive a fair hearing
- embedding all recommendations within the strongest possible evidence
I have a steep learning curve ahead, coming as I do from a cancer screening background. In particular, I recognise that the issues surrounding antenatal and newborn screening are quite different from those I have been used to dealing with. For example, the tests are usually single tests rather than repeated over periods of time, and the ethical issues involved are highly complex. This new dimension, although challenging, is extremely exciting and I look forward to learning a great deal over the next few months.
The UK NSC is a unique organisation. I know of no other country that takes such a careful evidence-based approach to introducing national screening programmes. I consider myself very lucky indeed to have the opportunity to be involved and, in this role, I hope I can make a useful contribution to the health of the British people.
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