Uptake of innovation is critical to improving the uptake of cancer screening

Adrian Waller, general manager of medical systems at Fujifilm looks at breast cancer screening and the challenges to improving uptake.

Early diagnosis and prevention are key priorities in the NHS Long Term Plan, published earlier this year. This is particularly important in the context of cancer, with early diagnosis dramatically improving outcomes for patients.

Introduced in 1988, the Breast Screening Programme has saved thousands of lives. It is one of the largest and most widespread early diagnosis programmes run by the health service, screening two million women a year.

Yet the current system is failing many women. Breast cancer screening rates have fallen to a 10-year low. Last year only 70.5% of eligible women responded to their screening invitation. That means more than 750,000 of eligible women went unchecked, leaving them at much greater risk.

A key part of the problem is a failure to tackle the reasons women do not re-attend screenings. Of those women who previously attended a screening appointment, more than 10% failed to do so in 2017/18, translating to an estimated 1,245 missed breast cancer diagnoses a year. Remarkably, up to 46% of women who fail to re-attend cite experiencing pain during screening as the reason. This is something we are dedicated to resolving.

NHS staff capacity problems are also compounding system pressures. The Royal College of Radiologists has found that radiologists’ workload of reading and interpreting scans increased by 30% between 2012 and 2017, while the number of consultant radiologists went up just 15% over that period. Without additional support, waiting times will grow and fewer women will be screened.

Technology can play a critical role in helping the NHS to address these two key issues and improve the early detection of disease. However, innovative technologies which reduce pain and save clinicians time are being stuck in the system – stifling innovation and leading to thousands of missed diagnoses a year.

The evaluation and procurement of screening technologies are unfortunately far too slow. In contrast to the National Breast Screening Programmes in Scotland, Wales and Northern Ireland and many other European countries, the Breast Screening Programme in England has introduced a number of additional processes which have significantly delayed technological evaluations. In many cases, the time delay can be measured in years, which is really impacting on the system – and on the NHS’ ability to use the best technology available.

Transparency, dialogue and collaboration between patients, clinicians, manufacturers, the health service and government remain a challenge. This can lead to a lack of ownership and clarity regarding equipment evaluation requirements and associated processes, resulting in confusion and delays in introducing new technologies.

However, there are promising signs that a step-change is afoot. Fujifilm is a pioneer in diagnostic imaging in the UK. We pride ourselves on developing innovations in mammography to help improve patient outcomes and experience, in particular, reducing pain and improving patient comfort. 88% of women reported a reduction in pain as a result of our flagship digital mammography solution, the AMULET Innovality. We hope that once rolled out it could help to put fewer women off attending appointments, leading to a significant increase in early detection.

After several years, the AMULET Innovality has recently been approved for use within the NHS Breast Screening Programme. We hugely welcome this positive step forward. But in order to realise the full potential of digital innovation across the sector, we need to speed up access to technology through timely evaluation and implementation.

Commissioning guidance should be clearer and better communicated to provide certainty to clinicians and commissioners. To ensure all evaluations can be compared equally, a recommended national data set should be introduced. There should also be an improved dialogue so clinicians, patients and industry can work better together to identify the issues in the evaluation and implementation process, and take action to deliver a more effective and wide-reaching screening programme.

There are positive signs from the NHS Breast Screening Programme that some of these changes are being made. It now has the potential to transform breast screening, allowing it to reach its potential and catch breast cancer early in thousands of more women a year, which would be a fantastic achievement.

Sir Mike Richards’ review of the screening service, due to report in the autumn, will look at the whole screening system, not just breast cancer, drawing on evidence from across the system – officials, clinicians, patient groups and industry. The changes proposed could allow for systemic transformation and mark a big step towards achieving the NHS long term plan aim of drastically improving the early detection of disease.

If we are to tackle the falling rates of screening, we must make the most of the best possible technology available, and to make that happen we need to urgently increase the uptake of innovation across the NHS.