Dr Henrietta Campbell
Watch Dr Henrietta Campbell, Chair of the UK National Screening Committee (UK NSC) from 1998 to 2006, talk about the experiences and challenges she has faced while working in screening.
This video covers:
- the prostate cancer risk management programme
- introducing the abdominal aortic aneurysm screening programme
- the accountability of the UK NSC
Hi, my name is Henrietta Campbell and I chaired the National Screening Committee from 1998 to 2006. At the time of that appointment I was Chief Medical Officer in Northern Ireland, and my background in medicine was firstly in general practice and then public health medicine.
In looking back over my career in medicine I regard it as a special privilege to have chaired the UK National Screening Committee (UK NSC). I was delighted to be asked to do so by Sir Kenneth Calman, whose vision together with that of Sir Muir Gray was the driving force behind the establishment of what has become an internationally-renowned body. It was their leadership and inspiration which saw the setting in place of the fundamental building blocks upon which the National Screening Committee has grown and indeed flourished.
The enduring success of the committee is due to the absolute integrity of its evidence-based decision making, based on criteria which are internationally recognised as a gold standard. The key to this success has been the leadership of people like Muir Gray and a myriad of others who are experts in their field, understand the primacy of public health and are willing to devote time and energy in the pursuit of excellence.
Chairing the UK NSC
For my part, chairing the National Screening Committee was a great experience. As set down in the code of practice, the main challenge for the Chair is to seek a unanimous view from the committee, in my time this never presented a problem as but the time decisions where required the committee was presented with evidence which was irrefutable, such was the diligence of this subcommittee and it's chairs and indeed the Secretariat.
A frequently recurring challenge was how to meet the persistent calls for prostate cancer screening with the PSA (prostate-specific antigen) test being cited as the means for doing so, and whilst we’ve become well-versed in how to establish and promote screening programmes, we had to develop ways and means of dissuading the public and some health professionals on the use of the PSA test. As well as expanding the unreliability of the PSA test and the fact that it's use could to do more harm than good, we recognise that more needed to be done.
In the absence of an effective screening tool it was Muir Gray’s excellent proposal that we should develop a prostate cancer risk management programme. But over a decade later the challenge of finding an effective screening tool for prostate cancer still remains.
Population screening is an incredibly stimulating and rewarding field in which to work. For me one of the most interesting discussions in my time this chair was the development of the screening programme for abdominal aortic aneurysm. Figures from 1998 had shown that rupture from abdominal aortic aneurysm was responsible for over 2 percent of all deaths in men over 65 years of age, half of those deaths taking place before a patient could reach hospital and the mortality rate for those beating hospital and undergoing emergency surgery anything from 30 to 70 percent.
We were aware that small trials had shown that an ultrasound screening programme to detect abdominal aortic aneurysms in older men may be effective but there was uncertainty amongst the committee about the cost-effectiveness of routine screening. But a study published in 2002 and presented to the NSC by the authors, showed that an ultrasound screening programme which have a projected cost pro-life gained after 10 years of £8,000, well below the perceived NHS threshold level. And whilst it would be some years before the programme would be introduced, this was a major step forward in saving lives.
Impact of screening programmes
The introduction of screening programmes such as that for abdominal aortic aneurysm often has a wider impact across the health service, examples include further specialization and the creation of centres of excellence, investment in radiology, laboratory and other support services and this is very evident when we look at screening programs for breast cancer where the program has often led to better access and higher quality of service for those with symptoms.
The National Screening Committee is accountable to the Cheif medical officers of the four countries of the UK they agree its work plan on an annual basis for me at that time as CMO for Northern Ireland i was interested in watching the evolving impact of political devolution. Each UK health department has and is responsible for setting its own screening policy, taking a kind of advice from the NSC but there was potential for devolution to fracture the United cause of the UK national screening committee, however devolution has offered opportunity rather than challenge, with for example some programs being piloted in one area and lessons being learned before further dissemination.
I believe there’s a great strength in having a united kingdom wide national screening committee and long may it remain so.
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