Agenda item - Cervical and Breast screening and human papillomavirus (HPV) vaccination

Report of the Director of Public Health, NHS England and NHS Sussex (copy attached).

26.1    This item was presented by Sarah Morgan, NHS England Screening & Immunisation Lead (Surrey & Sussex); Nicola Rosenberg, BHCC Consultant in Public Health; and Wendy Young, NHS Sussex Programme Director, Cancer & Planned Care.

26.2    Ms Morgan told the committee that screening was the testing of a non-symptomatic population for specific conditions. There are national screening programmes for breast and cervical cancer. There is a clear deprivation link to screening, with more deprived communities on average less likely to come forward to be screened and also more likely to experience cancers. The Covid epidemic has had a negative impact on screening, delaying appointment and leading to the later diagnosis of cancers. Services are working hard to get back to pre-Covid levels and to further improve screening take-up.

26.3    In response to a question from Cllr O’Quinn on age limits for screening, Ms Morgan told members that age-limits are set nationally and are evidence-based (e.g. breast screening in women over 70 is significantly less accurate due to natural changes in body tissue associated with ageing that are picked up as potentially problematic by the screening tests). The age limits are under constant review. It is also important to see screening as just one tool to identify cancers, alongside self-checking.

26.4    Cllr O’Quinn asked whether there was a local issue with testing hesitancy as there has historically been with vaccine hesitancy. Ms Rosenberg responded that there has historically been less hesitancy around testing than vaccination. With the latter, there has been progress in recent years, with good take up of Covid jabs. There is work to do on childhood vaccination, but with tailored communication, there is the opportunity to increase take-up.

26.5    Michael Whitty noted that the 2021 census identifies a growing population of older people in Brighton & Hove, and stressed the need to have communications tailored for this audience. Ms Morgan agreed and assured the committee that this was being taken forward.

26.6    Cllr Rainey asked why regular breast screening is only offered to women from the age of 50. Ms Morgan responded that screening is offered to women under 50 in certain situations: e.g. where there is a family history of cancers. The lower age limit reflects the fact that screening tends to be less accurate in populations with low disease prevalence. This is under constant review.

26.7    Cllr John asked about deprivation, particularly in the context of cervical screening rates. Ms Rosenberg responded that there is a deprivation link to all screening, with access a major issue for some communities. Ms Young added that commissioners used mapping tools to identify the best locations for the mobile screening sites. It is important to consider the actual availability of public transport as well as distance from a screening site. Ms Rosenberg noted that links with deprivation go beyond simple issues of access. For example, people who suffer from anxiety may be less likely to attend screening, and anxiety is most prevalent in deprived communities.

26.8    Cllr Barnett noted that there may be particular issues with some black and minority ethnic communities accessing screening, for instance in Hangleton & Knoll. Ms Rosenberg agreed, stressing to members that a bespoke approach to each community was required to identify what works for them. This may be around providing translated information, about building trust with a community, about using peer educators and so on. There is learning from the successful community outreach for Covid vaccinations to draw upon here. Ms Rosenberg offered to speak to the Chief Executive of the Hangleton & Knoll Project to see what more might be possible in terms of getting public health information to local communities.

26.9    Alan Boyd told members that Healthwatch had published a report on screening which he was happy to share with the committee.

26.10  In response to a question from Mr Boyd about initial breast screening appointments, Ms Morgan informed members that women will be called up between their 50^th and 53^rd birthdays, based on the locality of their GP practices (i.e. practice lists are taken in turn). There is no evidence that delaying screening until the 53^rd birthday increases population level risk, although it is important that women are aware of breast cancer symptoms and check for them.

26.11  In reply to a question from Mr Boyd about breast cancer in men, Ms Morgan told the committee that there was no programme for male screening as the condition is relatively rare. Ms Rosenberg added that there is some comms around male risk.

26.12  Nora Mzaoui asked about screening for women who are not registered with a GP. Ms Morgan acknowledged that this is a limitation of screening programmes. Ms Rosenberg added that services do work directly with specific communities with low GP registration rates: e.g. Gypsies & Travellers and the homeless community.

26.13  The Chair asked whether it was possible for people to choose to use a screening centre other than Preston Park. Ms Morgan replied that this is possible, although the process could be made easier.

26.14  In response to a question from the Chair on fixed Vs mobile screening sites, Ms Morgan responded that fixed sites are accessible for people with disabilities. Mobile sites may offer more convenient access, although there is down-time to be factored in when a mobile unit is moved. Ms Rosenberg added that innovative ways to improve access are being considered: e.g. taxi vouchers.

26.15  The Chair enquired why local screening rates have been relatively low for a number of years. Ms Rosenberg responded that Brighton & Hove has a highly mobile population, with large numbers of students and people resident for a relatively short period. When this is accounted for, city screening rates are similar to comparators.

26.16  The Chair thanked all the presenters for their contributions.

26.17  RESOLVED – that the report be noted.