Currently women with neurofibromatosis type 1 (NF1) who are considered at moderate or high risk of breast cancer, can be referred through clinical professionals such as specialists in genetics or oncology for annual breast screening which is managed at a local level.

An assessment has not made of the potential merits of automatically notifying women with NF1 before they are 40 years old that they are eligible to attend breast cancer screening from the age of 40 years.

The Department works with NHS England to raise awareness of cancers, including for people with increased risk of cancer. In January 2024, NHS England relaunched the Help Us Help You cancer awareness campaign, designed to increase earlier diagnosis by encouraging people to come forward with suspected signs of cancers.

For individuals with neurofibromatosis type 1 (NF1), who are at increased risk of breast cancer, the National Health Service in England recommends breast screening from the age of 40 years old. It is important that awareness of this is widespread among patients and general practices (GPs). Treatment for NF1 involves regular monitoring, and if a patient develops complex problems, their GP can usually refer them to one of two specialist NHS centres, so that a treatment plan can be drawn up. These centres are at Guy’s and St Thomas’ in London, and at Manchester University Hospital.

We expect clinicians to keep themselves appraised of developments within conditions, and to refer to the National Institute for Clinical Excellence guidance as part of their clinical decision-making process.

The UK National Screening Committee (UK NSC) currently recommends that all women aged 50 to 71 years old are invited for a breast screening every three years. The AgeX trial is looking at the impact of increasing or decreasing the screening age for breast screening, and the UK NSC will review its findings when they are available.

The UK NSC can be alerted to any new published peer reviewed evidence which may suggest the case for a new screening programme, or changes to an existing one. Proposals can be submitted via the UK NSC’s annual call in July 2024, which is available at the following link:

https://www.gov.uk/government/publications/uk-nsc-annual-call-submitting-a-screening-proposal/uk-nsc-annual-call-how-to-submit-a-proposal#:~:text=To%20submit%20a%20proposal%20for,your%20name

As part of the HIV Action Plan, NHS England made an initial £20 million available over three years up to 2025 for human immunodeficiency virus (HIV) opt-out testing in 34 emergency departments in areas with extremely high HIV prevalence, with five or more HIV cases per 1,000 residents aged 15 to 59 years old. This includes Blackpool at 4.9 HIV cases in 2019, and the whole of London, including some local areas with high HIV prevalence, specifically with two to five HIV cases per 1,000 residents aged 15 to 59 years old, with additional funding from NHS London.

The programme shows extremely encouraging outcomes and in the first two years, it has preliminarily delivered nearly 1.9 million HIV tests, and helped find more than 1,000 people with undiagnosed or untreated HIV.

In November 2023, the Department announced a new research project to evaluate an expansion of HIV opt-out testing in emergency departments in England. Backed by a further £20 million of funding from the National Institute for Health and Care Research, the research project will evaluate the testing programme in 47 new sites across England, where HIV prevalence is high. The research project is currently in its set-up phase and will run until the end of 2025/26, with sites receiving twelve months of funding for testing.

Decisions on whether to continue offering opt-out HIV testing in emergency departments in local areas with extremely high and high HIV prevalence will be based on outcomes of the current opt-out HIV testing programme and research project, as well as available funding.

We are committed to improving the NHS Bowel Screening programme, and welcome NHS England’s plans for pilot areas, which will reduce the faecal immunochemical test (FIT) down to 80µg/g. NHS England plans to publish an Expression of Interest to give all bowel screening services, and their partner symptomatic endoscopy providers, an opportunity to submit their interest in becoming a FIT@80 pilot site. These pilot sites are planned to be selected and launched later in 2024/25, and attention will be paid to ensure there is regional variation across the pilot sites selected.

The HIV Action Plan is the cornerstone of our approach to drive forward progress and achieve our goal of ending new human immunodeficiency viruses (HIV) transmissions, and acquired immune deficiency syndrome (AIDS) and HIV-related deaths within England by 2030. A key principle of our approach is to ensure that all populations benefit equally from improvements made in HIV outcomes, including through testing, and high-quality care for those with a positive HIV status.

While the disruption of the COVID-19 pandemic has resulted in a significant drop in HIV testing, we are pleased that services are recovering, and testing rates among gay and bisexual men are now at the highest level on record, with a 23% increase from 2019 to 2022. However, more progress is needed across all groups, which we are targeting through various initiatives.

As part of the HIV Action Plan, the Department funds the HIV Prevention Programme, which annually runs a National HIV Testing Week (NHTW) campaign to encourage those in underrepresented groups, such as women and black ethnic groups, to test for HIV. In 2023, we introduced the self-testing option, which we know is very popular with harder to reach groups. During the 2024 NHTW campaign, self-testing orders from black African women nearly doubled when compared with 2023, and orders of these kits by heterosexual women increased by 39%.

The introduction of opt-out testing for HIV in emergency departments, in the areas with extremely high diagnosed HIV prevalence, is also a crucial strategy to help us identify those living with undiagnosed or untreated HIV. By normalising testing as part of an emergency department attendance when blood is drawn, we help reach communities that are currently underserved by testing opportunities, such as black African and black Caribbean ethnic groups and women, and reduce the number of people presenting with a late HIV diagnosis.

A subgroup of the HIV Action Plan Implementation Steering Group (ISG), the Retention and Re-engagement in Care Task and Finish Group, is providing advice on increasing the number of people retained and re-engaged in care and receiving effective medical care, in particularly considering women and other groups disproportionally affected by HIV, which will be reviewed by the ISG in due course.

NHS Breast Screening Programme statistics are available at the following link:

https://digital.nhs.uk/data-and-information/publications/statistical/breast-screening-programme

As of May 2024, 19 community diagnostic centres (CDCs) are providing bone density scans, also known as DEXA scans. A total of 35 CDCs are planning to provide these scans in 2024/25.

NHS England North West has carried out significant work to improve access to cancer screening in the area, including: insight work into cervical screening, which has highlighted some issues, resulting in the piloting of potential solutions; a breast mobile site review being carried out, with findings and recommendations to be shared with trusts to act upon; five bowel and seven breast providers have been trained to use data to develop a Health Equity Audit, which will be submitted at the end of June 2024, with funding being offered to providers to design, develop, implement, and evaluate an intervention to reduce inequalities and barriers experienced by a population group they have identified in their Health Equity Audit; and funding being provided for Improving Uptake in Screening Officers, working to support non responders to take up the offer of breast screening.

NHS Breast Screening Programme statistics are available at the NHS Digital website's Breast Screening Programme page:

https://digital.nhs.uk/data-and-information/publications/statistical/breast-screening-programme

There are currently eight community diagnostic centres (CDCs) offering FibroScan testing, which are:

- Andover CDC in Andover, Hampshire;

- Bexhill CDC in Bexhill-on-Sea, East Sussex;

- Ely CDC in Ely, Cambridgeshire;

- Gloucestershire Quayside CDC in Gloucester, Gloucestershire;

- New QEII Hospital CDC in Welwyn Garden City, Hertfordshire;

- Poole Dorset Health Village CDC in Poole, Dorset;

- St Helens CDC in St Helen’s, Merseyside; and

- Woking Community Hospital CDC in Woking, Surrey.

There are six additional CDCs planning to offer Fibroscan testing in 2024/25, which are:

- Bolton CDC in Bolton, Lancashire;

- Bradford District and Craven CDC in Bradford, West Yorkshire;

- Northern Care Alliance Oldham CDC in Oldham, Greater Manchester;

- Peterborough CDC in Peterborough, Cambridgeshire;

- Wisbech CDC in Wisbech, Cambridgeshire; and

- Wood Green CDC in Haringey, London.

In total, NHS England plans to have rolled out FibroScan testing to 14 CDCs by 2024/25, and continues to explore further rollout of Fibroscans by March 2025.

The screening process is designed to capture basic information about the individual, immigration history and their protection claim and is conducted by a range of officials under the Home Office.

The Government is working with the National Health Service to support earlier diagnosis of liver disease, and to identify patients at risk. This includes plans agreed as part of the £2.3 billion diagnostics transformation programme, to upgrade the digital capabilities of laboratories across the country and ensure that they have the capability required to offer Intelligent Liver Function Tests (iLFTs).

NHS England is reviewing the liver fibrosis pathways, and looking at developing a diagnosis pathway starting in primary care that will make use of both laboratory-based tests, such as iLFTs, and community diagnostic centres. The Government will make a further assessment of this work once it is complete, including the benefits of an increased rollout of iLFTs across England.

Data on the number of bone density scans, also known as DEXA scans, conducted in community diagnostic centres, is publicly available in the NHS Diagnostics Waiting Times and Activity (DM01) dataset. This data has been published monthly since March 2023, and is available at the following link:

https://www.england.nhs.uk/statistics/statistical-work-areas/diagnostics-waiting-times-and-activity/monthly-diagnostics-waiting-times-and-activity/

While some data on scanning of the prostate is available from the Diagnostic Imaging Dataset, it does not distinguish between scans for non-cancer indications, scans for suspected cancer, namely cancer diagnosis, and scans to inform staging and treatment planning for cancer which is already diagnosed.

Screening for the most common cancer in men, prostate cancer, is complex but we are backing groundbreaking trials to improve diagnostic processes and save thousands more lives. In 2021, 43,378 men were diagnosed with prostate cancer, a 9% decrease compared to 2019. The recently announced TRANSFORM trial, which will be led by Prostate Cancer UK and supported by £16 million of Government funding, aims to find the best way to screen for prostate cancer. The trial will cover the whole of the United Kingdom, although final decisions on specific locations are yet to be taken. The UK National Screening Committee will be reviewing the evidence that is published by this study, which will help to inform any future recommendation on creating a national screening programme for prostate cancer.

To support faster diagnosis, NHS England is streamlining cancer pathways and in October 2022 introduced the best practice timed pathway for prostate cancer. This guidance recommends those with suspected prostate cancer undertake multi-parametric magnetic resonance imaging before biopsy, which ensures only those men most at risk of having cancer undergo an invasive biopsy.

Alongside cutting-edge research, we are helping more people get diagnosed earlier for cancer and other conditions by rolling out additional tests, checks and scans at 160 locations across England through our Community Diagnostics Centres programme.

While some data on scanning of the prostate is available from the Diagnostic Imaging Dataset, it does not distinguish between scans for non-cancer indications, scans for suspected cancer, namely cancer diagnosis, and scans to inform staging and treatment planning for cancer which is already diagnosed.

Screening for the most common cancer in men, prostate cancer, is complex but we are backing groundbreaking trials to improve diagnostic processes and save thousands more lives. In 2021, 43,378 men were diagnosed with prostate cancer, a 9% decrease compared to 2019. The recently announced TRANSFORM trial, which will be led by Prostate Cancer UK and supported by £16 million of Government funding, aims to find the best way to screen for prostate cancer. The trial will cover the whole of the United Kingdom, although final decisions on specific locations are yet to be taken. The UK National Screening Committee will be reviewing the evidence that is published by this study, which will help to inform any future recommendation on creating a national screening programme for prostate cancer.

To support faster diagnosis, NHS England is streamlining cancer pathways and in October 2022 introduced the best practice timed pathway for prostate cancer. This guidance recommends those with suspected prostate cancer undertake multi-parametric magnetic resonance imaging before biopsy, which ensures only those men most at risk of having cancer undergo an invasive biopsy.

Alongside cutting-edge research, we are helping more people get diagnosed earlier for cancer and other conditions by rolling out additional tests, checks and scans at 160 locations across England through our Community Diagnostics Centres programme.

NHS England does not hold this information at a national level. NHS England is committed to improving the accessibility of the screening programmes it commissions and contractually, providers of National Health Service screening services are required to make reasonable adjustments to ensure that their services are accessible for people with disabilities.

Services make reasonable adjustments within the constraints of mammography equipment, to ensure that people with disabilities are offered the opportunity to have screening; However, there may be situations where this is not possible.

Local providers will have a better understanding of any accessibility issues for individual patients and will deal with these on a case by case basis. Providers will offer an alternative approach as necessary. For example, for women who are unable to have a mammogram, may be offered a referral to a symptomatic breast clinic for a physical check.

United Kingdom blood services test blood donations for West Nile virus (WNV), if it is indicated by the information provided in the individual’s donor safety questionnaire that they have travelled to an area where WNV is circulating. Other tests for malaria, cytomegalovirus, and the parasite trypanosoma cruzi may be conducted if the donor has a history of recent travel to an area where one or more of these conditions is common.

The Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO) advises the Government on the most appropriate ways to ensure the safety of blood, including screening. The SaBTO Virology Subcommittee is conducting a review into the approach of screening for WNV. A report with their recommendations will be published following completion of the review.

We are aware of the issues faced by some people with physical or mental health conditions that can make attending a screening appointment, or carrying out a home test, more difficult. Currently, national screening IT systems do not have the facilities to flag conditions for individuals which could make it more difficult to carry out the bowel cancer screening, fecal immunochemical test (FIT) at home. It is therefore recommended that individuals contact their general practice (GP) in these situations, so that GPs can work with the screening provider to arrange further support. For example, carrying out a FIT test at the GP or at home, with the support of a family member or community nurse.

NHS England has started work to improve its national screening IT systems through the Digital Transformation of Screening programme. This will enable screening providers to flag heath issues that may make carrying out a FIT test at home more difficult, and to offer any appropriate support.