False-negative results in screening programmes: systematic review of impact and implications.

Abstract

Health Technology Assessment is indexed in Index Medicus/MEDLINE and Excerpta Medica/ EMBASE. Copies of the Executive Summaries are available from the NCCHTA web site (see overleaf). NHS R&D HTA Programme T he overall aim of the NHS R&D Health Technology Assessment (HTA) Programme is to ensure that high-quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most efficient way for those who use, manage and work in the NHS. Research is undertaken in those areas where the evidence will lead to the greatest benefits to patients, either through improved patient outcomes or the most efficient use of NHS resources. The Standing Group on Health Technology advises on national priorities for health technology assessment. Six advisory panels assist the Standing Group in identifying and prioritising projects. These priorities are then considered by the HTA Commissioning Board supported by the National Coordinating Centre for HTA (NCCHTA). This report is one of a series covering acute care, diagnostics and imaging, methodology, pharmaceuticals, population screening, and primary and community care. It was identified as a priority by the Population Screening Panel and funded as project number 95/40/01. The views expressed in this publication are those of the authors and not necessarily those of the Standing Group, the Commissioning Board, the Panel members or the Department of Health. The editors wish to emphasise that funding and publication of this research by the NHS should not be taken as implicit support for the recommendations for policy contained herein. In particular, policy options in the area of screening will be considered by the National Screening Committee. This Committee, chaired by the Chief Medical Officer, will take into account the views expressed here, further available evidence and other relevant considerations. Reviews in Health Technology Assessment are termed 'systematic' when the account of the search, appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. Criteria for inclusion in the HTA monograph series Reports are published in the HTA monograph series if (1) they have resulted from work either prioritised by the Standing Group on Health Technology, or otherwise commissioned for the HTA Programme, and (2) they are of a sufficiently high scientific quality as assessed by the referees and editors.

Psychosocial Aspects of Newborn Screening Programs for Cystic Fibrosis

“…False-negatives are also inherent to all screening programs, newborn or otherwise (Petticrew, Sowden, Lister-Sharp, & Wright, 2000). In CF NBS, with sensitivity rates of the initial IRT test estimated to be approximately 95%, it would be expected that programs would miss 5 infants with CF for every 100 correctly identified as having CF (Heeley & Bangert, 1992).…”

“…Inevitably this will result in further delaying the diagnosis of CF in those who received an initial false-negative screening result and the associated psychological consequences (reviewed above). Systematic review of all screening programs, including NBS, links false-negative results to parental feelings of being wrongly treated, a loss of faith in the medical profession, and, more often than not, legal action (Petticrew et al, 2000). It is essential, therefore, that CF NBS programs raise awareness of these limitations among the medical profession and stress the importance of continuing to consider CF as a possible diagnosis in children with suggestive symptoms.…”

Clinical indications for cardiovascular magnetic resonance (CMR): Consensus Panel report?

“…384,385 There are a number of medical society and governmental position papers on the economic value of CMR and other imaging techniques, and these are a useful further reference source for independent assessments of costbenefit. [384][385][386][387][388][389][390][391][392][393][394][395][396] A large amount of data reveals that there is a large economic burden placed upon society for the use of imaging tests for cardiovascular disease. For example, high rates of resource consumption are noted in the US (40 million non-invasive cardiac tests are performed annually for public and private health care payers; Medicare reimbursement of $372-$740 million; and high growth rates >20% using Medicare databases for some cardiac imaging modalities).…”

The effect of information about false negative and false positive rates on people's attitudes towards colorectal cancer screening using faecal occult blood testing (FOBt)

“…In the context of screening, the issue of test sensitivity (false negative screening rates) has received almost no attention. Systematic reviews show that little research has examined their impact either in cancer screening in general [22] or in the specific context of FOBt screening for colorectal cancer [23]. One exception is the study by Houston et al [24] which examined women's perceptions of cervical screening following publicity about screening errors, in a local service in 1996, in which abnormalities and early cancers had been missed.…”