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Implementing digital mammography services for breast screening in NHSScotland

Consultation Report

Determining the most clinically and cost-effective way of implementing digital mammography services for breast screening in NHSScotland

The consultation document considering the recommendations arising from the HTA is now available to download.

Reviewers are invited to submit comments on this consultation document by 2 November 2007 to Jennifer Graham.

An indication of the scope of interest in the topic would be appreciated from those submitting comments. Electronic files in plain text or in MS Office packages are preferred, but paper copies will be accepted. Comments should be sent by email to JenniferGraham@nhs.net or posted to NHS Quality Improvement Scotland, FREEPOST NAT 19799, GLASGOW G1 2BR.

Introduction

Breast Screening in Scotland

In Scotland, breast screening is offered to all women between the ages of 50 and 70 years every three years under the Scottish Breast Screening Programme. There are six breast screening centres in Edinburgh, Aberdeen, Irvine, Dundee, Inverness and Glasgow, and these centres are supported by 19 mobile screening units. In 2004/5 over 143,000 women were screened under the Programme and 1,164 cancers were detected.

Digital Mammography

In 2005, the Scottish Executive Health Department (SEHD) published Delivering for Health which outlined its ‘e-health strategy’ for establishing a common information and communications technology system (Scottish Executive, 2005). This is essential if NHSScotland is to deliver integrated care services, giving the opportunity for faster, safer, more efficient and more patient-centred services. One activity generated by the strategy was the creation of a national Picture Archive and Communications System (PACS) to enable electronic transfer of digital records such as X-rays and scans. National roll out of this system was to be complete by June 2007 and such developments have precipitated an increasing use of digital technology throughout NHSScotland.
 
The Breast and Cervical Screening National Advisory Group requested that NHS Quality Improvement Scotland (NHS QIS) considers a Health Technology Assessment (HTA) to assist with the proposed introduction of digital mammography into the Scottish Breast Screening Programme (SBSP). NHS QIS agreed to undertake the HTA and published a Project Initiation Document setting out the key questions in December 2006.
 
In England, a similar project has already been undertaken considering the same evidence and issues as this HTA, and resulted in a recommendation to implement digital mammography immediately.
 
Digital mammography is already being implemented elsewhere in the United Kingdom (UK). In England, the NHS Breast Screening Programme (NHSBSP) Digital Imaging Technologies Steering Group reported that frequently mammography is the only area of an imaging department still using film and as such it is becoming increasingly difficult to maintain film-screen mammography (FSM) equipment and good quality film processing chemistry. Advantages of converting from FSM to digital mammography include the potential for reduced radiation dose, environmental benefits, reduced physical strain on radiological staff and immediate access to and assessment of images, thus necessitating fewer technical repeats.

Scope of the HTA

The Breast and Cervical Screening National Advisory Group has requested that NHS Quality Improvement Scotland considers a health technology assessment to assist with the proposed introduction of digital mammography into the Scottish Breast Screening Programme.
 
The purpose of the HTA is to explore the most clinical and cost-effective way to implement digital technology for breast screening across Scotland, while maintaining the high standards of the existing quality-assured service. The scope is restricted to evaluation of the technology and the practicalities of its implementation, and does not extend to the wider ethical issues associated with screening programmes.

Date of publication

Background on HTA

What is an HTA?

HTA is a process used by NHS QIS to advise NHSScotland about a specific health intervention (eg medicine, equipment or diagnostic test). HTA evaluates the clinical and cost effectiveness of the various ways in which the health intervention can be used, comparing alternative interventions where appropriate. Patient and organisational aspects, including professional, legal and ethical issues are considered in detail.

At the end of all assessments, recommendations are made to NHSScotland. These are published in a comprehensive assessment report accompanied by a short summary suitable for people without specialist knowledge of the topic. The report and summary are made available to health professionals and the public. The recommendations are evidence based but value judgments are also made following discussion with experts.

It is recognised that some topics require less thorough investigation and have a narrower focus than others, perhaps with few organisational or patient issues.

How will the assessment be carried out?

HTA is an internationally recognised process. Evidence identified by literature searching together with evidence provided by experts, patient interest groups and manufacturers will be critically appraised and robust analyses will be undertaken by expert staff. Questionnaires may be undertaken to ascertain current clinical practice and patient preferences.

NHS QIS staff from a variety of disciplines will conduct the assessment and will also seek advice from health professionals who are expert in this area.

There will be a consultation period during which a draft report and recommendations will be published on this website. Anyone with an interest in the topic will be invited to submit comments. All comments will be given due consideration and the report will be updated accordingly.

How will the report affect patient care?

The results of the assessment will be used as the basis of recommendations for NHSScotland on the most cost effective way of implementing digital mammography services. It will then be up to health professionals in NHSScotland to ensure that these recommendations are put into practice.

How was this topic selected for assessment?

This health technology assessment was commissioned by the Breast and Cervical Screening National Advisory Group

Who should I contact about this assessment?

The assessment is being led by Dr Helen Brown who would welcome any enquiries:

Dr Helen Brown
Senior Statistician
NHS Quality Improvement Scotland
Delta House
50 West Nile Street
GLASOW G1 2NP
Tel: +44 (0)141 241 6303
 

NHS QIS invites comments regarding the proposed scope of this assessment and would welcome any submissions of evidence relating to the topic.