Sustained Smoking Cessation Can Lower Risk of Seropositive RA

Analysis of data demonstrates first time that behaviour change can delay or prevent most severe form of rheumatoid arthritis.

Smoking is an important risk factor for developing the most common form of rheumatoid arthritis (RA) and other inflammatory diseases, but a critical question remains: Can those who quit smoking delay or prevent RA or have they permanently and irrevocably altered their risk of the disease?

A new study by investigators from Brigham and Women's Hospital leverages data from the Nurses' Health Studies to find out. Their findings, which appear in Arthritis Care & Research, demonstrate for the first time that changing behaviour - in this case, sustained smoking cessation - can reduce risk of developing seropositive RA, the more severe form of the disease.

"Ours is the first study to show that a behaviour change can reduce risk for seropositive RA. Risk isn't just about genes and bad luck - there's a modifiable environmental component to the onset of this disease and a chance for some people to reduce their risk or even prevent RA," said corresponding author Jeffrey Sparks, MD, MMSc, of the Division of Rheumatology, Immunology and Allergy at the Brigham.

To conduct their study, Sparks and colleagues used data from the original Nurses' Health Study, established in 1976, and Nurses' Health Study II, a second cohort established in 1989. Both groups include registered nurses from across the U.S. who filled out health surveys every two years with questions that included information about smoking and health status.

Among more than 230,000 participants in this analysis, the researchers identified 1,528 who developed RA. The research team was especially interested in the 969 "seropositive" as opposed to "sero-negative" cases. Patients with seropositive RA have auto-antibodies related to RA, and generally have more severe disease manifestations, including joint deformities and disability.

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For seropositive RA, risk began to go down about five years after women quit smoking and continued to decrease the longer they stayed non-smokers. Participants who quit for good reduced their risk of seropositive RA by 37 per cent after 30 years. The team did not find any association between sero-negative RA and smoking, adding further evidence to the theory that sero-negative and seropositive RA may be two distinct diseases with distinct risk factors.

"One of the lessons here is that it takes sustained smoking cessation to reap the full benefit," said Sparks. "Whereas for other diseases, such as cardiovascular disease, quitting smoking can provide a more immediate effect, here we're seeing benefits decades later for those who quit smoking permanently."

While the biological mechanisms that link smoking and the development of RA are unclear, Sparks and others think that smoking may affect a preclinical disease process that leads to the formation of RA-related auto-antibodies and increases inflammation.

In addition to further studying the biology of RA, Sparks and colleagues want to extend their investigations to include men and interventional trials among active smokers to see if it is possible to prospectively prevent the formation of RA-related auto-antibodies and the progression of the disease among those at increased risk.

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Autism-Anorexia Link 'Must Be Acted On'

The NHS must change the way it assesses eating disorders to take account of a link with autism, a research charity has said.

Autistica said findings suggested one in five women presenting to UK clinics with anorexia may also have autism and tailored therapy was vital.

One woman said her autism had made her "obsessed" with counting calories, even though she did not want to lose weight.

Health watchdog NICE said more research was required.

Sophie McInnes, 24, told the BBC's Victoria Derbyshire programme her anorexia had developed not from issues surrounding body image or weight but because she had developed a set of rules for herself about how many calories she could eat.

She said she had wanted to put on weight but her autism - at that stage undiagnosed - had meant she would not let herself.

"It was all about the calories, all about the numbers," she said, having begun to write down what she was eating aged 19.

"I actually admitted myself into the eating disorder unit because I had started exercising a lot and I wasn't eating anything.

"They put me in a wheelchair and said my weight was so low that if I didn't eat, I would need to be sectioned."

Eventually, Sophie left the unit but she continued to struggle to gain weight.

It was only several years later, in 2018, that she was diagnosed with autism.

Had the link been spotted sooner, she said, it would have helped her recovery.

"It's just taken away a big chunk of my life so far, and I want to move on," she said.

More Research Needed

Autistica's director of science, Dr James Cusack, said is calling for new guidelines from the National Institute for Health and Clinical Excellence (NICE) to reflect this.

Currently, the guidelines do not contain any mention of autism.

"We also need more NHS services involved in research," Dr Cusack said, "both informing studies and carrying out trials in eating-disorder care settings."

His proposal has the backing of former Health Minister Norman Lamb.

The Lib Dem MP told the Victoria Derbyshire programme it was "vital" that practice caught up with research.

"We may well be applying inappropriate care to women with both conditions," he added.

NICE said in a statement that it recognised factors such as autism needed to be taken into account with regards to eating disorders, but there was currently "very little" evidence on whether the intervention of health professionals needed to be modified in such cases.

NHS England has been approached for comment.

Will Mandy, a leading autism researcher, from University College London, said part of the issue was that women and girls were much less likely than men to be recognised as having autism in the first place.

And he believes that the "high levels of stress and anxiety" caused by the condition going undiagnosed in childhood and adolescence can contribute to people experiencing severe mental health conditions, such as eating disorders.

Recognition among health professionals of the autism-anxiety link was key, he said.

"If you don't know somebody is autistic, it becomes quite hard to help them and to adapt treatment to being autistic," Mr. Mandy said.

A tailored approach can include simple changes, such as making communication easier and the environment friendlier.

Caroline Norton, from South London and Maudsley NHS Trust's Eating Disorder Service, said its autistic patients might have one-to-one sessions - to remove the noise of others in the same space - where they learned to make food with a dietician.

Healthcare professionals can also try to make patients more comfortable.

One of the service's former patients, Ms Norton said, would hardly communicate with the therapist face-to-face but would instead send a long response via email shortly after the session - so they learned from this.

"It's about meeting the individual at the level that they need," she added.

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Cannabis Use in Teens Linked to Depression

Parents should not be complacent about the risks of teenagers using cannabis, experts are warning.

UK and Canada researchers said they had found "robust" evidence showing using the drug in adolescence increased the risk of developing depression in adulthood by 37%.

They said the findings should act as a warning to families who saw cannabis use as part of the growing-up process.

The team added that the developing brain was particularly susceptible.

The researchers - from University of Oxford and Montreal's McGill University - said cannabis use in the young was an "important public health issue", particularly given that cannabis available today tends to be much stronger than it was previously.

Around one in nine young adults and teenagers use the drug each year in England and Wales.

Report author Prof Andrea Cipriani conceded some parents had a relaxed attitude to the drug, but added the evidence was clear.

"This is important information for parents and teenagers. The risk is modest, but it can have a devastating impact."

• Cannabis 'worse than alcohol' for teens
• Young 'think cannabis safer than alcohol'

How Risky is Cannabis?

This is the first time the actual risk has been quantified in this way.

The team looked at 11 previous studies, covering more than 23,000 young people, the journal JAMA Psychiatry reported.

Young people who had already shown signs of depression or had a family history of the condition were excluded.

It found cannabis use before 18 increased the chance of an individual developing depression in young adulthood - defined as before the age of 35 - by 37%.

In terms of numbers that means around one in 14 cases of depression in that age group - around 60,000 in the UK - could be attributed to drug use in the teenage years.

The study also looked at whether there was an association with anxiety and suicide attempts.

There was an increased risk of anxiety developing in young adulthood, but it was not considered statistically significant.

Meanwhile, those who used cannabis in their teenage years were three times more likely to try to kill themselves - although the data on that trend was not considered robust enough to draw a firm conclusion.

So is This Proof?

No. The researchers were unable to prove cannabis use was definitively causing depression.

Instead, they could only say it looked to be a strong link.

This is because of the figures they found, but also what is known about the impact cannabis has on the developing brain.

Evidence has suggested that the drug affects the parts of brain that govern rational and emotional thinking as well as serotonin levels that influence mood.

To prove the link, trials would have to be conducted on young people - something that will never be done because it is unethical.

King's College London psychiatrist Prof Sir Robin Murray said the research could not be considered conclusive, but acknowledged the findings were "probably correct".

He said the risk of developing depression was smaller than what has already been established for schizophrenia-like psychosis.

He also said it was likely that any risk would be also down to the amounts of cannabis consumed and the strength - something this study was unable to unpick.

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Onions and Garlic Could Protect Against Cancer

Aside from their ability to inject deep flavour into almost any meal, onions and garlic might also protect against cancer, according to a recent study.

A recent study adds to the evidence that allium vegetables reduce cancer risk.

Garlic, onions, leeks, chives, and shallots are classed as allium vegetables.

They are grown throughout much of the world and form the bedrock of family meals far and wide.

Earlier studies have shown that certain compounds in allium vegetables - including flavanols and organosulfur compounds - are bioactive.

Some have been shown to hinder the development of cancer.

Scientists from the First Hospital of China Medical University recently set out to understand whether consuming greater amounts of these vegetables might prevent people from developing colorectal cancer. They recently published their results in the Asia-Pacific Journal of Clinical Oncology.

Not counting skin cancers, colorectal cancer, also called bowel cancer, is the third most common cancer diagnosed in men and women in the United States.

Researchers are aware of certain dietary risk factors, such as consuming high levels of red or processed meats. However, they know less about foods that might protect against bowel cancer.

Unpeeling the Onion

Scientists have already investigated whether allium vegetables could reduce bowel cancer risk. Although some have identified a significant effect, others have found either a small interaction or none at all.

The authors of the latest study believe that the variation in results is partly due to how data was collected. For instance, some studies combined all allium vegetables into one group for analysis, and others did not include data from some, less common, types of allium vegetable.

With this in mind, the researchers designed a study that would more faithfully capture the impact of allium vegetables on colorectal cancer risk.

To investigate, they matched 833 individuals with colorectal cancer with 833 control participants without it, who were similar in age and sex and who lived in similar locations.

Each participant was interviewed, and their dietary habits were recorded using a validated food frequency questionnaire.

The Benefits of Allium Vegetables

The researchers found that, as theorized, there was a significant relationship between the level of allium vegetables that an individual consumes and their risk of colorectal cancer.

Specifically, in adults who consumed the highest levels of allium vegetables, the risk of developing colorectal cancer was 79 percent lower than those who consumed the lowest levels.

"It is worth noting that in our research there seems to be a trend: the greater the amount of allium vegetables, the better the protection." - Senior author Dr. Zhi Li.

The inverse relationship was seen in the overall consumption of allium vegetables, as well as in specific types, namely garlic, garlic stalks, leeks, onions, and spring onions.

The correlation was also significant in both men and women. This is interesting because, in some earlier studies, differences were seen between the sexes. For instance, one study found a weakly protective effect in women and a slight increase in colorectal cancer risk in men.

As previously mentioned, past research into allium vegetables and colorectal cancer risk produced conflicting results. However, evidence in favor of the relationship is now growing.

For instance, a study with Southern European participants found "an inverse association between the frequency of use of allium vegetables and the risk of several common cancers."

Similarly, a meta-analysis assessed links between allium vegetable intake and the presence of adenomatous polyps, which are precursors of colorectal cancer.

The authors concluded that "high intake of total allium vegetables may be associated with a risk reduction of colorectal adenomatous polyps."

A Simple Dietary Change

Dr. Li believes that this group of vegetables provides a simple lifestyle change that could help reduce the risk of colorectal cancer.

Of course, consuming these vegetables alone will not reduce risk in a meaningful way, but used in conjunction with other dietary changes, they might make a difference.

The debate is likely to continue for some time; there is a dizzying array of reasons why allium-rich diets may seem (or not seem) to impact cancer risk. For example, how a vegetable is cooked can significantly alter its chemical composition.

This might help explain why studies conducted among different global populations had differing results; future studies would do well to take this into account.

Conclusions cannot yet be drawn, but, if the results are replicated, adding extra onions and garlic to our dishes may be a tasty way to reduce colorectal cancer risk.

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Blueberries May Lower Cardiovascular Risk By Up to 20 Percent

The phytochemicals that give blueberries their blue color can significantly improve cardiovascular health, finds a new two-part study.

The positive effect that blueberries can have on blood pressure is comparable to that of hypertension drugs.

Dubbed "the silent killer" because it has no visible symptoms in its early stages, hypertension affects approximately 1 in 3 adults in the United States.

The condition puts a strain on the cardiovascular system, which in the long run may contribute to heart failure, stroke, and kidney failure.

The National Institutes of Health (NIH) recommend that people with high blood pressure stay in control of the condition by eating healthfully, exercising, not smoking, and maintaining a healthy weight.

But should you eat anything in particular to keep your arteries healthy? In a previous Spotlight feature, we rounded up 16 foods that studies have suggested can improve cardiovascular health.

Along with broccoli, spinach, pulses, and fish, berries may also reduce heart disease, due to their antioxidant polyphenols.

New research zooms in on the cardiovascular effects of blueberries and finds that anthocyanins - the phytochemicals that give blueberries their color - mediate the beneficial effects that this fruit has on the cardiovascular system.

The lead author of the study is Ana Rodriguez-Mateos, Ph.D., from the Department of Nutritional Sciences at King's College London, in the United Kingdom. The researchers published their findings in The Journals of Gerontology: Series A.

Anthocyanins and Blood Pressure

Rodriguez-Mateos and her colleagues recruited 40 study participants who were in perfect health and randomly divided them into two groups: One received a daily drink consisting of 200 grams (g) of blueberries, and another group received a control drink.

To examine the effects of the blueberries, the researchers took the participants' blood pressure and measured the flow-mediated dilation (FMD) of their brachial arteries.

FMD is a standard indicator of cardiovascular risk; it measures how much the brachial artery widens when blood flows at a higher rate.

In the second part of the study, the researchers compared drinking blueberries with drinking purified anthocyanins or control drinks that had concentrations of fiber, minerals, or vitamins equivalent to those in blueberries.

Blood pressure decreases by 5 mm Hg

The scientists noticed the beneficial effects of the blueberry drinks only 2 hours after the participants had consumed them.

"Purified anthocyanins exerted a dose-dependent improvement of endothelial function in healthy humans, as measured by [FMD]," report the authors.

The endothelium is a type of membrane inside the heart and blood vessels. It contains endothelial cells that help control the dilation and contraction of the arteries.

Endothelial cells also help keep blood pressure in check and play a key role in blood clotting.

The authors continue, "[t]he effects were similar to those of blueberries containing similar amounts of anthocyanins, while control drinks containing fiber, minerals, or vitamins had no significant effect."

After a month of having 200 g of blueberries each day, the participants' blood pressure decreased by 5 millimeters of mercury (mm Hg), on average. The researchers note that such a decrease is usually obtained with medication.

"Our results identify anthocyanin metabolites as major mediators of vascular bioactivities of blueberries and changes of cellular gene programs," conclude the researchers.

Rodriguez-Mateos comments on the findings, saying, "although it is best to eat the whole blueberry to get the full benefit, our study finds that the majority of the effects can be explained by anthocyanins."

The scientists explain that anthocyanins "circulate in [the] blood as phenolic acid metabolites."

"If the changes we saw in blood vessel function after eating blueberries every day could be sustained for a person's whole life, it could reduce their risk of developing cardiovascular disease by up to 20 percent." - Ana Rodriguez-Mateos.

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Flu Vaccine 'Working Better for Children'

The flu vaccine is so far proving more effective in children than in adults in the UK, mid-season figures suggest.

The nasal spray flu vaccine is 87% effective in children aged two to 17 against the main circulating flu strain, influenza A(H1N1)pmd09, Public Health England data indicates.

Meanwhile, the flu vaccine is 39% effective against the same strain in adults aged 18 to 64.

No data is yet available for the over-65s or for other flu strains.

The data shows that more children than ever are being vaccinated, although take-up is lower in younger age groups.

The figures are preliminary and are subject to being revised by the end of the flu season in May, when more data is available.

Some 43% of two-year-olds have been vaccinated, compared with 45% of three-year-olds.

Among school-aged children, 56% to 64% have been vaccinated, depending on the year group.

Last year's final figures for the whole flu season of 2017-18 showed that the vaccine was only 15% effective among all age groups.

This included effectiveness of about 27% in children aged two to 17, 12% among people in at-risk groups aged 18 to 64, and 10% in those aged 65 and over.

For this latest flu season, a new "booster" vaccine has been brought in to improve effectiveness among the over-65s.

'Super-Spreaders'

Dr Mary Ramsay, head of immunisation at PHE, said: "It is encouraging to see that this year's vaccines are offering a high level of protection against the main circulating strain of flu - particularly for children.

"Children tend to be 'super-spreaders' of flu and so protecting them is crucial for protecting the rest of the population.

"We're pleased that more parents have been taking up the offer of vaccination for their children and encourage anyone who is eligible to do so every winter.

"It's the best defence we have against this unpredictable virus."

Health Secretary Matt Hancock said: "The most basic instinct for any parent is to do whatever they can to protect their child. Vaccinations save countless lives and are absolutely vital.

"More children have been vaccinated this year to protect against flu and it is a positive sign that the vaccine itself appears to be more effective than in previous years.

"Our world-leading vaccination programme saves lives and I urge all parents of young children to make sure their child is vaccinated against flu and other childhood diseases."

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Provide Sanitary Products Free in All Hospitals, Says Doctors' Union

Two out of five hospital trusts and health boards in the UK do not give sanitary products to patients who need them, or only in emergencies, an investigation by the BMA has found.

The doctors' union says pads and tampons are a basic need and should be available free to inpatients.

But in some trusts, razors and shaving foam were handed out free while sanitary products were not.

The BMA has written to NHS England asking for action to be taken.

The BMA asked a total of 223 trusts and health boards across the UK about the policy towards supplying sanitary products.

Out of 187 who responded, 104 said they did supply them.

But 25 said they did not supply them at all and 54 said they did, but only in emergencies or in small amounts.

None of the trusts and health boards which responded said they had a policy on when sanitary products were handed out.

And at 27 trusts, there was nowhere to buy sanitary products anywhere on site.

The BMA's investigation is part of a wider campaign to end period poverty, which focuses on making sanitary items more affordable.

Eleanor Wilson, a member of the BMA medical students' committee, said: "When patients are under our care in the NHS, we need to make sure that we make them feel as welcome and as looked after as possible.

"By not providing them with something so key to their health and wellbeing, it has a big impact on their sense of self-worth - we are effectively withholding that dignity from them.

"While some hospitals have good provision, in others, patients have had to face embarrassment and hope that relatives can bring them in.

"For some that is not an option, and it can often become more challenging for young and teenage paediatric patients."

She said sanitary products should be part of a basic package including toilet paper, food, razors and shaving foam, made available to patients when they go into hospital.

Tackling Period Poverty

The BMA also says the impact on the wellbeing of a patient far outweighed the relatively small cost to the NHS.

Prof Dame Parveen Kumar, chair of the BMA board of science, said hospitals should provide clear information on how patients can access sanitary products during their stay in hospital.

"Hospitals have an opportunity to lead the way in tackling period poverty and should be a shining example of the progress that can be made on this important issue."

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More Over-75s Should Take Statins, Experts Say

More people over the age of 75 should be taking statins, scientists have said, following a review of research.

There had been a lack of evidence about how much the cholesterol-lowering drugs benefit this age group.

But the review found they cut the risk of major cardiovascular disease in all ages studied, including the over-75s.

Researchers said thousands of lives could be saved each year if more than the estimated third of UK over-75s who do take statins, were given them.

They also said it could improve quality of life for many people.

Cardiovascular disease kills about 150,000 people in the UK each year, with two-thirds of these occurring in people over the age of 75.

Statins reduce the build-up of fatty plaques that lead to blockages in blood vessels, though reported side effects and the extent of how often they are prescribed has attracted controversy.

Side Effects 'Massively Outweighed'

The review, which looked at 28 randomised controlled trials - often called the "gold standard" of studies - involving nearly 190,000 patients, found statins lowered the risk of major cardiovascular disease in the ages studied, from under-55s to over-75s.

There were similar reductions in risk for stroke and for coronary stenting or bypass surgery.

Authors of the paper said there had until now been an "evidence gap" around how effective the drugs are for the elderly.

They estimate that about a third of the 5.5 million people in the UK over 75 take a statin, when the "vast majority" of these would meet the medicine regulator's guidelines for being prescribed the drug.

Prof Colin Baigent, one of the authors of the paper, said: "One of the issues we have is that very often doctors are unwilling to consider statin therapy for elderly people simply because they're old, and that, I think, is an attitude that is preventing us from making use of the tools we have available to us."

The benefits were strongest in people who have already had vascular disease. There wasn't enough data in people over the age of 75 who haven't had it to show a benefit. Experts have called for more data to guide prescription for these people.

However, the authors said even a smaller reduction in risk was significant because the elderly have a higher baseline risk for cardiovascular disease in the first place.

The more people reduced their low-density lipoprotein (LDL), or "bad" cholesterol, the more the risk of cardiovascular disease was lowered, the study found.

A 1.0 mmol/L reduction in LDL cholesterol lowered the risk of major vascular events by about a fifth and a major coronary event by a quarter, when results from all age groups were combined.

To put this into perspective, about 2.5% of 63-year-olds with no history of vascular disease would be expected to have their first major vascular event per year, compared with 4% of 78-year-olds.

Reducing those risks by a fifth would prevent first major vascular events from occurring each year in 50 people aged 63 and 80 people aged 78 per 10,000 people treated.

Prof Baigent said there was an argument for giving statins to people over the age of 75 who have a "normal" level of LDL cholesterol.

He said: "In many circumstances, the person may be very healthy, they may be able to avoid having a stroke or having a heart attack simply by taking a cheap and safe tablet every day.

"That may be a choice they're willing to take. At the moment I feel we're not taking the opportunity to offer that."

'Reassuring'

There has been controversy about statin side effects and how often they are prescribed, especially in otherwise healthy people.

Common side effects include muscle pain, increased risk of type 2 diabetes and digestive problems.

It is possible to lower cholesterol levels without drugs by making lifestyle changes, such as by cutting down on saturated fat and eating more fruit, vegetables and fibre.

Prof Baigent said side effects were "massively outweighed, both in middle age and the elderly, by the benefits of statin therapy that we already know about".

And he also said he was not calling for people to pick statins over exercise and lifestyle changes.

"I think it's not an either/or," he added.

The Royal College of GPs welcomed the research and said it was "particularly reassuring" to see evidence of the benefit of statins in over-75s.

Prof Martin Marshall, vice-chairman of the college, said some patients would not want to be on long-term medication.

"But GPs are highly trained to prescribe and will only recommend the drugs if they think they will genuinely help the person sitting in front of them, based on their individual circumstances - and after a frank conversation about the potential risks and benefits."

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Health Screening 'Not Meeting Targets', Report Finds

None of the three main health screening programmes in England - for bowel, breast or cervical cancer - met their targets last year, according to a report by the National Audit Office.

There were also delays in cervical screening results reaching half of women tested, with a backlog of nearly 100,000 samples.

Bowel screening performed best, narrowly missing its 60% target.

A health think tank said the report was "deeply concerning".

But ministers said they were committed to making improvements to keep screening programmes "among the best in the world".

The NAO report comes after two recent incidents with breast and cervical screening raised concerns about about the management and organisation of both programmes.

Smear Result Delays

While bowel and breast screening met their minimum targets in 2017-18, neither met their upper target for the percentage of eligible people screened for signs of cancer.

However, with 72% of women eligible for cervical screening being tested last year, even the lower target of 75% was not met.

NHS screening programme Lower target for coverage Standard target for coverage

Percentage of eligible people screened in 2017-18

• Cervical screening 75% 80% 71.7%
• Breast screening 70% 80% 72.1%
• Bowel screening 55% 60% 59.6%

Many women also experienced delays getting their results after having smear tests, or cervical screening.

According to the Department of Health and Social Care, results should be received within 14 days, but this target has not been met since 2015.

In March 2018, a third of women received their results on time, improving to just over half (55%) by the end of last year.

But in October, 98,628 samples were still waiting to be tested in labs across England, the report said.

It is thought that a change in the way tests are carried out affected staffing in labs, leading to the delays.

The report also highlights variation in the percentage of people screened across the country, with the lowest levels of coverage mostly in London.

And it describes issues with complex, ageing IT systems, with the cervical screening programme relying on an estimated 350 different systems to make it work.

Complicated IT problems are reported to have resulted in 5,000 women not being invited for breast screening.

The report also raises questions about the way screening programmes are governed and monitored.

However, the report says NHS England and Public Health England have succeeded in introducing bowel scope screening, although only half of GP practices were linked to a screening centre delivering the service in 2016-17.

By September 2018, 166,000 people had been invited for this type of screening against a target of nearly 500,000.

'Unacceptable'

Rebecca Fisher, a GP and policy fellow at the Health Foundation, said the report painted "a deeply concerning picture of the state of screening programmes in England, with missed targets, inconsistent coverage, and ageing IT systems".

She said screening saved lives but the public must be able to trust the quality of the services being offered.

"Today's report highlights an urgent need for investment in the IT and equipment required to make improvements," she said.

"Policymakers must also consider how to most efficiently run screening programmes to ensure that these potentially lifesaving services are equally available right across the country."

Meg Hillier, chairwoman of the MPs' committee of public accounts, said: "Those responsible for screening programmes are not always capable of picking up when people are not invited for a screening appointment, or ensuring that people receive their test results on time.

"It is unacceptable that these important screening programmes are being let down by complex and ageing IT. The Department of Health and Social Care, NHS England and Public Health England need to get this fixed."

A Department of Health and Social Care spokesperson said: "Our screening programmes are widely recognised as among the best in the world, and we are committed to making any improvements needed to keep our offer to patients world-class.

"Prevention and early diagnosis of cancer are key priorities for this government, and we are already working closely with NHS England and Public Health England to address the issues this useful report highlights."

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