The UK National Screening Committee needs clear, unbiased evidence to decide whether screening programmes like those for cancer or heart disease do more good than harm—and the Bristol Evidence Synthesis for Screening (BESS) Group will produce that evidence. Screening can save lives by catching disease early, but it also carries risks: false alarms, unnecessary treatments, and costs to the health service. The UK NSC must weigh these trade-offs for each potential programme, from newborn blood spot tests to prostate cancer checks. Currently, the evidence base is patchy, and decisions can stall without rigorous, up-to-date reviews. BESS fills this gap by delivering between 3 and 10 evidence synthesis reports each year, including systematic reviews, cost-effectiveness models, and evidence maps. If successful, BESS will give the UK NSC the tools to make faster, more confident recommendations. This could mean fewer harmful screening programmes are introduced, and more beneficial ones are rolled out sooner. The group also trains staff in fast-moving methods, ensuring the UK’s screening decisions stay grounded in the best available science—quietly improving a system most people only think about when they receive a letter inviting them for a test.
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BACKGROUND Screening programs have potential to benefit populations but also carry risks. To evaluate whether a particular screening programme ultimately does “more good than harm at reasonable cost”, it is critical that relevant evidence is robustly evaluated. The University of Bristol (UoB) is an ideal host for a Specialist Evidence Synthesis Group (ESG) to carry out priority evidence synthesis to support the UK National Screening Committee (UK NSC). As a leading evidence synthesis group in the UK and internationally, UoB hosts one of the existing ESGs and the Bristol Technology Appraisal Group, in addition to a wealth of other NIHR infrastructure and staff working on evidence synthesis projects and methods. Our proposed Bristol Evidence Synthesis for Screening (BESS) Group includes: internationally recognised experts in evidence synthesis methodology and cost effectiveness modelling; practitioners experienced in screening delivery; academic clinicians; and two patient co-applicants. AIMS AND OBJECTIVES The BESS group aims to provide rigorous, balanced and timely reviews and reports to support the UK NSC’s decision-making process. We will: • Deliver between 3 and 10 evidence synthesis reports per year, according to the needs of the UK NSC • Produce high quality, clearly written reports on a range of evidence products used currently within the UK NSC’s decision-making framework (see Methods) • Work with the UK NSC secretariat to develop methods to meet the UK NSC needs and take account of emerging technologies • Embed PPIE across all our work • Respond flexibly to requests from the NIHR Evidence Synthesis Programme to contribute to projects within their general portfolio • Provide training and develop capacity to ensure BESS Group staff keep their skills up to date in the fast-moving fields of evidence synthesis methodology, screening and test evaluation and provide opportunities to support staff development. METHODS Using our substantial expertise in screening, evidence synthesis, modelling and test evaluation, we will produce the following reports: • Evidence maps to provide an evaluation of the volume and type of evidence on a particular screening topic, to help inform the NSC on whether there is sufficient new evidence to justify further assessment. • Evidence summaries to provide a balanced summary of the evidence on the quantity, quality, applicability and consistency of the evidence to inform NSC discussions and recommendations. • Rigorous systematic reviews to inform NSC discussions and recommendations on potential screening strategies. • Comprehensive cost effectiveness and clinical effectiveness models to assess the clinical and cost-effectiveness of potential screening strategies. The Research Oversight Group, which includes our two public co-applicants, will discuss each project, the staff required to work on the project, clinical expertise needed, whether any additional methodological expertise would be beneficial, and how to optimise patient involvement. IMPACT AND DISSEMINATION Our reports will provide clear, evidence-based summaries to assist the NSC in making recommendations. Where findings are of interest to a wider audience, we will publish in peer reviewed journals and present at relevant conferences. With our public co-applicants, we will explore innovative methods of communicating findings and the complexities of screening programmes to a lay audience.
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