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• Launch of NZ’s First Digital Mobile Breast Screening Unit

  

  New Zealand’s first digital mobile breast screening unit was launched at Waitemata District Health Board on 18 December, 2009.

  Commissioned by BreastScreen Waitemata Northland, the unit brings together the latest in digital x-ray, truck-building, and satellite technology. It has two change areas, a reception area, a private waiting area and a screening area. The unit will replace the existing, five-year-old analogue facility with its one change area. The new unit hit the road in January 2010 and will operate from Te Kao in the Far North to New Lynn in West Auckland.

  The unit’s increased capacity will enable the number of ‘mobile mammograms’ performed each week in Northland and Waitemata to grow from 100 to around 140.

  The move from analogue to digital technology will also play a big part in streamlining the process for women. The previous unit used x-ray film and there is a delay between the time when a woman has her mammogram and when the film is developed. If there’s a problem with the image quality, like blurring, women need to be recalled for repeat films. But with digital, the image is captured and checked instantly on screen before the woman leaves the unit.

  With the combination of new digital equipment and satellite technology in the unit, images can be ‘beamed’ back to base for a radiologist to interpret, removing the need to develop and transport mammograms taken on x-ray film. Images will still be interpreted within the usual two-week timeframe.

  The new unit can be staffed by two radiographers and will spend up to eight weeks in one place, while its extra capacity will enable visits to more locations than the existing unit can achieve during its two-year circuit.

  BreastScreen Waitemata Northland wishes to thank Waitemata DHB for its support in fully funding New Zealand's first digital mobile unit to deliver the BreastScreen Aotearoa programme.

  Image from left to right: Roslyne Bowring, Breast Screen Coordinator Te Ha O Te Oranga O Ngati Whatua (ISP); Pam Monk, BSWN Mobile Clinic Bookings Clerk; Scott McWilliams, BSWN Data Manager; Faye Price, Breastscreening Kaimahi, Te Hauora O Te Hiku O te Ika (ISP); Brendawyn Leeves, BSWN Lead MRT; Lingi Pulesea, BreastScreen Coordinator West Fono.

• Introduction of quality improvements in screening for Down syndrome and other conditions

  

  We are pleased to introduce the next stage of the quality improvements in screening for Down syndrome and other conditions. We are also pleased to announce that LabPlus with the support of Canterbury Health Laboratories will be providing laboratory services for the new screening options. 

  The choices are:

  1. First trimester combined screening.

  Two components are combined with maternal information provided on the laboratory form to give one screening result:

  • First Trimester Maternal Serum screening - a blood test carried out between 9 and 13 weeks and 6 days gestation. This is available fully funded and includes two analytes:
    • Beta Human Chorionic Gonadotropin (β-HCG)
    • pregnancy-associated plasma protein A (PAPP-A). 
  • Nuchal Translucency scan – an ultrasound scan carried out between 11 and 13 weeks and 6 days gestation. Available from ultrasound providers eligible to claim through the section 88 maternity notice. (Please note that part charges for ultrasound scans will still be required.)

  2. Second Trimester Maternal Serum screening. 

  Available between 14 and 20 weeks’ gestation and now includes four analytes:

  • Beta Human Chorionic Gonadotropin (β-HCG)
  • Alpha Fetoprotein (AFP)
  • Unconjugated oestriol (µE3)
  • Inhibin-A.

  Results are combined with maternal information provided on the laboratory form to give a screening result. This option is fully funded.

  All pregnant women presenting for maternity care prior to 20 weeks’ gestation should be offered access to antenatal screening for Down syndrome and other conditions. Their participation however is a personal choice and this choice must be respected. 

  To accompany the introduction of these screening options the NSU has developed and distributed Guidelines for maternity providers offering antenatal screening for Down syndrome in New Zealand and a supporting laminated summary sheet. These are intended to encourage consistency of messages so women are given appropriate information about screening to allow them to make an informed decision about participation.

  Also developed to support practitioner discussion with women are consumer pamphlets about both of the above screening options along with information about understanding an increased risk result. An antenatal and newborn screening time-line poster identifying available screening options and ideal times for screening has been produced.

  On-line practitioner education modules about screening and the quality improvements, along with the other antenatal and newborn screening programmes, are now available from: www.learnonline.health.nz or via the NSU website.  Completion of these will assist practitioners to support offers of screening with appropriate information.

  For more information about this quality improvement initiative or any of these resources go to the health professional section of this website.
  

• All antenatal and newborn education modules now available

  

  Training modules for the Antenatal HIV Screening Programme, the Universal Newborn Hearing Screening and Early Intervention Programme, the Newborn Metabolic Screening Programme and the Quality Improvements in Antenatal Screening for Down syndrome and Other Conditions are now available from: www.learnonline.health.nz.

  These resources are for service providers within the antenatal and newborn screening initiatives managed by the National Screening Unit (NSU). They contain the background education and programme information about screening that health practitioners are required to provide to women, their partners, family and whānau during pregnancy and in the early postpartum period.
  

• Guidelines for practitioners providing services within the Newborn Metabolic Screening Programme

  Guidelines for the Newborn Metabolic Screening Programme (NMSP) have now been developed and will be distributed in the next month to midwives, lead maternity carers, general practitioners, obstetricians and gynaecologists, District Health Boards (DHBs) and other interested parties.

  The guidelines include:

  • key programme messages
  • details of what the programme is about
  • informed consent requirements
  • appropriate sampling practice
  • results reporting
  • storage and use of blood spot cards
  • details about the disorders.

  Key Programme Messages

  • The success of the NMSP depends on the diligence and dedication of many health professionals, and Lead Maternity Carers (LMCs) in particular. Their input is integral to the continuation of a high-quality screening programme.
  • Many of the disorders the NMSP screens for can lead to serious illness or mortality within seven to ten days. Samples must be taken at 48 hours after birth or as soon as possible after this to prevent irreversible damage and life-threatening illnesses.
  • LMCs are responsible for the newborn metabolic screening process, including giving information and advice, offering screening, ensuring informed consent, documenting the process, taking a suitable sample and following up results.
  • Appropriate information about the NMSP must be given to parents/guardians during pregnancy.
  • Clear documentation of the screening process must be kept, including consents, declines, and sample information.
  • Samples must be taken at 48 hours after birth or as soon as possible after this.
  • Samples must be suitable for testing.
  • Samples must be sent to the laboratory as soon as they are dry.
  • Requests for repeat samples must be acted on urgently.
  • If there are clinical concerns about a baby, the baby must be referred to diagnostic and treatment services without waiting for screening results.
  • LMCs must reconcile laboratory reports with samples they have sent for testing, and clarify any discrepancies with the laboratory.
  • If a baby receives a positive screening result, LMCs must take further action, according to the advice of laboratory staff.
  • Parents/guardians can request that residual blood spots be returned after screening.

  Other programme resources include an online education module: www.learnonline.health.nz and programme DVDs which can be viewed or hard copies ordered from: www.nsu.govt.nz

• Universal Newborn Hearing Screening and Early Intervention Programme

  

  Workforce development for audiologists within the Universal Newborn Hearing Screening and Early Intervention Programme (UNHSEIP) will begin soon, as implementation continues across the District Health Boards. 

  We are pleased to announce that the University of Canterbury, Department of Communication Disorders will upskill audiologists working within the UNHSEIP. After consultation with national and international experts, the University of Canterbury has developed a three-phase upskilling programme.

  The first phase will involve on-line upskilling for audiologists that will include the latest literature, outcomes, and issues experienced by a variety of newborn hearing screening programmes from around the world, including those in Canada and Australia. 

  In the second phase, the university will host two international experts in diagnostics and rehabilitation for newborns. They will present two-day workshops in main centres in New Zealand. Discussions are underway with Professor Gary Rance in Australia (University of Melbourne) and Dr Marlene Bagatto in Canada (University of Western Ontario). The final phase will be regional follow-up workshops involving on-line discussions with the same experts.

  The first, on-line phase is expected to begin in late March with the workshops being conducted in early May. Newborn hearing screening is now offered by Waikato, Hawke’s Bay, Tairawhiti, Lakes, Bay of Plenty, Taranaki, Capital and Coast, Hutt Valley, South Canterbury and Canterbury, West Coast and Whanganui DHBs.

  Northland, Waitemata, Auckland, Counties Manukau, MidCentral, Wairarapa, Nelson Marlborough, Otago and Southland DHBs roll out their programmes between February and April 2010.
  

• Universal Offer Antenatal HIV Screening Programme

  

  Early identification and appropriate treatment of HIV in pregnancy can reduce the risk of perinatal transmission from as much as 31.5 percent to less than 1 percent. Screening should be offered to all women with their first antenatal blood screen.

  The Universal Offer Antenatal HIV Screening Programme (AHIV Programme) has been progressively implemented throughout the country since March 2006. 

  The NSU supported by the National AHIV Screening Implementation Advisory Group, has developed implementation guidelines, practice guidelines and policy and quality standards and also provided support and education to the DHB-employed regional AHIV coordinators to assist them to manage the implementation of the programme.

  Although we require all women to be offered screening and recommend that they accept that offer, all women have a choice about participation in any screening programme. Women must be given sufficient information to enable them to make the best choice.

  The AHIV test should be offered along with the other tests included in the routine first antenatal blood screen and women must consent to each of the tests. The Guidelines for health practitioners offering antenatal HIV screening in New Zealand and laminated summary sheet are designed to ensure practitioners have correct and consistent information to give to women. An education module for antenatal HIV screening is also available from: www.learnonline.health.nz and is endorsed for professional development/education points by the Royal New Zealand College of General Practitioners and the Midwifery Council of New Zealand.

  Consumer resources to support the practitioner discussion have also been published and include pamphlets about the AHIV Programme and a tear-off information sheet about all the first antenatal bloods including AHIV. The AHIV pamphlets are available from the NSU website or from: www.healthed.govt.nz. GPs can get the tear-off first trimester blood information sheet from CMP-Medica and midwives can get them from their local DHB AHIV coordinator.

• Benefits and risks of screening

  

  Screening programmes detect some conditions, reduce an individual’s chance of developing or dying from some conditions, and can improve a person’s quality of life. In some cases (for example, breast screening) screening may detect cancer at an early stage. In others (such as newborn metabolic screening) screening may find conditions which can be treated before the baby develops a preventable illness or disability.

  For example:

  • regular breast screening reduces your chances of dying from breast cancer by about 30 percent if you are between 50 and 65, and by about 45 percent if you are between 65 to 69
  • regular cervical screening reduces your chances of developing cervical cancer by about 90 percent
  • newborn hearing screening picks up hearing loss in babies and young children at an early stage. This means help such as resources, parent support groups, hearing aids, cochlear implants and the introduction of sign language can be offered as soon as possible
  • screening pregnant women to see if they have HIV and offering treatment will reduce the number of babies born with HIV from as much as 32 percent to less than 1 percent
  • newborn metabolic screening enables certain conditions that can be harmful to babies to be diagnosed and treated early, reducing illness and sometimes death.

  However, all screening has the potential to cause harm. Screening tests carry a risk of false results.

  A false negative result is when a person who does have the condition is put into the group of people who have a lower chance of having the condition. False negatives can provide false reassurance.

  A false positive is when a person who does not have the condition is put into the group of people who have an increased chance of having the condition. False positives can result in increased anxiety and referral to diagnostic tests.

  There is ongoing debate, both in New Zealand and overseas, about whether screening should be offered for some cancers. There is evidence that the risks of screening for some cancers may outweigh the benefits.

  For example, through screening a person may find out that they have a certain condition, and get treatment. However, the condition may not be harmful, and they will have gone through unpleasant treatment for no reason. In this case, it may have been better never to have known they had the condition. Or if the condition is harmful, there may be no effective treatment for it. In this case they will not live longer because the condition was found, they will just know for longer that they have the condition.

  It is vitally important that all who choose to participate in screening are aware of both the benefits and risks of screening. The NSU has developed a number of resources for women and practitioners that clearly state the benefits and risks of screening. These resources can be ordered from www.healthed.govt.nz and are also available from this website.