Sian Taylor-Phillips is Professor of Population Health at Warwick Medical School, University of Warwick, specialising in evaluation of medical tests and screening programmes. She leads Warwick Screening, a team of researchers which synthesises evidence for national policy-makers, and undertakes primary research across several screening programmes. She also has a particular interest in evaluating the benefits and harms of different versions of breast cancer screening and holds several grants in this area.

Professor Taylor-Phillips is one of six research leaders who received a prestigious NIHR Research Professorship in 2023, a scheme which funds researchers to promote the effective translation of research and aims to strengthen research leadership at the highest academic levels.

In addition, Professor Taylor-Phillips is a member of the UK National Screening Committee, and provides expertise to help shape the committee’s recommendations to government.

Tell us about your role with the UK National Screening Committee...

As a member of the UK National Screening Committee, we provide expertise to help shape the committee’s recommendations to government, but for the last year I have also chaired their Research and Methodology Group, and the remit of that group is really exciting. We advise on how the committee can synthesise evidence, so for instance, researchers come to us and say they would like to do a big trial in screening, and we give them feedback on how they can make it more useful to national policy makers, which is something we would really like to do at Warwick, on a slightly smaller scale. I currently develop the methods the Warwick Evidence Team use for evaluation of tests and have advised on that for the last 10 years or so.

You were recently awarded a very prestigious £1.8M NIHR Professorship. Can you tell us more about this?

The funding from NIHR will allow us to comprehensively research how decisions are being made on which screening programmes to roll out, both in the UK and worldwide, with the aim of helping governments make better decisions about which screening programmes to run, to understand how we can best collect and use routinely collected data about people who attend screening, and to prevent the large research waste of policy makers and scientists from different countries repeating the same evidence reviews on the same topics.

The team are already leading research into breast cancer screening, using routine data to look at the benefits and harms of different versions of breast screening, but this funding allows the extension of this work to ultimately produce an exemplar review of breast screening.

Our research focuses on evaluating health screening for a variety of conditions, with a particular focus on breast cancer screening. To give an idea of our research, we recently had a paper accepted in the BMJ that summarises our analysis of data on atypia (abnormal cells) diagnosed through screening. Currently if atypia is detected at screening women are then screened every year for five years. Our analysis showed no benefit from these invasive annual mammogram tests and, rather, demonstrated that the short-term risks are the same as any other woman. We hope that this research will lead to national recommendations being changed and allow doctors to reassure patients that there is no further short term risk. Not only will this benefit the NHS, but it will change the national narrative and reduce anxiety in patients who are detected.

This award will drive national policy for medical screening tests in the UK, which can potentially detect disorders or diseases in people who don’t have any symptoms. Tests can be offered to millions of people worldwide, ranging from adult cancer screening to rare disease screening in newborn babies.

I am also currently providing expertise on test accuracy on the LiSENUS project, led by Imperial College. This project aims to develop an ultrasound system that could replace armpit surgery as a test to find if cancer has spread to the lymph nodes. This could prevent surgery, and related complications such as lymphedema, in women with breast cancer. We are working with developers on this test and whilst it’s still at the first stage, it’s a perfect example of how test developers can work with the team.

Another high-profile piece of research we are currently undertaking is the SUMS project, funded by Cancer Research UK. The SUMS study will review the literature on cancer screening trials which have looked at death rates for specific cancers. These trials cost a lot and take a very long time. We will look for outcomes that predict future cancer death but can be assessed earlier. These are known as surrogate endpoints. Our aim is to assess how well each of these surrogate endpoints can predict cancer death. These findings will help inform the design of future trials. For trials already underway, this information will help us decide which trials should continue or stop early. It will also help determine whether screening is likely to significantly reduce cancer deaths.

An exciting area of research on the horizon is ‘Whole Genome Sequencing’ (WGS) which presents a novel challenge for policy makers. We are leading a methods review for the UK National Screening Committee (NSC) which will influence how policy makers approach this. The aim is to explore approaches in how the benefits and harms of WGS for 200+ rare diseases in newborn screening can be evaluated as it does not fit the traditional ‘one condition – one test’ situation. The NSC is keen to identify an approach they can use once WGS is being put forward as a suggestion for a new screening programme. We are undertaking five reviews of five rare genetic child-onset diseases, a review of WGS in newborn screening not specifying any conditions, an update of a review on the HE of WGS and exploring the usefulness of the online resource ClinGen.

Can you tell us about previous research and its direct impact on health screening policy?

Beyond breast cancer screening, we have carried out evidence reviews for the UK NSC across a wide range of topics. Recent reviews include evaluating the evidence for offering pregnant women non-invasive prenatal testing (NIPT) for trisomies – with the aim of avoiding having to carry out amniocentesis, which can cause miscarriage. After reviewing the evidence, the team concluded that NIPT using cell-free foetal DNA has very high sensitivity and specificity for Down syndrome, with slightly lower sensitivity for Edwards and Patau syndrome. However, it is not 100% accurate and should not be used as a final diagnosis for positive cases – read the paper here. 

We also recently carried out further modelling into newborn screening for tyrosinemia type 1. This is an autosomal recessive disorder of amino acid metabolism. Without treatment, death in childhood is common. Treatment with nitisinone and dietary restrictions are associated with improved outcomes; some studies suggest better outcomes when treatment begins at an asymptomatic stage. Newborn screening allows for earlier identification, and our latest review led to a change in recommendation. Screening for this condition is now recommended by the UK NSC. You can read the recommendations here.

Beyond the UK, in 2020, our team worked on a US preventative services task force review of screening for pre-diabetes and type two diabetes (asking if there is evidence that screening improves health outcomes). This was used to set diabetes screening policy for five years in the USA; changing what was offered for approximately 50 million people. We recently carried out an update of this review for the World Health Organisation, the results from which were shared at the Global Diabetes Summit in November 2023. You can read the paper here.

More information about Professor Sian-Taylor Phillips and her work can be found here and you can find out more about Warwick Screening here. Please feel free to contact the Warwick Screening Team if you have any questions.