Screening for Colorectal Cancer: Se0ng it up and making it work. Julie8a Patnick 4 December 2014
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1 Screening for Colorectal Cancer: Se0ng it up and making it work Julie8a Patnick 4 December 2014
2 Evaluation of the UK Colorectal Cancer Screening Pilot Two sites, population ~ 1m Coventry & Warwickshire Grampian, Tayside & Fife One UK screening round & evaluation nd incident round in England for people only & evaluation 3 rd bridging round in England before national programme began Nottingham RCT as benchmark UK Colorectal Cancer Screening Pilot Group Results of the first round of a demonstraaon pilot of screening for colorectal cancer in the United Kingdom BMJ 2004;329:133 5 Weller D, Coleman D, Robertson R, Butler P, Melia J, Campbell C, Parker R, Patnick J, Moss S. The UK colorectal cancer screening pilot: results of the second round of screening in England. Br J Cancer Dec 17;97(12):
3 Acceptance by Age and Sex 70.00% 60.00% 50.00% 40.00% 30.00% Male Female 20.00% 10.00% 0.00% < >65 England 58.6% vs Scotland 55.4% Male 52.1% vs Female 61.4%
4 Acceptance by Social Class 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% 1/ /7 Deprivation Index
5 Policy decisions year olds would be invited: group with highest uptake Guaiac FOBt would be offered (as per the trials) every two years Limited age range would not overburden services and would leave opaons open for later service development Surveillance of screen detected polyps would be part of programme
6 4.64 A new screening programme for bowel cancer will be rolled out from April This will be one of the first national bowel screening programmes in the world and will be the first cancer screening programme in this country to include men as well as women. When fully operational, around 2 million people each year will be sent a self-sampling kit to use in the privacy of their own homes. The kit is then returned by post to a regional laboratory. A pilot in the West Midlands has run very successfully for several years.
7 Political announcements In August 2005, in a Ministerial press release the DH announced that from April 2006 we will invite men and women aged to paracipate in the screening programme. The funding for 2006/7 and 2007/8 was also re- announced.
8 The Observer Sunday 11 December 2005
9 What preparaaons were made? Ministerial decisions Training bo8leneck IT systems Infrastructure in hospitals IntegraAon and flow through from screening to treatment A Commitment to Quality
10 PROPOSED ORGANISATION HUB HUB HUB HUB HUB Overarching Structure: 5 Programme Hubs across England, based on IT Local Service Providers (LSP) undertaking call/recall and lab funcaons 1 Programme Hub per LSP Each Programme Hub will have a number of Screening Centres
11 REENING CENTRES: LINKS Colonoscopy site Programme Hub PCT PCT Screening Centre PCT Colonoscopy site PCT
12 Training bo8leneck 10 endoscopy training schools funded for 3 years Development of nurse endoscopists Development of endoscopy technicians: more controversial
13 IT system NaAonal database of eligible populaaon Web access for all units (secure) Kit despatch, receipt and reporang managed through hubs Booking of nurse clinics managed through hubs Helplines provided through hub Local systems for colonoscopy NaAonal reporang and monitoring
14 Four levels of staasacal reporang Overall populaaon reports Professional quality reports OperaAonal reports Ad hoc reports (downloads to excel/access etc)
15 Monitoring by Hub and Centre Analysed by hub No. Days from positive result to first offered nurse appointment Polyps removed (number and percentage) Cancers detected (number and percentage) Analysed by screening centre Number of patients attending a positive test kit nurse clinic appointment Fail to Attend nurse clinic Number of patients attended at a colonoscopy or other test Fail to attend colonoscopy No Days from nurse clinic to colonoscopy Other test (imaging) Polyps removed (number and percentage) Cancers detected (number and percentage)
16 What did people worry about? Prevalent round peak in incidence Workload for endoscopy units, pathologists and cancer teams Missed cancers Deaths in healthy people PoliAcs and publicity
17 So what happened? 2006: first centre opened 2008: early implementer of screening (4 year plan for each centre) January 2010: last centre opened to screen January 2010: general roll out began of screening March 2013 flexisig screening 6 month pilot began January 2015: final centre should expand to screen 60-74!
18 Thank you for listening Follow us on ProtecDng and improving the nadon s health
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