Aneurin Bevan Health Board. Screening Programmes

Transcription

1 Aneurin Bevan Health Board Screening Programmes 1 Introduction The purpose of this report is to inform Board Members of the screening services offered nationally by Screening Services, Public Health Wales NHS Trust and the uptake rates for residents of Aneurin Bevan Health Board area. Board members are asked to note the contents of the Report. Financial Assessment and link to Financial Recovery Plan Risk Assessment Annual Operating Framework Standards for Health Services Wales Equality Impact Assessment There are financial benefits for the Health Board in terms of earlier detection of disease and earlier treatment arising from screening programmes. These remain public health responsibilities of the Health Board irrespective of support from the delivery mechanisms outlined below. These priorities have to be balanced with other targets and objectives. It is important to maintain both the corporate and locality focus on the current performance. This paper is relevant to AOF 1 actions on Our Healthy Future : Health improvement in pregnant women and pre school children and Preventing growth in health inequities ; and also to AOF 20: Access to cancer services. It is also relevant to Standards for Health Services 3g Having effective programmes to screen and treat disease. Screening services may have low uptake in certain ethnic minority groups, persons with learning disabilities, socioeconomically deprived communities and other vulnerable groups. 1

2 2 Background Wales receives guidance and advice about all aspects of screening policy from the UK National Screening Committee. Using research evidence, pilot programmes and economic evaluation, the Committee assesses the evidence for programmes against a set of internationally recognised criteria covering the condition, the test, the treatment options and the effectiveness and acceptability of the screening programme. Screening is defined by the UK National Screening Committee as a process of identifying apparently healthy people who may be at increased risk of a disease or condition. They can then be offered information, further tests and appropriate treatment to reduce their risk and/or any complications arising from the disease or condition (National Screening Committee 2010). 3 Update on implementation of screening programmes Public Health Wales provides four national screening programmes within Wales: Newborn Hearing Screening Wales Breast Test Wales Cervical Screening Wales Bowel Cancer Wales. Antenatal Screening Wales is a managed clinical network, hosted by Public Health Wales, to promote improvements in the standard of antenatal screening in Wales. The antenatal screening tests are provided by Aneurin Bevan Health Board as part of local maternity services. Annual Reports are produced for the majority of the screening programmes. An update on each of the aforementioned screening programmes will be presented in turn below. The diabetic retinopathy screening programme is not administered by Public Health Wales. 2

3 3.1 Newborn Hearing Screening Wales Aneurin Bevan Health Board The aim of the Newborn Hearing Programme is to identify babies with hearing impairment which, without additional help and support, is of sufficient severity to cause or potentially cause a disability. This will enable the earlier provision of family friendly support services, which will help the child to develop better language and communication One or two babies in every 1000 are born with a hearing loss. Most of these babies will be born into families where no one else has a hearing loss. Early detection of hearing loss leads to improved outcomes in speech and language development and in the general well being of the child and family. Evidence shows that early fitting of hearing aids improves outcomes for deaf babies. Screening detects most but not all hearing loss and cannot prevent future hearing difficulties Target population The programme is offered to all newborn babies whose mother is resident in Wales. Most babies are tested in the first week of life. For babies born early, or who require admission to Special Care Baby Unit the test is conducted as soon as it is appropriate to do so Results Newborn Hearing Screening Wales has developed many standards against which the performance of the programme can be monitored. Standards relate to the screening process, hearing assessment of babies referred from the screen and the ongoing management (habilitation) of those babies found to have a hearing loss after assessment. The latest report provides data for the financial year April 2008 to March 2009, therefore, reporting on babies born between 1 st April 2008 and 31 st March 2009 (Newborn Hearing Programme 2009). The report reflects screening and assessment in the former NHS Trusts which became Health Boards in October Relevant points from the report for Aneurin Bevan Health Board are highlighted below; other neighbouring sites have also been included (Cardiff and Vale and Cwm Taf Health Boards) due to a number of babies from Gwent delivered at these sites. 3

4 Uptake of screening The screening programme has continued to perform to the highest standards. The coverage rates in Aneurin Bevan Health Board are excellent with screening being offered to 99.9% of eligible babies and 99.7% tested, with very few parents declining the screen. This is similar to the all Wales average. Assessment Following initial screening 1.3% of babies are referred for assessment in Aneurin Bevan Health Board area, which is in line with the Welsh average. 0.7% of babies referred for assessments are found to have normal hearing as a proportion of all babies screened; this is well within the 3% target and the same as the Welsh average. Referrals for assessment are higher in Cwm Taf and Cardiff and Vale University Health Board areas at 1.6% and 1.5% respectively. Following Assessment For the period 1 st April 2008 until 31 st March 2009, 1.3 per 1000 babies in Wales were identified with a permanent significant hearing loss in both ears. Babies are both diagnosed and fitted with hearing aids at a younger age than in previous years, showing the high standard of care provided to these babies and their families. This is shown in Table 1 below. The all Wales average age of confirmation of hearing loss was 9.9 weeks compared to 12.2 weeks in ; and compared with 22 months prior to the introduction of screening in Audiological confirmation was achieved in 96% of babies by the age of 6 months, which is an improvement since The mean age of a hearing aid being fitted was 12.4 weeks compared to 19.1 weeks in the previous year. 4

5 Table 1 Age of confirmation and age of hearing aid fitting Division Average age of confirmation of hearing loss Average age of confirmation of hearing loss Average age of hearing aid fitting (allowing for prematurity) Average age of hearing aid fitting (allowing for prematurity) North Wales 8.7 weeks 12.3 weeks 13.9 weeks 13.7 weeks Mid & West Wales 8.1 weeks 9.1 weeks 9.6 weeks 17.5 weeks South Wales 11.1 weeks 13.8 weeks 13.2 weeks 22.4 weeks Wales 9.9 weeks 12.2 weeks 12.4 weeks 19.1 weeks However, the standard to fit hearing aids within 4 weeks of diagnosis falls short of the target of >=99% (actual 76%) and has decreased since the previous year. Action plans for each Health Board area are being implemented and will be reported in Breast Test Wales The aim of breast screening is to reduce mortality from breast cancer through early detection of breast cancer. Breast cancer is the most common cancer amongst women in both Wales and the Aneurin Bevan Health Board area (WCISU 2010). Breast cancer affects one in nine women in Wales at some time in their lives. The risk of developing breast cancer increases with age. Breast cancer also accounts for the second most common cancer deaths amongst the locality s and Principality s female population (WCISU 2010). Breast screening involves taking x-rays (mammograms) of the breast in order to look for breast cancer before symptoms show. Over one in every three breast cancer cases are now diagnosed through screening Target population All women of 50 years of age and over are eligible for breast screening, however only women aged between 50 and 70 are invited automatically. The upper age range increased from 64 to 70 years in early Women over the age of 70 can self refer. 5

6 Screening is offered every three years, meaning that women may be 52 years of age by the time they receive their first appointment Results The latest Breast Test Wales results are for the period 1 st April 2008 to 31 st March 2009 (Breast Test Wales 2009a, 2009b). Two key programme measures to ensure that screening is effective are: i. Coverage: The proportion of eligible women in the population who are screened within the previous three years ii: Uptake: The proportion of invited women who attend their screening appointment in a given time period. Note: In breast screening, the eligible group (age 50-70) is not the same as the invited group. As women are invited every three years for screening, there are always women who have become eligible (i.e. reached aged 50) who have not yet been invited. The minimum standard set for maximising the number of eligible women who attend for screening is > 70%. The coverage achieved for all localities within Aneurin Bevan are above the Welsh average of 73.7% and the NHS Breast Screening Standards target of 70%, as shown in Table 2. Table 2 Coverage of breast screening within Aneurin Bevan area for the period 01/04/08 31/03/09, age Local Health Board Resident & eligible women Number screened within 3yrs of review period Coverage Blaenau Gwent % Caerphilly % Monmouthshire % Newport % Torfaen % Wales % Table 3 shows the uptake of screening which is the percentage of women invited for breast screening who are subsequently screened. The uptake results are an indication of overall acceptance of the screening programme. Uptake of screening 6

7 in Aneurin Bevan is amongst the highest in Wales and exceeds the minimum threshold of the NHS Breast Screening Standard of 70% or more. Table 3 Uptake of screening - percentage of invited women who attended screening Health Board Round 1 Round 2 Round 3 Round 4 Round 5 Abertawe Bro 76.5% 77.1% 77.1% 77.8% 77.3% Morgannwg University Aneurin Bevan 78.4% 78.5% 79.1% 78.2% 75.6% Betsi Cadwaladr 76.0% 75.2% 76.0% 75.2% 73.3% University Cardiff & Vale 68.8% 69.2% 72.5% 74.4% 74.2% University Cwm Taf 73.0% 74.9% 78.0% 77.4% 76.4% Hywel Dda 78.5% 78.8% 79.1% 78.7% 77.9% Powys 80.3% 80.0% 79.0% 79.3% 76.6% 3.3 Cervical screening programme The aim of cervical screening programme is to reduce the incidence of, and morbidity and mortality from, invasive cervical cancer. Overall, deaths from cervical cancer in Wales have slowly decreased from 107 deaths in 1992 to 60 deaths in 2006 (WCISU 2008). However, compared to the other three UK countries, Wales has the highest death rate for cervical cancer (Welsh Assembly Government 2010). Cervical screening is not a test for cancer. Cervical screening is a test to check the health of the cervix. Screening detects possible abnormalities, or changes in the cells, which may develop into cancer if they are not treated. Almost all abnormalities are successfully treated with regular cervical screening potentially preventing up to 90% of cancers from developing Target population In Wales, cervical screening is offered to all women aged years of age. Eligible women are routinely invited for screening every three years. 7

8 3.3.2 Results The latest annual report for the Cervical Screening Programme reports on the results for the financial year 1 st April 2008 to 31 st March 2009 (Cervical Screening Wales). The All Wales Cervical Screening Standards dictate that five year coverage of greater than 80% should be achieved for women aged between 25 and 64. The percentage tested within this age group within the last five years, in Wales, reached 75.5%. Table 4 Percentage of target age group (20-64 years) screened within the last 3 and 5 years: 2008/09 Local Health Board Last 3 years Last 5 years Blaenau Gwent 68.7% 77.7% Caerphilly 67.0% 77.3% Monmouthshire 71.2% 80.5% Newport 66.6% 76.1% Torfaen 68.1% 77.9% Wales 65.5% 75.5% Across Wales, 1.6% of tests submitted to the pathology laboratory in 2008/09 for analysis were reported as inadequate samples with wide variation between laboratories, ranging from 1.2% to 3.4%. The percentage of inadequate test was reported as 1.6% by the Royal Gwent laboratory which is in line with the Welsh average. However, a number of pathology laboratories may serve the Gwent community. In addition to the Royal Gwent, Prince Charles and Shrewsbury laboratories have the potential to analyse samples from the Aneurin Bevan Health Board area and reported results of 1.8% and 1.3% respectively. Table 5 presents the test results for women aged for the period 1 st April 2008 to 31 st March Of the total adequate samples analysed, 92.3% of tests were reported as negative across Wales. Locally, negative results were higher than the Welsh average, ranging from 92.6% in Caerphilly to 94.5% in Monmouthshire. In general, test results for the Local Health Board areas within Aneurin Bevan were similar to the rates reported for all 8

9 Wales. However, the percentage of women with moderate dyskaryosis result was slightly higher than the all Wales average for the Local Health Board areas of Blaenau Gwent, Caerphilly, Newport and Torfaen. Table 5 Percentage and number of test results of women aged 20-64, 2008/09 Local Health Board Negative (number) Borderline (number) Mild dyskaryosis (number) Moderate dyskaryosis (number) Positive* (number) Blaenau Gwent 92.9% (5,322) 3.2% (185) 2.0% (112) 0.9% (50) 1.0% (57) Caerphilly 92.6% (13,271) 3.3% (470) 2.3% (334) 0.9% (128) 0.9% (134) Monmouthshire 94.5% (6,325) 2.6% (177) 1.6% (106) 0.6% (40) 0.7% (46) Newport 92.9% (10,094) 3.2% (345) 2.2% (244) 0.8% (92) 0.8% (90) Torfaen 93.1% (6,739) 3.7% (266) 1.8% (131) 0.7% (53) 0.6% (46) Wales 92.3% (217,735) 4.0% (9,405) 2.2% (5,281) 0.6% (1,520) 0.9% (2,062) * Positive includes results reported as severe dyskaryosis and possible carcinoma, or glandular neoplasia In September 2008, the Human Papillomavirus (HPV) vaccination was introduced into the routine childhood immunisation schedule, to protect girls and young women against the two most common types of virus that can lead to cervical cancer. It is expected that having the vaccine will reduce the risk of developing cervical cancer by up to 70%. 3.4 Bowel Cancer Screening The Bowel Cancer Screening programme s aim is to reduce the number of people dying from bowel cancer in Wales by 15% by The Welsh screening programme for bowel cancer was launched in October 2008, along with an awareness raising 9

10 campaign based on the strap line Don t die of embarrassment. Colorectal cancer is the third most common cancer in Wales with over 2000 new cases diagnosed each year and approximately 1000 deaths per year (WCISU 2010). The lifetime risk of being diagnosed with bowel cancer is around 1 in 20 for women and 1 in 18 for men. If bowel cancer is picked up early enough, it is more likely that the disease will be treated successfully. Evidence has shown that population screening of people over the age of 50 for non-visible (occult) blood in the faeces and further assessment by colonoscopy can reduce the risk of dying from bowel cancer by 15% Target population All men and women resident in Wales are eligible for bowel screening when they reach 50 years of age. Screening will then be offered every two years until they reach 74 years. The programme is being introduced in a phased manner, initially; people aged between year olds will be invited to take part. By 2015, the programme will be extended to invite everyone aged between 50 and 74 for screening. The test consists of a home testing kit and supporting information being sent out to all eligible individuals. Completed test kits are returned by post to a national laboratory for analysis. Participants receive their results, via a letter, within two weeks. Follow-up for an individual according to their test result is outlined below: Result Negative Weak positive/ Unclear Outcome for participants Return to recall for another test in 24 months Sent another test kit (immunochemical test) to establish referral. If this test is negative they return to routine recall. If positive, referred to Specialist Screening Practitioner. Positive FOB Referred to Specialist Screening Practitioner for assessment for further investigation e.g. colonoscopy FOB = Faecal occult blood A national free phone helpline has been set up in support of the programme. Specialist Screening Practitioners have been employed to support participants through the screening journey. 10

11 Results An uptake of at least 60% is required to achieve the aim of the programme. Uptake results for the first year of the programme are not yet available. 3.5 Antenatal Screening Wales Antenatal Screening Wales is a managed clinical network, hosted by Public Health Wales, to promote improvements in the standard of antenatal screening in Wales. Antenatal screening is offered and provided as part of maternity care. Screening tests can help to detect some of the conditions that may affect either mother or baby. If a screening test shows that there is a higher chance of having a certain condition, a diagnostic test will be offered. For some conditions, specific management is available during the antenatal period or after delivery to improve the baby s health or delivery in a tertiary centre may be beneficial. For others the condition can be identified during the antenatal period but no treatment is available. With high quality counselling women can then make an informed choice about whether they wish to continue the pregnancy. Screening tests offered include: Early pregnancy ultrasound scan; Screening for HIV Screening for hepatitis B Screening for syphilis Screening for rubella Screening for blood group and antibodies Screening for sickle cell and thalassaemia Screening for Down s syndrome Fetal anomaly ultrasound scan Target population All pregnant women in Wales have the opportunity to have a number of screening tests using blood tests and ultrasound, within a very short time frame, as part of their antenatal care. 11

12 Pregnant women can choose whether or not to have some or all of the tests Results Revised and updated all Wales policies and standards for antenatal screening were recently updated and published, in May 2010, by the Antenatal Screening Wales. Following the publication of the initial standards and protocols in 2005, all Health Board in Wales have adopted the same policies, standards and protocols for antenatal screening and antenatal screening services have improved for pregnant women. Table 6 shows the uptake of antenatal screening tests for Aneurin Bevan area for the period 1 st January 2009 to 31 st December In general, the uptake of antenatal ultrasound in Wales is considered to be around 100% and, therefore, not a useful discriminator when looking at local needs. In addition, the figures relating to the uptake of Down s syndrome screening are confounded by the provision of private screening tests. The uptake of the screening tests offered is generally in line or above the all Wales rate. The overall uptake of HIV testing in Aneurin Bevan Health Board is one of the highest in Wales, however the uptake at Caerphilly Birth Centre is significantly lower than in other parts of the Health Board (but still higher than in a number of sites across Wales). The uptake of sickle cell and thalassaemia screening also varies across the maternity departments and, apart from the Royal Gwent Hospital, is lower than the all Wales rate. This test is selectively offered depending on ethnicity. Table 6 Uptake of antenatal screening tests: 2009 (The test uptake rates are calculated using number of rubella tests as the denominator. However, this is not an accurate denominator as it is assumed that nearly all women will have this test and it does not include women who opt for private testing). 1 Data supplied by Antenatal Screening Wales 12

13 % HIV % Syphilis % Hepatitis B % Sickle cell and thalassaemia % Down s syndrome screening Caerphilly Birth Centre Aneurin Bevan Health Board Neville Hall Hospital Royal Gwent Hospital Aneurin Bevan Health Board All Wales Rate 90% 99.5% 99% 97% 93.5% 100% 99.8% 100% 99.9% 97% 100% 99.9% 99.7% 99.9% 97% 3% 5% 18% 10% 16% 61% 62% 47% 55% 56% % Amniocentesis and Chorionic Villus Sampling* 0 5% 5% 3% 3.1% * Amniocentesis and Chorionic Villus Sampling are diagnostic tests and only offered if the result of a screening test identifies a problem. 4 Recommendation The Board is asked to note the contents of this report. Sponsored by: Dr Gill Richardson Director of Public Health Authors: Mererid Bowley Locum Consultant in Public Health Anna Morgan Health Promotion Officer (Health Protection) Contributor: Gareth Holyfield Principal Pharmacist in Public Health Date: 7 th September 2010 References: Breast Test Wales (2009a) Report: Local Health Board Coverage. KC /09. Accessed at: Breast Test Wales (2009b) Report: Local Health Board Uptake for the first five rounds of screening. Accessed at: 13

14 Cervical Screening Wales (2009) Cervical Screening Programme Wales 2008/09. KC53/61/65 Statistical Report 2008/09. Accessed at: Newborn Hearing Screening Wales (2009) Report of the Associate Director Accessed at: National Screening Committee (2010) Accessed at: Welsh Assembly Government (2010) Health Statistics Wales Welsh Assembly Government, Cardiff. Accessed at: WCISU (2008) Cancer in Wales : A comprehensive Report. Welsh Cancer Intelligence and Surveillance Unit, Cardiff. Accessed at: 08%5FEnglish.pdf WCISU (2010) Fact sheets for Health Boards in Wales. Welsh Cancer Intelligence and Surveillance Unit, Cardiff. Accessed at: df 14