Breast Screening Data Stephen Scott Head of Informatics LCA

Transcription

1 Breast Screening Data Stephen Scott Head of Informatics LCA

2 The London Cancer Alliance Overview 62 day screening to 1 st treatment performance Key surgical measures monitored by LCA Screening coverage Overview of Breast Cancer incidence and mortality rates Breast Cancer Routes to Diagnosis (PHE reports)

3 The London Cancer Alliance Overview 62 day screening to 1 st treatment performance Key surgical measures monitored by LCA Screening coverage Overview of Breast Cancer incidence and mortality rates Breast Cancer Routes to Diagnosis (PHE reports)

4 The London Cancer Alliance 62 day screening to 1 st treatment standard National standard 90% across all tumour types Performance is allocated as follows 0.5 case/breach to screening provider 1 st seen 0.5 case/breach to provider of 1 st treatment England performance in Q2 2014/15 Breast 97% Gynaecology 93% Lower GI 79% Overall 94%

5 The London Cancer Alliance 62 day screening to 1 st treatment standard London performance October 2014 to September 2015 Oct 14 - Sept 15 Cases Breaches % in target Croydon Health Services NHS Trust % Lewisham and Greenwich Healthcare NHS Trust % The Whittingdon Hospital NHS Trust % The Hillingdon Hospitals NHS Trust % King's College Hospital NHS Foundation Trust % North Middlesex University Hospital NHS Trust % Chelsea and Westminster Hospital NHS Foundation Trust % Barking, Havering and Redbridge Univeristy Hospitals NHS Trust % London North West Healthcare NHS Trust % The Royal Marsden NHS Foundation Trust % Guy's and St Thomas' NHS Foundation Trust % Royal Free London NHS Foundation Trust % St George's University Hospital NHS Foundation Trust % Imperial College Healthcare NHS Trust % Barts Health NHS Trust % University College London Hospitals NHS Foundation Trust % Kingston Hospital NHS FoundatioN Trust % London overall % London overall performance 2% less than national average Only 5/17 providers above England average

6 The London Cancer Alliance Overview 62 day screening to 1 st treatment performance Key surgical measures monitored by LCA Screening coverage Overview of Breast Cancer incidence and mortality rates Breast Cancer Routes to Diagnosis (PHE reports)

7 The London Cancer Alliance Overview 62 day screening to 1 st treatment performance Key surgical measures monitored by LCA Screening coverage Overview of Breast Cancer incidence and mortality rates Breast Cancer Routes to Diagnosis (PHE reports)

8 The London Cancer Alliance By CCG across London 31 st July 2015

9 The London Cancer Alliance By CCG across London 31 st July 2015

10 The London Cancer Alliance By CCG across London 31 st July 2015 More than 70% coverage 36 month Organisation coverage % NHS BEXLEY CCG 74.3 NHS BROMLEY CCG 74.1 NHS HAVERING CCG 73.3 NHS HARROW CCG 72.2 NHS ENFIELD CCG 70.1 More than 60-70% coverage 36 month Organisation coverage % NHS HILLINGDON CCG 69.2 NHS BARNET CCG 67.8 NHS RICHMOND CCG 67.4 NHS HOUNSLOW CCG 67.2 NHS SUTTON CCG 67.2 NHS REDBRIDGE CCG 67 NHS KINGSTON CCG 66.7 NHS WALTHAM FOREST CCG 66.4 NHS EALING CCG 65.4 NHS CROYDON CCG 63.3 NHS HARINGEY CCG 63.3 NHS MERTON CCG 63.3 NHS BRENT CCG 63 NHS LEWISHAM CCG 61.3 NHS WANDSWORTH CCG 60.6 NHS SOUTHWARK CCG 60.4 NHS GREENWICH CCG 60.2 More than 50-60% coverage 36 month Organisation coverage % NHS HAMMERSMITH AND FULHAM CCG 59.8 NHS LAMBETH CCG 59.8 NHS NEWHAM CCG 59.6 NHS ISLINGTON CCG 57.7 NHS TOWER HAMLETS CCG 57.4 NHS CENTRAL LONDON (WESTMINSTER) CCG 57.3 NHS WEST LONDON CCG 54.7 NHS CAMDEN CCG 51.1 Less than 50% 36 month Organisation coverage % NHS CITY AND HACKNEY CCG 48.4 Overall London coverage 64.3% 49,729 patients short of 70% target

11 The London Cancer Alliance By GP practice across London 31 st July 2015

12 The London Cancer Alliance By GP practice across London 31 st July 2015

13 The London Cancer Alliance By GP practice across Bexley CCG 31 st July 2015

14 The London Cancer Alliance By GP practice across Bexley CCG 31 st July 2015

15 The London Cancer Alliance By GP practice across City and Hackney CCG 31 st July 2015

16 The London Cancer Alliance By GP practice across City and Hackney CCG 31 st July 2015

17 The London Cancer Alliance Screening coverage summary London screening coverage (50-70 year olds) at end of July 2015 only 64.3% 49,749 patients short of 70% standard CCG performance varies from 74% to 48% Only 5 CCGs (16%) meet the 70% standard Only 21% of GP practices meet the 70% standard

18 The London Cancer Alliance Overview 62 day screening to 1 st treatment performance Key surgical measures monitored by LCA Screening coverage Overview of Breast Cancer incidence and mortality rates Breast Cancer Routes to Diagnosis (PHE reports)

19 Incidence and Mortality rates - Breast Cancer by England area team Source National Cancer Registration Service:- CancerStats

20 Trend in incidence rates London Cancer Alliance/London Cancer Source National Cancer Registration Service:- CancerStats

21 Trend in mortality rates London Cancer Alliance/London Cancer Source National Cancer Registration Service:- CancerStats

22 Actual numbers of cases and deaths per year Breast Cancer (C50) Female only Diagnosis per year Diagnosis per year % change from to London Cancer Alliance 2,806 3, % London Cancer 1,441 1, % London overall 4,247 4, % England 36,804 42, % Deaths per year Population Change during this period: London - +17% Deaths per year % change from to England- +8% London Cancer Alliance % London Cancer % London Overall 1,279 1, % England 10,528 9, % Source National Cancer Registration Service:- CancerStats

23 The London Cancer Alliance Breast Cancer Incidence and Mortality summary Both London Cancer Alliance and London Cancer a lower incidence of breast cancer than England overall. Mortality in London Cancer Alliance and London Cancer is inline with mortality of breast cancer in England. Age standardised rates of breast cancer are rising, with mortality dropping Within London from to the number of breast cancers diagnosed from has increased by 16.5%. Numbers of deaths have decreased by 16.0%.

24 The London Cancer Alliance Overview 62 day screening to 1 st treatment performance Key surgical measures monitored by LCA Screening coverage Overview of Breast Cancer incidence and mortality rates Breast Cancer Routes to Diagnosis (PHE reports)

25 Routes to diagnosis overview Routes to diagnosis work produced by National Cancer Intelligence Network (NCIN) within PHE. Looks at Cancer Waiting Times (CWT) Dataset, Screening dataset and Hospital Episode Statistics (HES) to identify presentation route for new cancers. National reports produced published on NCIN website PHE have also produced a London version for use within London Note:- England report does not include male breast cancer, where as London one does 25

26 Relative by routes to diagnosis - England 26

27 Stage at diagnosis by route of presentation - England 27

28 Routes to diagnosis London Difference from England proportions Screen detected Two week wait Other GP referral Other outpatient Inpatient elective Emergency presentation Death certificate only Unknown London overall -4% -6% 5% 1% 0% 1% 1% 3% 28

29 Route to diagnosis by sector of London Breast Cancer North Central London Screen detected 2 week wait GP Other GP Other outpatient Inpatient elective Emergency Death Certificate Unknown 23% 36% 22% 4% 0% 6% 1% 8% North East London 25% 47% 15% 3% 0% 6% 0% 4% North West London 24% 39% 17% 5% 0% 5% 1% 9% South East London 25% 46% 15% 4% 0% 4% 0% 6% South West London England overall 26% 44% 15% 3% 0% 5% 0% 7% 29% 48% 12% 3% 0% 4% 0% 4% 29

30 Trend in route to diagnosis 30

31 Trend in route to diagnosis 31

32 London breast cancer patient demographics vs England overall Key points Age Larger proportion of patients under 50 in London (25% vs 20%) Ethnicity Greater proportion of patients with non-white ethnicity in London (28% vs 9%) Deprivation More deprived population in London than rest of England London England 1 Least deprived 14% 22% 2 14% 23% 3 18% 21% 4 26% 19% 5 Most deprived 27% 15% 32

33 Breakdown of % of patients presenting via screening in London by demographic Age breakdown Age bracket Sample size London value % presenting via screening Difference from England value Under 50 9,385 3% -1% ,595 45% -4% ,799 50% -6% ,832 14% -3% ,492 2% 0% 85% 2,869 0% 0% 33

34 Breakdown of % of patients presenting via screening in London by demographic Ethnic breakdown Age bracket Sample size London value % presenting via screening Difference from England value Asian 3,297 28% 0% Black 3,299 18% 0% Chinese % +1% Mixed % +1% White 27,269 26% -3% Other ethnic group 1,441 22% -2% Unknown 1,906 20% -7% 34

35 Breakdown of % of patients presenting via screening in London by demographic Deprivation bracket Age bracket Sample size London value % presenting via screening Difference from England value 1 (Least deprived) 5,213 25% -6% 2 5,455 26% -4% 3 6,926 26% -3% 4 10,011 25% -3% 5 (Most deprived) 10,367 23% -2% 35

36 The London Cancer Alliance Routes to diagnosis summary - Screening 3 year relative survival for patients presenting is 100% (compared with 89% for 2 week wait) 95% of patients presenting via screening have stage 1 or 2 disease (compared with 81% for 2 week wait) In London 25% of breast cancer patients presented via the screening route from This compares with 29% across England The proportion of patients presenting via screening has increased slightly from 2006 to 2013 (24% to 26%)

37 The London Cancer Alliance Routes to diagnosis summary - Screening London has a younger, more deprived more ethnically diverse breast cancer population than the rest of England Proportion of patients with ethnicity recorded as black presenting via screening relatively low for London and England (18% compared with 25% overall for London) Less likely to present as via screening if from the most deprived background (Deprivation score 5-23% vs 25% overall in London)

38 The London Cancer Alliance Routes to diagnosis summary - Screening Source of work Source:- Routes to diagnosis analyses by NCIN, Public Health England England workbook published by NCIN: England workbook with stage breakdown published by NCIN- CRUK partnership: London workbook published by local analysts team in NCIN, available on request

39 Breast Cancer Services In London Presented by Donna Chung & Michael Sharpe Presenting information compiled and analysed by Karen Linklater (NCRS) and Stephen Scott (LCA) Breast Cancer Services in London Public Health England 2015

40 What are you sending to the Registry? Overview Breast Cancer Services in London Public Health England 2015

41 What are you sending to the COSD live from Jan 2013 Registry? Stands for Cancer Outcomes and Services Dataset Includes all new diagnoses of primary cancer and recurrences Source Details Submission schedule MDT PAS Pathology Radiology From you local cancer recording system Somerset Infoflex, etc From your clinical coders - Same as your HES/SLAM/SUS data. Cancer positive path reports and reports on cancer patients Text of radiology reports for cancer patients 25 working days after end of month Same as SLAM/HES, etc. Submitted 6 weeks after end of month. 25 working days after end of month Covered by Remote Access Overview Breast Cancer Services in London Public Health England 2015

42 How do we process it? Overview Breast Cancer Services in London Public Health England 2015

43 January: Level 1 Level 1 Report NCRS Reporting Portal NCRS JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC NHS Trust COSD / Path JANUARY Data Breast Cancer Services in London Public Health England 2015

44 January: Level 2 Level 1 Report NCRS Reporting Portal Level 2 Report NCRS Reporting Portal NCRS NCRS JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC NHS Trust PAS COSD / Path JANUARY Data Breast Cancer Services in London Public Health England 2015

45 January: Level 3 Level 1 Report NCRS Reporting Portal Level 2 Report NCRS Reporting Portal Level 3 Report NCRS Reporting Portal NCRS NCRS NCRS Process Data JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC SEP NHS Trust PAS COSD / Path JANUARY Data Breast Cancer Services in London Public Health England 2015

46 How are we looking at the data? Overview Breast Cancer Services in London Public Health England 2015

47 How are we looking at the data? Karen Linklater and Stephen Scott took the Level 3 data and the PAS data for 2013 and compared them for every Trust in London They produced a series of metrics including, among others: Volumes of Breast PAS data that matched with a new diagnosis of Cancer Number of patients diagnosed per Trust Number of Mastectomies per Trust Proportion of Immediate Reconstructions Distribution of Length of Stay Percentage of consultants undertaking 30 or more breast cancer surgeries per year Breast Cancer Services in London Public Health England 2015

48 More of this What is the future for this Discussions around doing this on a more prospective, on-going basis, first using raw Trust data and then final Level 3 data data? London based at the moment, however discussions about whether this should go on the NCRS portal And other, similar initiatives Clinical Headline Indicators, clinical metrics based on the Level 3 data National, able to drill down to Specialty at Trust level Decided by the SSCRGs, Breast and Lung going live first Breast Cancer Services in London Public Health England 2015

49 Breast Cancer Services in London Public Health England 2015

50 Thank you for your contributions so far Michael Sharpe Donna Chung Breast Cancer Services in London Public Health England 2015