NHS BREAST & CERVICAL SCREENING PROGRAMMES

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1 NHS BREAST & CERVICAL SCREENING PROGRAMMES PERFORMANCE REPORT HARINGEY Reducing mortality from breast and cervical cancer December 2012 Breast cancer is the most common cancer among women in the UK, affecting one in every eight women. Annually, over 11,000 women die in the UK due to invasive breast cancer. Early detection and advanced treatment has contributed to an increase in survival over the past decades. The latest data suggest that five year survival rate is at 85%. Mortality from cervical cancer is declining nationally and incidence is remaining low in the UK. The 5 year survival rate for cervical cancer screening is 67%. Evidence suggest that about 70% of cases are caused by sexually transmitted infection with the human papilloma virus (HPV), which can lead to pre-cancerous changes in the cervix. If left untreated, these changes can lead to development of cancer. Breast cancer Figure 1: Directly age-standardised incidence rates of breast cancer per 100,000, to (three year average) DSR per 100,000 population Cervical cancer Three-year period Haringey London 115 new cases of breast cancer in Haringey each year deaths per year due to breast cancer in Haringey % (25) of deaths due to breast cancer are in women under Figure 2: Directly age-standardised incidence rates of cervical cancer per 100,000, to (three year average) DSR per 100,000 population Haringey London 10 new cases of cervical cancer in Haringey each year Three year period

2 NHS Breast Cancer Screening Programme NHS BSP provides free screening for all women aged 50 to 70, every three years. Women over 70 years of age are not routinely invited but can self-refer into the programme. The national minimum standard is set at 70% coverage for women between 53 and 70 years of age. The North London Breast Screening Service, based at Barnet and Chase Farm Hospital, provides screening for women in Barnet, Enfield and Haringey. The Central and East London Breast Screening Service, at Bart s Health, provides screening for women in Camden and Islington. An age extension project is being phased into the programme, extending the screening invitations to women aged 47 to 73 years, in Barnet, Enfield and Haringey. It is expected that Camden and Islington will implement age extension in Figure 3: Actual and planned coverage of breast cancer screening in women aged 53-70, by NCL PCT, 2008/ / % 90% ACTUAL PLANNED uptake 80% 70% 60% 50% 40% 30% 20% 10% 0% 08/09 Time period (quarterly) plan plan Barnet Camden Enfield Haringey Islington Target Table 1: Number and percentage of women for breast cancer, Haringey s registered population aged 53-70, 2011/2012. Haringey - Breast cancer screening uptake among women aged 53 to /2012 The number of people 12,633 of people 65% Number missing to meet the target 1138 Target 70% Please note: London Quality Assurance Data is delayed and therefore data used in this report is based on Open Exeter (registered population only).

3 NHS Cervical Cancer Screening Programme Women aged 25 to 49 are invited for screening at three years intervals while those between 50 and 64 years old are invited every five years. Minimum national standard for coverage for all age groups eligible is set at 80%. The introduction of HPV testing and test of cure has commenced nationally. Figure 4: Actual and planned coverage of cervical cancer screening in women aged 25-64, by NCL PCT, 2011/ / % 90% ACTUAL PLANNED 80% uptake 70% 60% 50% 40% 30% 20% 10% 0% plan plan Time period (quarterly) Target Barnet Camden Enfield Haringey Islington Table 2: Number and percentage of women for cervical cancer, Haringey s registered population aged 25-64, 2012/2013 Haringey - Cervical cancer screening uptake among women aged 25 to /2013 The number of people 64,301 of people 74% Number missing to meet the target 5,397 Target 80% Please note: London Quality Assurance Data is delayed and therefore data used in this report is based on Open Exeter (registered population only).

4 Table 3: Number and percentage of women for breast cancer (aged 53-70) and cervical cancer (aged 25 to 64), by Haringey GP practice,, 2012/2013 and 2011/2012, respectively. GP practice Cervical cancer 20 Breast cancer 20 missing from target Number Number missing to the target 1 Grove Road 74% 6% % - 1 Spur Road 82% % High Road 66% 14% 99 60% St Johns Road 76% 4% 96 60% Philip Lane 80% % Myddleton Road 70% 10% 88 61% Green Lanes 50% 30% % - Alexandra Surgery 78% 3% % 32 Allenson House Surgery 81% % - Arcadian Gardens 66% 14% % - Bounds Green Group Practice 73% 7% % 44 Bridge House Medical Practice 66% 14% % 27 Broadwater Farm HC 79% 1% % 14 Bruce Grove HC 69% 11% % 53 Charlton House Medical Centre 72% 8% % - Christchurch Hall Surgery 80% 0% % 5 Crouch Hall Road Surgery 85% % - Dowsett Road Surgery 80% 0% % - Dukes Avenue Surgery 80% % - Evergreen House Surgery 81% % 12 Fernlea Surgery 63% 17% % 21 Green Lanes 0% 80% 1 100% - Green Lanes (Park Lane MC) 67% 13% 14 39% 11 Grosvenor Road Surgery 74% 6% % 7 Havergal Surgery 63% 17% % 21 High Road Surgery 65% 15% % 2 Highgate Group Practice 75% 5% % 99 Hornsey Park Surgery 69% 11% % 10 JS Medical Practice 73% 7% % - Laurels Medical Practice 68% 12% % 54 Laurels Neighbourhood Practice (APMS) % 15 Lawrence House Surgery 76% 4% % - Manheim 72% 8% % 115 Morris House 78% 2% % 94 Park Lane Practice 79% 1% 55 56% 14 Park Road Surgery 82% % - Queens Avenue Surgery 78% 2% % - Rutland House Surgery 78% 2% % 15 Somerset Gardens FHC 79% 1% % 74 St Pauls Road 58% 22% 67 63% 8 Stuart Crescent HC 77% 3% % 17 The 157 Medical Practice 68% 12% 97 61% 14 The 157 Medical Practice 70% 10% 57 70% 0 The Old Surgery 67% 13% 62 55% 17 The Queenswood Practice 77% 3% % 91 The Vale Practice 81% % 18 Tottenham Health Centre 85% % 14 Tottenham Lane 70% 10% 35 51% 13 Tottenham Primary Care Group Ltd 68% 12% % 18 Tynemouth Road Health Centre 72% 8% % 51 West Green Road 77% 3% % 23 Westbury Avenue 67% 13% % 14 Westbury Medical Centre 74% 6% % 34 Haringey 74% 6% 12,633 65% 1,138 Please note: London Quality Assurance Data is being delayed and therefore data used in this report is based on the Exeter (registered population only). The percentages reported are rounded to the nearest whole number. The targets are 80% and 70% for cervical and breast cancer, respectively.

5 Commentary from NCL breast and cervical cancer screening lead Commissioning of cancer screening programmes will become a responsibility of the NHS Commissioning Board Authority from April North Central London Cluster is preparing detailed handover certificates to enable smooth transition. Clarity is sought on future responsibilities on improving the uptake and coverage of these programmes and it is likely that Directors of Public Health will have an assurance role rather than the operational role. Public Health support for these programmes will come from the Public Health London Centre. Breast Cancer Screening Haringey s Action Plan for 20 Breast cancer screening Implement high risk screening by the end of 20 financial year Community Outreach work focused on GP practices with high DNA rates and multiethnic communities Haringey Public Health Directorate commissioned support for practices with low previous achievement. This has been very effective with uptake rates increasing by between 5% and 17% The 2 nd appointment initiative has now become business as usual with women who DNA offered a second appointment Ensure safe transition of cancer screening lead to the NHS Commissioning Board Authority and Public Health Cervical cancer screening Support the implementation of HPV testing Coverage of breast cancer screening has been improving steadily across the whole Cluster and recovery trajectories agreed with the NHS London suggest four boroughs remain on the target. Camden remains behind the target. The NCL Cancer Screening Board reviewed the effectiveness of different initiatives to improve uptake and coverage, which has informed health promotion action plans across North Central London. These action plans are regularly monitored by both Consortia (North London Breast Screening Service and City & East London Breast Screening Service) and North Central London Cancer Screening Board. Key actions to continue to improve against this target include enhanced work on did not attend (DNA) rates with GP practices, visits to GP practices with low uptake to drive performance, regular list cleaning and community outreach interventions. Barnet, Enfield and Haringey will be implementing screening for high risk women (familial history screening) before the end of this financial year. Cervical Cancer Screening Cervical cancer screening coverage is improving slightly, after a dip in performance at the beginning of this financial year. Coverage in younger women (25 to 39 years of age) still remains low for all five boroughs (ranging from 62% to 74%). The whole cluster is achieving 14 days turnaround time and the HPV testing and test of cure implementation commenced in November Screening co-ordinators have been delivering extensive training on the HPV implementation for sample takers and practice administration staff. Funding for Practice Nurse Development has been secured across the Cluster and most appointments are now in place. NCL Cervical Cancer Screening Action Plan is focusing on work with DNAs and targeting younger age groups with different initiatives. Liaise with Practice Development Nurse to agree a work-plan for sample takers support, mainly focusing on new sample takers and those with high inadequacy rates Audit outliers with high exclusion list Initiate focused work with women living with learning disabilities Continue to support practices with work on following DNAs and additional practice nursing time until funding is available Ensure safe transition of cancer screening lead to the NHS Commissioning Board Authority and Public Health For more information on Haringey s action plan for NHS Breast and Cervical Cancer Screening Programmes, contact Tamara Djuretic (Assistant Director of PH) on tamara.djuretic@haringey.gov.uk or