Download Cheshire and Merseyside Bowel Cancer Screening Programme

Bowel Cancer Screening Programme
Cheshire and Merseyside NHS North West
Aims and Objectives
• To provide information about the BCSP
• To give a Public Health perspective
• To raise awareness of health inequalities
• To increase knowledge of Bowel Cancer
symptoms
Public Health Perspective
• Bowel Cancer is the third most
common cancer in the UK
• Approximately 34,900 new cases p.a
• It is is the second largest cause of
cancer deaths in the UK (Cancer Research UK,
2005. Cancerstats).
Public Health Perspective
• In 2004 approximately 16,100 people
died from bowel cancer in the UK, 737
deaths within Cheshire & Merseyside
• Life time risk of developing Bowel
Cancer in the UK is about 1:18 for men
and 1:20 for women
Who is at risk of developing bowel
cancer?
• Both men and women
• People who– Take little exercise
– Are overweight
– Have a diet high in red meat and
low in vegetables, fruits and fibre
Warrington PCT
• Strategy For Sport, Physical Activity and Health
•
•
•
•
•
•
In Warrington 2007-2010
Chair Based Exercise
Reach for Health Scheme
Warrington Partnership for Food and Health
Initiatives
Healthy Weight Strategy
Food and Health Plan
Food and Health Workers
Who is at risk of developing bowel
cancer? (continued)
• People with a family history (CRC
•
•
Relatives)
Inflammatory Bowel Disease
Genetics– Familial Adenomatous Polyposis
(FAP)about 1% of cases
– Hereditary Non-Polyposis Colorectal
Cancer (HNPCC) about 2-5% of cases
Who is at risk of developing bowel
cancer? (continued)
• The risk of developing bowel cancer
increases with age.
• About 80% of people who get Bowel
cancer are aged 60 and over
Clinical Epidemiology
Age-specific Incidence
Rate per 100,000
500
450
400
350
300
250
200
150
100
50
0
20-24
30-34
40-44
50-54
Age (years)
60-64
70-74
80-84
Colorectal Cancer an Important Health
Problem
www.statistics.gov.uk
35,579 new cases in 1999
Colorectal Cancer an Important Health
Problem
www.statistics.gov.uk
16,152 deaths in 2001
Bowel Cancer Symptoms
• A persistent change in bowel habit,
or diarrhoea for several weeks
• Rectal bleeding without any obvious
reason
• Anaemia
Bowel Cancer Symptoms
• Abdominal pain, especially if it is
severe; and a palpable lump in the
abdomen.
• Increased suspicion if symptoms last
for four to six weeks.
• Nausea, anorexia
• Weight loss
Wilson and Jungner Criteria for
Population Screening
• Is it an important Health problem ?
• Is effective treatment available ?
• Does the disease have an early or
latent stage ?
• Is there a suitable screening test ?
• Are diagnostic and treatment
facilities available ?
Wilson and Jungner Criteria for
Population Screening
• Is the Natural History of the
condition known?
• Is there agreed criteria for who
should be treated ?
• Is the programme a continuing
process ?
• Is the programme economically
viable?
Why not increase access for
Symptomatic patients?
• 30% of colorectal cancers present as
emergencies
• The 2 week rule has had no impact
• 5% 2 week rule referrals have
colorectal cancers
• As yet there has been no shift in
Dukes stage
Natural History
Adenoma- Carcinoma Sequence
Morson 1960s
Normal Mucosa
Prevalence in 50 yr olds
Adenoma
18%
High Risk Adenoma
4%
Carcinoma
0.25%
Diagram of the Bowel
A=85-95%
Dukes Staging Diagram
B=60-80%
C=30-60%
D=<10% 5
year
survival
100%
90%
65%
25%
15%
5 yr survival
11%
33%
33%
23%
Proportion
Bowel Cancer Screening Pilot
• In 2000 the Bowel Cancer screening Pilot
began in Scotland (Dundee) and England
(Rugby)
• Evidence from pilot studies showed that
early detection through regular Bowel
Cancer Screening has a significant impact
upon overall survival rates
• BCSP can reduce mortality (deaths) by
16% in the population invited for
screening
Nottingham study
Stage shift
Dukes
stage
A
B
C
D
Screen
20%
33%
24%
21%
Controls
11%
32%
31%
22%
Hardcastle, 1996
Health Inequalities of the BCSP
Pilot
• Men were less likely to participate in FOBt
• Lower uptake in deprived areas.
• Poor uptake in Black and Ethnic Minority
groups particularly Muslims.
• Ethnic groups more likely to DNA before
colonoscopy.
Health Inequalities of the BCSP
• Other groups who may experience
inequalities
–
–
–
–
–
–
–
–
–
Learning disabilities/ difficulties
Blind and Visual impairment
Deaf
People with mobility problems
Illiterate
Mental illness
Travellers
Homeless
Prison population
Responsibility for the BCSP
• Cheshire & Merseyside NHS North West have
the lead responsibility for BCSP initially.
Thereafter PCT’s will commission the
programme.
• Central budget £10 million first wave, second
wave also funded approximately £461K per
500,000 head of population
Agreed Model
• Consortium Approach
• Local Implementation Group
• Key stakeholder consensus reached
Agreed Model
• Operationally driven and managed by 1
host Trust.( Aintree) This is the local
BCSP administration centre.
• Endoscopy nurse-led screening
assessment clinics (community)
Quality Assurance Standards
• Global Rating Scores (Patient
experience)
• Satisfactory Joint Advisory Group
(JAG) assessment & visitation
• Accreditation of colonoscopists
• Health Promotion and Health Inequality
considerations( Uptake, awareness)
SHA BCSP Statistics
• Screening population 327,683
• Assume 60% uptake based on pilot figures =
•
•
196,610 of which,
Approximate 2% will have a positive FOBt = 3,932
of which,
11% of FOBt positive patients will have cancer
=433.
• 35% will have polyps requiring surveillance =1376
Proposed organisation
Overarching Structure:
• 5 Programme Hubs across
England, based on IT Local
Service Providers (LSP)
undertaking call/recall and lab
functions
HUB
HUB
HUB
HUB
HUB
• 1 Programme Hub for approx 20
screening centres
Role of HUB
•
•
•
•
•
•
To Manage call and recall for the screening
programme
To provide a telephone help line for people
invited for screening
To dispatch and process test kits
Send results letters to participants and notify
GP
Book the first appointment at a nurse led clinic
for patients with an abnormal test result
Coordinate Quality assurance activities
BCSP Process
• FOB testing will be offered
to all men & women aged
60-69 - 2 yearly.
BCSP Process
• 70+ can request to join the BCSP
but have to contact Regional Hub
at Rugby.
Faecal Occult Blood Testing
(FOBT) - Guaiac Testing
The participant is instructed
to smear the stool onto the
spots from 2 separate parts
of the specimen on three
separate days
Model in brief
• Invitation letter is sent to participant
from Rugby dispatch centre (HUB).
• Participants can opt out of the BCSP
by contacting Rugby.
Rugby
Administrative Offices
Pathology
Laboratory
Envelope Prepared
FOBt Kits
Preparing Kit
Preparation of Kit
Solution Added To Process Kit
Results to be checked
Normal result
Abnormal Result
Data base
Model in brief
• National hub despatch kit
• Participants smear the stool sample onto
the 2 Squares in the 1st flap indicated on
the kit. This is repeated on 2 further days
until all 6 Squares are completed
Screening Journey
• Completed kit is returned by post to
Rugby within 2 weeks of the 1st
sample being smeared on the kit
(foil-lined envelope supplied)
Results
Negative result
Unclear Result (1-4 of the squares are
positive)
Spoilt Kit
Technical Failure
Positive Result
Screening Centres
•They will provide nurse led clinics for patients with
an abnormal test result
•Arrange colonoscopy appointments for patients with
an abnormal test result
•Arrange alternative appointments for patients in
whom colonoscopy has failed
•Ensure appropriate follow-up or treatment for
patients after colonoscopy
Screening Centres
•Provide information about the screening
programme for the local health community
•Promote the screening programme to the
general public in their locality
•Provide information and support for local people
in completing the FOB test(on referral from the
programme hub
Screening Journey
• Appointment arranged at Endoscopy
Nurse screening assessment clinic if the
FOBt is positive. The participant will
receive:
• Counselling
• A health questionnaire
• Information
• Consent
• Preparation for the procedure
• Bowel Cancer Screening-The
colonoscopy Investigation (leaflet)
Screening journey (Continued)
• Referred to screening provider unit for
colonoscopy
• Follow-up dependant on procedure results
– Normal, sent a BCSP kit in 2 years
– Polyps, surveillance by BCSP
– Cancer detected cases referred to local
Multi Disciplinary Team (local Cancer
Team)
Role of Primary Care
• Encourage members of the public to
participate in the BCSP
• Provide general information on the
BCSP to participants
• Direct inquiries to the national
freephone help-line telephone service
Role of Primary Care
• Add results to the GP practice IT
systems
• Encourage patients to complete the
whole BCSP process.
• GP will be notified if patients DNA or
opt out of the programme
Contact Details
• Maureen Sayer
Health Improvement Practitioner
[email protected]