Cheshire & Merseyside Bowel Cheshire & Merseyside Bowel Cancer Screening ProgrammeCancer Screening Programme

April 2008April 2008

• Programme first of its kind in Europe offered to both men & women (60-69, over 70 opt in)

• Clear evidence that FOB testing can reduce death rates by 16%

• Central budget of £12.5m 06/07 & £25m 07/08

National BCSP ProfileNational BCSP Profile

Organisation in England by March 2007

• 5 Programme Hubs across England, based on IT Local Service Providers (LSP) undertaking call/recall and lab functions

Gateshead

Nottingham

London

Guildford

Rugby

Roll out planRoll out plan

Cancer Reform Strategy Cancer Reform Strategy ChangesChanges

• Extending screening from 2010 to 70-74 Extending screening from 2010 to 70-74 year oldsyear olds

• 62 day waits to apply – end 200862 day waits to apply – end 2008• Consideration of people in their 50s is next Consideration of people in their 50s is next

stepstep– Flexi-sig trial results will be available in 2/3 Flexi-sig trial results will be available in 2/3

yearsyears

• Immunological testing and CT colography Immunological testing and CT colography to be considered in due course to be considered in due course

Cheshire & Merseyside Cheshire & Merseyside ProgrammeProgramme

• Total population of 2.38 million

• Screening population of 330,000

• Working across 8 Primary Care Trusts

• 18 PCT-based clinics

• 11 colonoscopy lists per week at RLH, Aintree and Leighton

Health Promotion Health Promotion ActivityActivity• MediaMedia• PHCT EducationPHCT Education Community EducationCommunity Education- Training and Health Events- Training and Health Events• Health InequalitiesHealth Inequalities- Sensory ImpairmentSensory Impairment- Black and Racial MinoritiesBlack and Racial Minorities- Learning Disabilities and Patients Learning Disabilities and Patients

with Mental Health Problemswith Mental Health Problems- Low LiteracyLow Literacy

BCSP Clinical Statistics fromBCSP Clinical Statistics fromSeptember 2006- March 2008September 2006- March 2008

• Overall Uptake rate 55%Overall Uptake rate 55%

• 1268 patients seen in nurse led clinics following FOB 1268 patients seen in nurse led clinics following FOB positive resultpositive result

• 1215 colonoscopies performed 1215 colonoscopies performed

• 38 patients refused to have colonoscopy (2.6%)38 patients refused to have colonoscopy (2.6%)

• 31 patients deemed clinically inappropriate (2.1%)31 patients deemed clinically inappropriate (2.1%)

• 15 patients had completion barium enema (1%)15 patients had completion barium enema (1%)

NEOPLASIANEOPLASIA

• Total number of adenomatous polyps Total number of adenomatous polyps removed = 1330 (498 patients )removed = 1330 (498 patients )

• Total number of hyperplastic polyps Total number of hyperplastic polyps removed =314removed =314

• Total number of malignant polyps Total number of malignant polyps removed= 21 patientsremoved= 21 patients

Patient OutcomesPatient Outcomes

• 10% patients to have 1 year surveillance (High 10% patients to have 1 year surveillance (High risk polyps)risk polyps)

• 18% patients to have 3 year surveillance 18% patients to have 3 year surveillance (Intermediate risk polyps)(Intermediate risk polyps)

• 60% to return to screening programme with 2 60% to return to screening programme with 2 yearly invitation to repeat participation in yearly invitation to repeat participation in screening ( Low risk polyps)screening ( Low risk polyps)

• 12% referred to local MDT for cancer 12% referred to local MDT for cancer treatment ( 141 patients )treatment ( 141 patients )

Duke Staging of CRC on Duke Staging of CRC on BCSPBCSP

• Duke A 53% (including malignant polyps)Duke A 53% (including malignant polyps)

• Duke B 21.4%Duke B 21.4%

• Duke C Duke C 21.4%21.4%

• Duke D Duke D 4.2%4.2%

• These figures are based upon 115 patients who These figures are based upon 115 patients who had undergone surgery at time of audit and had had undergone surgery at time of audit and had definitive post-operative staging.definitive post-operative staging.

Liverpool Screening Liverpool Screening UptakeUptake

• Total screening population 52,408Total screening population 52,408

• January -January - March 07 = March 07 = 57.9% 57.9%

• April -April - June 07 =June 07 = 53.03%53.03%

• June -June - Sep 07 = Sep 07 = 52.52%52.52%

• Oct -Oct - Dec 07 = Dec 07 = 54.99%54.99%

• Jan -Jan - March 08 = March 08 = 50.43%50.43%

Liverpool ActivityLiverpool Activity

• September 2006 _ March 2008 September 2006 _ March 2008

• Total invitations sent Total invitations sent 34,61234,612

• Self Referrals (over 70’s) Self Referrals (over 70’s) 378 378

• FOB Positive patients FOB Positive patients 441 441

• Nurse Clinic AttendanceNurse Clinic Attendance 350 350

• Colonoscopy PerformedColonoscopy Performed 353 353 • (including surveillance )(including surveillance )

Liverpool ActivityLiverpool Activity

• Adenomas removed from patients = Adenomas removed from patients = 197197

• Cancers detected = 54Cancers detected = 54

RLBUH DUKES RLBUH DUKES CLASSIFICATIONCLASSIFICATION• DUKES A = 52.17%DUKES A = 52.17%

• DUKES B = 8.69%%DUKES B = 8.69%%

• DUKES C = 34.8%DUKES C = 34.8%

• DUKES D = 4.34%DUKES D = 4.34%

• Total number of MDT referrals to date = 31Total number of MDT referrals to date = 31

UHA DUKES UHA DUKES CLASSIFICATIONCLASSIFICATION• DUKES A = 53.3%DUKES A = 53.3%

• DUKES B = 20.0%DUKES B = 20.0%

• DUKES C = 26.7%DUKES C = 26.7%

• DUKES D = 0%DUKES D = 0%

• Total number of Liverpool MDT referrals to date = 23 Total number of Liverpool MDT referrals to date = 23 (Sefton patients not included = 6)(Sefton patients not included = 6)

WIRRAL DUKES WIRRAL DUKES CLASSIFICATIONCLASSIFICATION• DUKES A = 33.3%DUKES A = 33.3%

• DUKES B = 33.3%DUKES B = 33.3%

• DUKES C = 26.8%DUKES C = 26.8%

• DUKES D = 6.6%DUKES D = 6.6%

• Total number of MDT referrals to date = 33Total number of MDT referrals to date = 33

WESTERN CHESHIRES WESTERN CHESHIRES DUKES CLASSIFICATIONDUKES CLASSIFICATION• DUKES A = 87.5%DUKES A = 87.5%

• DUKES B = 0%DUKES B = 0%

• DUKES C = 12.5%DUKES C = 12.5%

• DUKES D = 0%DUKES D = 0%

• Total number of MDT referrals to date = 18Total number of MDT referrals to date = 18

CENTRAL AND EASTERN CENTRAL AND EASTERN CHESHIRE DUKES CHESHIRE DUKES CLASSIFICATIONCLASSIFICATION• DUKES A = 53.8%DUKES A = 53.8%

• DUKES B = 46.2%DUKES B = 46.2%

• DUKES C = 0%DUKES C = 0%

• DUKES D = 0%DUKES D = 0%

• Total number of MDT referrals to date = 23Total number of MDT referrals to date = 23

Further InformationFurther Information

• www.cancerscreening.nhs.ukwww.cancerscreening.nhs.uk

• www.bcsp.nhs.ukwww.bcsp.nhs.uk

• www.endoscopy.nhs.ukwww.endoscopy.nhs.uk

• www.grs.nhs.ukwww.grs.nhs.uk

• www.thejag.org.ukwww.thejag.org.uk

• www.doh.gov.ukwww.doh.gov.uk