Colorectal Cancer Programme Screening for Colorectal Cancer

1. Colorectal Cancer ProgrammeScreening for Colorectal Cancer A/P Susan Parry, Gastroenterologist, CD MOH Bowel Cancer Programme

2. Ministry of Health Bowel Cancer Work Programme • Bowel Screening Pilot – result recommendations previous working groups • Colonoscopsy wait time indicators • National Endoscopy Quality Improvement Programme • NZ Familial Gastrointestinal Service • Standards of service provision for bowel cancer Dec 2013 • Work force planning with Health Workforce NZ • Supported by the National Bowel Cancer Working Group • Bowel Screening Advisory Group – subgroup NBCWG • Liasing with relevant professional bodies

3. Colonoscopy past and present wait time indicators

4. Colonoscopy Wait – Time Indicators Wrap round initiatives • Development of national • National Endoscopy Quality Improvement Programme • Utilising Global Rating Scale for endoscopy units as in UK • MOH bowel cancer team visits/communication DHB’s • Provide high level support to deliver sustainable increase in colonoscopy capacity

5. National progress : timely colonoscopy delivery

6. Number of colonoscopies performed

7. Colonoscopy: numbers waiting

8. May results: Urgent

9. May results: Non urgent

10. June 2014 results: Non urgent

11. Number of colonoscopies performed

12. Numbers waiting for a colonoscopy

13. Bowel Screening Pilot Bowel Screening Pilot commenced in Waitemata DHB October 2011

14. Waitemata Bowel Screening Pilot (BSP) • Duration 4 years, two screening rounds • Age range 50-74yrs, men & women (approximately 136,000 eligible people) • Screening test - faecal immunochemical test for haemoglobin (FIT) - every two years - predetermined cut off for positivity • FIT (OC – Sensor) is mailed to eligible participants and completed at home Acknowledge the hard work and commitment of the Waitemata Team. Mike HulmeMoir, Clinical Director Gaye Tozer, Manager

15. Service delivery model

16. Round 1 results: Between 1 January 2012 and 31 December 2013:* • Over 121,000 eligible people invited to take part in the Pilot • Coverage 97.5% (based on census data) • The programme participation rate was 55.8% • Overall positivity rate was 7.5% • 96% of those with a +ve FIT went to colonoscopy • CRCs found in 186 (22) people (46.2% TNM Stage 1) • * Data pulled March 2015

21. Participation in the BSP Round 1 and the first year of Round 2

22. Participation in the BSP, by age and sex Round 2

23. Participation in the BSP by ethnicityRound 1 and the first year of Round 2

24. Participation in the BSP by deprivation groupRound 1 and the first year of Round 2

25. Positivity in the BSPRound 1 and the first year of Round 2

26. Bowel Screening Pilot results to Dec 2014 Rd 1 Rd 2 CRC detection rate DR/1000 screened 2.8 (1-8-9.5) 1.3 Advanced adenoma DR 15.9 7.5 Adenoma DR 36.9 (13.3-22.3) 22.8 PPV CRC % 4.2 (4.5-8.6) 2.6 PPV Advanced adenoma % 24.2 15.2 PPV adenoma % 56.1 (9.6-40.3) 46.5 Those with low risk adenoma returned to screening Remainder offered ongoing colonoscopic surveillance

28. Next steps • BSP extended until end Dec 2017 – opportunity to trial some new initiatives • Consultation to inform a business case • a phased restricted age national roll out beginning 2017 • Results from Round 1 & 2 to inform decisions re phased roll out to • maximise cancer detection within potentially available colonoscopy resource ( need to ensure timely symptomatic/surveillance procedures) • maximise cancer detection/ minimise detection low risk lesions for participants • minimise disparities • ensure quality maintained • optimise cost effectiveness

29. Next Steps • Continue to monitor • progress screening programmes in other countries • new screening tests • In determining phased roll out options consider possibility of subsequent inclusion of other screening tests eg flexible sigmoidoscopy as in UK • Continue international dialogue/peer review/meetings – MOH & BSAG

30. Waitemata BSP Team Ministry of Health Bowel & Prostate Cancer Team