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BOWEL SCREENING SCOTTISH PATHOLOGY NETWORK 2 May 2006

BOWEL SCREENING SCOTTISH PATHOLOGY NETWORK 2 May 2006. MARGARET BALSITIS CONSULTANT PATHOLOGIST. WHY? WHO? HOW? WHERE? WHEN? ….AND WHAT ABOUT PATHOLOGY?. WHY?. BOWEL CANCER IN SCOTLAND INCIDENCE 3,500 PER YEAR 95% ARE AGED OVER 50 YEARS MORTALITY 1,600 PER YEAR

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BOWEL SCREENING SCOTTISH PATHOLOGY NETWORK 2 May 2006

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  1. BOWEL SCREENINGSCOTTISH PATHOLOGY NETWORK 2 May 2006 MARGARET BALSITIS CONSULTANT PATHOLOGIST

  2. WHY? WHO? HOW? WHERE? WHEN? ….AND WHAT ABOUT PATHOLOGY?

  3. WHY?

  4. BOWEL CANCER IN SCOTLAND INCIDENCE 3,500 PER YEAR 95% ARE AGED OVER 50 YEARS MORTALITY 1,600 PER YEAR DEATH RATES ARE HIGHER IN MEN BY AGE 74, 1 IN 27 MALES AND 1 IN 38 FEMALES WILL DEVELOP BOWEL CANCER

  5. AIM OF THE SCREENING PROGAMME To reduce mortality in the general population

  6. Mandel et al N Engl J Med 1993 Kronborg et al Lancet 1996 Hardcastle et al Lancet 1996

  7. PILOT STUDIES (SCOT & ENGL) ESTABLISHED TO EVALUATE FEASABILITY IN GENERAL POPULATION (UK CRC SCREENING PILOT EVALUATION FINALREPORT 2003)

  8. INCREASE IN EARLY (DUKES A) CANCERS OF 10% IN THE FIRST YEAR FOLLOWING SCREENING IMPLEMENTATION

  9. ESTIMATED THAT ONCE PROGRAMME IS ESTABLISHED, 75 DEATHS FOR EACH SEX WLL BE PREVENTED. Breast screening prevents 40 deaths; cervical screening prevents 60 cases and 26 deaths. (Scottish Executive Health Department 2001. cancer Scenarios: An aid to planning cancer services In Scotland in the next decade. Edinburgh: The Scottish Executive)

  10. WHO?

  11. 74 50

  12. HOW?

  13. WHERE?

  14. BOWEL SCREENING – THE PROCESS KINGS CROSS,-CALL RECALL SYSTEM DUNDEE -HELPLINE -CENTRAL FOB LAB INVITATIONS ISSUED BASED ON COMMUNITY HEALTH INDEX (CHI) TESTING KIT RETURNED TO DUNDEE RESULT ISSUED NHS BOARD PATIENT GP PRE-COLONOSCOPY ASSESSMENT COLONOSCOPY (OR Ba ENEMA OR CT COLOGRAPHY) FURTHER MANAGEMENT AS APPROPRIATE TO DIAGNOSIS

  15. THE DATE OF ISSUE OF A POSITIVE RESULT EQUATES TO DATE OF “URGENT” REFERRAL

  16. WHEN?

  17. ROLL-OUT TO NON-SCREENING NHS BOARDS - FROM END OF 2007 – 2009 - NATIONAL COVERAGE COMPLETE BY 2011 - NO DECISION YET ON ORDER - ON COMPLETION OF LOCAL PLANS, A NATIONAL OVERVIEW WILL BE DEVELOPED AND AGREED BY THE SCOTTISH BOWEL SCREENING PROGRAMME BOARD

  18. SCOTTISH EXECUTIVE HEALTH DEPT HEALTH IMPROVEMENT DIRECTORATE NHS HDL (2006)3 3 FEB 2006 “BOWEL (CANCER) SCREENING PROGRAMME”

  19. VARIOUS ACTIONS REQUIRED BY NHS BOARD AREAS: -NOMINATE LEAD CLINICIAN, PUBLIC HEALTH CONSULTANT/SPECIALIST & PROGRAMME MANAGER -ESTABLISH LOCAL MULTIDISCIPLINARY STEERING GROUP -DEVELOP LOCAL PLAN THAT WILL FEED INTO NATIONAL PLAN

  20. INFORMATION SERVICES (ISD), NHS NATIONAL SERVICES SCOTLAND (NSS) – overall monitoring and evaluation of the programme Carol Colquhoun – National Screening Coordinator Carol Morton – Project Manager (Bowel Screening) Prof. RJC Steele – Programme Director NHS QUALITY IMPROVEMENT SCOTLAND (QIS) - responsibility for developing and publishing quality standards

  21. KEY PERFORMANCE INDICATORS DETECTION RATE OF CANCER ADENOMA HIGH RISK ADENOMA POSITIVE PREDICTIVE VALUE OF POS FOB INTERVAL CANCER RATE

  22. WHAT WILL BE THE IMPACT ON PATHOLOGY?

  23. SCOTTISH PATHOLOGY NETWORK SCOTTISH GASTROINTESTINAL PATHOLOGY GROUP

  24. MAIN SOURCES OF PATHOLOGY INFORMATION Evaluation of the UK Colorectal Cancer Screening Pilot Final Report (February 2003, revised May 2003) The UK CRC Screening Pilot Evaluation Team NHS Scotland Discussion Document Proposal for Scottish Bowel Cancer Screening Programme NHS Scotland Screening Programmes. NSD. NHS NSS October 2005 V5 Bowel Screening Programme NHS BOARD PROJECTIONSMarch 2006

  25. PROBLEMS WITH INTERPRETATION OF DATA VARIABLE PRESENTATION OF FINDING OF LESIONS - % OF ELIGIBLE POPULATION % OF SCREENED POPULATION (PARTICIPANTS) LESIONS PER 100,000 POPULATION LESIONS PER 1000 POPULATION LESIONS PER 1000 SCREENED (PARTICIPANTS) UPTAKE 60% or 55%

  26. INVITATION TO PARTICIPATE (CHECK BIOPSY FIGS) FOB TEST POS FOB TEST NEG INVITATION TO COLONOSCOPY ACCEPTED NO BIOPSY BIOPSY 27% % 54% PATHOLOGY FURTHER MANAGEMENT

  27. VARIABLES TO CONSIDER AGEING POPULATION UPTAKE MULTIPLE LESIONS DECREASE OVER TIME OF SYMPTOMATIC CASES

  28. Screening every 2 years 60% uptake 2.1% positive FOB of these positives - 2% polyp cancer 7.9% other colorectal cancer 30% adenoma 13.8% negative biopsy

  29. FOR POPULATION OF 100,000 RETURN FROM 2 YEAR CYCLE TOTAL SPECIMENS 777

  30. BOWEL SCREENING PROJECT BOARD – NHS BOARD PROJECTIONS

  31. BOWEL SCREENING PROJECT BOARD – NHS BOARD PROJECTIONS

  32. FOR POPULATION OF SCOTLAND (50-74) 685,955 RETURN FROM 1 YEAR CYCLE TOTAL SPECIMENS 5325 (5293)

  33. TIME & COST BIOMEDICAL SCIENTIST/LAB PATHOLOGIST CLERICAL

  34. THE ROYAL COLLEGE OF PATHOLOGISTS GUIDELINES ON STAFFING AND WORKLOAD FOR HISTOPATHOLOGY & CYTOPATHOLOGY DEPARTMENTS (2ND EDITION) JUNE 2005

  35. MACROSCOPY

  36. SCORE 3 NEGATIVE BIOPSY 1193 CANCER BIOPSY 683 ADENOMA 2593 TOTAL SPECIMENS 4469

  37. SCORE 7 POLYP CANCER 173

  38. SCORE 10 CANCER RESECTION 683

  39. TOTAL SPECIMENS = 5325 TOTAL SCORE = 21448 /40 = 536 PA per annum ASSUMING 7.5 PA / WEEK / WTE for 40 WEEKS = 1.8WTE FOR REPORTING ONLY

  40. REQUIREMENT FOR 100,000 INVITED POPULATION 47 PA per annum

  41. AYRSHIRE AND ARRAN – 115,000 BMS 0.28 WTE CLERICAL 0.2WTE CONSUMABLES £4,009 + VAT

  42. EXTRAPOLATION OF AYRSHIRE AND ARRAN FIGURES TO SCOTLAND-WIDE CAUTION! BMS 3.3 WTE (0.24 / 100,000) CLERICAL 2.4 WTE (0.17 / 100,000) CONSUMABLES £47,825 + VAT (£3,486 / 100,000)

  43. = £95.03 TAMOXIFEN 39 MONTHS METHADONE 3 MONTHS STATIN 24 MONTHS

  44. PATHOLOGY STANDARDS

  45. ESSENTIAL Pathology reporting is in accordance with RCPath and SIGN guidelines*. This includes use of a minimum dataset proforma, if applicable to the specimen type being reported 80% of the specimens submitted from colonoscopy are reported within 5 working days of receipt of the specimen DESIRABLE The histopathology laboratory has unconditional accreditation by Clinical Pathology Accreditation (UK) Ltd

  46. EXTENDED ROLE OF BMS IBMS/RCPATH BOWEL CANCER SCREENING WORKING GROUP

  47. SUMMARY • NHS BOARD PLANS READY JUNE 2006 • BOWEL SCREENING ROLL-OUT FROM LATE 2007 • APPROX 388 SPECIMENS PER YEAR PER 100,000 • APPROX 5325 SPECIMENS PER YEAR IN SCOTLAND • DISCUSSION DOCUMENT ESTIMATE = £95.03

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