1. www.virgincare.co.ukPrivate and confidential1 BREAST SERVICES IN GUILDFORD Julie Cooke Consultant Radiologist Jarvis Screening Centre and Royal Surrey County Hospital, Guildford

2. www.virgincare.co.uk What is available NHS Breast screening programme –Jarvis Centre Symptomatic breast services –Jarvis Centre –Royal Surrey County Hospital –Ashford/St Peters –Frimley Park Hospital –Surrey and Sussex Healthcare Private and confidential 2

3. www.virgincare.co.uk NHS Breast Screening Asymptomatic population screening, – call and recall 3 yearly Usually on mobile units Age range 50-70 Age extension randomisation –trial 47-50 and 70-73 Over 70 (73) self refer Private and confidential 3

4. www.virgincare.co.uk Key prognostic indicators, breast screening (2013-14) Uptake to invitation 71% (>70%) Recall rate 6.0% Cancer detection 7.4/1,000 (=>4.1) Round length (how may screened within 36 months of previous screen) –97% (=>90%) Process targets –Screen to results 99% (=>90%) –Screen to date of first offered assessment 93% (=>90%) –Date of attendance at assessment 84.5% (=>90) Private and confidential 4

5. www.virgincare.co.uk Screening problems 3 year cycle, so uptake variable Referrals to acute trusts with breast cancer diagnosis depends on van location, peaks and troughs Staff holidays, sickness, maternity leave, gaps in cover Low areas of uptake –Ethnic minorities, Woking, Spelthorne Private and confidential 5

6. www.virgincare.co.uk Marmot report Cancer UK Department of Health 2012 Breast cancer deaths 20% reduction in breast cancer mortality One death prevented for every 235 invited (180 attended ) 1300 deaths prevented per year 22,000 years of life saved per year For 10,000 women invited, age 50+, 20 years, –681 cancers diagnosed, 43 deaths prevented Private and confidential 6

7. www.virgincare.co.uk Over diagnosis Detection of a cancer that would not have come to light in the woman's lifetime 11% for population and 19% from woman's perspective DCIS; 10% will develop invasive disease within 10 years For 10,000 women invited, age 50+, 20 years –681 cancers diagnosed, 43 deaths prevented –129 cancers over diagnosed (19% estimate) Private and confidential 7

8. www.virgincare.co.uk Breast cancer treatment Private and confidential 8 Wide local excision Radiotherapy Hormone therapy Mastectomy Reconstruction Chemotherapy

9. www.virgincare.co.uk Symptomatic breast referrals Urgent, cancer suspected (TWR); seen within 2 weeks –Refer to RSCH or other acute trusts Non urgent; seen within 2 weeks –Refer to Jarvis or RSCH, or acute trusts –The choice is yours Why has the Jarvis stopped seeing urgent (TWR) referrals Private and confidential 9

10. www.virgincare.co.uk Urgent, cancer suspected (TWR) Two weeks from referral to appointment (93%) 31 days from decision to treat to 1 st treatment (96%) 62 days from referral to 1 st treatment (85%) 62 days from attendance at screen to 1 st treatment (90%) Private and confidential 10 Refer 2 weeks 31 62 Rx

11. www.virgincare.co.uk Non urgent referrals, cancer not suspected Two weeks from referral to appointment (93%) Diagnosis can take longer as on different pathway 31 days from decision to treat to 1 st treatment (96%) Family history and cosmetic referrals are excluded Private and confidential 11 Refer 2 weeks Rx Cancer 31days 62 days decision No cancer18 week

12. www.virgincare.co.uk Be Clear on Cancer 1 in 3 women who get breast cancer are over 70, so don’t assume you’re past it Private and confidential 12 Feb/March 2014

13. www.virgincare.co.uk THANK YOU Any questions? Private and confidential 13