2. Not for reproduction IT Infrastructure NHS BCSP Julietta Patnick November 2007

3. Not for reproduction Organisation in England 5 Programme Hubs across England, based on IT Local Service Providers (LSP) undertaking call/recall and lab functions 1 Programme Hub per LSP Each Programme Hub has a number of Screening Centres Overarching Structure: Gateshead Nottingham London Guildford Rugby

4. Not for reproduction Bowel Cancer Screening System (BCSS) A single national database, written in Oracle Accessible from anywhere in NHS over secure weblinks Manages call, recall, results and appointments into local screening centres Collects and analyses clinical data from all returning a kit

5. Not for reproduction LOCAL HOSPITAL: LINKS Cancer treatment centres SC Programme Hub Screening Centre Colonoscopy site

6. Not for reproduction BCSS Links SNOMED Codes used Will link to –Cancer registries –NBOCAP –Endoscopy systems? –Pathology systems? –Depends on National Programme for IT overall strategy

7. Not for reproduction BCSS Datasets: Cancer types can handle synchronous tumours, each tumour described separately –Malignant tumour –Polypoid tumour –Fungating tumour –Frond-like/villous tumour –Ulcerated tumour –Infiltrative tumour –Submucosal tumour –Partial obstructing tumour –Complete obstructing tumour

8. Not for reproduction BCSS Datasets: Interventions SNOMED CodeDescriptionCancerPolyp 82035006PolypectomyNoYes 86273004BiopsyYes 413199002Tissue destructionNoYes 14792009TattooingYes Mucosal resectionNoYes 372034000Haemostatic techniqueNoYes 360017003ClippingNoYes 119266004CoagulationNoYes 276913007Laser vaporisationNoYes 413240005ChromoscopyNoYes 363105001DilationNoYes

9. Not for reproduction Polyp Reporting 1.IDENTIFYING THE POLYP 1.Polyp ID 2.Diagnostic Test ID 3.Polyp Location 4.Polyp Class 5.Polyp Size Estimate 2.POLYP HISTOLOGY 1.Polyp Histology ID 2.Polyp ID 3.Polyp Type 4.Polyp Microarchitecture 5.Polyp Excision Complete 6.Polyp Size 7.Polyp Dysplasia 8.Polyp Carcinoma 9.Polyp Stalk Invasion 10.Polyp Lymphovascular Invasion 11.Polyp Margin Distance

10. Not for reproduction BCSS Datasets: Polyps Each polyp separately recorded SNOMED Code DescriptionSessilePendunculatedAdenoma Kikuchi Sm1 - tumour invades upper 300u of submucosa YesNoYes Kikuchi Sm2 - tumour invades upper 2/3 of submucosaYesNoYes Kikuchi Sm3 - tumour invades full thickness of submucosa YesNoYes Haggitt 1 - tumour invades into upper part of head of polyp NoYes Haggitt 2 - tumour invades into lower part of head of polyp NoYes Haggitt 3 - tumour invades into the top of the stalkNoYes Haggitt 4 - tumour invades into the submucosal at the base of the stalk NoYes

11. Not for reproduction Lesion Lookup List in the Cancer Histology entity SNOMED CodeDescriptionDifferentiation Applicable NBOCAP IDNBOCAP Description 408645001AdenocarcinomaYes1Adenocarcinoma M8140/3 32048006AdenomaNo 17621005Normal mucosaNo 28899001Squamous cell carcinoma Yes2Other M8000/3 21964009Malignant lymphoma Yes2Other M8000/3 2092003Malignant melanoma Yes2Other M8000/3 28755003GISTYes2Other M8000/3 48554007Malignant carcinoidYes2Other M8000/3 253000007Neuro-endocrine carcinoma Yes2Other M8000/3 2424003SarcomaYes2Other M8000/3

12. Not for reproduction T Category Lookup List for cancer audit NBOCAP CodeProcedurePre-TreatmentPathology 1Tx 2T1 pT0 3T2 pT1 4T3 pT2 5T4 pT3 6pT4

13. Not for reproduction Changing the system

14. Not for reproduction Thank you for listening www.cancerscreening.nhs.uk www.bcsp.nhs.uk