NHS CANCER SCREENING PROGRAMMES Delivering the service in Primary care Anne Morton 3/2/15

Learning Outcomes List the 3 Cancer screening programmes available in England Explain the causes of bowel, breast, and cervical cancer Describe the services available to manage the screening in primary care List the modifiable risk factors associated with those cancers

Breast Cancer Screening Women from age 50 to 70 called every 3 years Being extended to 47 & 73 in some areas of England. (At present age 70 invited to self book at 73) Mammography low dose x ray of the Breast tissue X ray detects early changes in breast tissue before being seen/ felt. Can detect the disease but not prevent it Could pick up tumour that may not cause damage to the woman over a lifetime Picks up ductal carcinoma in situ. Cancer confined to the ducts. Ductal carcinoma 50% chance of spreading if left untreated

Breast Cancer Risk Age 80% of women are diagnosed over age 50 Family history (I) Mother or sister diagnosed age < 40 2 close relatives from same side of family 3 close relatives or father & brother at any age A close relative with ovarian and another with breast cancer Not breast feeding, not having children or having them after 30 Exposure to female hormones small risk in women who used oestrogen contraceptive pills Hormone replacement therapy (HRT) 19 extra cases in every 1000 women who take HRT for 10 years

Lifestyle Risk Factors 30% of Breast cancer cases could be prevented through lifestyle changes Alcohol slightly increases the risk . In 2010 6.4% of cases were linked to alcohol consumed Weight. Being overweight after menopause . Oestrogen levels linked to the amount of fat In 2010 9% of breast cancer diagnosed was directly linked to women being overweight Exercise reduces your risk about 1/3. 3.4% of those diagnosed were linked to lack of exercise

Cervical Cancer 25-50 every 3 years. 50-64 every 5 years 65+women not had test since the age of 50 or recent abnormal tests Recall system ( Open Exeter). Hospital fail safe system. GP practice can recall hard to reach. GP Practice recall system (Payment for achieving 80% population to be screened) All Practice Nurse undergo special training to learn how to take cervical smears

Causes of Cervical Cancer Human Papilloma virus (HPV) Infection HPV types 16&18 cause 70% of cervical cancer. HPV vaccine not protective against all strains Other sexual infections and HPV Number of sexual partners, family history, social class, occupation- dry cleaning chemicals. Smoking ( if you smoke and have HPV infection you are twice as likely to get cervical cancer) Weak immune system (HIV infection) Taking the contraceptive pill for more than 5 years doubles your risk (still a small risk)

Bowel Cancer Screening Age 60-69 .Being extended to age 75. Every 2 years IN England starting scope bowel screening test once at age 55 + screen from age 60 Sent test kit to sample faecal occult blood (FOB). Scope looks for polyps Scotland starts FOB screen at age 50 2% of FOB tests are abnormal . 80% of those have a colonoscopy. 50 % of colonoscopy tests are normal.37.5 % will have polyps, 12.5% will have cancer

Risks for Bowel Cancer Age 80% diagnosed in over 60 Strong family history ( 1 first degree relative diagnosed before age 40 ,2 first degree diagnosed at any age. Some rare genetic disorders History of Ulcerative colitis and Crohn’s disease Smoking, Being less physically active Eating a diet low in fibre & high in red and processed meats.

Resources http://www.cancerresearchuk.org/ http://www.smallc.org.uk/ http://www.cancerscreening.nhs.uk