BOWEL CANCER SCREENING 11/7/18 Neil Smith

Bowel cancer is the 4th most common cancer in the UK, accounting for 12% of all new cancer cases Bowel cancer is the 2nd most common cause of cancer death in the UK, accounting for 10% of all cancer deaths

Around 6 in 10 (59%) people diagnosed with bowel cancer in England and Wales survive their disease for five years or more. When diagnosed at its earliest stage, more than 9 in 10 people with bowel cancer will survive their disease for five years or more compared with less than 1 in 10 people when diagnosed at the latest stage.

NG12-2ww referral Lower GI

Colorectal cancer - symptoms Symptoms are common, none specific and unlikely to be cancer (abdominal pain) Symptoms occur late (abdominal mass, IDA) Concentrating on symptomatic disease unlikely to major impact on colorectal cancer mortality 2ww system not ideal for improving outcomes Screening can make a difference

Taking part in bowel cancer screening lowers your risk of dying from bowel cancer. (16%) Screening can pick up cancers at an early stage, when there is a good chance of successful treatment. Screening can find non-cancerous growths (polyps) in the bowel that may develop into cancer in the future. Removing these polyps can reduce your risk of getting bowel cancer.

Bowel cancer survival screening Uptake – of those invited the proportion who were adequately FOBt screened. Excludes late responders.

Variations in GP uptake (BwD CCG)

HOW TO IMPROVE BOWEL CANCER SCREENING Write down 1 action that you could do to increase uptake of bowel cancer screening Share this with a friend Discuss with another couple What is your top tip?

Community Bowel Screening Volunteers Project Raising screening rates, increasing early diagnosis Jonny Hirst – 11th July 2018

Bowel screening saves lives If caught early, 97% of people will have successful treatment But only 58% of people across Greater Manchester take up the offer of bowel screening Start this slide with the ‘story of the Regional Manager role’ - Stress the need for screening rates to increase and the difference this could make. This will save lives - Highlight that this is also about health inequality. Those in the poorest areas are the least likely to do the screening tests and therefore more likely to have a late stage diagnosis of cancer.

So what’s the plan?

The evidence behind our approach GP endorsed letters: Average screening increase in studies of 6-7% Health promotion by telephone: highest positive impact on screening rates (7.6% increase in screening population) Face to face promotion: at GP surgeries was also seen to have a positive impact (4.7% increase), (Shankleman et al, 2014) Approach also based on a many conversations across NW

Deprivation score by CCG area across GM

Bowel screening (6 months) GM CCGs 2016/17

Deprivation in Trafford by GP practice area

In the development and the delivery of this project, we needed to work closely with a number of key partners… Including the Screening Hub

Outcomes and impact Give latest updates on Stockport, Wigan and Trafford

Talk about the other ways that we’re tracking outcomes here too

Completion rates for patients sent a new kit (489 kits sent)

GP Practice outcomes data From the 12 GP practices data was gathered from, 489 kits were sent to patients after a conversation with a volunteer. From these 489: 161 screening kits completed after being resent a kit   4 abnormal results 2 of these abnormal results went to colonoscopy and no further action was needed 2 of these abnormal results went to colonoscopy and had potentially cancerous high risk adenomas removed

G.P. Endorsement Pennine Lancashire None participants Opportunistically Reorder kit Phased development

2014/15 Phase 1 • 160 (15.9%) returned kit. • >1000 none participants contacted. • 160 (15.9%) returned kit. • 14 positive tests (8.75% positivity –5x national average). • At least 2 new cancers found.

2014/15 Phase 1 Value of electronic coding and “pop up” reminder Face to face advocacy was more than twice as likely to encourage subsequent participation than letters or telephone calls. GPs unanimously asked to be able to order kits directly via their IT systems during a consultation.

2015/16 Phase 2 2016/17 Phase 3 ACE project Patient seen opportunistically >1000 Kit requested

‘This little kit could save your life’. The key message for the public is ‘This little kit could save your life’. Other key messages include: If you're aged 60-74 you'll be sent a free bowel cancer screening kit in the post, once every two years It's meant for people with no bowel related symptoms at all It can help detect the disease early, when it's easier to treat So don't ignore it, take the test Be Clear on Cancer Increase 2-4% uptake- especially deprived, first timers and previous, none responders

2017/18 Phase 4 Bowel screening template >3,000 Cancer LIS 2017/18 2017/18 Phase 4 Bowel screening template >3,000 Kits sent by HUB >2,500 Kits returned by patient >1,000 Percentage success >40% Positive results >42 Estimated neoplasia found >15

Is it making a difference? Phase 4 > 1.5% Bowel Screening increase HUB report 4% increase in last 3 years 7% when take into account late responders and re-requests

CHALLENGES TO IMPROVING SYSTEM IT and coding Fixed practice- resistance Governance GP support / advocacy Patient understanding/ engagement

What happens to positive results? 2% screening test positive Of those with positive result (G.P. told ‘no action’) - 10% have bowel cancer - 20-30% adenomatous polyps - 36% colorectal neoplasia

10% of those with positive results do not attend for follow up and colonoscopy Practice 10,000 patients approximately 2 unknown patients who have a 36% risk bowel Cancer Search on positives in last 2 years Audit to ensure attended colonoscopy Discuss with patient and refer if not

2018/19 Phase 5 Agree Banner Advocate screening opportunistically Aiming for 2/1000 Whole Lancashire South Cumbria Alliance Early Diagnosis bid funding project & CCG “cancer bundles”

2019/20 Phase 6 Support and evaluate Learn and improve Sustainable through standardised cancer bundles National ambition

IT’S COMING HOME