BOWEL CANCER SCREENING IN LEWISHAM Lewisham CCG /Lewisham CEPN Education Event October 18th, 2017 Sue McNulty, Cancer Research UK Facilitator, Greenwich and Bexley

WHY IS SCREENING IMPORTANT? Screening reduces the number of people dying from cancer by: Detecting cancer early 63% of cancers detected through screening are at an early stage (stage I) Preventing cancer Bowel scope screening and cervical screening can both prevent cancer

BOWEL SCREENING

THE ENGLISH PROGRAMME USES 2 DIFFERENT TYPES OF BOWEL SCREENING TEST: Faecal Occult Blood Test (FOBt) Bowel Scope

BOWEL CANCER SCREENING: THE FOBT Men and women aged between 60-74 are invited every 2 years. Must be registered with a GP practice to receive invitation Anyone over 74 can request a kit by calling 0800 707 6060 Screening kit is completed at home and sent to the hub The screening hub analyses the kit The test detects tiny amounts of blood in the sample of poo, which can’t be seen by the eye The FOBt does not diagnose bowel cancer

Video https://www.youtube.com/watch?v=m2f-wY0C_1Q

WHAT HAPPENS TO THE COMPLETED FOBT KITS? The hub/centre/laboratory tests the kit to see whether there are any traces of blood There are 3 potential outcomes: No blood detected (normal result) – person receives letter informing them no further action is needed Result is unclear – test needs to be repeated (programme sends individual a second kit) Blood is detected (abnormal result) – The patient will have an appointment with a specialist nurse to discuss and arrange a colonoscopy For every 100 people screened with FOBt, 2 will have an abnormal result

BOWEL SCOPE (FLEXIBLE SIGMOIDOSCOPY) A one-off bowel screening test offered to men and women at 55 years who are registered with a GP. Aims to detect polyps in the lower part of the bowel Uses a thin flexible tube with a tiny camera on the end For every 220 people screened by bowel scope, 1 less person will die from bowel cancer over 17 years.

BOWEL SCOPE PROCESS People are invited by post A home enema kit is sent, which the person should complete on the day of the test People discuss the procedure with a specialist nurse beforehand Procedure takes about 20 mins – if polyps are found they can usually be removed there and then People are told if biopsies have been taken, and if so they will get their results within two weeks

THE FUTURE OF BOWEL CANCER SCREENING: FIT The Faecal Immunochemical Test (FIT) will replace FOBt in England, Scotland and Wales over the next few years What is FIT? Type of faecal occult blood test which uses antibodies that specifically recognise human haemoglobin (Hb). It is used to detect and quantify the amount of human blood in stool samples.

THE BENEFITS OF FIT AS A SCREENING TEST Detects human haemoglobin Numerical result generated by machine analyser Scope around threshold levels Easier to use Improved uptake

WHAT ARE THE BENEFITS AND HARMS OF BOWEL CANCER SCREENING?

THE BENEFITS OF BOWEL CANCER SCREENING The FOBt kit and bowel scope test save lives People taking part in FOBt screening reduce their risk of dying from bowel cancer by 25% People having the bowel scope test have a 40% lower risk of dying from bowel cancer Bowel scope can prevent some cancers from developing The risk of developing bowel cancer is reduced by a third These benefits last for at least 17 years

THE HARMS OF BOWEL CANCER SCREENING Screening can give an abnormal result even though the person doesn't have cancer – a false positive result Screening can miss cancer – a false negative result People over-interpret a normal result and do not report symptoms they experience in the future – false reassurance A bowel cancer or polyp that would not have caused any harm is diagnosed and treated - over diagnosis Follow up tests from FOBt/FIT, as well as bowel scope itself, have risks such as bleeding, damage (perforation) to the bowel wall, or (very rarely) death Deciding whether to be screened is individual – a person’s attitudes and values shape their view on the relative benefits and harms

BOWEL CANCER SCREENING UPTAKE National uptake - FOBt % of invited people screened adequately within 6 months of invitation: England: 56.4% Scotland: 57.0% Wales: 54.4% Northern Ireland: 56.8%

THE LEWISHAM PICTURE The proportion of people aged 60-74 screened for bowel cancer within 6 months of invitation (uptake) is 43.7% in Lewisham CCG. This is lower than the England average (56.4%) London uptake = 46.4%

Lewisham 6 month uptake – distribution by practices

WHAT ARE THE BARRIERS TO PARTICIPATION IN THE BOWEL CANCER SCREENING PROGRAMME?

BOWEL CANCER SCREENING BARRIERS Knowledge of screening E.g. thinking screening isn’t relevant because they don’t have symptoms Fear and fatalism E.g. believing that death is predetermined The test itself E.g. dislike and social taboo around handling faeces Motivation and practical barriers E.g. competing demands on time Beliefs related to culture, gender, or deprivation E.g. screening and preventative tests are not familiar parts of healthcare

WHAT CAN YOU DO TO INCREASE UPTAKE?

HOW CAN YOU HELP INCREASE UPTAKE? Improve awareness of bowel cancer screening Training Ensure all staff know about the bowel screening programme and are familiar with the FOBt Have a screening lead Use the CRUK GP Good Practice Guide Display screening information Bowel cancer screening information cards Leaflets and posters about bowel cancer and bowel cancer screening Animation: how to do the test Bowel Cancer Awareness Month in April

HOW CAN YOU HELP INCREASE UPTAKE? (CONT) Endorse the Bowel Cancer Screening Programme Contact your local screening hub/ centre to see if they can provide you with Prior Notification Lists (PNLs) for bowel screening OR Search for patients approaching their 60th birthday and 60-74 year olds with a non response result in the last 2 years Consider contacting people via: Letter (templates are available) Telephone (a telephone script is available) Opportunistically (Use alerts) Use READ codes to record any interventions

THANK YOU Sue.mcnulty@cancer.org.uk 07900 748422 cruk.org/facilitators