1. Training for Practice Nurses and Health Care Assistants on CANCER SCREENING PROGRAMMES
Trainer Notes:
This module can be delivered by a non clinician, and as an individual module.
It covers the current cancer screening programmes in England.
Start off by asking participants what they know about screening and if they are aware of the cancer screening programmes.
Key messages:
Cancer screening involves testing apparently healthy people for the signs that could mean a cancer is developing.
- Benefits of screening
Screening can detect cancer at an early stage. If cancer is picked up early, it means that treatments are more likely to work and more people survive.
Some screening programmes can also prevent cancer. The cervical screening programme, as well as the new Bowel Scope test, can detect abnormal changes before they can turn into cancer. Treating these early changes can prevent cancer from developing.
- Risks of screening
Screening is not perfect, and it can miss cancers. How often this happens varies for different types of screening test. That’s why it is still important to know your body and see your doctor about any unusual changes, even if you have had screening.
Screening can also mean people have to come back for more tests and then find out they don’t have cancer. If this happens, you might feel very anxious.
Sometimes, screening can pick up cancers that would not grow at all, or be very slow growing, and the person may never even know they had it. This is called overdiagnosis. It means that people can get a diagnosis of cancer, and have to go through lots of treatments, that they didn’t really need. But doctors can’t tell which cancers need treating and which don’t, so they offer treatment to everyone diagnosed with cancer. This is a particular problem with breast screening.
Sometimes, the tests themselves can have risks or side effects, like bleeding, pain, or infections
Read more at
HCA PN Cancer screening programmes training slides

2. Screening programmes for cancer
Breast
Screening programmes for cancer
Bowel
Trainer Notes:
Confirm the cancer screening programmes are:
bowel
breast
cervical
Cervical
HCA PN Cancer screening programmes training slides

3. Bowel screening
What is bowel screening? Bowel screening aims to detect bowel cancer at an early stage when treatment is more likely to work.
Trainer Notes:
Bowel screening aims to detect bowel cancer at an early stage when treatment is more likely to work. It can also sometimes prevent bowel cancer from developing in the first place.
HCA PN Cancer screening programmes training slides

4. Bowel screening What’s the test…and who gets tested?
And people 75 and over can request a screening test
What’s the test…and who gets tested?
Men and women from the age of 60 to 75.
Trainer Notes:
Who is tested in the screening programme?
Men and women from the age of 60 to 75.
Over 75 people can request a screening test - phone
What is the test?
The test used in bowel screening in the UK is the FOB or faecal occult blood – this looks for hidden traces (occult) blood in poo (stool or faces).
There is also a test called bowel scope where a thin tube with a camera is inserted into the lower bowel (known as a flexible sigmoidoscopy) – This is offered as a one off examination at age 55 and is being rolled out across the country (Check if bowel scope is being offered in the patch where the module is being delivered and let participants know)
HCA PN Cancer screening programmes training slides

5. Bowel screening – the kit
Trainer Notes:
Bowel screening kit
The kit is sent out by post from the bowel screening hub for the Midlands and North West based in Rugby.
The kit is a simple way to collect small samples of poo on a special card which is then hygienically sealed and sent back in a pre-paid envelope.
If a patient does not respond for the first screen – a reminder is sent. If a patient does not respond to this then the GP practice is informed and the patient will be recalled again in 2 years.
The results of the test are returned in two weeks. The GP practice also receives notification of the result.
If the kit is lost or the patient changes their mind to take the test, a replacement kit can be ordered by phoning
Each kit is bar coded and specific for the patient – so they cannot be given out in surgery.
HCA PN Cancer screening programmes training slides

6. Bowel Screening Cancer Research UK
Trainer Notes:
This short animation provides a clear overview of the Bowel Screening Programme involves for patients
HCA PN Cancer screening programmes training slides

7. Bowel screening 2025 Trainer Notes: Talk about the benefits:
The benefits of bowel screening – early diagnosis – 90% survive 5+ years.
Estimates are that by 2025 the programme will save 2000 lives a year
HCA PN Cancer screening programmes training slides

8. Cervical screening Trainer Notes
Gather some ideas about cervical screening and what it involves
Key Message: Cervical screening is a way of preventing cancer by finding and treating early changes in the neck of the womb (cervix). These changes could lead to cancer if left untreated.
HCA PN Cancer screening programmes training slides

9. What is the test used in cervical screening?
Cervical screening uses a test called liquid based cytology (LBC) – known to many as a smear test.
Trainer Notes:
Cervical screening uses a test called liquid based cytology (LBC) – known to many as a smear test. A nurse or doctor takes a sample of cells from the cervix with a small brush. The sample is sent to a lab to check for abnormalities and in some cases the samples are tested for a virus called HPV (human papilloma virus) that increases the risk of cancer. The result comes back to the patient within two weeks.
HCA PN Cancer screening programmes training slides

10. Who has cervical screening?
Women aged 25 to 49 are invited every three years and after that every five years until the age of 64.
Trainer Notes:
Ask the question “Who has Cervical screening?”
In England, Northern Ireland and Wales the NHS Screening programme invites women from the ages of 25 to 64 for screening.
Women aged 25 to 49 are invited every three years and after that every five years until the age of 64.
HCA PN Cancer screening programmes training slides

11. Why do younger women not have screening?
Trainer Notes:
Ask the Question – Why are younger women under the age of 25 not offered screening?
We know from research that cervical cancer is very rare in women younger than 25. The graph above demonstrates the low incidence. However cancer of the cervix can occur in women under 25 – so abnormal patterns of bleeding need to be taken seriously and investigated by clinicians.
Changes in the cervix are quite common in this age group and can lead to unnecessary worry and treatments.
The graph shows Cervical Cancer (C54), European Age-Standardised Mortality Rates, By Age, Females, UK,
(Read more at
Source: Cancer Research UK Cervical cancer age statistics
HCA PN Cancer screening programmes training slides

12. What happens after a Smear Test?
Trainer Notes:
The cell sample is then sent off to a laboratory for analysis and patients should receive the result within two weeks.
Most samples are normal and women will be asked to attend again in 3/5 years depending on their age.
However the test may reveal a number of potential outcomes:
Inadequate – not enough cells or infection or period or cervix inflamed. Repeat after 3 months.
Borderline or mild changes (low grade dyskaryosis) - An HPV test will be done on the same sample of cells (this test is called HPV triage). This will be done automatically if your test shows up with borderline or low grade dyskaryosis. If your test shows no high risk HPV (it is negative) you can return to your regular screening intervals (three or five years). If the test shows positive for high risk HPV, you will be invited to attend a colposcopy clinic for a further check up
Moderate or severe changes (high grade dyskaryosis) - You will be invited to attend a colposcopy clinic. Abnormal cells usually need to be removed and further treatment will be based on the colposcopy and any biopsy results of the affected area
Scientists and experts estimate that cervical screening saves around 4500 lives each year in the UK.
HCA PN Cancer screening programmes training slides

13. Breast Screening
<iframe width="560" height="315" src=" frameborder="0" allowfullscreen></iframe>
HCA PN Cancer screening programmes training slides

14. What is the test used in breast screening?
Breast cancer can affect 1 in 9 women in their lifetime.
Trainer Notes:
Breast cancer can affect 1 in 9 women in their lifetime.
Mammograms are used to look for early signs of breast cancer – these are x-rays of the breast.
HCA PN Cancer screening programmes training slides

15. Who is tested for breast cancer?
Trainer Notes:
The programme invites women between the ages of 50 and 70 for screening every 3 years.
The programme is currently being extended to 47 to 73 but over 73 a patient can request a mammogram 3 years after their last.
HCA PN Cancer screening programmes training slides

16. What happens after the mammogram?
Trainer Notes:
The results are posted back to the woman with 2 weeks.
4 out of 10 will be called back for some abnormalities.
Only 1 in 5 of these will have cancer.
The screening programme finds about 8 in 1000 women with cancer.
Source
HCA PN Cancer screening programmes training slides

17. What are the benefits and harms
Trainer Notes:
BENEFITS
Very early cancers are much easier to treat.
Early diagnosis can result in a cure.
Evidence demonstrates 1300 lives saved a year by screening.
Early stage cancers  9 in 10 chance (90%) 5 year survival.
HARMS
false positives and false negatives
Screening doesn’t always find cancer.
False positives = anxiety
False negatives = delayed diagnosis.
There are some issues about over-diagnosis and treatment.
The evidence is not completely clear – as some of the cancers found may never have caused a problem – ductal carcinoma in situ.
Plus there is additional risk of exposure to radiation.
For every 1 life saved, 3 women are overdiagnosed.
HCA PN Cancer screening programmes training slides

18. What barriers can you identify that may prevent patients participating in screening programmes?
Breast
Bowel
What ideas can you think of that may overcome these and increase uptake for your practice?
Trainer Notes:
This is a group work session, depending on the number and size of the groups, allocate a group a screening programme and ask them to identify the potential barriers for patients and any initiatives or approaches that could be implemented to overcome these barriers.
Ensure there is time for feedback and discussion once groups have completed this work.
Encourage participants to record any actions or ideas in their workbook that could be implemented in their own place of work to promote screening uptake.
Cervical
HCA PN Cancer screening programmes training slides

19. Any Questions? Trainers notes
You can use this time to reflect on any ideas that have been generated in the group work session.
HCA PN Cancer screening programmes training slides