1. Cancer Public Health, SWAG Cancer Alliance
Dr Ardiana Gjini, Consultant in Public Health, Screening and Immunisation Lead, PHE and NHS England

2. Public Health aspects of cancer
Prevention Inequalities Earlier diagnosis Reducing emergency presentations Lifestyle – pre and living with and beyond cancer

3. PHE Work programme
Nationally: based on PHE progress report to Taskforce Recommendations July17 New tobacco control plan within the next 12 months. Obesity HPV vaccination – boys if c/e by 2020, current MSM FIT – 2019 ,75% uptake by 2020 , GPs to take responsibility for uptake HPV primary for cervical screening – fully implemented by NSC – evidence on lung and ovarian cancer screening; PHE to pilot within 12m with a national rollout plan Locally across SWAG: follows suit with focus on screening uptake

4. Prevention – lifestyle factors and cancer

5. South Region Cancer delivery plan
To reduce variation in screening uptake and patient outcomes across STP geographies and contribute to a reduction in skin cancers by There will be an agreed programme of work by 30/11/17 relating to prevention of cancer with the cancer alliances to be delivered within

6. PHE SW - Health and Wellbeing plan
To reduce variation in screening uptake and patient outcomes across STP geographies and contribute to a reduction in skin cancers by There will  be an agreed programme of work by 30/11/17 relating to prevention of cancer with the cancer alliances to be delivered within
Ensure that by 2020 every person affected by cancer has access to the Recovery Package by applying the learning from the Transformation Funds implementation of Recovery Programme Package across the region through

7. Right Care Some paradoxes: eg Breast cancer B&NES Low incidence
Medium early dg (Stage 1&2)
High emergency presentations

8. BN&ES incidence 100,000 pop

9. % of Early (stage 1&2) diagnosis B&NES
9 ppl
2014

10. Emergency presentations breast cancer - DSR per 100,000 pop B&NES

11. Bath, Swindon & Wiltshire
Bowel screening BGSW
Indicator
Target (%)
Bath, Swindon & Wiltshire
Gloucestershire
Waiting times:
% seen by specialist screening practitioner within 14 days
100% ≤14 days
100
99.7
Diagnostic test waiting times:
% first offered colonoscopy within 14 days of being seen
95.2
75.2
82.5
91.1
76.94
83.9
Positivity:
% adequately screened with a definitive FOB test abnormal outcome
Expected value = 2%
1.78
1.7
1.8
1.87
1.6
Uptake:
% adequately screened out of those originally sent a letter
52%
58.4
58.9
63.9
61.1
62.8
61.60

12. Breast screening BGSW Indicator % screening coverage Target (%)
B&NES
Glos
Swindon
Wiltshire
England
>70%
75.4
80.4
79.2
80.0
77.0
74.1
80.3
78.8
76.4
76.0
80.2
79.3
79.9
75.9
75.6
79.6
76.1
79.1
78.7
79.0
75.5

13. Cervical screening BGSW
Indicator
Target (%)
Year
Bath
(%)
Glos
Swindon
Wiltshire
England
Women screened:
% of women screened (25-64 year olds) within 5 years
80%
75.8
78.0
73.5
76.4
74.2
74.8
77.4
72.4
75.9
79.4
77.0
77.5
72.7

14. Bowel screening uptake by deprivation, BSW
Most people in B&NES, Swindon and Wiltshire live in neighbourhoods in the least 30% deprived deciles.
Uptake by grouped deprivation deciles in 2015:

15. Bowel screening , BSW Effects of age, gender and deprivation cluster
lowest uptake among men aged years old in the most deprived quintile (33.2%)
highest among women aged years old in the most affluent quintile (71.9%).
Variation by GP practice from 32% to 71%
variation by GP practice could mirror deprivation
and/or reflect practice endorsement of screening
Variation by GP practice: could mirror deprivation.
And/or reflect practice endorsement of screening.
GP practices with more eligible people had higher uptake than GP practices with fewer eligible people. Might be spurious result and/or reflect a combination of practice endorsement, deprivation etc.

16. Inequalities in cancer screening programmes
To address inequalities in uptake of screening & immunisation programmes across BGSW – we are funding a pilot service:
one year – paying for a full work time equivalent staff part of our community providers to work under our professional leadership in increasing the uptake of priority screening and imms progs
Prioritisation of prog will be based on inequity issues (eg HEA undertaken, baseline data) based on localities;
bowel screening is a priority in all four our areas,
cervical screening in Swindon.
Will be undertaking a HEA for breast which will inform the prioritisation

17. Cancer screening work plan 2017-18 SW / BGSW
Roll out phase three of bowel scope
Glos – 3 lists currently, by end of (Cheltenham *2, Stroud, Cirencester)
BSW – Currently 2 lists in SFT, RUH Sept 17, GWH Nov 17
Bowel screening implement FIT
Prep for HPV primary, mitigate backlogs
Pilot a service aimed at reducing inequalities in uptake and improvement of uptake – Bowel and Cervical screening as priority (along with primary imms, MMR)
Prostate cancer diagnosis - ProtecT

18. SWAG Cancer
PH – indicators for prevention of adverse outcomes through life- course indicators for reduction of inequalities SWAG Cancer Alliance – prevention and early dg subgroup