1. BOWEL CANCER SCREENING 11/7/18
Neil Smith

3. 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

4. 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.

5. NG12-2ww referral Lower GI

6. 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

7. 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.

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

11. Variations in GP uptake (BwD CCG)

12. 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?

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

14. 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.

15. So what’s the plan?

16. 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

17. Deprivation score by CCG area across GM

18. Bowel screening (6 months) GM CCGs 2016/17

19. Deprivation in Trafford by GP practice area

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

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

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

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

24. 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

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

27. 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.

29. 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.

30. 2015/16 Phase 2 2016/17 Phase 3 ACE project
Patient seen opportunistically
>1000 Kit requested

33. ‘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 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

35. 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

36. 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

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

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

39. 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

40. 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”

43. 2019/20 Phase 6 Support and evaluate Learn and improve
Sustainable through standardised cancer bundles
National ambition

44. IT’S COMING HOME