1. FOBt Bowel Cancer Screening & Bowel Scope Screening Lancashire Bowel Cancer Screening Programme
Louise Newton & Cathy Corcoran
Lead Specialist Screening Practitioner & Deputy Lead SSP
We are based in Home 5 BVH , Team include Clinical Director MTH, PM, Lead SSP, Deputy Lead SSP, admin, 9 Screening colonoscpists based at either BGH RPH / CDH and BVH, 1 Dual Role Nurse Endoscopist / Senior SSP and 16 SSPs

2. Bowel Cancer: The Facts
16,000 deaths/year from Bowel cancer
2nd commonest cause cancer death
Over 34,000 new cases/year
Over 80% occur in over 60s
Lifetime risk 1 in 20
Screening
FOB 16% Mortality reduction
Detect cancers earlier stage
Bowel Scope - mortality reduction 31-43%

3. Bowel Cancer Screening Programme
Aim of BCSP is to reduce the mortality rate of bowel cancer and to detect cancer at an early stage
The BCSP provides screening for men and women aged between 60 and 75 years using a FOBt
Participants who have a +FOB are invited to see a Specialist Screening Practitioner
Cancer deaths 16, Reduces mortality by 16%

4. Lancashire BCSP Population
Covers a population size of 1.3 million
160,000 of 60 – 69 year olds
50,735 of 69 – 75 year olds
8 CCGs commission the service
Patient can self refer at & after age 75

5. Guaiac FOBt testing kit
Patient applies sample
Positive Spots

6. How is FIT different to gFOBT?
Faecal Immunochemical Test
gFOBT
Guaiac Facal Occult Blood Test
Measures HUMAN blood
Measures any mamalian blood including that in the diet
Single faecal sample
6 faecal samples from 3 bowel motions
Sample put into plastic container
Sample put onto cardboard
Automated objective analysis
Subjective visual assessment
Adjustable Hb cut-off concentration
Non-adjustable Hb cut-off (sensitivity)
Higher participation rate than gFOBT
Lower participation rate than FIT

7. How is FIT different to gFOBT?
Faecal Immunochemical Test
gFOBT
Guaiac Faecal Occult Blood Test
Higher detection rate of cancers & adenomas
Lower detection rate of cancers and adenomas
Estimated 22% reduction in CRC mortality
Estimated 16% reduction in CRC mortality
TRIAL positivity rate about 2.11% at 120µg/g faeces
Current BCSP positivity rate 1.4%
More expensive than gFOBT
Less expensive than FIT

8. FIT Impact on Lancashire Screening Centre
20-30% Increase in demand with FIT kit vs FOBt kit
3 additional colonoscopy list p.w. required
Overall Screening centre 3 additional Specialist Nurse pre assessment clinics required p.w.

9. BCSP Targets
Specialist Screening Practitioner (SSP) assessment clinic within 7-10 calendar days of +ve FOB
Colonoscopy appt within 14 days of SSP assessment clinic
Post colonoscopy clinic or telephone clinic to be offered within 21 days – results

10. The Screening Centre
The SSP is the 1st face of the screening pathway for the patient
The Screening Centre is based in Secondary Care setting at Blackpool Victoria Hospital
The Assessment clinics are based in appropriate locations to cover the wide area of the programme
The Colonoscopy lists are within the 4 Accredited Hospital sites.

11. SSP Clinics – 9 per week Burnley Hospital
Barbara Castle Way PCC, Blackburn
Healthport Clinic Fulwood, Preston
Eccleston Health Centre, Chorley
Ashurst Clinic, Skelmersdale
Blackpool Victoria Hospital
Fleetwood Hospital
Lytham PCC

12. The Role of The SSP Qualified Nurses providing Nurse Led service
Establishment to cover Central Lancashire, East Lancashire, Blackburn with Darwen, Blackpool & Fylde and part of North Lancashire
Role
Pre-assessment of patients
Intra-procedure
Post-procedure

13. Nurse-Led Assessment Clinic
45 minute appointment
Discuss the implications of a positive FOB
Assess patient:
Medically fit for colonoscopy
Medically fit for bowel Prep
Medically fit for sedation
Obtains consent / starts consent process
Offer Colonoscopy appointment
SSP may need further information about a patient from notes, clinical specialist and GP
1 in 10 a cancer , 4 in 10 polyps, 5 in 10 normal

14. Colonoscopy Appointment
8 colonoscopy lists per week
SSP attends colonoscopy and supports patient
Data to be documented during colonoscopy
Ensures Quality Assurance Standards
SSP informs patient of findings
Cancer suspected – suppport pt

16. Pathways Colonoscopy NAD Polyp Other pathology Recall 2 years
Refer/treat
/advise
Cancer
Refer MDT
High Risk
>5 adenoma or
>3 adenomas at least 1
>1cm
Intermediate
Risk
3 or 4 small adenoma
or 1>1cm
Low Risk
1 or 2 small
adenomas
FOBt in
2 years <70
3yr col
surveillance
until 2 neg
Col after
12 months then
3 yearly col
Until 2 neg

17. Post Procedure/Follow up care
Following day phone call after colonoscopy
Once Histology results received, follow-up planned and verified with colonoscopist
Nurse-Led Follow–up appointment arranged
Surveillance Colonoscopy within the BCSP
May need booking for further procedure, large EMR, site check of polyp site
If failed colonoscopy, repeat if due to prep; book CTC if due to looping etc

18. Cancer Diagnosis Discuss findings with patient
Initiate staging investigations (CT / MRI)
Contact CNS and hand over patient
Refer to MDT Co-ordinator
Referral Pathways to 8 Trusts established

19. Cancer in polyps Experienced SSP will inform of diagnosis
Attendance at MDT meetings
Attendance of LJMU SSP Course
Advanced Communication Course
Local BCSP Training and competence in Breaking Bad News

20. National Comparisons in Dukes staging of cancers
Symptomatic Pts
Dukes A = 13%
Dukes B = 38%
Dukes C = 49%
Screening Pts
Dukes A = 48%
Dukes B = 25%
Dukes C = 27%
This is reflected in our local figures, does this reflect anyone elses figures? This is great for the screening pt but also by providing the BCSP service and getting pts an the early stage of Dukes A we are saving the Trusts and PCTs so much money To treat a pt with Dukes A is just over £7,000 compared to an advanced Dukes C which is over £17,000

21. Development of Service
Inclusion of prisoners
Increase uptake especially in ethnic minority groups/deprived areas/learning disabilities
LPMDM
FIT test

22. Bowel Scope Screening

23. WHY?
2/3 of CRCs and adenomas are located in the rectum and sigmoid colon – which can be examined by flexible sigmoidoscopy, a well accepted, safe and quick test
Professor Wendy Atkin and a team of researchers tested the hypothesis that ‘only one flexible sigmoidoscopy screening between 55 and 64 years of age can substantially reduce cancer incidence and mortality’

24. Bowel Scope Screening One-off FS examination for all 55 year olds
Complements FOB programme
Home self-administered phosphate enema
Unsedated 5 minute procedure
Aim to reach SF but low threshold for stopping if discomfort
Remove polyps <10mm, defer larger polypectomies
Refer for colonoscopy if 1 large of 3+ small adenomas

25. Lancashire B/Scope Roll Out
Currently 4 lists at BVH – commenced Feb 2014
Currently 3 lists at ELTH commenced November 2016
Currently 1 list at LTH commenced November 2016 ongoing discussions

26. Conclusion Bowel Screening very cost effective
20- 30% reduction in mortality
Screening Cancers Detected at Early Stage
Promotion of the BCSP is important to improve uptake
Target low uptake areas – deprived areas
BCSP develops according to research

27. Lancashire BCSP Team