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

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

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 2019-20 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

Prevention – lifestyle factors and cancer

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 2020. 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 2017-18

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 2020. 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 2017-18 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 2017-19

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

BN&ES incidence 100,000 pop

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

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

Bath, Swindon & Wiltshire Bowel screening BGSW Indicator Target (%) Bath, Swindon & Wiltshire Gloucestershire 2013-14 2014-15 2015-16 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

Breast screening BGSW Indicator % screening coverage Target (%) B&NES Glos Swindon Wiltshire England 2011-12 >70% 75.4 80.4 79.2 80.0 77.0 2012-13 74.1 80.3 78.8 76.4 2013-14 76.0 80.2 79.3 79.9 75.9 2014-15 75.6 79.6 2015-16 76.1 79.1 78.7 79.0 75.5

Cervical screening BGSW Indicator Target (%) Year Bath (%) Glos Swindon Wiltshire England Women screened: % of women screened (25-64 year olds) within 5 years 80% 2013-14 75.8 78.0 73.5 76.4 74.2 2014-15 74.8 77.4 72.4 75.9 2015-16 79.4 77.0 77.5 72.7

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:

Bowel screening , BSW Effects of age, gender and deprivation cluster lowest uptake among men aged 59-64 years old in the most deprived quintile (33.2%) highest among women aged 65-69 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.

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

Cancer screening work plan 2017-18 SW / BGSW Roll out phase three of bowel scope Glos – 3 lists currently, by end of 2017-18 4 (Cheltenham *2, Stroud, Cirencester) BSW – Currently 2 lists in SFT, RUH Sept 17, GWH Nov 17 Bowel screening implement FIT 2018-19 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

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