Screening programmes Practice nurse forum 13 th January 2009

Screening – an overview 12:45 –Helen Knowles Cervical screening –Helen Knowles / Elizabeth Stephens Breast screening –Jane Sarify-Nafis/ Amanda Dixon Bowel cancer –Helen Knowles/ Alison Ball Chlamydia –Cass Golumbina Retinal screening –Helen Knowles

National screening programmes Antenatal Downs Fetal anomaly Sickle cell and thalassaemia Communicable disease HIV Syphilis Rubella Hep B Newborn Newborn Hearing Bloodspot MCADD CHT CF Sickle Cell and Thalassaemia PKU Chlamydia CancerCervical Breast Bowel VascularDiabetic Retinopathy Abdominal Aortic Aneurysm

Biological onset of disease Early diagnosis possible Usual clinical diagnosis Recovery/ disability/death Screening Longer pre-disease state = ↑ chance of being detected Detected earlier so less severe disease

Inviting and Informing eligible population Screening test Results and communication about results Assessment Decision making A screening programme Systematic call / recall

Disease positive Disease negative Test Positive True positive False positive Test negative False negative True negative Falsely reassured. No difference to their disease outcome Further unnecessary investigations and anxiety Reassured. But may not lead to desirable behaviour May benefit from early detection. But outcome may not change for everybody.

Where’s the harm in screening? Breast pathology that would become symptomatic Breast pathology that would remain latent No breast pathology and not destined to develop symptomatic disease before next routine screen The test (mammogra phy) +veTrue positive‘True positive’False positive -veFalse negative‘False negative’True Negative

L&D Adden BHT Stoke M Lister MK PSU call/recall GP practices (58) PCT Specialist labs SCG spec consortium Child health records HVs Lab Clinical Lab Clinical Community Provider Child health Records out of area PSU Out of area

L&D Adden BHT Stoke M Lister MK PSU call/recall GP practices (58) PCT Lab Clinical Lab Clinical Community Provider PSU Out of area Cervical screening

L&D Adden BHT Stoke M Lister MK GP practices (58) PCT Specialist lab 1 SCG spec consortium Child health records HVs Clinical Child health Records out of area Newborn bloodspot Specialist lab 2 Specialist lab 3

Screening programmes – key actions Develop clarity about service specification and description Improved monitoring of performance Development of programme boards Development of programme guides/ policies for primary care: How the programme works Flow chart diagrams Roles and responsibilities within the programme Local contact information Failsafe processes Information material for patients – leaflets, posters etc Letters etc that are used within the programme

Cervical screening Aims to detect abnormalities that could develop into cancer National programme 1988; death rate now 50% of what it was then Screening programme (changed in 2003) 25 – 49 year olds 3 yearly screening year olds 5 yearly screening Not for under 25s

Under 25 screening Incidence of cervical cancer very low in under 25s (less than 40 cases per year) Low grade cervical changes relatively common Risk of doing more harm than good

Coverage in cervical screening BPCT : –81.2% in 5yrs for yr in 07/08 –71.0% in 3.5 yrs in in 07/08 Coverage declining nationally especially in younger age (25 – 34 ) groups

TAT - Turnaround time Target for women to receive results within 14 days of sample from April 09 LBC introduction to reduce inadequate rate (from 9% to less than 3% and decreasing) Implications –Reduce out of programme samples (<25, screening intervals as per programme ie 3 yearly and 5 yearly) – i.e. implement good practice in line with national standards –Sample to lab time –Lab turnaround time (processing and reading of samples, results to PSU). Bigger labs- more automation of processing and reading. Regional review of cervical screening lab and call / recall provision –Planning for PSU to send out all results letters (but those with abnormal results will still need to be contacted by practice)

Inadequate audit Local lab providers not yet able to log unique code within IT system to track sample. Continue with in-practice codes as now so that each sample can be matched with sample taker Working on obtaining practice and PCT level data to be communicated on regular basis.

Questions Discussion