1. CANCER RESEARCH UK UPDATE
Tip to presenter: If you are only presenting on cervical screening you could just use these slides and some of the intro section slides
Discussion prompt:
You might want to take this opportunity to ask your audience what they know about cervical cancer. For example do they know:
How common it is
The survival rate
What the main risk factor is
The answers are on the next slide
CANCER RESEARCH UK UPDATE

2. CERVICAL SCREENING UPTAKE PACK
Tip to presenter: If you are only presenting on cervical screening you could just use these slides and some of the intro section slides
Discussion prompt:
You might want to take this opportunity to ask your audience what they know about cervical cancer. For example do they know:
How common it is
The survival rate
What the main risk factor is
The answers are on the next slide
CERVICAL SCREENING UPTAKE PACK

5. Ipswich and East suffolk CCG Percentage of females aged 25–64 attending cervical screening within target period

10. PRIMARY CARE CANCER UPTAKE PACK
Tip to presenter: If you are only presenting on cervical screening you could just use these slides and some of the intro section slides
Discussion prompt:
You might want to take this opportunity to ask your audience what they know about cervical cancer. For example do they know:
How common it is
The survival rate
What the main risk factor is
The answers are on the next slide
PRIMARY CARE CANCER UPTAKE PACK

11. PRIMARY CARE CANCER UPDATE PACK 2017/18 MENDLESHAM HEALTH CENTRE
Donna Reeve (CRUK Facilitator Manager East of England) E: T:
Dr Andrew Yager Macmillan GP E: T: 11 11 11 11

12. Mendlesham Health Centre CANCER TRENDS
Indicator
2014/15
2015/16
2016/17
2017/2018
Percentage of persons aged 60–74 screened for bowel cancer in the last 30 months - target 60%
65.5%
66.5%
68.1%
65.9%
Percentage of females aged 50–70 screened for breast cancer in the last 36 months – Target 70%
80.1%
79.5%
79.7%
Percentage of females aged 25–64 attending cervical screening within target period– Target 80%
77.4%
78.2%
77.9%
77.7%
CARE –THE FOLLOWING FIGURES CAN BE DUE TO THE SMALL NUMBERS
Percentage of Two Week Wait referrals with cancer (conversion rate)
7.3%
9.4%
10.5%
No data available
Percentage of new cancer cases treated which are Two Week Wait referrals (detection rate)
55.9%
38%
56.5%
58.1%
Number of emergency presentations (count) 7 11 2 6 12 12 12 12

13. East and West Suffolk Percentage of persons aged 60–74 screened for bowel cancer in the last 30 months - target 60%

14. East and West Suffolk Percentage of females aged 25–64 attending cervical screening within target period– Target 80%

15. East and West Suffolk Practices Percentage of females aged 50–70 screened for breast cancer in the last 36 months – Target 70%

16. All practice staff are trained so they can discuss bowel screening with patients?
Does the practice use system alerts
Does practice regularly review defaulter lists?
Does the practice try to contact screening defaulters?
Is the practice aware of patients who may need more assistance?
Is ‘easy read’ literature available and embedded in service delivery?
Is bowel, cervical, and breast screening promoted on practice screens and noticeboards?
Does practice take part in national campaigns?
TOP TIPS
SCREENING
Top Tips are some of the things that practices can do to 16 16 16 16

17. URGENT 2WW REFERRAL TOP TIPS
Are all GPs familiar with new NICE cancer guidance (NG12)?
Does the practice use the update regional 2ww forms?
Do GPs use referral decision support tools?
Does practice ensure patients given information leaflet/card with 2ww referral?
Does practice carry out any audits on cancer cases eg SEA?
Does practice keep a record of 2ww referrals and review progress?
Does practice have a standardised safety netting protocol in place?

18. RECOGNITION & REFERRAL TOOLS 18

19. BANANA SKINS LUNG PANCREAS OVARY
COPD patients have an increased risk x4 – 1% risk per annum
Atypical presentations – often vague – haemoptysis is most specific indicator PPV at 2.4% (NG 15 3%)
Thrombocytosis – cancer risk increased - mainly lung and CR
Negative CXRs – BJGP 2006 – 164 patients 3/12 before diagnosis – 90% abnormal 10% no suspicion of malignancy
1 year before 23% missed
PANCREAS
Easily missed - abdominal and back pain – jaundice late presentation NB new onset diabetes
Around 10 % 2ww Emergency presentation 50%
Ultrasound - remember does not have a 100% sensitivity – around 75-89% Lancet – if still worried further Ix needed
OVARY
Remember new presentation urinary frequency/urgency / change in bowel habit / new onset IBS >50
Do a Ca 125 – Ca Ovary 1:500 symptoms/signs dropping to 1:150 if Ca 125 > 35
Ca 125 most reliable tumour marker at the moment – elevates in up to 90% cases, but only 50% elevated stage 1 +

20. BANANA SKINS HAEMATURIA LYMPHOMA BANANA SKINS
Trace haematuria on dipstick can be ignored – 1+ and above Care with stick storage
2.5 – 20% of population have NVH – 1.5% have pathology
Visible haematuria has a PPV of around 5% for bladder/renal ca NICE 2WW age 45
Anaemia in males PPV 1.4% for urological cancer - do not forget urine in Ix of anaemia
Symptomatic NVH / raised WBC is significant NICE 2WW age 60
Bladder cancer in females easily missed – NB recurrent UTIs NICE 2ww age 45
2-3, 1+dipsticks done on different days in asymptomatic NVH is significant
LYMPHOMA
6th most common cancer - increasing incidence
PPVs over 60 are; - Unexplained LN = 18.6%; Head and neck mass = 4.6%; mass anywhere else in body 1.1%
Non Hodgkins 70% occur > 60 years

21. LOCAL PREVENTION SERVICE PROVIDERS
There are many local and national partner organisations that offer services and initiatives and training providers that are available for GP’s to sign post or refer patients to.
Stop smoking services
Weight management
Exercise referral
(West Suffolk and Felixstowe)
(All Suffolk)
Healthwatch
Alcohol and drug service
One You self management
Change for Life self management
Macmillan Cancer Support
Adapt slide to represent local services available
Lifestyle;
-Smoking
-Alcohol
-National campaigns 21

22. PRIMARY CARE CANCER EDUCATION IN SUFFOLK
PRIMARY CARE NURSE CANCER COURSE
EVERY SIX MONTHS
5-10 NURSES EACH TIME
30+ PRACTICES COMPLETED
3 DAYS FACE TO FACE & DISTANCE LEARNING
PRIMARY CARE CANCER UPDATE
FREE 1 DAY UPDATE FOR ALL PRACTICE CLINICAL STAFF
NEXT ONE 6TH JUNE 2019
Topics included November 2018 – breast cancer, FIT testing, Immunotherapy

23. CANCER EDUCATION
CRUK Talking About Cancer: Reducing Risk, Early Detection and Myth busting- FREE online training
(Can also organize a training session for health professionals)
Macmillan E-learning courses- FREE
RCGP Behaviour change E-Learning course- FREE
This module is aimed at healthcare professionals who would like to promote behaviour change in their patients to reduce their cancer risk.
Other CRUK CPD training- FREE
Add in VBA
Oral cancer toolkit
Skin cancer toolkit
RCGP link
All of these courses are available free of charge
-Red Whale suitable for GPs
-CRUK online tool suitable for reception, admin, HCA staff, PN’s
-Macmillan e learning have courses and training for all primary care staff
-CRUK facilitator training can be suitable for any primary care audience
CRUK Facilitator and Macmillan GP led training- FREE
Delivery of training for primary care professionals on a variety of topics such as prevention, early diagnosis, screening and safetynetting
Donna Reeve (CRUK Facilitator Dr Andrew Yager Macmillan GP 23

24. National Cancer Diagnosis Audit

25. Colorectal Cancer in the UK Faecal Immunochemical Test (FIT)
41,804 new cases in 2015
15,903 deaths in 2014
4th most common cancer
2nd most common cause of cancer death
Faecal Immunochemical Test (FIT)
Care - this slide needs to fit with local symptomatic FIT arrangements so may need amending or deleting
FIT and bowel screening
FIT in primary care is completely separate from the National Bowel Screening Programme, and a recent negative screening test does not preclude a primary care test if there is clinical concern.
FIT EAST (FIT Poo) study
A large scale study of FIT usage in primary care is taking place across the East of England, and all patients aged 40 and over will be offered the opportunity to take part; further information for patients will be included in the FIT kits. The researchers (from the University of Cambridge) will also invite some primary care team members to take part in short interviews. 25

26. FIT testing in primary care
What is FIT?
FIT stands for Faecal Immunochemical Test and is an antibody test for the presence of human globin in faeces. It is a highly sensitive, quantitative test performed on a single sample, unaffected by diet. A positive test (>10ug/g) indicates lower GI bleeding and the need for further referral.
Who should be offered the test?
NICE has produced guidance (DG30) on which patients should be offered FIT: Primary care clinicians are, however, encouraged to offer FIT testing to those patients whose symptoms may represent colorectal cancer but do not meet existing 2WW criteria. The suggested management pathway is overleaf, which also summarises NICE guidance.
How is the test arranged?
Practices will be supplied with FIT kits by their local laboratories and the test is ordered and reported on ICE just like any other primary care test. A recent FBC is also needed.
FIT and fast-track referral pathways
NG12 guidance and current 2WW colorectal pathways are unaffected and these patients do not need a FIT test.
The small print
A negative FIT test effectively rules out current colorectal cancer but clinical judgement is still needed for safety netting and follow-up.

28. Participated in a Cancer Update
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Participated in a Cancer Update
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Health Professional Engagement Facilitator
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Cancer Research UK
Tel :
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