1. BOWEL CANCER SCREENING IN LEWISHAM
Lewisham CCG /Lewisham CEPN Education Event
October 18th, 2017
Sue McNulty, Cancer Research UK Facilitator, Greenwich and Bexley

2. WHY IS SCREENING IMPORTANT?
Screening reduces the number of people dying from cancer by:
Detecting cancer early
63% of cancers detected through screening are at an early stage (stage I)
Preventing cancer
Bowel scope screening and cervical screening can both prevent cancer

3. BOWEL SCREENING

4. THE ENGLISH PROGRAMME USES 2 DIFFERENT TYPES OF BOWEL SCREENING TEST:
Faecal Occult Blood Test (FOBt)
Bowel Scope

5. BOWEL CANCER SCREENING: THE FOBT
Men and women aged between are invited every 2 years.
Must be registered with a GP practice to receive invitation
Anyone over 74 can request a kit by calling
Screening kit is completed at home and sent to the hub
The screening hub analyses the kit
The test detects tiny amounts of blood in the sample of poo, which can’t be seen by the eye
The FOBt does not diagnose bowel cancer

6. Video

7. WHAT HAPPENS TO THE COMPLETED FOBT KITS?
The hub/centre/laboratory tests the kit to see whether there are any traces of blood
There are 3 potential outcomes:
No blood detected (normal result) – person receives letter informing them no further action is needed
Result is unclear – test needs to be repeated (programme sends individual a second kit)
Blood is detected (abnormal result) – The patient will have an appointment with a specialist nurse to discuss and arrange a colonoscopy
For every 100 people screened with FOBt, 2 will have an abnormal result

8. BOWEL SCOPE (FLEXIBLE SIGMOIDOSCOPY)
A one-off bowel screening test offered to men and women at 55 years who are registered with a GP.
Aims to detect polyps in the lower part of the bowel
Uses a thin flexible tube with a tiny camera on the end
For every 220 people screened by bowel scope, 1 less person will die from bowel cancer over 17 years.

9. BOWEL SCOPE PROCESS People are invited by post
A home enema kit is sent, which the person should complete on the day of the test
People discuss the procedure with a specialist nurse beforehand
Procedure takes about 20 mins – if polyps are found they can usually be removed there and then
People are told if biopsies have been taken, and if so they will get their results within two weeks

10. THE FUTURE OF BOWEL CANCER SCREENING: FIT
The Faecal Immunochemical Test (FIT) will replace FOBt in England, Scotland and Wales over the next few years
What is FIT?
Type of faecal occult blood test which uses antibodies that specifically recognise human haemoglobin (Hb).
It is used to detect and quantify the amount of human blood in stool samples.

11. THE BENEFITS OF FIT AS A SCREENING TEST
Detects human haemoglobin
Numerical result generated by machine analyser
Scope around threshold levels
Easier to use
Improved uptake

12. WHAT ARE THE BENEFITS AND HARMS OF BOWEL CANCER SCREENING?

13. THE BENEFITS OF BOWEL CANCER SCREENING
The FOBt kit and bowel scope test save lives
People taking part in FOBt screening reduce their risk of dying from bowel cancer by 25%
People having the bowel scope test have a 40% lower risk of dying from bowel cancer
Bowel scope can prevent some cancers from developing
The risk of developing bowel cancer is reduced by a third
These benefits last for at least 17 years

14. THE HARMS OF BOWEL CANCER SCREENING
Screening can give an abnormal result even though the person doesn't have cancer – a false positive result
Screening can miss cancer – a false negative result
People over-interpret a normal result and do not report symptoms they experience in the future – false reassurance
A bowel cancer or polyp that would not have caused any harm is diagnosed and treated - over diagnosis
Follow up tests from FOBt/FIT, as well as bowel scope itself, have risks such as bleeding, damage (perforation) to the bowel wall, or (very rarely) death
Deciding whether to be screened is individual – a person’s attitudes and values shape their view on the relative benefits and harms

15. BOWEL CANCER SCREENING UPTAKE
National uptake - FOBt
% of invited people screened adequately within 6 months of invitation:
England: 56.4%
Scotland: 57.0%
Wales: 54.4%
Northern Ireland: 56.8%

16. THE LEWISHAM PICTURE
The proportion of people aged screened for bowel cancer within 6 months of invitation (uptake) is 43.7% in Lewisham CCG. This is lower than the England average (56.4%)
London uptake = 46.4%

17. Lewisham 6 month uptake – distribution by practices

18. WHAT ARE THE BARRIERS TO PARTICIPATION IN THE BOWEL CANCER SCREENING PROGRAMME?

19. BOWEL CANCER SCREENING BARRIERS
Knowledge of screening
E.g. thinking screening isn’t relevant because they don’t have symptoms
Fear and fatalism
E.g. believing that death is predetermined
The test itself
E.g. dislike and social taboo around handling faeces
Motivation and practical barriers
E.g. competing demands on time
Beliefs related to culture, gender, or deprivation
E.g. screening and preventative tests are not familiar parts of healthcare

20. WHAT CAN YOU DO TO INCREASE UPTAKE?

21. HOW CAN YOU HELP INCREASE UPTAKE?
Improve awareness of bowel cancer screening
Training
Ensure all staff know about the bowel screening programme and are familiar with the FOBt
Have a screening lead
Use the CRUK GP Good Practice Guide
Display screening information
Bowel cancer screening information cards
Leaflets and posters about bowel cancer and bowel cancer screening
Animation: how to do the test
Bowel Cancer Awareness Month in April

22. HOW CAN YOU HELP INCREASE UPTAKE? (CONT)
Endorse the Bowel Cancer Screening Programme
Contact your local screening hub/ centre to see if they can provide you with Prior Notification Lists (PNLs) for bowel screening OR
Search for patients approaching their 60th birthday and year olds with a non response result in the last 2 years
Consider contacting people via:
Letter (templates are available)
Telephone (a telephone script is available)
Opportunistically (Use alerts)
Use READ codes to record any interventions

23. THANK YOU
cruk.org/facilitators