Colorectal Cancer Programme Screening for Colorectal Cancer AP

Colorectal Cancer Programme Screening for Colorectal Cancer A/P Susan Parry, Gastroenterologist, CD MOH Bowel Cancer Programme PREPARED BY

Ministry of Health Bowel Cancer Work Programme • Bowel Screening Pilot – result recommendations previous working groups • Colonoscopsy wait time indicators • National Endoscopy Quality Improvement Programme • NZ Familial Gastrointestinal Service • Standards of service provision for bowel cancer Dec 2013 • Work force planning with Health Workforce NZ • Supported by the National Bowel Cancer Working Group • Bowel Screening Advisory Group – subgroup NBCWG • Liasing with relevant professional bodies

Colonoscopy past and present wait time indicators

Colonoscopy Wait – Time Indicators Wrap round initiatives • Development of national • National Endoscopy Quality Improvement Programme • Utilising Global Rating Scale for endoscopy units as in UK • MOH bowel cancer team visits/communication DHB’s • Provide high level support to deliver sustainable increase in colonoscopy capacity

National progress : timely colonoscopy delivery

Number of colonoscopies performed

Colonoscopy: numbers waiting

May results: Urgent

May results: Non urgent

June 2014 results: Non urgent

Number of colonoscopies performed

Numbers waiting for a colonoscopy

Bowel Screening Pilot commenced in Waitemata DHB October 2011

Waitemata Bowel Screening Pilot (BSP) • Duration 4 years, two screening rounds • Age range 50 -74 yrs, men & women (approximately 136, 000 eligible people) • Screening test • FIT (OC – Sensor) is mailed to eligible participants and completed at home - faecal immunochemical test for haemoglobin (FIT) - every two years - predetermined cut off for positivity Acknowledge the hard work and commitment of the Waitemata Team. Mike Hulme Moir, Clinical Director Gaye Tozer, Manager

Service delivery model

Round 1 results: Between 1 January 2012 and 31 December 2013: * • Over 121, 000 eligible people invited to take part in the Pilot • Coverage 97. 5% (based on census data) • The programme participation rate was 55. 8% • Overall positivity rate was 7. 5% • 96% of those with a +ve FIT went to colonoscopy • CRCs found in 186 (22) people (46. 2% TNM Stage 1) * Data pulled March 2015

Participation in the BSP Round 1 and the first year of Round 2

Participation in the BSP, by age and sex Round 2

Participation in the BSP by ethnicity Round 1 and the first year of Round 2

Participation in the BSP by deprivation group Round 1 and the first year of Round 2

Positivity in the BSP Round 1 and the first year of Round 2

Bowel Screening Pilot results to Dec 2014 Rd 1 Rd 2 CRC detection rate DR/1000 screened 2. 8 Advanced adenoma DR 15. 9 7. 5 Adenoma DR 36. 9 (13. 3 -22. 3) 22. 8 PPV CRC % 4. 2 (4. 5 -8. 6) 2. 6 PPV Advanced adenoma % 24. 2 15. 2 PPV adenoma % 56. 1 (9. 6 -40. 3) 46. 5 Those with low risk adenoma returned to screening Remainder offered ongoing colonoscopic surveillance (1 -8 -9. 5) 1. 3

Next steps • BSP extended until end Dec 2017 – opportunity to trial some new initiatives • Consultation to inform a business case • a phased restricted age national roll out beginning 2017 • Results from Round 1 & 2 to inform decisions re phased roll out to • maximise cancer detection within potentially available colonoscopy resource ( need to ensure timely symptomatic/surveillance procedures) • maximise cancer detection/ minimise detection low risk lesions for participants • minimise disparities • ensure quality maintained • optimise cost effectiveness

Next Steps • Continue to monitor • progress screening programmes in other countries • new screening tests • In determining phased roll out options consider possibility of subsequent inclusion of other screening tests eg flexible sigmoidoscopy as in UK • Continue international dialogue/peer review/meetings – MOH & BSAG

Waitemata BSP Team Ministry of Health Bowel & Prostate Cancer Team