9.11 Screening Programmes for Older People

March 2012: Next Review September 2012
9.11 Screening Programmes for Older People
Abdominal Aortic Aneurysm (AAA) Screening
Men are invited for screening during the year (1st April to 31st March) when
they have their 65th birthday. Men aged over 65 years can self refer.
Trafford figures for men invited in 2010/11, (men born from 1st April 1945 to
31st March 1946), are as follows:
• 1062 men in the cohort
• 981 invited for screening, (92.4% of the cohort)
• 798 attended, (coverage is 75.1% of the cohort, uptake is 81.3% of those
invited)
• 759 had normal results, (95.1% of those attending – no further screening
required)
• 37 had small aneurysms (4.64% of those attending – further surveillance
within the screening programme required at either yearly or 3 monthly
intervals)
• 2 had large aneurysms (0.25% of those attending – referred to a
Consultant Vascular Surgeon for further investigation and possible
treatment).
Data by area or level of deprivation within Trafford is not yet available. Nor are
there any regional or national figures to compare the data with. The south
sector of Greater Manchester was one of 6 national early implementer sites.
Screening commenced in 2009. In July 2010, it was decided to roll out
screening to the remainder of Greater Manchester and Central & East
Cheshire.
The Trafford uptake figure of 81.3% compares favourably with the average of
72.4 % for Greater Manchester and Central & East Cheshire. These uptake
figures have been achieved without proactive promotion of the service.
Screening venues in Trafford are: Chapel Road Clinic, Sale; Davyhulme
Medical Centre; and Partington Health Centre. However, men can attend any
of the 34 screening venues in Greater Manchester and Central & East
Cheshire.
No health professionals in Trafford services are directly involved in the
delivery of the AAA screening programme. However, GPs have been
informed of the programme and do receive copies of the result letters sent to
participants.
People not registered with a GP are not invited for screening, although they
can self refer (and arrangements are being made for prison populations).
The Greater Manchester AAA Screening Programme has received very
positive feedback. The National Screening Committee has described it as a
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March 2012: Next Review September 2012
model of best practice and the Greater Manchester Public Health Network has
been requested to support other regions to replicate the model.
Recommendations.
AAA screening saves lives.
Whilst the uptake figures appear good, further information is required to look
at variations within Trafford.
The reasons for 7.6% of the cohort not being invited need to be looked at.
While there are some valid reasons for exclusion from screening, e.g.
previous diagnosis of or treatment for AAA, it is not clear that these would
account for 7.6% of the cohort.
People not registered with a GP should be encouraged to register.
We have a working relationship with those involved in delivering the AAA
screening programme. This will be used to seek further information as
described above.
The discussion in the bowel cancer screening section about accuracy of
names and addresses used for sending invitations is also relevant to AAA
screening.
We need to request further information to monitor the impact of the AAA
screening programme, with particular reference to coverage and variations
within Trafford.
Data sources:
AAA Screening Management and Referral Tracking (SMaRT) system
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March 2012: Next Review September 2012
Bowel Cancer Screening Programme (BCSP)
The best available indicator of the extent to which the bowel cancer screening
programme meets population need is uptake, (adequately screened people as
a percentage of those aged 60 to 69 years who were sent an invitation). Also
relevant is positivity rate, (people with abnormal screening results as a
percentage of those adequately screened).
For Trafford, uptake in 2010/11 was 53% and positivity was 1.9%, (which is
similar to the North West average). Uptake by quarter shows a small but
steady increase. Within Trafford, uptake is lower in areas of deprivation and
areas with a high proportion of minority ethnic groups. These also tend to be
the areas with the highest positivity rates.
Uptake Rates
2009/10
65
2010/11
Trafford Av
60
% uptake 55
50
45
40
35
30
Most deprived 2
3
4
Quintile
Least deprived Source: NW QARC
Positivity Rates
2009/10
4.0
2010/11
Trafford Av
3.5
% positivity
3.0
2.5
2.0
1.5
1.0
0.5
0.0
Most deprived 2
3
Quintile
3
4
Least deprived Source: NW QARC
March 2012: Next Review September 2012
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Pilot sites also reported:
• Lower uptake in men (47.7%) than in women (56.2%)
• Higher uptake in the older age group (65–69 years) (58.5%)
The initial screening test is done by post. Invitations are sent every 2 years
from the hub located in Rugby. Samples are returned by post to the hub.
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March 2012: Next Review September 2012
People with an abnormal screening result need further investigation. They are
invited to the Bowel Cancer Screening Centre for the Greater Manchester
BCSP South Sector, which is located at Withington Hospital.
No health professionals in Trafford are directly involved in the delivery of the
BCSP. However, GPs have been informed of the programme and do receive
copies of the result letters sent to participants.
People not registered with a GP are not invited for screening, although they
can request a test by telephone, (if they have an address for the kit to be sent
to).
The BCSP is a new programme. It started in Trafford in December 2009. It is
now due to be extended from 60 to 69 year olds to 60 to 74 year olds.
The first Quality Assurance visit to the hub in Rugby took place on 6 July
2011. It was reported that the team found a well-run service with evidence of
the delivery of high quality screening and many specific areas of good
practice. Almost all of the national standards were being met. Withington
Bowel Cancer Screening Centre will have a Quality Assurance visit in 2012.
Findings
There is a correlation between low uptake and areas of deprivation and areas
with a high proportion of minority ethnic groups. This is of particular concern
given that these also tend to be the areas with the highest positivity rates.
Given that no health professionals in Trafford are directly involved in the
delivery of the BCSP, the main actions that can be taken within Trafford are
health promotion and ensuring that the lists of names and addresses used by
the BCSP to send invitations are accurate. These lists of names and
addresses come from information held by GP practices, (when patients
register with a GP).
It is very important that when patients change address, they inform their GP
so that BCSP invitations get sent to the correct address.
It is possible that “ghost patients”, (patients registered with a GP but no longer
resident in the area) are an issue. In 2006, the number of people registered
with a GP and resident in Trafford was 12% higher than the number of
Trafford residents in the 2001 census. It was 36% higher in Clifford ward, 27%
higher in Talbot ward and 18% higher in Bucklow-St Martins ward, which
could be part of the explanation for lower uptake in these areas. (However
given that AAA screening for men aged 65 has 81% uptake across Trafford, it
is clear that ghost patients could not explain the 28% lower uptake for bowel
screening.)
People not registered with a GP should be encouraged to register.
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March 2012: Next Review September 2012
Recommendations
The BCSP saves lives. Early in 2012, there will be a national bowel cancer
awareness campaign to encourage people with symptoms to go their GP. It
will be important that this is not confused with screening, which is for people
without symptoms.
Health promotion is recognised to be an important component of the BCSP.
The Greater Manchester BCSP has funding for this. There is currently little
evidence about the type of health promotion that would be effective for the
BCSP, but it is likely that a multistrategy approach would have the best
outcome. This would include general health promotion (local newspaper, radio
and television), targeting hard-to-reach groups and giving information to
professionals in the community via continuing professional development
(CPD) training. The national office has a number of research initiatives in
hand to investigate the most appropriate way to inform choice about the
programme.
The Health Improvement Practitioner in the Greater Manchester BCSP has
liaised with the PCT and been put in touch with contacts working in areas of
deprivation. Distribution of a leaflet is planned.
Uptake needs to be monitored over time to see if current health promotion
activities are working or if something else needs to be tried.
The BCSP needs to be asked if it can provide information on invitations
returned undelivered by MSOA.
The NHS Operating Framework 2012/13 states that PCT clusters must work
with GP practices to undertake a full review of practice registered patient lists;
ensuring patient anomalies are identified and corrected by March 2013.
Information held by Trafford Council could be useful for this exercise. This
would also have benefits for the other adult screening programmes.
Data sources:
National Bowel Cancer Screening System
North West Bowel Cancer Screening Quality Assurance Reference Centre
NHSIA Registered Patient Database
Census 2001
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