Cancer Reform Strategy - NHS Cancer Screening Programmes

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48 CANCER REFORM STRATEGYwill include access to MRI scanning asstated in the NICE partial update of theFamilial Breast Cancer Guideline (October2006). It is expected that this new systemwill be in place from 2009.3.27 There is also a need to ensure that healthinequalities are tackled with targetedprogrammes that increase the uptake ofscreening in poor communities and in BMEcommunities. Commissioners in PCTs withlow coverage levels will wish to developthese programmes.Improving bowel screening3.28 Rollout of the NHS Bowel CancerScreening Programme started in 2006. Thisprogramme is aimed initially at men and womenaged 60-69, as this is the age group for whomthe benefits of screening are expected to belargest. Test kits will be sent to participants everytwo years.3.29 The programme is being coordinatedthrough five regional hubs based on the fiveConnecting for Health clusters: Midlands & theNorth West (located in Rugby), North East andYorkshire (Gateshead), Eastern (Nottingham),Southern (Guildford) and London (Harrow).These hubs are responsible for the call and recallsystems and for sending the test kits to people’shomes. They also receive and process thecompleted test kits. People who are givenpositive test results are then booked in to localscreening centres that are responsible fordiscussing the results with the patient and forundertaking colonoscopies.3.30 Fifteen local screening centres wereestablished in the first wave (2006-07) with afurther 20 centres expected to come on streamin Wave 2. As at the end of October 2007, over574,000 kits had been sent out and over305,000 kits returned. Over 10,000 men andwomen aged 70 or over had self-referred forscreening. Just under 5,500 men and womenhad positive test results and were referred totheir local screening centre for furtherassessment. Over 3,500 colonoscopies had beenundertaken, with over 1,600 polypectomies andover 400 cancers detected. Full rollout to peopleaged 60-69 is expected by December 2009.3.31 As announced in September 2007, theNHS Bowel Cancer Screening Programmewill be extended from 2010 to invite menand women aged 70 to 75 to take part.As a result, around one million more men andwomen will be screened each year. Research andpilot evidence shows this is feasible and effectiveand 61% of bowel cancers occur in those aged70 and over. 21 Men and women aged 75 andover will be able to request a kit to be testedevery two years.3.32 This extension will be managed by NHSCancer Screening Programmes in partnershipwith local health services. In 2008/09, we willpilot the extension in five sites. This willenable us to learn lessons to inform the fullrollout of the extension from 2010.3.33 By the end of 2010, decisions will betaken about possible roll out to people intheir 50s. Depending on forthcoming researchfindings, a possible extension of the screeningprogramme to people in their 50s could eitherbe through the introduction of flexiblesigmoidoscopy or by extending faecal occultblood testing (FOBT).3.34 We will continue to monitor researchevidence on other new technologies closely,such as immunological FOBT and CT colographyand will take the opportunity presented by thenational screening programme to pilot newapproaches.Screening for other cancers3.35 The cancer research community iscommitted to investigating screeningapproaches in other cancers, particularly in themost common forms of cancer where a nationalscreening programme is most likely to be costeffective. Research is also underway intobiomarkers of early cancers where patients oftenhave no symptoms until the cancer has reacheda very late stage, such as pancreatic cancer.We will continue to support and monitor thisresearch and evaluate the potential for theintroduction of new screening technologies as
CHAPTER 3: DIAGNOSING CANCER EARLIER 49the evidence develops, working closely with theUK National Screening Committee.Screening for lung cancer3.36 There is an increasing weight of evidencein support of introducing a trial for thescreening of lung cancer. The Department ofHealth is leading work on behalf of the NationalCancer Research Institute (NCRI) to commissionresearch on the feasibility of a UK trial of CTscreening for lung cancer. The National Institutefor Health Research (NIHR) Health TechnologyAssessment programme has issued acommissioning brief, taking full account of thetrials already underway in the US and Europe,with a view to funding feasibility studies as soonas possible. If there is progression to anexploratory trial and then a full randomisedcontrolled trial, these will take a number ofyears to complete and will require consortiumfunding which will be brokered through NCRI.Screening for prostate cancer3.37 There is currently insufficient evidence toshow that screening based on existingtechnology would reduce deaths from prostatecancer. The efficacy of the Prostate SpecificAntigen (PSA) test for the screening or earlydiagnosis of prostate cancer remainscontroversial. Many cancers detected initiallythrough the PSA test would have caused noproblems during a man’s natural life span.In addition, there is no consensus amongstclinicians on the best form of treatment forlocalised prostate cancer, be that surgery,radiotherapy or active monitoring. TheDepartment of Health through its NIHR HealthTechnology Assessment programme is funding atrial of surgery versus radiotherapy versus activemonitoring for PSA-detected localised prostatecancer at a cost of over £30m (the ProtecT trial).Associated research in partnership with CancerResearch UK is examining the impact of PSAtesting. Results from major trials are expected inthe next three to five years and the UK NationalScreening Committee keep prostate cancerscreening closely under review.3.38 The Prostate Cancer Risk ManagementProgramme (PCRMP) was introduced in 2002 tohelp GPs and practice nurses in advising menwithout symptoms of prostate cancer on theimplications of having a PSA test. This empowersmen to make an informed choice on whether ornot to have a test based on their own lifestylesand values. An evaluation of the PCRMP wasfunded by the Department of Health to helpinform the future direction of the programmeand the PCRMP pack is currently being reviewed.A consultation will be published in the spring,with the intention of launching the revisedPCRMP packs in the summer of 2008. Thereview will take full account of the results of theProstate Cancer in Ethnic Subgroups (PROCESS)study 22 , which showed that black men are threetimes more likely to develop prostate cancercompared to white men.3.39 The Department of Health is supportingthe development of screening technology forprostate cancer by having a comprehensiveresearch strategy into all aspects of prostatecancer. We are jointly with other NationalCancer Research Institute (NCRI) membersfunding two NCRI Prostate Cancer ResearchCollaboratives and the Department of Healthfunded half of the original cost of £7.4 million.Following a review of progress by aninternational expert panel the Department ofHealth, Cancer Research UK and the MedicalResearch Council have agreed to provide afurther three years funding of £3.9 million.Screening for ovarian cancer3.40 In ovarian cancer, the Medical ResearchCouncil, Cancer Research UK and theDepartment of Health are funding the UKCollaborative Trial of Ovarian Cancer Screening(UKCTOCS), which began in 2000 and involves200,000 post-menopausal women aged 50 to74 across twelve UK centres. The trial isassessing the effectiveness of two possiblemethods of ovarian cancer screening, an annualCA125 test (a blood test for a cancer antigen)and an annual trans-vaginal ultrasound. Fullresults are not expected before 2012.New developments in screening3.41 Working with the UK National ScreeningCommittee, we will continue to monitor andassess research evidence for the effectiveness ofscreening for these and other cancers such as
Page 1: Cancer Reform Strategy
Page 4 and 5: DH INFORMATION READER BOXPolicyHR/W
Page 7: 3Forewordby the Prime MinisterAt on
Page 10 and 11: 6 CANCER REFORM STRATEGY9. Your NHS
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Page 16 and 17: What the Cancer Reform Strategy mea
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Page 21 and 22: 17Chapter 1:The challenge of cancer
Page 23 and 24: CHAPTER 1: THE CHALLENGE OF CANCER
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Page 37 and 38: 33Chapter 2:Preventing cancerChapte
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Annexes
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135Annex 2:References1 Cancer is ou
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ANNEX 2: REFERENCES 13737 K. Moser,
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