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NCSS PUBLISHES RECOMMENDATIONS FOR COLORECTAL CANCER SCREENING PROGRAMME

National Cancer Screening Service Acknowledges Ongoing Commitment to Introduction of Colorectal Screening Programme

The Board of the National Cancer Screening Service (NCSS) today publishes its ‘Recommendations for a Colorectal Cancer Screening Programme’ and acknowledges the ongoing commitment of Minister for Health and Children Mary Harney, TD to the introduction of a national, population-based colorectal screening programme.

Following a request by the Minister, the Board of the NCSS established an Expert Advisory Group on Colorectal Cancer to explore the potential benefits of introducing a colorectal cancer screening programme. On completion of this evaluation in December 2008, the Board of the NCSS recommended a national, population-based, colorectal cancer screening programme for men and women aged 55-74 years.

Commenting on the publication of the Report, Tony O’Brien, CEO of the NCSS said: “Population screening for colorectal cancer has the potential to be one of the most effective public health interventions in the history of the Irish healthcare system. We now have a real opportunity to introduce a quality assured programme that is capable of providing huge clinical benefit in a cost effective manner”.

The NCSS Expert Advisory Group on Colorectal Cancer, chaired by Professor Niall O’Higgins was established in April 2007. The Group, representing medical consultant specialists, public health consultants and epidemiologists, general practitioners, nursing and administrative experts from the National Cancer Screening Service completed an extensive evaluation of current medical and scientific evidence on the subject.

In Ireland, colorectal cancer is the second most commonly diagnosed cancer among both men and women. Each year approximately 1,900 new cases of colorectal cancer occur – 1,070 in men and 830 in women. Colorectal cancer is the second most common fatal cancer among men and women in Ireland. Approximately 930 people die from colorectal cancer each year in Ireland, 525 men and 405 women.

The report of the Expert Group was peer reviewed by an international panel of experts from the UK, France and the United States before submission to the Board of the NCSS.

Further commenting, Tony O’Brien said: “Having given due consideration to the reports of the Expert Group and the report of the International Validation Panel, the Board of the NCSS has provided recommendations on the organisation of a  national, population-based screening programme, operating on a two yearly cycle for individuals aged 55-74 years.

The Board of the NCSS submitted a business implementation plan which it believes can provide the foundation for Ireland to establish a screening programme for colorectal cancer of the highest international standard and meet the aspirations set out in EU Council Recommendations and the Report of The National Cancer Forum in 2006.”

The Board recommended that the immunochemical faecal occult blood test (iFOBt) which operates on an automated testing platform should be the primary screening tool for a population-based colorectal cancer screening programme in Ireland. This would be the first international population-based screening programme for colorectal cancer that utilises this technology as the primary screening tool.

The Board of the NCSS has recommended that as part of a national colorectal cancer screening programme, persons with a positive result from the primary screening test should be offered a full colonoscopy. When a screen-detected cancer is diagnosed the screening process should continue until the end of primary treatment, after which time the patient should join the symptomatic service for clinical follow-up.

Over the last 15 years the number of cases of colorectal cancer has risen by approximately 20% in both sexes. By 2020 the number of new cases of colorectal cancer diagnosed each year in Ireland is projected to increase by 79% in men and 56% in women. This projected growth is primarily attributable to an increasing and ageing population.

Professor Niall O’Higgins, Chair of the NCSS Expert Advisory Group on Colorectal Cancer added: “The recommendations in this report apply to the population at average-risk for colorectal cancer. We are confident that the proposals are in keeping with current best practice and that, when implemented, will undoubtedly reduce the number of deaths from colorectal cancer in Ireland.”

In developing a business implementation plan a number of assumptions were made that included an eligible population of 700,000 and a 60% response rate to invitation to screening.

The Board recommended that four screening centres, each with two endoscopy suites, would be initially required to provide the necessary 11-12,000 colonoscopies per year for national implementation of a population-based screening programme. It recommended that these screening centres should be designed, equipped and operate discretely from the symptomatic service. Screening colonoscopy centres should be located in association with a designated cancer centre and form part of the cancer networks so that ancillary facilities of a symptomatic service can be available. Additional consultant medical staff, specialist nurses and radiographers, administrative and technical staff would be required.

Commenting on the recommendation, Tony O’Brien continued: “The Board recognised that there is a need to design a screening programme which is compatible and consistent with best practice and where the demand for symptomatic colonoscopy services is not excessively impacted. An opportunity now presents itself to optimise current service delivery to address both the requirements for screening and existing challenges in symptomatic colonoscopy services by developing an eight colonoscopy centre model, managed by the NCSS.

We believe there are a number of means of reducing programme implementation costs, including examining the potential integration of existing colonoscopy services, expanding the role of the Advanced Nurse Practitioner and recouping a portion of the approximate €3 million currently paid to private health insurers annually for screening related activities.”

Based on the previous experience of the NCSS in the implementation of BreastCheck and CervicalCheck it is estimated that it would take in excess of two years from policy and funding approval to the commencement of screening.

The NCSS requested HIQA to undertake a Health Technology Assessment (HTA) so that the cost-effectiveness of the proposed screening programme can be measured. This will be published by HiQA.

The NCSS is committed to working with the Department of Health & Children and its agencies to examine ways in which we can deliver a timely and cost effective national programme with due regard to current economic circumstances.

In summary the Board of the NCSS is recommending:

  • The introduction of an immunochemical faecal occult blood test (iFOBt) as the primary screening tool for a population-based colorectal screening programme.
  • A target population for screening of all men and women aged 55 to 74 years with a screening interval of two years.
  • Total colonoscopy to be offered to those individuals who test positive with the iFOBt.
  • Dedicated screening programme capacity for the provision of colonoscopy services to the screened population. Supported by fully integrated governance and quality assurance on a similar basis to BreastCheck.

 

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