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NATIONAL CANCER SCREENING SERVICE BEGINS IMPLEMENTATION OF NATIONAL POPULATION-BASED COLORECTAL CANCER SCREENING PROGRAMME

The National Cancer Screening Service (NCSS) today welcomed receipt of approval to proceed with the introduction of a national population-based colorectal cancer screening programme for men and women in Ireland.

At a joint press conference with the NCSS, the Minister for Health and Children, Ms Mary Harney TD, today announced approval of the NCSS to commence preparation and implementation of Ireland’s first colorectal cancer screening programme.

In Ireland, colorectal cancer is the second most commonly diagnosed cancer and the second most common fatal cancer among both men and women. Approximately 930 people die from colorectal cancer each year, 525 men and 405 women. In 2007 there were 2,174 cases of colorectal cancer diagnosed – 1,277 in men and 897 in women. Over the last 15 years the number of cases of colorectal cancer diagnosed each year in Ireland has risen by approximately 20 per cent in both sexes.

Commenting on the announcement, Tony O’Brien, Chief Executive Officer 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. One of the significant aspects of colorectal cancer screening is that it can detect pre-cancerous adenomas and is therefore a true cancer preventative health measure. The NCSS has been preparing for the introduction of a national programme, for men and women aged 55 to 74, for some time and today welcomes the approval of the Minister to proceed, particularly in this time of fiscal restraint.”

The incidence of colorectal cancer increases with age and the highest rate of incidence is among men and women aged 55-74. The NCSS has recommended the introduction of screening for this age group on a two yearly cycle using the faecal immunochemical test (FIT) which operates on an automated testing platform, as the primary screening tool. This will be one of the first international population-based screening programmes for colorectal cancer that utilises this technology as the primary screening tool.

In order to develop capacity to implement a screening programme for the full 55-74 population, the programme will be implemented on a phased basis starting with men and women aged 60-69. Fifty per cent of all cases of colorectal cancer in the 55-74 year age group are diagnosed in men and women aged 60-69.

Commenting on the implementation of the programme, Tony O’Brien continued: “The purpose of screening is to identify the population most at risk of colorectal cancer and most likely to benefit from early detection and treatment. A phased approach to screening, initially targeting those most at risk, is reasonable and ethical in order to build up significant capacity to screen men and women aged 55-74. Phase one of the programme (60-69 age group) is to be introduced in 2012. The programme will be extended to include the full age group (55-74) on a phased basis.

Over time the programme will be expanded to include younger and older individuals until the full 55-74 age group is reached. This phased approach is based on a clear commitment to reaching the full target population as soon as possible.

The maximum benefit in reduction in incidence, mortality and cost-effectiveness will be available when the programme targets the full 55-74 age population. However the NCSS is confident that very real benefits can be delivered and significant impact made on the incidence and mortality among the initial 60-69 age group once the programme commences” he concluded.

In 2007 the Minister for Health and Children asked the Board of the NCSS to explore the potential for a national, quality assured programme in Ireland. An Expert Group, chaired by Professor Niall O’Higgins evaluated the clinical and organisational requirements for the establishment of an effective, efficient and quality assured service. An independent peer review of the Group’s findings was sought from an international panel of experts on colorectal cancer screening and the Group made its final recommendations to the Board of the NCSS in October 2008. The Board of the NCSS submitted its recommendations to the Minister in December 2008.

In June 2009 the Minister asked the Health Information and Quality Authority (HIQA) to explore means of delivering a high quality colorectal cancer screening programme within existing resources. The NCSS played a central role in this process through the provision of detailed briefings, interviews and discussions.

In preparation for the introduction of a programme in 2012, the NCSS has identified a number of work streams, namely:
• Colonoscopy capacity, accreditation and training – the NCSS will focus on immediately identifying and building sufficient capacity in colonoscopy services nationwide to sustain the implementation of the programme, but also maintaining and enhancing the symptomatic service capability
• Quality assurance framework development and implementation – developing a full suite of quality assurance standards from a multidisciplinary perspective
• Procurement of FIT service – tendering for the provision of FIT service including procurement of FIT kits, supply, distribution, receipt logging result analysis and related data events
• Development of population communications – developing communications channels and materials to encourage participation in the programme
• Creation of client support system– provision of support and assistance to those willing to take part in the programme
Enhanced organisational capacity – appointing appropriate clinical leadership within the NCSS to effect change in the operation of colonoscopy services
• Creation of data and programme evaluation systems – ensuring clinical data systems at each colonoscopy service are linked to NCSS systems and investigate the potential for developing an integrated screening register for all NCSS screening programmes

The NCSS will focus immediately on colonoscopy capacity. Accordingly the NCSS has already requested expressions of interest from all publicly funded hospitals that wish to be considered as a screening centre as part of a national programme.

The NCSS will then undertake a baseline analysis of those endoscopy facilities that have expressed interest. This will be conducted in partnership with the representative professional bodies, the Royal Colleges and the National Endoscopy Team who have acted as advisors to the Joint Advisory Group on Gastroenterology (JAG) in the UK. Baseline analysis visits will be completed by Quarter 2 (Q2) 2010.

Any minor capital works and equipping will be completed by Q4 2010. The NCSS aims to have an appropriate Service Level Agreement (SLA) with each host hospital by Q3 2011 and identification of human resources requirements is to be completed by Q3 2010.

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