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NATIONAL COLORECTAL SCREENING PROGRAMME

The National Cancer Screening Service (NCSS) is responsible for the development and implementation of Ireland’s first national population-based colorectal cancer screening programme. To ensure the quality assurance standards demanded by the programme can be met, the programme is scheduled for introduction in late 2012.

The programme will be initially available to men and women aged 60-69. In Ireland, colorectal cancer is the second most commonly diagnosed cancer and the second most common fatal cancer among both men and women. One of the significant aspects of colorectal cancer screening is that it can detect pre-cancerous adenomas and is therefore a true cancer preventative measure.

Commenting on the introduction of the programme, Dr Alan Smith, Medical Director – Screening Policy, NCSS said: “It is vital that the national colorectal screening programme operates in line with the highest possible standards. There can be no compromise on quality or patient safety. It is the responsibility of the NCSS to ensure that the programme is capable of meeting these standards before commencing screening. It is only this rigorous adherence to best practice that will ensure that a national colorectal screening programme has a significant impact on reducing the mortality of colorectal cancer in Ireland.”

Men and women aged 60-69 will be offered a free home test known as a FIT test. Approximately 94 to 95 per cent of people who take part in the programme will receive a normal FIT test result and will be offered another home test in a further two years. Approximately five to six per cent of people screened will receive a result that will require an additional test. They will be referred for a screening programme colonoscopy.

A set of quality assurance (QA) standards have been developed that will ensure that every aspect of the screening programme pathway of care will operate in accordance with international best practice. The QA standards have been reviewed and approved by an international peer review panel that included leading experts in the delivery of colorectal cancer screening, endoscopy, CT colonography, histopathology and colorectal surgery.

The panel has recommended that the NCSS must be satisfied that a number of criteria are fully met before the commencement of the screening programme, to ensure that it can consistently and reliably deliver best outcomes for the men and women who participate in the programme.

The criteria to be met include the development of a robust ICT system to capture the flow of data during each screening event, the establishment of a strong QA and management governance structure that will ensure the minimisation of risks and maximisation of best clinical outcomes for patients, and ensuring that the introduction of the programme does not adversely affect the symptomatic (diagnostic) service.

The NCSS has made significant progress in developing the national colorectal screening programme. Advances made to date include:

  • Drafting of QA standards that will underpin the delivery of the programme.
  • International peer review and approval of the QA standards.
  • Baseline assessment visits to all 31 endoscopy units in Ireland that expressed an interest in participating in the programme.
  • Selection of 15 initial ‘candidate’ screening colonoscopy units to provide the colonoscopy requirements to the programme.
  • Procurement of the FIT test.
  • Procurement of laboratory services to process the FIT test.
  • Ongoing recruitment of advanced nurse practitioner (ANP) candidates.
  • Procurement of a two year educational programme for training of ANP candidates and subsequent integration into the screening programme.
  • Ongoing development of the required ICT system.

The NCSS is working closely with the 15 candidate colonoscopy units that have been initially selected to provide the colonoscopy requirements to the programme. Achieving confirmed status as a screening colonoscopy unit is contingent upon these 15 sites demonstrating sufficient endoscopy capacity, reducing waiting times for all endoscopy procedures, adherence to clinical performance targets and quality standards and completing the UK Joint Advisory Group on Gastroenterology (JAG) accreditation process.

 

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