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Objectives To compare performance measures across all three rounds of the English bowel cancer screening faecal occult blood test pilot and their relation to social deprivation and ethnicity. Methods In each round in three primary care trusts, data for a restricted population of over 48 500 aged 60-69 years were analysed. Individual-based data included postcode linked to area-based data on the Index of Multiple Deprivation (IMD) 2004, and ethnicity. Outcomes were the rates of screening and colonoscopy uptake, positivity and detection of neoplasia (adenomas or bowel cancer) and bowel cancer, and the positive predictive values (PPVs) of a positive test for neoplasia and bowel cancer. Sensitivity was calculated by the proportional incidence method using data on interval cancers identified from cancer registrations. Results The overall uptake rate was 61.8%, 57.0% and 58.7% in the first, second and third rounds, respectively. Although the PPV for cancer decreased over the course of the three rounds (10.9% in the 1st round, 6.5% in 3rd round), the PPV for all neoplasia remained relatively constant (42.6% in 1st round, 36.9% in 3rd round). Deprivation and non-white ethnic background (principally Indian subcontinent in the pilot region) were associated with low screening and colonoscopy uptake rates, and this changed little over the three screening rounds. Uptake was lower in men, although differences in uptake between men and women decreased over time. Non-participation in previous rounds was a strong predictor of low uptake. Conclusions Performance measures are commensurate with expectations in a screening programme reaching its third round of screening, but a substantial ongoing effort is needed, particularly to address the effects of deprivation and ethnicity in relation to uptake. [ABSTRACT FROM AUTHOR]

Background: The original role of the National Health Service breast screening programme (pathology) external quality assessment (EQA) scheme was educational; it aimed to raise standards, reinforce use of common terminology, and assess the consistency of pathology reporting of breast disease in the UK. Aims/Methods: To examine the performance (scores) of pathologists participating in the scheme in recent years. The scheme has evolved to help identify poor performers, reliant upon setting an acceptable cutpoint. Therefore, the effects of different cutpoint strategies were evaluated and implications discussed. Results/Conclusions: Pathologists who joined the scheme improved over time, particularly those who did less well initially. There was no obvious association between performance and the number of breast cancer cases reported each year. This is not unexpected because the EQA does not measure expertise, but was established to demonstrate a common level of performance (conformity to consensus) for routine cases, rather than the ability to diagnose unusual/difficult cases. A new method of establishing cutpoints using interquartile ranges is proposed. The findings also suggest that EQA can alter a pathologist's practice: those who leave the scheme (for whatever reason) have, on average, marginally lower scores. Consequently, with the cutpoint methodology currently used (which is common to several EQA schemes) there is the potential for the cutpoint to drift upwards. In future, individuals previously deemed competent could subsequently be erroneously labelled as poor performers. Due consideration should be given to this issue with future development of schemes. [ABSTRACT FROM AUTHOR]

Presents an overview of the effectiveness of mammography screening for breast cancer in reducing mortality from the disease. Benefits of various screening methods; Organizational aspects of screening programs; Association of patient age and screening frequency with the health benefits of screening; Potential drawbacks and health risks involved in screening.

Abstract Introduction and aims Older women are more likely to delay presentation in breast cancer, which in turn contributes to poorer survival. We have developed a health professional-delivered intervention to promote early presentation in older women with breast symptoms (Promoting Early Presentation (PEP) Intervention) to be delivered when they attend for their final routine mammogram. We aimed to evaluate its efficacy in an randomized controlled trial (RCT) and adapt it for use in routine clinical practice. Methods We randomised 867 women attending for their final round of screening on the NHS Breast Screening Programme to receive either the PEP Intervention delivered by a radiographer or usual care. We measured breast cancer awareness at baseline and 2 years post-randomisation. We are adapting and piloting the PEP Intervention to be suitable for adoption in routine practice across the NHS Breast Screening Programme. Results In the RCT, the PEP Intervention increased the proportion breast cancer aware at 2 years compared with usual care (21% vs 6%, OR: 8.1, 95% CI: 2.7 to 25.0). We have adapted the intervention so that it can be delivered feasibly while maintaining consistent quality. Conclusions We have demonstrated the efficacy of the PEP Intervention in an RCT. We plan to evaluate its effectiveness in routine practice by implementing it in three breast screening services, and measuring feasibility, costs and health outcomes (comparing these with health outcomes in control services). Our findings will provide the data needed to inform possible implementation across the entire NHS Breast Screening Programme. [ABSTRACT FROM PUBLISHER]

Introduction Increasing colonoscopy withdrawal time has previously been shown to be associated with increasing adenoma detection rate (ADR). Current guidelines recommend a minimum withdrawal time of 6 min. The optimum mean withdrawal time for adenoma detection is not known. Methods The mean withdrawal time in negative complete colonoscopies (nc-CWT) was estimated for 147 colonoscopists in the NHS Bowel Cancer Screening Programme; colonoscopists were grouped in four levels of nc-CWT (<7, 7–8.9, 9–10.9 and ≤11 min). Logistic regression was used to analyse the relationship between CWT and ADR. Results The study examined data from 31,088 procedures by 147 colonoscopists undertaken between August 2006 and August 2009. The mean ADR in each group was 42.5% in colonoscopists with a mean nc-CWT <7 min, 45.5% in the 7–8.9-min group (p = 0.002 for difference compared to lowest nc-CWT group), 47.3% in the 9–10.9-min group (p < 0.001) and 47.1% in the ≤11-min group (p < 0.001). In multivariable analysis, the ADR of colonoscopists with an nc-CWT of around 10 min was 11% higher than those with an nc-CWT of around 6 min (p < 0.001). Both the proportion of adenomas less than 1 cm in size and the proportion of adenomas detected in the proximal colon increased for longer withdrawal times. Advanced adenoma detection was not affected by increasing withdrawal times. Conclusion Increasing average nc-CWT is shown to be associated with increasing ADR up to 10 min. Beyond 10 min no significant further increase in adenoma yield is seen. This is evidence of the ‘ceiling effect’ of withdrawal time on adenoma detection. Inadequate bowel preparation quality increases mean withdrawal time in complete colonoscopies but this is not associated with any change in ADR. The increase in adenoma detection as a result of longer withdrawal is due to detection of more small and right sided lesions, no increase in detection of large or advanced adenomas is seen. We recommend, on the basis of the findings of this study, that the optimal average nc-CWT per colonoscopist for screening colonoscopy is around 10 min. [ABSTRACT FROM PUBLISHER]

Introduction Colonoscopy is a central investigation in all colorectal cancer (CRC) screening strategies. Success of CRC screening is dependent on the quality of colonoscopy. The NHS Bowel Cancer Screening Programme (BCSP) offers biennial faecal occult blood testing to adults aged 60–74 years. Colonoscopy is offered to individuals with a positive faecal occult blood (FOB) test. All colonoscopists practicing within the screening programme are required to meet predefined standards through summative assessment and are subject to ongoing quality assurance. In this study we examine the quality of colonoscopy in the NHS BCSP and describe the measures taken by the BCSP to achieve high quality colonoscopy. Comparison of current quality indicators with existing quality standards and evidence from the UK pilot study of FOB screening will be undertaken. Methods The NHS BCSP national database prospectively collects detailed data on all screening colonoscopies. Data from the first 3 years of the programme (August 2006 to August 2009) were analysed. Colonoscopy quality indicators (adenoma detection rate, polyp detection rate, colonoscopy withdrawal time, caecal intubation rate, rectal retroversion rate, polyp retrieval rate, mean sedation doses, patient comfort scores, bowel preparation quality and adverse event incidence) were calculated for this period. All screening centres were contacted directly to verify adverse event data. Results In the study period, 2,269,983 individuals returned FOB tests and 36,460 colonoscopies were performed. Mean caecal intubation rate was 95.2% and mean withdrawal time for normal procedures was 9.2 min. The mean adenoma detection rate (ADR) per colonoscopist was 46.5%. ADR did not differ between prevalent and incident rounds (p = 0.90). Patient comfort scores were high and adverse event rates low. Conclusion The NHS Bowel Cancer Screening Programme provides high quality colonoscopy as demonstrated by high caecal intubation rate, adenoma detection rate and comfort scores and low adverse event rate. This quality is achieved by ensuring that BCSP colonoscopists are trained to a high standard and that these standards are maintained through ongoing quality assurance measures. [ABSTRACT FROM PUBLISHER]

Introduction The aim of screening colonoscopy is twofold: Firstly to detect colorectal cancer, secondly to detect and remove adenomas. This study examines the influence of both patient factors (age, gender, body mass index (BMI), smoking, alcohol use, deprivation, geographical location) and colonoscopy factors (withdrawal time, bowel preparation quality, rectal retroversion, colonoscopist, intravenous antispasmodic use, sedation use, time of procedure) on the risk of detecting one or more adenomas, advanced adenomas and right sided adenomas during screening colonoscopy. Methods All patients undergoing colonoscopy in the NHS Bowel Cancer Screening Programme (BCSP) between August 2006 and August 2009 were included in this study. Demographic, lifestyle, procedural and histological data were retrieved from the national database. The relationships between patient and colonoscopy factors with adenoma detection were examined using univariable and multivariable analysis. Results 31 088 patients undergoing screening colonoscopy were included in the analysis. 14 423 had one or more adenomas (46.7%). The following factors increased the relative risk of adenoma detection at screening colonoscopy in both univariable and multivariable analysis (p value <0.001 in multivariable analysis unless otherwise stated): male gender, increasing age, current or previous smoking, current alcohol use, increasing withdrawal time, higher quality bowel preparation, intravenous antispasmodic use, earlier procedure start time (p=0.018) and increasing colonoscopist experience. Increasing level of deprivation was associated with a reduced risk of adenoma detection (p=0.007). Similar results are demonstrated for the effect of these factors on advanced adenoma and right sided adenoma detection. Rectal retroversion did not increase adenoma detection or rectal adenoma detection. Conclusion This is the largest study to examine the effect of both patient and colonoscopy factors on adenoma detection at colonoscopy following a positive FOB test. The known impact of smoking, alcohol use, and male gender on adenoma risk is also observed in this setting. The relative effect of colonoscopy factors is also demonstrated with caecal intubation, bowel preparation quality, withdrawal time, intravenous antispasmodic use, colonoscopist experience and earlier sessional start time significantly affecting the risk of adenoma detection. This study demonstrates the need for high quality colonoscopy to optimise adenoma detection. [ABSTRACT FROM PUBLISHER]

Introduction The NHS Bowel Cancer Screening Programme (BCSP) commenced in England in August 2006. Patients are offered colonoscopy if they have a positive FOB test. If a patient is found to have 3 to 4 small (<10 mm) adenomas or 1 to 2 adenomas of which at least one is 10 mm or greater in size, they are defined as being at ‘intermediate risk’ of having advanced adenomas or cancer in the future. Such patients are offered a surveillance colonoscopy three years after their screening colonoscopy. Methods The aim of the study was to assess the findings at, and hence appropriateness of 3-year surveillance colonoscopy for intermediate risk patients. Data regarding each patient entering the screening programme is contemporaneously recorded on the National BCSP database. The database was interrogated for individuals who underwent screening colonoscopy between August 2006 and September 2007 and who were classified as intermediate risk. Details of the endoscopic and histological findings at 3-year surveillance colonoscopy were ascertained. Findings at surveillance colonoscopy were classified according to the BSG Adenoma surveillance guidelines. Patients with incomplete datasets were excluded. Results 352 patients underwent 3-year surveillance colonoscopy. This accounts for 10.3% of all patients undergoing screening colonoscopy in that time period. The mean age of patients was 67.1 years. 243/352 (69.0%) were male. At 3-year surveillance, 13 patients (3.7%) were categorized as high risk, 42 (11.9%) intermediate risk, 86 (24.4%) low risk and 202 (57.3%) had normal colonoscopies (i.e., no adenomas detected). No cancers were detected. 9 (2.6%) had incomplete data. Conclusion Approximately 40% of intermediate risk patients had one or more adenomas detected. A small proportion of individuals undergoing 3-year surveillance colonoscopy have multiple or large adenomas. In this group, no surveillance cancers were detected. Although the number of individuals in this study is relatively small, these data suggest that the 3-year interval for surveillance may be unnecessary for many intermediate risk individuals. Further work on larger datasets may help identify individuals at high risk of having advanced adenoma at surveillance. This may allow the criteria for determining surveillance interval to be refined. [ABSTRACT FROM PUBLISHER]