Report in English with a Dutch summary (KCE reports 45A)

134 Screening for Colorectal Cancer: Appendices KCE reports vol.45
out over the next three years. The deadline however could not be met, because
it takes about six months to commission the screening centres. A central
budget has been announced of 18,5 million for 2006/7 and 37 million for
2007/8. However no funding has been provided yet 555. Uptake, defined as the
proportion of those invited who returned an adequate kit in the first phase of
screening was 58,5 % in the first round (2000-2002) of the pilot and 51,9 %
(127.746 were invited) in the second round (february 2003-april 2005) 556.
Uptake of colonoscopy was 80,5 % in the first round and 82,8 % in the second
round.
In the national program men and women aged 60 to 69 registered with the
NHS will be invited to take part in FOBT screening every two years. This age
range is narrower than in many other countries because of concerns about the
capacity of the National Health Service to deliver sufficient numbers of
colonoscopies without affecting the symptomatic service 30. People over 70 can
request a screening kit by calling a freephone helpline when the program
reaches their area. Five program hubs will operate a national call and recall
system to send out fecal occult blood (guaiac FOBT) test kits, analyse samples
and dispatch results. The population expected to be covered by each
programme hub is 10 million people.
The program hubs will have the following functions:
Responsibility for up to 20 screening centres
Call/recall of population for initial screening
Assembly and dispatch of kits to invited population
Laboratory test the returned kits
Dispatch of test results to individuals within 48 hours of receipt
Book appointments at specialist screening nurse clinics for
people receiving an abnormal result (nurse positive clinics) at
local screening centre with result letter within one week of
result
Provide a help line
Have overview of screening centres/clinic space
Facilitate polyp surveillance for screening patients
The first screening centres are situated in Wolverhampton, Norwich, Liverpool
and Torbay. By March 2007, all five program hubs and around fourteen local
screening centres will be established. Screening centres will be selected based
on a global rating scale. The parameters are waiting times and patient
experience, adequate number of accredited colonoscopists to provide timely
colonoscopy per year and ability to offer all patients a colonoscopy within two
weeks of a nurse positive clinic appointment. In order to achieve a high level of
quality control, a system of accreditation will be introduced 557. Screening
centres will link not only to the program hub but also to local hospitals and
cancer centres where the planning will take place for associated treatments
such as pathology, surgery, further imaging, oncology and palliative care.
Competence and performance of colonoscopists will be evaluated by
submission to a regular audit of practice that will include observation of two
colonoscopies by tri-split video. Quality indicators are: a completion rate with
photographic evidence of ileo caecal valve > 90 %, an adenoma detection rate of
at least 35 %, complete polyp resection of over 90 % of those excised, correct