Agreement reached on Provision of Nursing Staff for Colposcopy Services
17 December 2008 - The Board of the National Cancer Screening Service (NCSS) today published its first Annual Report. Since its establishment in January 2007, the Board has overseen the national expansion of BreastCheck – The National Breast Screening Programme and the introduction of CervicalCheck – The National Cervical Screening Programme. In addition, significant policy development work has been undertaken and detailed in the report.
The pioneering clinical-led model developed for BreastCheck has proven successful in minimising the risks associated with breast screening. The aim of BreastCheck is to detect breast cancer at the earliest possible stage. To be effective it is imperative that women attend their screening appointment when invited. Service standards and quality assurance systems are in place throughout BreastCheck to minimise the risk of a cancer misdiagnosis, ensuring women can retain their confidence in the service. To date, BreastCheck has provided almost 450,000 free mammograms to over 206,800 women and detected over 2,700 breast cancers.
The OECD has ranked BreastCheck fifth in the world for percentage of women screened in its 2007 ‘Health at a Glance’ survey, ahead of long established screening programmes in countries including the UK, USA, France and Australia.
One of the major features of the establishment of the NCSS was the transfer out of the HSE of the former Irish Cervical Screening Programme, Phase One. A clear objective of the Minister for Health and Children was to see a quality assured national cervical screening programme implemented nationally. The successful BreastCheck model has been used and adapted for CervicalCheck – The National Cervical Screening Programme. CervicalCheck became available to the 1.1 million women aged 25 to 60 years living in Ireland on 01 September 2008.
Approximately 2-5% of women screened as part of the CervicalCheck programme will require access to colposcopy services. The NCSS is making a major investment in colposcopy services at 15 locations nationwide to enhance the service delivered to women as part of the CervicalCheck programme. A major element of this investment is the provision of adequate staffing levels to support a quality assured, consultant-led colposcopy service. The NCSS has now reached agreement for the provision of colposcopy nurses, health care assistants, administration and support staff at each of the 15 locations.
Key to colposcopy service provision is to ensure that women can access colposcopy services within international best practice timeframes; the adherence to quality assured clinical practice and the achievement of best clinical outcomes for women. The NCSS will be responsible for the monitoring and audit of colposcopy services to ensure the quality assured standards are adhered to.
The NCSS Board’s mandate also includes a policy, development and advisory role. This has related initially to formulating recommendations for a colorectal screening programme and the establishment of an Expert Group on Hereditary Cancer Risk comprising of experts in the areas of breast cancer, colorectal cancer, cancer epidemiology and medical genetics.
At the request of the Minister for Health and Children, the Board of the NCSS undertook a thorough review of the role of HPV vaccines in the prevention and control of cervical cancer. The Board is also empowered to provide advice to the Minister for Health and Children relating to other screening developments and has advised on the evidence base for introducing additional screening programmes for prostate, lung and bladder cancer.
Commenting on the contents of the first Annual Report, NCSS Chief Executive Officer Tony O’Brien said: “Since the establishment of the NCSS, exceptional growth and development has been accomplished. One of the main priorities for the NCSS in the year ahead is to complete the national expansion of BreastCheck, bringing this vital service to all women aged 50-64 living in Ireland. In addition, the Board will continue to assess new and emerging evidence in screening benefits to ensure the services delivered by the NCSS are world class leaders in the provision of population based cancer screening.”
The National Cancer Screening Service Annual Report 2007-2008 is available to view and download by clicking on the link below;
National Cancer Screening Service Annual Report 2007-2008
BreastCheck
Since the service began, a total of 442,612 BreastCheck mammograms have been provided to women aged 50 to 64 and 2,717 breast cancers have been detected and treated (2000–September 2008).
BreastCheck began screening in the South and West in December 2007. It is estimated that there are more than 149,000 women to be screened in the expansion area and that the first round of screening will take over 24 months to complete, commencing December 2007.
At the time of publication, screening is either complete or has been commenced in more than half of the Western and Southern counties with the remainder to follow shortly. This is the expected pattern for a programme which is designed to screen in each area in an alternating two-year cycle. Screening of eligible women has been completed in County Roscommon and is underway in Counties Cork, Galway, Limerick, Mayo, Tipperary North, Tipperary South and Waterford.
CervicalCheck
The NCSS is responsible for establishing and implementing CervicalCheck – Ireland’s first national cervical screening programme. On average, 180 new cases of cervical cancer are diagnosed each year in Ireland and the average age of a woman at diagnosis is 46 years. The average age at death from cervical cancer is 56 and on average 73 women die from cervical cancer annually in Ireland.
A successful national cervical screening programme has the potential to cut current incidence rates from cervical cancer by up to 80% in Ireland. The NCSS launched CervicalCheck – The National Cervical Screening Programme on 01 September 2008. Efforts and preparations were made to ensure that a quality assured, organised, cost effective programme be made available free of charge to all eligible women living in Ireland aged 25 to 60.
Over 4,000 smeartakers (general practitioners, medical practitioners and practice nurses) in over 1,400 locations have signed up to participate in the CervicalCheck programme.
Colorectal cancer screening
Following a request by the Minister for Health and Children, the Board of the National Cancer Screening Service (NCSS) established an Expert Advisory Group on Colorectal Cancer to explore the potential benefits of introducing a colorectal cancer screening programme. The Expert Group has completed its evaluation and submitted its recommendations for a national, population-based, colorectal cancer screening programme using an immunochemical faecal occult blood test as the primary screening tool for men and women aged 55-74.
The NCSS Expert 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 reports of the Expert Group were validated by an international panel of experts in the field of colorectal cancer screening before submission to the Board of the NCSS. The Board has now submitted its recommendations to the Minister.
Hereditary cancer risk
As cancer in high risk groups frequently occurs outside the age range that has been recommended for population screening, a programme to detect cancers in such individuals will also be required to ensure a comprehensive programme of colorectal cancer screening. In that context the NCSS has established an Expert Group on Hereditary Cancer Risk which will submit its report in mid-2009 to the Board of the NCSS on the organisation and development of an integrated cancer control and screening service for those with an inherited familial pre-disposition to colorectal cancer.
Other cancers
The Board of the NCSS is also empowered to provide advice to the Minister for Health and Children relating to other screening developments and has advised on the evidence base for introducing additional screening programmes for prostate, lung and bladder cancer.
A. Prostate cancer
Currently available evidence is insufficient to recommend a population based screening programme because of concerns that it may not improve survival or quality of life and may ultimately cause more harm than good. Two large international randomised controlled trials (RCTs) are currently underway with initial results expected from 2009/10 onwards. These trials should provide crucial information on the effectiveness of screening and treatment regimens for prostate cancer in the context of population based screening.
B. Lung cancer
Currently available evidence is insufficient to recommend a population based lung cancer screening programme but results from international RCTs that are currently underway, and specifically designed to answer the question of whether CT lung cancer screening can impact on mortality, will provide crucial information in the future.
C. Bladder Cancer
Based on currently available evidence, the potential harms of screening for bladder cancer outweigh any potential benefits.
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