A final decision has yet to be taken on the sensitivity threshold for the faecal immunochemical test on its introduction to the bowel cancer screening programme in April 2018. Setting the threshold will require the balancing of a number of different factors, including how endoscopy capacity is affected.

In current NHS England commissioning practice, testing for Lynch syndrome in people with colorectal cancer is targeted using criteria based on family history and age of cancer onset to determine people at high risk.

New National Institute for Health and Care Excellence (NICE) guidance recommends extending this offer to all people with colorectal cancer when they are first diagnosed. Offering tests to all people with colorectal cancer will need to be considered by NHS England as part of its policy development process. Each year, a number of new drugs, medical devices, tests and treatments in specialised services are put forward to NHS England. The promising proposals are considered by experts in the field, including doctors, public health experts and lay people. These groups, established by NHS England, are known as Clinical Reference Groups (CRGs). The CRGs make detailed assessments of the new treatments, tests and devices through Policy Working Groups.

The NICE guidance has been sent to the Genetic Medicine CRG and they have been asked to submit a Preliminary Policy Proposal and to identify a Clinical Lead for progressing the proposal.

Consideration of the commissioning position and any financial implications will only be discussed once the proposal has been rigorously assessed.

A final decision has yet to be taken on the sensitivity threshold for the faecal immunochemical test on its introduction to the bowel cancer screening programme in April 2018. Setting the threshold will require the balancing of a number of different factors, including how endoscopy capacity is affected.

I refer the hon. Member to the answer I gave to the hon. Member for Dulwich and West Norwood (Helen Hayes MP) on 10 March 2017 to Question 66349.

In 2015 the UK National Screening Committee (UK NSC) reviewed the evidence for screening for major causes of sudden cardiac death in young people between the ages of 12 to 39 and recommended that screening should not be offered.

The UK NSC will review the evidence again in 2018/19 or earlier if any new peer reviewed evidence emerges in the meantime.

The trends in NHS Health Check in England are assessed every quarter, using data submitted by local authorities. These trends are published at:

https://fingertips.phe.org.uk/profile/nhs-health-check-detailed/data

Cost-benefit modelling estimates the cost of the programme to be £332 million each year at full roll out with the average annual benefit to be £3.678 billion. The estimated savings to the National Health Service budget nationally are around £57 million over four years, rising to £176 million over a 15-year period. The National Institute for Health Research has launched a call for applications to review the health gain and cost effectiveness of the NHS Health Check.

The information for this assessment is not held centrally. It is for local clinicians to decide what treatment is most appropriate for their patients.

I refer the hon. Member to the answer I gave to the hon. Member for Dulwich and West Norwood (Helen Hayes MP) on 10 March 2017 to Question 66349.

The United Kingdom National Screening Committee (UK NSC) reviews the evidence for screening conditions every three years as per its published evidence review process. When bowel screening using Faecal Occult Blood testing was fully implemented in England in 2010 the Cancer Programme and the NHS Bowel Cancer screening programme assessed what the best combination of screening would be to reduce the burden of bowel cancer in England for people aged 50-75. As a result, a one off examination of the bowel at 55 followed by regular screening for blood in the stool at 60 every two years to the age of 70 (later extended to 74) was concluded to be the best combination of tests to discover, prevent and treat the most bowel cancer within existing resources.

The first test is the Bowel Scope Screening (BSS). This is a direct examination of the left hand large bowel with a camera mounted on a flexible tube. It allows a trained professional to see and remove small polyps (growths) from the bowel. If they are not removed they can slowly develop into cancer. Both men and women are invited to attend this around their 55th birthday. If people are not screened at 55, they can request BSS up to the age of 59. Evidence shows that men and women aged 55-64 attending a one-off bowel scope screening test for bowel cancer could reduce their individual mortality from the disease by 43% (31% on a whole-population basis) and reduce their individual incidence of bowel cancer by 33% (23% on a whole-population basis).

In addition to BSS, the UK NSC recommended the move to use Faecal Immunochemical Test (FIT) in November 2015 as the primary screen for bowel cancer. Evidence has shown that use of the self-sampling FIT test kit can increase screening uptake by around 10% due to the test being easier to use, more acceptable and more accurate. Introduction of FIT will result in around 200,000 more people a year being tested, potentially saving hundreds of lives. FIT will be implemented across England from April 2018.

It is expected that the introduction of FIT will have a significant and positive impact on helping us tackle bowel cancer. The acceptability and accuracy of the test will allow the programme to screen, treat and save lives from bowel cancer.

The United Kingdom National Screening Committee (UK NSC) reviews the evidence for screening conditions every three years as per its published evidence review process. When bowel screening using Faecal Occult Blood testing was fully implemented in England in 2010 the Cancer Programme and the NHS Bowel Cancer screening programme assessed what the best combination of screening would be to reduce the burden of bowel cancer in England for people aged 50-75. As a result, a one off examination of the bowel at 55 followed by regular screening for blood in the stool at 60 every two years to the age of 70 (later extended to 74) was concluded to be the best combination of tests to discover, prevent and treat the most bowel cancer within existing resources.

The first test is the Bowel Scope Screening (BSS). This is a direct examination of the left hand large bowel with a camera mounted on a flexible tube. It allows a trained professional to see and remove small polyps (growths) from the bowel. If they are not removed they can slowly develop into cancer. Both men and women are invited to attend this around their 55th birthday. If people are not screened at 55, they can request BSS up to the age of 59. Evidence shows that men and women aged 55-64 attending a one-off bowel scope screening test for bowel cancer could reduce their individual mortality from the disease by 43% (31% on a whole-population basis) and reduce their individual incidence of bowel cancer by 33% (23% on a whole-population basis).

In addition to BSS, the UK NSC recommended the move to use Faecal Immunochemical Test (FIT) in November 2015 as the primary screen for bowel cancer. Evidence has shown that use of the self-sampling FIT test kit can increase screening uptake by around 10% due to the test being easier to use, more acceptable and more accurate. Introduction of FIT will result in around 200,000 more people a year being tested, potentially saving hundreds of lives. FIT will be implemented across England from April 2018.

It is expected that the introduction of FIT will have a significant and positive impact on helping us tackle bowel cancer. The acceptability and accuracy of the test will allow the programme to screen, treat and save lives from bowel cancer.

The independent Cancer Taskforce reported significant variation across England in screening uptake, patient experience and survival outcomes in the 2015 Cancer Strategy.

Public Health England and NHS England are working with general practices with the lowest levels of screening uptake to understand barriers and mechanisms for improvement.

In December 2016 NHS England announced that a £200 million fund will be available to Cancer Alliances and the national cancer vanguard over the next two years to specifically support the areas the Cancer Taskforce’s strategy estimated would need additional investment, including supporting earlier diagnosis and the full roll out of the Recovery Package across all communities.

The National Cancer Intelligence Network was merged with the National Cancer Registration Service in 2016 to form the National Cancer Registration and Analysis Service (NCRAS). Public Health England’s (PHE’s) National Cancer Registration and Analysis Service collects data on all cancers diagnosed in people living in England. NCRAS is working continuously to to improve the quality and completeness of the data held. This includes NCRAS data liaison teams working with the National Health Service trusts to help them submit more high-quality data to the Cancer Register. This has led to more than 85% of cancers diagnosed in 2015 having a complete stage. NCRAS is also working closely with colleagues in PHE Screening to access more screening information in a timely manner.

In addition, NCRAS is using multiple data sources to increase the completeness of data on a person’s ethnic group; to the point where this is now known for 92% of cases. Although we have not carried out any assessment on White Irish people, it is recognised that minority ethnic groups have varied experience of access to cancer services. NCRAS is working with Cancer Research UK on the National Cancer Diagnosis Audit which will help identify variation on cancer diagnosis and related inequalties. The audit has recently finished collecting data on patients diagnosed in 2014, with initial results expected in the summer. Age is also an important factor in cancer inequalities, and by collecting date of birth NCRAS is able to incorporate age into any analyses.

The National Institute for Health and Care Excellence (NICE) published diagnostics guidance in February 2017 recommending that everyone who is diagnosed with colorectal cancer should be tested for Lynch syndrome.

In current NHS England commissioning practice, testing for Lynch syndrome in people with colorectal cancer is targeted using criteria based on family history and age of cancer onset to determine people at high risk. NHS England will be considering this proposed change to eligibility in practice as part of its clinical development process. NICE has also published a support tool alongside its guidance that provides practical information and advice to help National Health Service organisations to implement its recommendations.

The Department’s Policy Research Unit on Cancer Awareness Screening and Early Diagnosis has undertaken a qualitative research study in which members of the public were given access to available leaflets on ovarian cancer awareness and then participated in six focus groups and interviews on their acceptability and how they would be received and understood if included within the all clear screening results letter from the breast or cervical screening programme. This study is now complete and is being prepared for peer-reviewed publication. A further qualitative research study with professionals will commence when approval is received from the Health Research Authority.

A second project is a synthesis of published incidence, mortality, stage distribution and stage-specific survival rates for ovarian cancer by age. The aim of this project is to identify which age group would be most likely to benefit from such an intervention, in terms of risk of ovarian cancer and room for improvement in stage at diagnosis. This project is also complete and is being prepared for peer-reviewed publication.

The Department’s Policy Research Unit on Cancer Awareness Screening and Early Diagnosis has undertaken a qualitative research study in which members of the public were given access to available leaflets on ovarian cancer awareness and then participated in six focus groups and interviews on their acceptability and how they would be received and understood if included within the all clear screening results letter from the breast or cervical screening programme. This study is now complete and is being prepared for peer-reviewed publication. A further qualitative research study with professionals will commence when approval is received from the Health Research Authority.

A second project is a synthesis of published incidence, mortality, stage distribution and stage-specific survival rates for ovarian cancer by age. The aim of this project is to identify which age group would be most likely to benefit from such an intervention, in terms of risk of ovarian cancer and room for improvement in stage at diagnosis. This project is also complete and is being prepared for peer-reviewed publication.

NHS England is working with Primary Care Support England to develop a new information system for the NHS Cervical Screening Programme. A key element of this is a database to ensure women are managed accurately and safely through the programme. This will be particularly important when the programme converts from cytology screening to human papilloma virus primary screening by April 2019.

The new database is currently in development and is planned to be introduced from mid-2018. The original timeframe (first – second quarter 2017) was reviewed and revised to ensure the database solution is fit for purpose and implemented safely and effectively, to realise the intended benefits for service users.

The NHS Bowel Cancer Screening programme is a biennial programme, in which eligible men and women are invited every two years to be screened.

The baseline performance for the Bowel Cancer Screening Programme, defined as the percentage of people aged 60-74 in a population eligible for bowel screening at a given point in time who were screened adequately within the previous 2.5 years, was set at 57.1% in the 2016/17. Published data from 2016 shows that providers in 75 out of 152 local authority areas are meeting or exceeding the baseline of 57.1%.

Bowel cancer screening in England is offered at two stages to help detect bowel cancer early. Bowel scope screening (BSS) is offered as a one off test at 55. The NHS Bowel Cancer Screening Programme then offers screening by Faecal Occult Blood (FOBt) testing every two years for men and women aged between 60 and 74.

In June 2016, Ministers accepted the UK National Screening Committee (UK NSC) recommendation for Faecal Immunochemical Testing (FIT) to be used as the primary test for bowel cancer replacing FOBt as a more sensitive, accurate and acceptable test. FIT is expected to increase screening uptake by around 10% and result in around 200,000 more people a year being tested, potentially saving hundreds of lives. FIT will be implemented from April 2018.

Public Health England’s (PHE) Be Clear on Cancer campaigns aim to raise awareness of the signs and symptoms of specific cancers, and to encourage those with symptoms to see their doctor promptly to aid early diagnosis.

PHE is also working in partnership with Cancer Research UK to run a regional test of a Be Clear on Cancer branded campaign promoting uptake of bowel screening. The results of this pilot will be thoroughly evaluated and, if successful, it will be considered for wider rollout.

Health Education England pledged to fund the training of 200 non-medical endoscopists (NMEs) to significantly increase endoscopy capacity in England. The first cohort began training at the end of January 2016 and the second in April 2016 to deliver 40 NMEs. Following a successful evaluation, a further 40 NMEs began training in January 2017.

The National Institute for Health and Care Excellence’s updated referral guidelines for suspected cancer (June 2015) could save around 5,000 lives a year, with general practitioners urged to think of cancer sooner and lower the referral threshold for tests.

Cervical screening data is provided at local authority level and is published by Public Health England (PHE).

The percentage of women in the resident population of Wolverhampton who are eligible for cervical screening who were screened adequately within the previous 3.5 years or 5.5 years according to age (3.5 years for women aged 25-49 and 5.5 years for women aged 50-64) on 31 March is 68.1%.

Cervical screening is commissioned by NHS England and is based upon a national service specification developed by PHE. NHS England closely monitors the coverage rates for cervical screening in all age groups and is committed to improving coverage and reducing variation between all age groups. In Wolverhampton, NHS England is working with local sexual health services to improve access for women who wish to access the cervical screening programme outside of general practice. PHE and NHS England are also working with general practices with lowest levels of uptake to understand barriers and mechanisms for improvement.

The human papillomavirus (HPV) adolescent vaccination programme for girls is well established in the United Kingdom and is expected to have a significant impact on reducing cervical cancer. Since the start of the programme in 2008, more than 8.5 million doses of the HPV vaccine have been given in the UK, with close to 90% of eligible teenagers vaccinated.

Bowel cancer screening is offered at two stages, once with a flexible camera at age 55 and then every two years between 60 and 74.

In July 2003, bowel cancer screening by Faecal Occult Blood (FOB) testing for men and women aged 50-74 was recommend by the UK National Screening Committee (UK NSC). Roll out in England was initially offered to men and women aged 60-69 years old, with more than 80% of cancers being detected in this age group. The Cancer Reform Strategy (2007) extended bowel screening to 70-74 year olds.

The roll out of FOBt in England required the NHS Bowel Screening Programme to take into account and help balance the increased workloads and pressures placed upon services providing diagnosis and treatment to all people with bowel cancer (not only those found through the screening programme) as well as consider the possible introduction of bowel scope which was then introduced eight years on.

In 2011 the UK NSC agreed for Bowel Scope Screening (BSS) to be offered to men and women at the time of their 55th birthday as an alternative and complementary bowel screening methodology to Faecal Occult Blood (FOBt). Evidence has shown that men and women aged 55-64 attending a one-off BSS test for bowel cancer can reduce their individual mortality from the disease by 43% (31% on a whole population basis) and reduce their individual incidence of bowel cancer by 33% (23% on a whole population basis)¹.

On 15 January 2016 the UK NSC announced the recommendation that Faecal Immunochemical Test (FIT) is used as the primary test for bowel cancer instead of the currently used FOB test. Ministers have accepted this recommendation and FIT will be implemented from April 2018.

Note:

¹ The Lancet, Volume 375, Issue 9726, Pages 1624 - 1633, 8 May 2010