Beating cancer: ambition and action

4. Improving Survival

Our Ambitions

To improve cancer survival to a level at least equivalent to other UK and European countries.

To reduce variation in survival rates among the least affluent and most affluent areas across Scotland.

To reduce variation as much as is possible in survival rates in different types of cancer.

To empower people to make balanced and informed decisions around participation in national cancer screening programmes.

To stop anyone dying from breast cancer by 2050, a shared ambition with Breast Cancer Now.

We know that participating in the national population cancer screening programmes is one of the best ways to detect cancer early and to help reduce health inequalities in cancer.

We have three well-established and successful population screening programmes for breast, bowel and cervical cancer. The last of these plays an active part in preventing cancer in the first place. Breast and bowel screening both have a significant role in identifying cancer at an early stage which improves the chances of survival.

Improving our ability to detect cancer at an early stage will make a significant contribution towards achieving our ambition of increasing survival from cancer and in reducing variation in survival rates across Scotland.

Stage of diagnosis, as a proxy indicator for survival, shows that for the three most common cancers in Scotland (breast, lung and colorectal) there is a correlation between later stage presentation and increased deprivation.

Through the Detect Cancer Early programme (DCE) we are already raising awareness of the benefits of screening programmes and improving information available for people to make informed decisions about screening programme participation.

Building on this progress we will further develop a new approach to better understand and tackle inequalities of access to screening services. This will focus on stronger strategic goals and actions, supported by partnerships and effective local delivery in order to change perceptions and attitudes to cancer in Scotland in a bid to reduce fear around the disease and encourage earlier presentation.

National Population Cancer Screening Programmes

The UK National Screening Committee (NSC)^[40] is a body of independent experts who advise the NHS and Governments across the UK on screening policy. NSC will also provide advice in the area of genetic screening and to consider risk stratification within new and existing screening programmes.

Any new screening programmes are subjected to the rigorous criteria set out by the NSC before being implemented in Scotland.

The Scottish Standing Committee for national screening programmes, which will start work during 2016, will carefully consider NSC recommendations and provide advice to ensure recommendations and decisions are taken in the context of the challenges facing the NHS in Scotland.

Sharing national data plays an important role in encouraging improvement of inequalities of access to screening programmes in local areas. Our successful focus on improved access and use of data on inequalities to identify new ways to ensure equal uptake of screening will continue to underpin DCE.

We understand that a national approach cannot fully address the diverse needs of the population, and so we will continue to encourage local initiatives and provide Health Boards with the tools to measure the effect of interventions looking to support further expansion where possible.

The third sector provides valuable support and information to those who engage with the national population cancer screening programmes. Their role is also important to work within the screening programmes in identifying and engaging with hard-to-reach communities.

National Breast Screening Programme

In Scotland, women between the ages of 50 to 70 are invited for breast screening every 3 years. Since 2010, all attendances for breast screening consist of two mammograms taken from different views.

The extension of the ages of women screened from 64 to 70 in 2003 and the subsequent introduction of two mammograms being taken at each screening appointment have contributed to the increased detection of cancer.^[41]

National Bowel Screening Programme

Over the past few years we have seen considerable progress in relation to bowel screening. All men and women registered with a Community Health Index (CHI) number and aged between 50 to 4 years are invited to participate and to be screened every 2 years. Those aged 75 or over are able to self-refer to the bowel screening programme every two years by requesting a screening kit through the Scottish Bowel Screening helpline.^[42]

National Cervical Screening Programme

All women aged 20 to 60 across Scotland are currently invited to have a cervical screening test every 3 years. A set of leaflets are available to inform and enable women to make an informed choice to attend their screening appointment.^[43]

Actions - Improving Survival

• Invest up to £5 million in the next 5 years in new activity targeted to improve outcomes by addressing health inequalities, including in screening and by supporting the development of an NHSScotland network to develop innovative strategies and share learning on inequalities in screening.
• Add cervical cancer to bowel and breast through targeted public awareness campaigns in areas of higher deprivation.
• Working in partnership with organisations such as CRUK, Breast Cancer Now, Walk the Walk, Jo's Cervical Trust, and Bowel Cancer UK we will participate in projects to explore how we can best make improvements to our screening programmes.
• Complete the roll-out of digital mammography to all our breast screening centres in 2016. Due to superior imaging quality this investment in upgrading mammography screening equipment to capture digital images will further enhance our ability to detect cancers early.
• Make the current home testing for bowel screening easier from 2017. Replacing the current kit with the quantitative Faecal Immunochemical Test, or FIT. Not only is this a more sensitive test, which will increase our ability to detect cancers at the earliest stages, it is more user-friendly as it requires only a single sample to be taken. It is anticipated that its relative ease of use will encourage more people to participate in the programme.
• Examine the evidence from an ongoing trial to determine the need for a national roll-out of a flexible sigmoidoscopy one-off test that looks at the lower part of the bowel where most bowel cancers are found.
• Change the age range and frequency for cervical screening in line with the National Screening Committee recommendations.^[44]
• Following a successful pilot, we will introduce Human Papilloma Virus HPV testing for all women who have had treatment for cervical intra-epithelial neoplasia (CIN). This will be available at their next cervical screening test. Women who have a test that shows normal cervical cells and no HPV (HPV negative) 6 months after treatment for CIN will return to routine 3-yearly screening.
• Introduce HPV testing as a first-line test in the cervical screening programme, dovetailing with the HPV vaccination programme. An expert group is currently considering a business case for the introduction of HPV testing within the programme.