I thank the Chairman. Members of the committee have received a detailed presentation and in the interests of expediency I shall abridge it and skip over some of the points.
The National Cancer Screening Service encompasses BreastCheck, CervicalCheck and the planned national colorectal cancer screening programme. The aim of BreastCheck, the national breast screening programme, is to detect breast cancer at the earliest possible stage. It does that by providing free mammograms to women aged 50 to 64 years, sequentially, on an area-by-area basis, approximately every two years. It is the world's first fully digital programme. It is well supported by the population and the OECD ranked it third in the world for percentage of women who had taken part in the programme.
Some of the key statistics in terms of the programme since its inception to date are that it has provided almost 680,000 mammograms to more than 321,000 women and 4,259 women have had their breast cancer diagnosed through BreastCheck and, therefore, proceeded to earlier treatment than would otherwise have been the case. That is based on an overall acceptance to invitation of 78% — the minimum target being 70%. Obviously we would like a greater acceptance level to invitations.
I have provided some detailed briefing in respect of our plans in County Donegal. There are some issues with regard to surgical admission. The age range for BreastCheck is 50 to 64 years. In Ireland, more than 70% of breast cancers occur in women aged over 50 years. While the incidence of breast cancer in women aged 40 to 49 is increasing, the incidence is still approximately 50% lower than that for the 50 to 59 age group. On completion of the first full round of screening to all women aged 50 to 64 years and subject to overall resources and the reallocation of resources, the former board of the National Cancer Screening Service, which no longer exists, approved extending the upper screening limit to women aged 69 years. This is in accord with the European Council's recommendations and with the cancer control strategy. At present, there is no timetable in place but it is a key priority for the screening programme.
The eligible population for CervicalCheck is approximately 1.1 million women aged 25 to 60 years living in Ireland. The aim of CervicalCheck is to reduce the incidence and mortality from cervical cancer by detecting changes in the cells of the cervix before they become cancerous. According to the recently published detailed statistics, in the first year of operation which ended on 31 August 2009, 284,833 women availed of the programme. Some 85% of those women received a negative or normal result. Of the remainder, 13.9% showed low grade abnormalities, 1.4% showed high grade abnormalities, resulting in 11,112 women being referred to colposcopy for further investigation and 4,714 women received treatment. In that first year, 100 women were diagnosed with cervical cancer. The overall aim of the programme is not to detect cervical cancer but it is natural, at this early stage, that we would do that.
During the reporting period, CervicalCheck's laboratories recorded in excess of 86% positive predictive value for high grade abnormalities and in excess of 95% for low grade abnormalities. That is considered a very good result by international standards. While a detailed report for the second year of operation is not yet available, I can share that during its second year of operation CervicalCheck provided 304,000 smear tests to 278,000 women aged 25 to 60. This shows that overall participation in the programme held up well between the first and the second year of services.
I have detailed the significant investment that has been made in colposcopy services but I will not absorb time by going through it in detail.
We have specific initiatives in place to target "harder to reach" populations. The programme has gone through different phases. In the first year of operation where the aim was to recruit people who had been having annual smear tests, we had what was known as open access. In the second year, we successfully established the call recall system which was met with some concern at the time but the data show it has been successful. Now in the third year we have a combination of call recall and direct recruitment by smeartakers in general practice or women's health clinics. This is part of the strategy of getting to 80% participation over the first two screening rounds, in other words the first six years. Evidence internationally has shown that if we can successfully do that, we can potentially reduce mortality from cervical cancer by up to 80%. That is our major target.
In regard to the planned national colorectal cancer screening programme which has an overall eligibility target of women and men aged 50 to 74 years we have been preparing for this for some time. In January 2010 the Minister for Health and Children, Deputy Mary Harney, asked us to proceed with the introduction of a national population-based colorectal cancer screening programme. We will be implementing it on the basis of recommendations from a number of expert groups which recommended the introduction of screening for this age group on a two-yearly cycle, using the faecal immunochemical test, FIT, which operates on an automated testing platform, as the primary screening tool. We have a few samples — members may be interested to see them because they are new in terms of the way we run population cancer screening programmes. FIT is a screening test that is carried out in the home. Eligible men and women who wish to participate in the screening programme will be posted a test kit and instructions for use. A stool sample is taken and returned to a screening laboratory by Freepost. This will be one of the first international population-based screening programmes that utilises this technology as the primary screening tool.
The vast majority of people who carry out the FIT screening test at home will receive a normal result. It is expected that approximately 6% of all people screened will require further investigation, primarily by colonoscopy. In order to develop capacity to implement a screening programme for the 55 to 74 age group, the programme will be implemented on a phased basis starting with men and women aged 60 to 69. Phase 1 of the programme, for that age group, is to be introduced in 2012. The target date for the first of these kits to be posted out is the first working day of January 2012. There are approximately 400,000 men and women, aged 60 to 69 years. The programme will be extended to include the full age group on a phased basis as soon as possible thereafter. We expect that over time the programme will be expanded to include younger and older individuals until the full 55 - 74 age group is reached. This phased approach is based on a clear commitment to reaching the full target population as soon as possible.
In the preparatory phase, leading up to 2012, there are a number of work streams under way. The most important of these in some respects is the process of developing colonoscopy capacity, accreditation and training. The vast majority of the population screened will receive a normal result from their screening but approximately 6% will require further investigation by colonoscopy. The NCSS is focused on immediately identifying and building sufficient capacity in colonoscopy services nationwide to sustain the implementation of the programme, while maintaining and enhancing the symptomatic service capability. Some 30 public hospitals nationwide expressed an interest in providing colonoscopy services. Baseline assessment visits have been conducted by the NCSS in partnership with the representative professional bodies, namely the royal colleges and the national endoscopy team who have acted as advisers to the Joint Advisory Group on Gastroenterology in the National Health Service in the UK. All 30 of those who expressed an interest in providing the services will attend facilitated workshops next month with the aim of reviewing and building upon individual unit baseline assessment reports and developing a standardised approach to common problems encountered in endoscopy service provision. All units will receive a follow-up visit from the assessment team that carried out the first visit by the end of this year. In January of next year we expect to make an initial selection of eight to 12 candidate screening colonoscopy units that are best placed to provide screening colonoscopies in addition to their symptomatic workload. All endoscopy units will operate to a common, quality assured standard. During 2011, selected units will be required to demonstrate their capability of managing this workload while adhering to the quality assurance standards for the screening programme. Each will be required to achieve international accreditation by the end of 2011. For those centres not initially selected, there is a process to enable them to become screening colonoscopy services later. The quality and clinical directorate of the HSE will support these units in achieving international accreditation. Each of those units must be up to date in terms of its symptomatic workload to be a screening centre.
We are developing also an overarching quality assurance process. We have established a number of multi-disciplinary committees to do that. As with CervicalCheck, the guidelines will be internationally validated and will be completed by mid-2011. The faecal immunochemical test, FIT procurement will be under way. I emphasis that based on the age range, there is a 6% positivity range. If 50% of the target population take part — which by international standards would be considered a good uptake, although we would aim for a higher level — and we select ten locations, that would result in a referral panel of about ten to 12 additional colonoscopies per centre per week.
I also make the point that whereas colonoscopy is often and widely referred to as a cancer test, it is a test with much wider application in terms of its general population usage. Approximately 97% of those who have a colonoscopy receive a result other than cancer and a wide range of other symptoms and causes will be investigated. It would be unfortunate if in the general discourse around colonoscopy as a cancer screening test, we would produce the result where persons referred for colonoscopies by their GPs automatically assume there is a suspicion of cancer. I have had contact from individuals in that situation, needing to be passed on to those who can reassure them in that regard. It is important that we ensure there is a proper understanding of the full nature and usage to which colonoscopy is put.