Women Missed by the Scottish Breast Screening Programme

Published 18 October 2017 | Reference: 2016-000504 | Charge: No charge

Question

  1. In the wake of concern that women had been missed by the Scottish Breast Screening Programme, whether you have checked if patients have been overlooked by other screening programmes.
  2. Have you verified if patients had been missed by the bowel cancer screening programme? When? How many patients were found not to have received invitations to screening?

  3. Have you verified if patients had been missed by the abdominal aortic aneurysm screening (AAA) screening programme? How many patients have not received invitations to screening?

  4. Have checks been carried out to see if any patients were missed by any other screening programmes? Which programmes were these? How many patients were missed?

  5. The health care Improvement Scotland report says 3,831 women did not receive invitations to breast screening in line with the national policy to check women within a specific age band every three years. The report also says checks to ensure no women have been missed by the screening programme will be run every three months. Excluding the 3831 women mentioned above, have any further women who did not receive letters within the policy time frame been identified? Can you tell me how many?

Response

 

  1. Yes, programmes that involve call and / or recall are being assessed. It should be noted that the bowel, cervical and AAA screening programmes do not invite participant by GP Practice and therefore the risk of participants not being recalled because of the issue regarding change of GP Practice is much lower than that for the Scottish Breast Screening Programme prior to the new IT system. There is still a risk for some individuals that do not have a permanent address. All screening programmes also invite participants not registered with a GP.

    While it is difficult to guarantee that every person will receive an invitation, dependent on the accuracy of the information in relation to their addresses in the Community Health Index database (CHI), each screening programme has continual service improvement work in progress to try to ensure that all eligible participants receive their invitations. This work includes investigations into how to best serve people who change address around the time of their recall date, those in long-term care, and those in prison whose addresses have not been updated in CHI database (CHI) due to serving short sentences.
  2. The Scottish Bowel Screening Programme strives to ensure its entire eligible population is routinely invited to participate. To be eligible, an individual must be aged 50-74, a Scottish resident, have a CHI number, an accurate and permanent address and not have a medical reason which excludes them from participating. Individuals are invited once every two years around the time of their birthday. Individuals over age 75 who fulfil the other criteria can opt-in to the programme by requesting a test.

    There is no evidence that any person with a CHI number, an accurate and permanent address, who does not have a medical reason that excludes them from participating, has been excluded from the programme, other than for the reason outlined above.

    The Bowel Screening Programme also works to co-ordinate with NHS Boards that try to address situational factors such as letters not being directly delivered to all apartments in some tower blocks.

  3. Men are offered a one-off AAA screening at age 65. There is no evidence that any men with a CHI number, an accurate and permanent address, who do not have a medical reason that excludes them from participating, have been excluded from the programme.

  4. Checks have been carried out on other screening programmes. These include:

    Cervical Screening - There is no evidence that any women with a CHI number, an accurate and permanent address, who do not have a medical reason that excludes them from participating, have been missed from the programme. This was evidenced by a sample audit of GP Practice Reports totalling 13,000 women and this identified that all of these women had received a screening test reported in the previous 5.5 years, unless they had a valid reason for not being screened.

    Diabetic Retinopathy Screening (DRS) – This system invites and recalls all men and women (over 12 years of age) who are registered as having diabetes through the DRS system. DRS is not populated by CHI but through the Diabetes register on the Scottish Clinical Information – Diabetes Care (SCI-DC). This register is populated daily from information supplied by GP Practices and hospitals. The system does not call by GP Practice and therefore is at reduced risk from missing patients that have changed Practice. The DRS Programme reports on invitation rate against the eligible population on a quarterly basis.

  5. A report is taken from the Breast Screening IT system to demonstrate compliance with the HIS standard that at least 90% of women are invited once every three years. Based on the 3,831 women not invited at the appropriate interval, this standard was achieved for 99.4% of women. The report is also run quarterly as a failsafe to pick up women who have moved into Scotland, changed address and/or GP practice in that quarter. It is therefore intended that this report will generate invitation letters for a number of women who are outwith 3 year recall. The report run in October 2016 identified 808 women who have gone beyond 36 months. Approximately 250,000 women are invited annually.