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CANCER IN SCOTLAND SUSTAINING CHANGE
02 PREVENTING AND DETECTING CANCER EARLY
THE BEST POSSIBLE OUTCOME IS TO PREVENT CANCER FROM EVER STARTING
Smoking
Smoking is by far the largest preventable cause of cancer in Scotland.
What we said we would do:
What has been achieved:
With our partners, the Scottish Executive has delivered new and expanding smoking cessation services, nicotine replacement therapy on prescription, high quality communications campaigns, the establishment of Partnership Action on Tobacco and Health, a ban on tobacco advertising and enhanced health warnings on cigarette packets.
The first ever tobacco control action plan
A Breath of Fresh Air for Scotland was launched in January 2004. It offers a broad-based programme of action aimed at:
- accelerating reductions in smoking in smoking prevalence;
- extending and improving smoking cessation services with an injection of 7 million of new funding
between 2003-04 and 2005-06;
- through legislative and other action reducing the availability and attractiveness of cigarettes particularly to children and young people;
- sponsoring a public debate on action to minimise the impact of second-hand smoke.
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A new Ministerial Working Group, chaired by the Deputy Minister for Health and Community Care, has been set up to guide the implementation of the action plan and help to shape the future direction of national tobacco control policy in Scotland. The Executive believes that
A Breath of Fresh Air for Scotland represents an important opportunity to improve the health of the people. New smoking cessation targets will be set for each NHS Board this year.
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Diet
We know that the Scottish diet is far from healthy and that dietary factors may be responsible for up to 30% of cancers.
The Scottish Diet Action Plan (SDAP) is one of Scotland's most developed and mature health improvement programmes. It sets the context for all action to tackle Scotland's poor diet. We are currently focusing on the key targets of increasing consumption of fruit and vegetables and upon reducing consumption of fat, particularly saturated fat.
What we said we would do:
What has been achieved:
A national Diet Action Coordinator was appointed in July 2001 and has been working in partnership with a wide range of stakeholders both local and national.
The healthyliving campaign, as part of the SDAP work, was launched in January 2003. It is the largest public health education campaign ever undertaken in Scotland and aims to encourage and sustain a cultural shift in attitudes towards healthier eating over a number of years.
Achievements over the last year include the introduction of national standards for school meals,
Hungry for Success backed by a major investment of 63.5 million and detailed monitoring and inspection programme. The introduction of free fruit in schools for primaries 1 and 2. The food industry is now moving to support policy changes in Scotland. In response to
Hungry for Success, Coca-Cola removed branded vending machines from all Scottish schools and agreed to provide water and healthier choices.
Product specifications were developed by the Food Standards Agency Scotland, to set levels for fat, salt and sugar in processed food for Scottish school menus. In response, suppliers and manufacturers, including Brakes, developed new healthier ranges.
There is also a wide programme of activity driven by local authorities and health boards. Increased investment is supporting the development and implementation of local nutrition action plans throughout Scotland supported by the publication of
Improving Health in Scotland - The Challenge.
Physical Activity
Exercise can protect against a range of cancers as well as promoting good physical and mental health.
What we said we would do:
What has been achieved:
A national Physical Activity Coordinator was appointed in June 2002 and is developing partnerships with local and national organisations to help secure sustainable improvements and affect changes in attitudes and lifestyles.
Scotland's national physical activity strategy
Let's Make Scotland More Active was published in February 2003 and the goal is for 50% of adults and 80% of children to meet the minimum recommended levels of physical activity for health by 2022 (an increase of 1% per year from 2002 to 2022).
Active Schools Programme - 24 million being invested during 2003-06 to provide a range of indoor/outdoor, sports and physical activity opportunities for all pupils in and around the school day supported by 600 coordinators.
In November 2003, the Deputy Minister for Health and Community Care announced a National Walking Campaign to encourage walking as the main focus for increasing levels of physical activity. Nearly 38 million ring fenced funding has been allocated to local authorities over the period 2000-06 for cycling, walking and safer streets projects, including safer routes to school.
Alcohol Consumption
Excessive alcohol consumption is associated with several types of cancer, for example cancers of the head and neck and oesophagus.
What we said we would do:
What has been achieved:
In January 2002 the Scottish Executive published a national
Plan for Action on Alcohol Problems. The two key priorities of the Plan are to reduce binge drinking and to reduce harmful drinking by children and young people. The plan seeks to kick-start a cultural change in current harmful drinking patterns.
The Executive has also launched a national communications strategy, published the
Alcohol Problems Support and Treatment Services Framework, and set up the National Alcohol Information Resource.
Local Alcohol Action Teams have been strengthened and have produced 3-year plans for local delivery. An injection of 8 million is available between 2004-05 and 2005-06 to support this local action.
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The responses to the Nicholson Committee's Report on the Review of Liquor Licensing Law have been independently analysed and are being considered by Ministers. In due course the Scottish Executive will publish a White Paper which is expected to lead to new liquor licensing legislation for Scotland. A sub-group of the Scottish Ministerial Advisory Committee on Alcohol Misuse has been set up to lead a review on the progress in delivering the
Plan for Action on Alcohol Problems and in determining future priorities. Action flowing from the Nicholson Review, the consultation on anti-social behaviour proposals and the English Alcohol Harm Reduction Strategy will have a significant bearing on how we take future action forward.
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Environmental Factors
Even in a country with Scotland's climate, ultraviolet radiation is a major risk factor for skin cancers including malignant melanoma.
What has been achieved:
The Scottish Executive, in partnership with the other UK health departments, supports the Cancer Research UK skin cancer prevention campaign "SunSmart" which aims to increase the profile of the risks of getting skin cancer and methods of effective sun protection.
NHS Board Health Promotion Departments are active in the promotion of healthy lifestyles through the provision of information and advice on a range of aspects including the safe use of tanning beds and sun safety.
Sun Awareness Week is a national campaign (10-16 May) and many Health Promotion Departments participate in this with special events.
An award-winning media campaign by NHS Health Scotland on sun safety runs through the summer months. The adverts are triggered by a weather forecast announcing three consecutive days of sunshine.
A leaflet on Sun Safe Protection Tips was produced by NHS Health Scotland and distributed through Health Boards, Visit Scotland, The Passport Office, Thomas Cook, six Scottish airports and pharmacies throughout Scotland.
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Skin cancer experts from Cancer Research UK met with The Sunbed Association at a Sunbed Summit in March 2004 and agreed plans for stricter self regulation of the tanning industry. The Sunbed Association have agreed to have their Code of Practice and training materials vetted by a team of health experts and will give consideration to reducing the number of recommended sessions. |
Chemoprevention of Cancer
The possibility that some agents may help prevent the development of specific cancers is currently the subject of active research.
What we said we would do:
What has been achieved:
To look at the current position and associated issues a Chemoprevention Seminar was held in October 2002 involving a range of national and international experts. A report of the proceedings was published in July 2003 and is available on
www.cancerinscotland.scot.nhs.uk . The key recommendation was to maintain a watching brief and, with expert advice, consider emerging evidence from international clinical trials.
THE NEXT BEST STRATEGY (AFTER PREVENTION) IS TO DETECT AND TREAT CANCER EARLY
National Cancer Screening Programmes
What we said we would do:
A new nationally coordinated IT system for cervical cancer screening will be developed by late spring 2003.
Introduce Liquid Based Cytology (LBC) - an alternative method of processing smears - into the screening programme.
Upper age limit for the Scottish Breast Cancer Screening Programme will be raised from 65 to 70 years commencing in 2003-04.
What has been achieved:
Implementation of the new national call-recall system is being phased in and should be fully implemented by the end of 2006. As a first step user acceptance testing of call-recall functionality began in June 2003.
LBC has now been fully introduced into the cervical screening programme. It is expected that LBC will reduce the rate of unsatisfactory smears which means that 24,000 women each year will not need a repeat smear.
The extension of routine invitation for breast cancer screening to 70 years is being phased in across Scotland from spring 2003. It is expected that the extension will have begun in all areas of Scotland by mid 2005 with full implementation over a 3-year round of screening. Women over the age of 70 will be able to continue to self refer.
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The introduction of the new call/recall system for cervical cancer screening will continue in 2004 and the introduction of LBC will be monitored. Continuing the introduction and monitoring of the extension of the upper age range for invitation for breast cancer screening.
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Bowel Cancer Screening Pilot
What we said we would do:
What has been achieved:
The Scottish arm of the UK Bowel Screening Pilot in Fife, Grampian and Tayside has been extended for a second round. The Evaluation Report published in July 2003 confirmed the potential benefits of bowel cancer screening and the feasibility of Faecal Occult Blood testing (FOBt) in a NHS setting.
The report identified a number of areas where further work is needed such as the impact on primary and secondary care services, workforce and training requirements. In addition, while the pilot was based on FOB testing there are other screening methodologies which will need evaluation.
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A Bowel Cancer Screening Pilot Project Board has been established to oversee and coordinate the second round of screening in Fife, Grampian and Tayside and to assist with the roll out of the screening programme. The challenges presented by the roll out of bowel cancer screening across Scotland and the development of bowel cancer services to support the screening are recognised. The planning process will take around 3 to 5 years and will take into account the issues identified in the Evaluation Report, any advice from the UK National Screening Committee and the implications of the Council of European Union recommendation for bowel cancer screening. Advice to the service on the roll out of screening will be developed and issued later in 2004. Cancer in Scotland: Action for Change - A Bowel Cancer Framework for Scotland was published in April 2004. It brings together into one framework all of the ongoing initiatives and investment already underway and sets out the direction of future travel in order to support bowel cancer services in Scotland. The Scottish Executive will set up a National Steering Group to map out next steps and agreed approach to build capacity and ensure services are ready to support a national screening programme over the next 3 to 5 years. Department of Health Bowel Cancer Advisory Group set up in March 2004, includes representation from Scotland.
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Prostate Cancer
Many men who develop prostate cancer do not die of it. Indeed, a great many men are never actually aware that they have prostate cancer and live long lives before dying of other, unrelated conditions.
The level of prostate specific antigen (PSA) in the blood is one of a range of investigations which may be undertaken to help confirm a diagnosis of prostate cancer. Currently available tests cannot differentiate between those men whose prostate cancer will grow rapidly and aggressively and those in whom it will remain localised to the prostate for the rest of their lives. PSA levels may also be raised in a number of conditions unrelated to cancer. As with other cancers, none of the diagnostic procedures and treatment options for prostate cancer is without side effects.
For these reasons PSA testing as a means of population screening for prostate cancer is not currently recommended by the UK Screening Committee.
What we said we would do:
A variety of actions have been taken over the last 3 years to support men and health care professionals when making decisions about PSA testing.
What has been achieved:
In December 2001 the Scottish Executive advised that asymptomatic men who ask their GP for a PSA test should be able to have one and any follow up necessary from the NHS. A Prostate Cancer Risk Management Primary Care Resource Pack developed by the Department of Health in England was circulated to every GP in Scotland to help and advise asymptomatic men.
Regional Cancer Advisory Groups (RCAGs) have confirmed through their 6-monthly routine monitoring reports that many of the recommendations of the Prostate Cancer Working Group Report (2001) have been or are being implemented by the cancer networks.
A Prostate Cancer Charter for Action was launched in the House of Commons in January 2003 to ensure collaboration and communication between Charter members and government. The Department of Health announced simultaneously the establishment of a Prostate Cancer Advisory Group membership of which includes Scottish Executive officials, voluntary sector, healthcare professionals and patients.
A urological cancer networks development workshop: "A Focus on Prostate Cancer" was held on 30 April 2004 to share learning and to find ways to further support collaboration and networking. This also provided an opportunity to hear about the progress of the Scottish Urological Cancer Audit (SUCA) and to consider how this national audit links into the quality improvement agenda for regional urological cancer networks.
Men's Health
There are well-recognised issues surrounding men's attitudes to health - the stoical Scots who refuse to visit the doctor or even to talk to their friends about things they feel are too personal. There has been a noticeable change in men's attitudes to cancer over recent years with increased profile for the two main gender-specific cancers, testicular cancer and prostate cancer.
What has been achieved:
In October 2003 the First Minister opened the UK's first male cancer centre at Western General Hospital in Edinburgh. Funded by a donation from the HEBA Foundation, and known as the HEBA clinic, it acts as a focus for the multidisciplinary management of urological cancers, particularly testis and prostate cancer and a hub for health education, concentrating as much on prevention as cure.
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Men do not attend "traditional" clinics in NHS general practice. The
Partnership Agreement committed to supporting further improvements to health screening services and improve accessible to those services by developing a range of innovative programmes, including well man clinics. The Scottish Executive has developed a strategy whose aim is to:
- promote healthier lifestyles and attitudes among men;
- provide men with the opportunity to undertake a health assessment and to obtain advice and support on health and lifestyle issues;
- effectively engage all men. |
Oral Cancer
What we said we would do:
What has been achieved:
The Scottish Executive has supported a feasibility study for oral cancer screening in the primary care setting through an allocation of 25,000 Primary Care Development Funding. The project is ongoing and should report early in 2005.
Originally launched in 2000, an Oral Cancer training package "
Oral Cancer Prevention and Detection for the Primary Healthcare Team", developed by Glasgow University Dental School and the predecessors to NHS Education for Scotland and NHS Health Scotland (Scottish Council for Postgraduate Medical and Dental Education and Health Education Board for Scotland) was updated and sent out to pharmacies, general practices and dental surgeries in October 2003. The revision follows on from a tracking exercise, which indicated that the pack led to positive changes in practice, particularly by professionals trained over 10 years ago. A small study looking at referrals in one area in the years both before and after an increase in training is due to report shortly.
A range of professional educational events were organised in collaboration with NHS Education for Scotland to support Mouth Cancer Awareness Week and the launch of the West of Scotland Cancer Awareness Project (WOSCAP).
WOSCAP, a partnership between the five West of Scotland NHS Boards, is funded by the New Opportunities Fund (NOF) with a remit to develop a high profile public awareness campaign on the early detection of mouth and bowel cancer. This is the biggest NOF cancer project in Scotland and runs from Jun 2002 to June 2005, with a budget of 1.3 million. The mouth cancer campaign ran in October 2003 through to March 2004. The bowel cancer campaign will run from October 2004 to March 2005. Fuller details of all NOF projects are available from
www.nof.org.uk .
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The
Partnership Agreement announced a commitment to the phasing in of free dental examinations for all by 2007. This should help to ensure that patients are not deterred from visiting the dentist for an oral examination on grounds of cost. Consideration will be given as to how to phase in free dental examinations to ensure that patients at risk of oral cancer have an opportunity to receive a regular oral examination and advice on the prevention of oral cancer. The Executive's response to the recent consultation on dental services in
Scotland Modernising NHS Dentistry in Scotland will consider the views of a wide range of stakeholders on how future dental services in Scotland will be shaped to provide a high quality service which reflects the need for a more preventive approach to care, including the prevention of oral cancer. We will assess the results of the Adult Oral Health Feasibility Study to consider how oral cancer screening can be taken forward in Scotland. The Scottish Intercollegiate Guidelines Network (SIGN) is in the process of developing a head and neck cancers guideline due to be published in 2004. We will consider how this may influence the shape of dental services in Scotland.
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Genetic Screening
What we said we would do:
What has been achieved:
A national overview of audit data drawn from information collected at the Aberdeen, Dundee, Edinburgh and Glasgow Genetic centres including the volume of referrals of individuals and families with a history of cancer being handled by the genetic clinics in Scotland. It showed that the bulk of referrals are for women with a family history of breast cancer with the next largest group being men and women with a family history of colorectal cancer.
There is also evidence to show that prior to a clinic appointment the checking of the family information for accuracy results in changes in risk categorisation.
The colorectal audit data showed that the numbers requiring regular colonoscopic surveillance on the basis of family history alone is likely to be significantly reduced when compared with past practice.
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- update of Guidance to NHSScotland to take account of new developments and emerging new evidence, e.g. publication of SIGN Guidelines;
- review and advise on core information available for patients with a family history of cancer, clinical trials available for those at high risk of developing cancer to include funding criteria/information;
- finalise and agree a nationally agreed data set to audit process and outcomes. |
Increased Risk of Breast Cancer after Supradiagphragmatic Radiotherapy
This was not a feature of
Cancer in Scotland but was additional work undertaken in response to emerging evidence of risk for patients.
What we have done:
Following advice from the National Cancer Research Institute (NCRI) a UK-wide identification and notification exercise was planned and coordinated across the four UK Departments of Health to inform individual patients of increased risk of breast cancer following supradiaphragmatic radiotherapy for Hodgkin's disease.
A Scottish Hodgkin's Group was set up to advise and provide a toolkit, setting out clearly the management arrangements to be put in place in Scotland. The notification exercise commenced in November 2003.
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The Scottish Hodgkin's Group will meet later this year to review the exercise and agree whether a further follow up data collection exercise is needed over and above current routine processes. |
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