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Written Statement - Saving lives through early risk identification: Improving national population cancer screening in Wales

Rebecca Evans Minister for Social Services and Public Health

Population screening helps identify whether apparently healthy people are at higher risk of having a particular condition.  It saves lives and improves people’s quality of life through early risk identification, allowing appropriate action to be taken.  

Wales has eight national screening programmes. They are based on robust evidence which demonstrates that the benefit of those programmes significantly outweighs any potential associated harm.  The programmes are universally respected and are a cornerstone of preventative and prudent healthcare.  When efforts to improve uptake are targeted appropriately, they also have the potential to reduce inequalities.  
Cancer is a major cause of ill health and premature death in Wales, and the number of new cases continues to rise.

More than 400,000 men and women are already routinely screened in Wales each year as part of the breast, cervical and bowel cancer screening programmes.

The recently published annual report on the progress and performance of our national population screening programmes during 2015/16 shows some considerable successes, as well as some of the ongoing challenges. 

A particular success has been the significant increase in the uptake of the bowel screening programme in Wales, with nearly 24,000 extra kits returned and tested in 2015/16 - increasing uptake by 3.6% on the previous year to 54.4%. Uptake for breast screening has increased for the third consecutive year to 72.5%.

However, whilst nearly 8 in 10 eligible women take up cervical screening, there has been a slowly declining trend in uptake over recent years.

The inequity of uptake between people living in the most and least affluent areas remains stubbornly high across all the cancer screening programmes, and this is of real concern.
   
For these screening programmes to reach their full potential, the uptake of screening by the people of Wales needs to increase - particularly amongst people living in our most deprived communities.  We must also continue to invest in those tests which are most reliable and accurate. A combination of awareness raising and more accessible and practical testing will accelerate improvements. We have already modernised the breast cancer screening programme, making it the first fully digitalised service in the UK with new and more accessible mobile screening units on the road from 2012.

I am now pleased to confirm that the Cabinet Secretary for Health, Wellbeing and Sport and I have recently agreed to implement better and more user friendly testing for both cervical cancer screening and bowel cancer screening in Wales. These are key actions within the revised cancer delivery plan.

Implementing primary testing for Human Papillomavirus (known as HPV) – a test for the cause of cervical cancer - represents a completely new approach to cervical screening. Whilst the initial screening process for women will remain the same, the test used will be more sensitive and will allow the NHS to identify women requiring treatment more effectively than it can at present. There will be more appropriate referrals to healthcare services, resulting in quicker treatment; and women will be discharged back to routine screening more quickly, avoiding lengthy periods of annual surveillance.

A pilot programme reaching approximately 20% of women will roll-out across Wales from April 2017. The findings from this exercise will help inform full roll-out, which we anticipate will commence in the first six months of 2018/19.

With regard to screening for bowel cancer, we will be implementing primary Faecal Immunochemical Testing (known as FIT) – a more accurate test which will mean more cancers are detected. More importantly the new test is far easier to carry out at home with pilots showing significant increases in uptake, including amongst hard to reach groups.

The move to FIT within the bowel screening programme in Wales will be implemented as soon as practicable. Roll-out is likely to commence during 2018/19.

Public Health Wales has established project groups to take forward implementation of these key service improvements. The Wales Screening Committee will oversee progress and keep me informed. I will provide an update on progress in early 2018.