Bowel cancer screening programme standards: valid for data collected from 1 April 2018
Updated 12 March 2021
Applies to England
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BCSP-S01: coverage
Description
The proportion of eligible men and women aged 60 to 74 invited for screening who had an adequate faecal occult blood test (FOBt) screening result in the previous 30 months.
Rationale
To:
-
maximise timely attendance within 24 months of screening in the eligible population (allowance of 6 months for episodes to be closed)
-
provide evidence that the eligible population previously invited, aged 60 to 74, were adequately identified and invited by the screening programme
Definition
Numerator: number of eligible men and women who have had an adequate FOBt screening result in the previous 30 months.
Denominator: number of eligible men and women aged 60 to 74 registered with a GP during the reporting period.
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
An adequate FOBt screening result is defined as reaching a definitive FOBt outcome: normal or abnormal (from potentially multiple test kits).
Performance thresholds
To be set.
Caveats
There are a number of men and women in the eligible age range who are not registered with a GP and subsequently not called for screening as they are not on the screening population index (SSPI). Screening units have a responsibility to maximise coverage of eligible men and women in their target population and should support GP registration where appropriate, or employ programme-approved alternative mechanisms, on request.
If screening services have any screening slippage (people not invited within 30 months of their previous screen or invitation), it will adversely impact on rates of coverage.
Data collection and reporting
Data source: National Health Application and Infrastructure Services (NHAIS).
Responsible for data quality and completeness: local screening provider, NHS Digital.
Responsible for submission: not applicable as extracted from NHAIS and the bowel cancer screening system (BCSS) by the bowel cancer screening programme (BCSP).
Reported by: not applicable as extracted from NHAIS and BCSS by the BCSP.
Published by: local authority, clinical commissioning group (CCG), GP practice.
This standard is also KPI BCS2.
Reporting period
Quarterly (6 months in arrears).
Review dates
Date standard introduced: April 2006.
Date standard last updated: 8 August 2018.
BCSP-S02: uptake
Description
The proportion of men and women aged 60 to 74 invited to participate in bowel cancer screening who adequately participate.
Rationale
An important objective of the BCSP is to maximise uptake in the invited population.
The expected effectiveness of the bowel screening programme in reducing bowel cancer mortality requires a minimum uptake of 52.0%.
Definition
Numerator: number of invited men and women aged 60 to 74 who adequately participated in screening within 6 months of the invitation.
Denominator: number of men and women aged 60 to 74 who are invited to participate in bowel cancer screening, within the reporting period.
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
Adequately participated is defined as reaching a definitive FOBt outcome, normal or abnormal (from potentially multiple test kits).
This standard counts men and women (not test kits/appointments).
Performance thresholds
Acceptable level: greater than or equal to 52.0%.
Achievable level: greater than or equal to 60.0%.
Caveats
There are a number of men and women in the eligible age range who are not registered with a GP and subsequently not called for screening because they are not on the SSPI.
Data collection and reporting
Data source: BCSS
Responsible for data quality and completeness: local screening provider.
Responsible for submission: not applicable as extracted from BCSS by the BCSP.
Reported by: not applicable as extracted from BCSS by the BCSP.
Published by: screening centre, programme hub, GP practice, CCG.
This standard is also the key performance indicator BCS1.
Reporting period
Quarterly (3 months in arrears).
Review dates
Date standard introduced: April 2006.
Date standard last updated: July 2019.
BCSP-S03: test: FOBt kit turnaround time
Description
The proportion of completed and returned FOBt kits read by the programme hub within 3 calendar days.
Rationale
The programme hub needs to read completed FOBt kits in a timely manner so that people receive their screening results as soon as possible.
Definition
Numerator: number of FOBt kits returned to the hub and read within 3 calendar days, within the reporting period.
Denominator: number of FOBt kits returned and logged by the hub, within the reporting period.
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
The day of logging counts as day 0.
Performance thresholds
Acceptable level: greater than or equal to 80.0%.
Achievable level: greater than or equal to 85.0%.
Caveats
None.
Data collection and reporting
Data source: BCSS.
Responsible for data quality and completeness: local screening provider.
Responsible for submission: not applicable as extracted from BCSS by the BCSP.
Reported by: not applicable as extracted from BCSS by the BCSP.
Published by: bowel cancer screening hub.
Reporting period
Annually (1 month in arrears).
Review dates
Date standard introduced: April 2006.
Date standard last updated: 8 August 2018.
BCSP-S04: test: bowel scope screening adenoma detection rate
Description
The proportion of bowel scope screening procedures where at least one histologically confirmed adenoma was resected and retrieved out of all the bowel scope screening procedures performed.
Rationale
To achieve the intended reduction in bowel cancer mortality, it is essential that adenomas (which may develop into cancer) are detected.
Definition
Numerator: number of bowel scope procedures where at least one histologically confirmed adenoma was resected and retrieved, during the bowel scope procedure, within the reporting period.
Denominator: number of attended bowel scope procedures where the scope was inserted, within the reporting period.
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
Performance thresholds
Acceptable level: greater than or equal to 6.8%.
Achievable level: greater than or equal to 10.0%.
Caveats
None.
Data collection and reporting
Data source: BCSS.
Responsible for data quality and completeness: local screening provider.
Responsible for submission: not applicable as extracted from BCSS by the BCSP.
Reported by: not applicable as extracted from BCSS by the BCSP.
Published by: screening centre.
Reporting period
Annually (3 months in arrears).
Review dates
Date standard introduced: April 2006.
Date standard last updated: 8 August 2018.
BCSP-S05: diagnosis or intervention: computed tomography colonography (CTC) as a diagnostic procedure
Description
The number of CTC procedures performed out of all the diagnostic tests performed.
Rationale
It is important that people with an abnormal screening test have the best diagnostic test to find cancers and adenomas. Colonoscopy is the gold standard diagnostic test for BCSP. Although CTC may be performed as a diagnostic test within the programme for a small proportion of patients for specified clinical reasons, it is important that CTC is performed appropriately.
Definition
Numerator: number of diagnostic tests that are performed by CTC within the reporting period.
Denominator: number of all diagnostic tests performed within the reporting period regardless of test type.
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
Performance thresholds
To be set.
Caveats
None.
Data collection and reporting
Data source: BCSS.
Responsible for data quality and completeness: local screening provider.
Responsible for submission: not applicable as extracted from BCSS by the BCSP.
Reported by: not applicable as extracted from BCSS by the BCSP.
Published by: screening centre.
Reporting period
Annually (1 month in arrears)
Review dates
Date standard introduced: April 2006.
Date standard last updated: 8 August 2018.
BCSP-S06: referral: SSP clinic appointment waiting time
Description
The proportion of participants with an abnormal FOBt result who are offered a specialist screening practitioner (SSP) appointment within 14 days of their referral date.
Rationale
It is important to minimise anxiety for participants in the programme with an abnormal FOBt result who need to attend for an assessment clinic.
Definition
Numerator: number of participants with an abnormal test result offered an SSP clinic appointment within 14 days of their referral date, within the reporting period.
Denominator: number of participants with a definitive abnormal test result within the reporting period.
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
Performance thresholds
Acceptable level: greater than or equal to 95.0%.
Achievable level: greater than or equal to 98.0%.
Caveats
None.
Data collection and reporting
Data source: BCSS.
Responsible for data quality and completeness: local screening provider.
Responsible for submission: not applicable as extracted from BCSS by the BCSP.
Reported by: not applicable as extracted from BCSS by the BCSP.
Published by: screening centre.
Reporting period
Quarterly (1 month in arrears).
Review dates
Date standard introduced: April 2006.
Date standard last updated: 8 August 2018.
BCSP-S07: referral: diagnostic procedure waiting time
Description
The proportion of participants with an abnormal FOBt result whose first offered diagnostic test date falls within 14 days of their SSP clinic appointment, out of those given a diagnostic test date.
Rationale
To reduce anxiety for participants with an abnormal FOBt result, it is important they are offered an appropriate diagnostic procedure in a timely manner.
Definition
Numerator: number of people who attend an SSP clinic appointment and are subsequently offered a diagnostic test within 14 days, within the reporting period.
Denominator: number of participants who attend an SSP clinic appointment and are subsequently offered a diagnostic test, within the reporting period.
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
Diagnostic test is inclusive of all procedure types.
Performance thresholds
Acceptable level: greater than or equal to 90.0%.
Achievable level: greater than or equal to 95.0%.
Caveats
None.
Data collection and reporting
Data source: BCSS
Responsible for data quality and completeness: local screening provider.
Responsible for submission: not applicable as extracted from BCSS by the BCSP.
Reported by: not applicable as extracted from BCSS by the BCSP.
Published by: screening centre.
Reporting period
Quarterly (1 month in arrears).
Review dates
Date standard introduced: April 2006.
Date standard last updated: 8 August 2018.
BCSP-S08: diagnosis or intervention: time to attendance at diagnostic procedure
Description
The proportion of participants with an abnormal FOBt result where the elapsed time between the date attended for a diagnostic test and the date of last attendance at an SSP clinic falls within 14 days, out of those people given a ‘diagnostic test date’.
Rationale
It is important that people who need a diagnostic test are offered an appointment that they can attend. Evidence shows that the offered date and actual attendance date can vary significantly, due to a number of reasons. Offered appointments indicate the capacity of a unit. Attended appointments measure the patient experience. To minimise anxiety to people with an abnormal screening test, a screening service needs to make sure that people are offered diagnostic tests that they can actually attend.
Definition
Numerator: number of people who attend an SSP clinic appointment and subsequently attend a diagnostic test within 14 days, within the reporting period.
Denominator: number of participants who attend an SSP clinic appointment and subsequently attend a diagnostic test, within the reporting period.
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
Diagnostic test includes colonoscopy and CTC procedures.
Performance thresholds
To be set.
Caveats
None.
Data collection and reporting
Data source: BCSS.
Responsible for data quality and completeness: local screening provider.
Responsible for submission: not applicable as extracted from BCSS by the BCSP.
Reported by: not applicable as extracted from BCSS by the BCSP.
Published by: screening centre.
Reporting period
Quarterly (1 month in arrears).
Review dates
Date standard introduced: April 2006.
Date standard last updated: 8 August 2018.
BCSP-S09: referral: pathology turnaround time
Description
Proportion of samples where the elapsed time between ‘date sample received’ and ‘date sample reported’ falls within 7 days, out of the number of samples sent to pathology (resected and retrieved).
Rationale
To reduce anxiety, it is important for participants who have a diagnostic procedure where pathology samples are taken, that results are reported in a timely manner.
Definition
Numerator: number of specimens removed at the endoscopy procedure that are received in the reporting pathology laboratory and reported within 7 days of receipt, within the reporting period.
Denominator: the number of specimens removed at the endoscopy procedure that are received and reported on by the reporting pathology laboratory, within the reporting period.
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
Performance thresholds
Acceptable level: greater than or equal to 90.0%.
Achievable level: greater than or equal to 95.0%.
Caveats
None.
Data collection and reporting
Data source: BCSS.
Responsible for data quality and completeness: local screening provider.
Responsible for submission: not applicable as extracted from BCSS by the BCSP.
Reported by: not applicable as extracted from BCSS by the BCSP.
Published by: screening centre.
Reporting period
Quarterly (1 month in arrears).
Review dates
Date standard introduced: April 2006.
Date standard last updated: 8 August 2018.
BCSP-S10: population: programme hub helpline answer rate
Description
The proportion of telephone enquiries made to the programme hub that are answered.
Rationale
As the bowel cancer screening programme offers a postal screening test, the helpline (provided by the hub) is the frontline service for the public to ask questions about the screening test. It is important that callers are able to get through to the helpline, as any barriers may stop them from participating and or result in a loss of confidence in the programme.
Definition
Numerator: number of effective calls answered during the reporting period.
Denominator: number of calls received during the reporting period.
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
Includes: BT ‘Answer Indicator’ codes ‘0’ and ‘8’ which equate to an effective call.
Performance thresholds
To be set.
Caveats
There may be periods when the helpline is not working due to issues outside of the programme hub’s control. This could affect performance against this standard.
Data collection and reporting
Data source: BT inbound architect.
Responsible for data quality and completeness: local programme hub and or BT inbound architect.
Responsible for submission: not applicable as extracted from BT by the BCSP.
Reported by: not applicable as extracted from BT by the BCSP.
Published by: programme hubs.
Reporting period
Annually (1 month in arrears).
Review dates
Date standard introduced: August 2018.
Date standard last updated: 8 August 2018.
BCSP-S11: diagnosis or intervention: diagnostic procedure uptake rate
Description
The proportion of participants who have an abnormal FOBt result who go on to have a diagnostic procedure.
Rationale
It is important that those participants who have an abnormal FOBt result go on to complete the screening pathway and have a complete diagnostic assessment.
Definition
Numerator: number of participants with a definitive abnormal FOBt result who go on to have a diagnostic procedure, within the reporting period.
Denominator: number of participants who have a definitive abnormal FOBt result within the reporting period.
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
Diagnostic test includes colonoscopy and CTC procedures.
Performance thresholds
Acceptable level: greater than or equal to 81.0%.
Achievable level: greater than or equal to 90.0%.
Caveats
None.
Data collection and reporting
Data source: BCSS.
Responsible for data quality and completeness: local screening provider.
Responsible for submission: not applicable as extracted from BCSS by the BCSP.
Reported by: not applicable as extracted from BCSS by the BCSP.
Published by: screening centre.
Reporting period
Annually.
Review dates
Date standard introduced: April 2006.
Date standard last updated: 8 August 2018.
BCSP-S12: intervention or treatment: adenoma detection rate (FOBt)
Description
The proportion of screening index colonoscopies where at least one histologically confirmed adenoma was detected out of all the screening index colonoscopies performed.
Rationale
To achieve the intended reduction in bowel cancer mortality, it is essential that adenomas (which may develop into cancer) are detected, removed and retrieved at colonoscopy.
Definition
Numerator: number of screening index colonoscopies where at least one histologically confirmed adenoma was detected, within the reporting period.
Denominator: number of screening index colonoscopies within the reporting period.
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
Includes only the screening index colonoscopy within each patient’s episode once closed, and only when this first colonoscopy is ‘complete’.
Performance thresholds
Acceptable level: greater than or equal to 40.0%.
Achievable level: greater than or equal to 50.0%.
Caveats
None.
Data collection and reporting
Data source: BCSS.
Responsible for data quality and completeness: local screening provider.
Responsible for submission: not applicable as extracted from BCSS by the BCSP.
Reported by: not applicable as extracted from BCSS by the BCSP.
Published by: screening centre.
Reporting period
Annually (3 months in arrears).
Review dates
Date standard introduced: April 2006.
Date standard last updated: 8 August 2018.
BCSP-S13: intervention/treatment: caecal intubation rate
Description
The proportion of colonoscopies carried out where caecal intubation is achieved with photographic or video evidence taken.
Rationale
It is important that people attending for diagnostic colonoscopy have their bowel examined as thoroughly as possible, to maximise the finding of adenomas and cancers. Caecal intubation (reaching the caecum with the colonoscope) is an important marker of the quality of the procedure as it indicates the entire bowel has been looked at. Photographic or video proof of caecal intubation being achieved during colonoscopy must be taken.
Definition
Numerator: number of colonoscopies where caecal intubation was achieved with photo/video evidence taken, within the reporting period.
Denominator: number of all colonoscopies undertaken within the reporting period.
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
Caecal intubation is defined as reaching the terminal ileum, appendix, ileo-caecal valve or anastomosis.
Includes:
-
all colonoscopy types (screening, surveillance, diagnostic and therapeutic)
-
multiple colonoscopies per patient
-
colonoscopies where consent was withdrawn during the procedure
-
incomplete colonoscopies.
Performance thresholds
Acceptable level: greater than or equal to 92.0%.
Achievable level: greater than or equal to 97.0%.
Caveats
None.
Data collection and reporting
Data source: BCSS.
Responsible for data quality and completeness: local screening provider.
Responsible for submission: not applicable as extracted from BCSS by the BCSP.
Reported by: not applicable as extracted from BCSS by the BCSP.
Published by: screening centre.
Reporting period
Annually (1 month in arrears).
Review dates
Date standard introduced: April 2006.
Date standard last updated: 8 August 2018.
BCSP-S14: intervention or treatment: scope withdrawal time
Description
The average time (in minutes) taken to withdraw the colonoscope (from caecum to extubation) for all complete colonoscopies where the procedure outcome was normal (no abnormalities found).
Rationale
It is important that people attending for diagnostic colonoscopy have their bowel examined as thoroughly as possible, to maximise the finding of adenomas and cancers. Scope withdrawal time is an important marker of the quality of the procedure, with the time taken to withdraw the colonoscope (from caecum to extubation) of sufficient duration so to allow for a thorough inspection of the bowel.
Definition
Numerator: aggregated scope withdrawal time (from caecum to extubation) for each normal complete colonoscopy within the reporting period.
Denominator: number of normal complete colonoscopies within the reporting period.
We calculate performance by dividing numerator by denominator to give the mean time in minutes.
Includes:
-
all colonoscopy types (screening, surveillance, diagnostic and therapeutic)
-
multiple colonoscopies per patient
-
only complete colonoscopies with a ‘normal’ outcome (no abnormalities found)
Performance thresholds
Acceptable level: greater than or equal to 6 minutes.
Achievable level: greater than or equal to 10 minutes.
Caveats
None.
Data collection and reporting
Data source: BCSS
Responsible for data quality and completeness: local screening provider.
Responsible for submission: not applicable as extracted from BCSS by the BCSP.
Reported by: not applicable as extracted from BCSS by the BCSP.
Published by: screening centre.
Reporting period
Annually (1 month in arrears).
Review dates
Date standard introduced: April 2006.
Date standard last updated: 8 August 2018.
BCSP-S15: intervention or treatment: polyp retrieval rate
Description
Proportion of polyps retrieved during the endoscopic procedure from all those seen and resected.
Rationale
In order to maximise the potential for the programme to find adenomas and cancers in the screened population, it is important that all polyps resected during the endoscopic procedure are retrieved for pathological assessment.
Definition
Numerator: number of resected and retrieved polyps for histological analysis within the reporting period.
Denominator: number of recorded and resected polyps within the reporting period.
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
Includes:
-
all endoscopy procedures (colonoscopy, flexible sigmoidoscopy and limited colonoscopy)
-
all endoscopy procedure types (screening, surveillance, diagnostic and therapeutic)
-
multiple endoscopy procedures per patient
-
endoscopy procedures where consent was withdrawn during the procedure
-
incomplete endoscopy procedures (caecum not reached).
Performance thresholds
Acceptable level: greater than or equal to 90.0%.
Achievable level: greater than or equal to 95.0%.
Caveats
None.
Data collection and reporting
Data source: BCSS
Responsible for data quality and completeness: local screening provider.
Responsible for submission: not applicable as extracted from BCSS by the BCSP.
Reported by: not applicable as extracted from BCSS by the BCSP.
Published by: screening centre.
Reporting period
Annually (1 month in arrears).
Review dates
Date standard introduced: April 2006.
Date standard last updated: 8 August 2018.