Bowel Screening Pilot Monitoring Indicators

Understanding the monitoring indicators for the Bowel Screening Pilot.

The information collected in the Bowel Screening Pilot has been compared with international bowel screening standards to make sure that our pilot is progressing in a safe and effective way.

  • Round 1: Final results for people invited from 1 January 2012 to 31 December 2013
  • Round 2: Final results for people invited from 1 January 2014 to 31 December 2015
  • Round 3: Initial results for people invited from 1 January 2016 to 30 September 2016.

Note: Unless otherwise stated, these figures do not include people who have exited the programme and had private colonoscopies, or adenomas and cancers detected through them. However, where reliable data for colonoscopies undertaken privately is available, this information has been included to show a more complete view of the effects of the Bowel Screening Pilot.

Indicator 1

Description Overall participation
Evidence This is the % of people with a final FIT result (+ve or –ve) out of all those eligible invited by the programme, for the first and subsequent screening rounds.
Target 60% for first screen (Round 1)
Value Round 1: 56.8%  

 

  Round 2: Average: 55.2% Where Round 2 was first screen
  • Aged in or moved in: 46.6%
  • Did not respond or unsuccessful in Round 1: 25.2%
Where Round 2 was subsequent screen: 84.6%
  Round 3: Average: 54.9% Where Round 3 was first screen
  • Aged in or moved in: 45.7%
  • Did not respond or unsuccessful in previous rounds: 19.5%
Where Round 3 was subsequent screen: 82.4%

Indicator 2

Description Coverage
Evidence This is the % of eligible people in Waitemata DHB region who were invited to participate during the first and subsequent screening rounds.
Target >95%
Value Round 1: 97.5%*
Round 2:  96.3%#

* For Round 1, the number of eligible people in Waitemata is defined as all those people residing in Waitemata DHB region, aged 50–74 based on census 2013 data (Statistics NZ).

#For Round 2, the number of eligible people in Waitemata is defined as all those people residing in Waitemata DHB region, aged 50–74 based on the population estimate as at 31 Dec 2014 (Statistics NZ). This number excludes those who had a positive FIT result in Round 1 and proceeded to have a colonoscopy.

Indicator 3

Description Time to colonoscopy for Round 3
Evidence This is the % of people whose time between the laboratory receiving a positive FIT and being offered a first appointment or having a colonoscopy carried out was within a specified target (excludes persons who decline colonoscopy or those having a colonoscopy performed privately).
Target 95% ≤ 11 weeks
Value 98.2%

Indicator 4

Description Proportion of individuals with a positive screening test undergoing colonoscopy or CT colonography
Evidence This is the % of screened people with a positive FIT result who have had a colonoscopy or CT colonography through the programme, or have a date booked for a colonoscopy.
Target > 90% undergo colonoscopy or CT colonography
Value
  • Round 1: 88.1%
    (95.1%)**
  • Round 2: 85.7%
    (93.4%)**
  • Round 3: 84.8%
    (92.3%)**

** This includes those that chose to receive a colonoscopy through a private provider

Indicator 5

Description Colonoscopy completion rate as at September 2016
Evidence This is the % of completed colonoscopies (reaching the caecum).
Target
  • Acceptable >90%
  • Desirable > 95%
Value
  • Round 1: approximately 97%
  • Round 2: approximately 97%
  • Round 3: approximately 98%

Indicator 6

Description Colonoscopy complication rate for perforation or bleeding
Evidence This is the number of people requiring admission to hospital for an intermediate or serious adverse event related to perforation or bleeding occurring within 30 days of colonoscopy, per 1000 of those who had a colonoscopy during the first and subsequent screening rounds.
Target <10 per 1000 colonoscopies*** 
Value 3.3 per 1000***

*** This number was calculated on the expected number of adverse event rates reported in the UK Bowel Cancer Screening Programme Quality Assurance Guidelines for Colonoscopy and based on the fact that 7 out of 10 pilot participants proceeding to colonoscopy are identified to have had a lesion.

Indicator 7

Description Colonoscopy complication rate for events other than perforation or bleeding
Evidence This is the number of people requiring admission to hospital for other intermediate or serious adverse events not related to perforation or bleeding occurring within 30 days of colonoscopy, per 1000 of those who had a colonoscopy during the first and subsequent screening rounds.
Target No agreed international standard
Value 0.4 per 1000

Indicator 8

Description Positivity rate  
Evidence This is the % of people with a positive FIT during the first and subsequent screening rounds.
Target 6–8% for first screen (Round 1) No agreed target for subsequent screens
Value Round 1: 7.5%

 

 
  Round 2:
Average: 5.9%
Where Round 2 was first screen
  • Aged in or moved in: 5.2%
  • Did not respond or unsuccessful in Round 1: 8.5%
Where Round 2 was subsequent screen: 5.4%
  Round 3:
Average: 5.5%
Where Round 3 was first screen
  • Aged in or moved in: 6.1%
  • Did not respond or unsuccessful in previous rounds: 7.2%
Where Round 3 was subsequent screen: 5.1%

Indicator 9

Description Colorectal Cancer (CRC) detection rate
Evidence This is the number of people diagnosed with any CRC per 1000 screened with a FIT result available for the first and subsequent screening rounds.
Target 1.8–9.5 For first screen (Round 1) per 1000
(Range from population screening programmes with FIT)
Value
  • Round 1: 2.8 per 1000
    (3.1 per 1000) ****
  • Round 2: 1.5 per 1000
    (1.7 per 1000) ****
  • Round 3: 1.5 per 1000
    (1.5 per 1000) ****

****This figure includes those who had cancer found through a colonoscopy undertaken privately.

Indicator 10

Description Colorectal Cancer (CRC) Stage at diagnosis (including polyp cancers)
Evidence This is the TNM staging for CRC detected at the first and subsequent screening rounds. In cases where more than one staging was given for an individual only the most serious staging result is included. For cancers found through public colonoscopy.
Target No agreed international standard
Value % of staged cancers by TNM stage
  Round 1
  • Stage 1: 44.9%
  • Stage 2: 24.9%
  • Stage 3: 22.2%
  • Stage 4: 8.1%

No Stage: 7 (out of 192)

Round 2
  • Stage 1: 49.5%
  • Stage 2: 17.9%
  • Stage 3: 27.4%
  • Stage 4: 5.3%

No Stage: 13 (out of 108)

Round 3
  • Stage 1: 61.8%
  • Stage 2: 8.8%
  • Stage 3: 26.5%
  • Stage 4: 2.9%

No Stage: 6 (out of 40)

Indicator 11

Description Advanced Adenoma detection rate
Evidence This is the number of people diagnosed with any advanced adenoma (villous or tubulovillous or, high grade dysplasia or, greater than or equal to 10 mm in size) per 1000 screened with a FIT result available for the first and subsequent screening rounds.
Target No agreed international standard
Value
  • Round 1: 15.5 per 1000
  • Round 2: 7.7 per 1000
  • Round 3: 5.8 per 1000

Indicator 12

Description Adenoma detection rate
Evidence This is the number of people diagnosed with any adenoma per 1000 screened with a FIT result available for the first and subsequent screening rounds.
Target 13.3–22.3 per 1000 (Range from population screening programmes with FIT)
Value
  • Round 1: 36.2 per 1000
  • Round 2: 23.7 per 1000
  • Round 3: 23.7 per 1000

Indicator 13

Description Positive predictive value of FIT for cancer
Evidence This is the % of people with a malignant outcome in those having a colonoscopy for the first and subsequent screening rounds.
Target PPV Cancer first screen 4.5%–8.6%
Value
  • Round 1: 4.3%
    (4.4%) *****
  • Round 2: 3.1%
    (3.1%) *****
  • Round 3: 3.3%
    (3.1%) *****

*****This figure includes those who had cancer found through a colonoscopy undertaken privately.

Indicator 14

Description Positive predictive value of FIT for advanced adenoma
Evidence This is the % of people with any advanced adenoma in those having a colonoscopy for the first and subsequent screening rounds.
Target No agreed international standard
Value
  • Round 1: 24.0%
  • Round 2: 15.8%
  • Round 3: 12.7%

Indicator 15

Description Positive predictive value of FIT for adenoma
Evidence This is the % of people with any adenoma in those having a colonoscopy for the first and subsequent screening rounds.
Target PPV adenoma first screen 9.6 – 40.3%
Value
  • Round 1: 56.1%
  • Round 2: 48.3%
  • Round 3: 52.0%
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