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Screening Division of Public Health Wales BSW Annual Statistical Report 2014/15

Date: January 2016 Version: 1 Page: 1 of 27 Screening Division of Public Health Wales BSW Annual Statistical Report 2014/15

Screening Division of Public Health Wales

Bowel Screening Wales

Annual Statistical Report 2013/14

Author: Screening Division Informatics Team

Date: January 2015 Version: 2

Publication/ Distribution:

 BSW Programme Board

 Stakeholders via Screening for Life Internet site

 NHS Wales via links on Screening Professionals site

 Public Health Wales via web story and links to screening sites

Purpose and Summary of Document:

This report is a detailed summary of information on work undertaken by Bowel Screening Wales for the financial year 2013/14

For more information about this report contact: Helen Beer, Senior Information Manager and Research Specialist,

Date: January 2016 Version: 1 Page: 2 of 27 Screening Division of Public Health Wales BSW Annual Statistical Report 2014/15 Screening Division of Public Health Wales, 18 Cathedral Road, Cardiff, CF11 9LJ Tel: 029 2078 7803 WHTN: 0896 7820 or 7803 Fax: 029 2078 7900 Email: [email protected]

For more information about this report contact: Helen Clayton, Interim Head of Service, Information and Data, Informatics Team, Public Health Wales, 18 Cathedral Road, Cardiff, CF11 9LJ Tel: 029 2078 7803 WHTN: 0896 7820 or 7803 Fax: 029 2078 7900

Email: [email protected]

Contents

Date: January 2016 Version: 1 Page: 3 of 27 Screening Division of Public Health Wales BSW Annual Statistical Report 2014/15 Table 1a - Bowel Screening Coverage (within 2.5 years) by Health Board of Residence, as at 1st October 2015 ...... 7 Graph 1a: Bowel Screening Coverage (within 2.5 years) by Health Board of residence, as at 1st October 2015...... 8 Table 1b - Bowel Screening Coverage (within 2.5 years) by Deprivation Quintile and Health Board of Residence, as at 1st October 2015...... 9 Graph 1b - Bowel Screening Coverage (within 2.5 years) by Deprivation Quintile and Health Board of Residence, as at 1st October 2015...... 10 Table 1c - Bowel Screening Uptake by Health Board of residence...... 11 Graph 1c - Bowel Screening Uptake by Health Board of residence ...... 12 Table 1d - Bowel Screening Uptake by Deprivation Quintile and Health Board of Residence ...... 13 Graph 1d - Bowel Screening Uptake by Deprivation Quintile and Health Board of Residence ...... 14 Table 1e - All Wales Bowel Screening Uptake - Historical Comparison. 15 Table 1f - All Wales Bowel Screening Uptake by Type of Recall...... 15 Table 2a - Number of male participants invited for bowel screening – by age and Health Board of residence ...... 16 Table 2b - Number of female participants invited for bowel screening – by age and Health Board of residence ...... 17 Table 2c - Total participants invited for bowel screening – by age and Health Board of residence ...... 18 Table 3a - Bowel Screening Kits validated by test result and Health Board of residence – FOB kit ...... 19 Table 3b - Bowel Screening Kits validated by test result and Health Board of residence – FIT kit...... 19 Table 3c - Bowel Screening Kits validated by test result and Health Board of residence – Total kits ...... 20 Table 4 - Waiting time for screening test results, (from receipt of test kit to validated result) ...... 21 Table 5 - Attendance at index colonoscopy/ flexible sigmoidoscopy by Health Board of residence...... 22 Table 6 - All Wales Cancer / Polyp / Adenoma detection rates at index colonoscopy/ flexible sigmoidoscopy ...... 23

1 Introduction

This is the second annual statistical report published by Bowel Screening Wales (BSW). This report covers data for the financial year 2014/15, with the exception of coverage which was run on 1st October 2015 and displays the latest available figure. BSW was launched in October 2008 and aims to reduce the number of people dying from bowel cancer in Wales by 15% by 2020 in the group of people invited for screening. To achieve this aim the bowel screening programme must identify cancer early when treatment is more successful and also identify and remove polyps that may otherwise go on to become malignant. In the year 2014/15 Bowel Screening Wales diagnosed 236 people with cancers and detected and removed polyps in 1269 participants.

The proportion of colorectal cancers diagnosed by screening is greater in Wales than in England at 12% compared to an overall average for England and Wales of 10% (NBOCAP 2015). There are indications that the rate of emergency admissions for colorectal cancer has reduced in Wales since the bowel screening programme was implemented and this is currently being evaluated further.

Key messages about the programme

 Bowel screening reduces your risk of dying from bowel cancer.  Men and women aged 60 to 74 are invited to take part every two years.  You may feel well even if you have early bowel cancer. Finding cancer early gives you the best chance of survival.  Bowel screening is a free NHS test that can be completed easily in your own home.  Screening will miss some cancers, and some cancers cannot be cured.  Taking part in bowel screening is your choice. Read the information pack carefully to help you make your decision.

Programme delivery

The Screening Division of Public Health Wales is responsible for managing, delivering and quality assuring the programme. The programme employs a Head of Programme, administrative staff, nursing staff and Quality Assurance Advisors for Screening Colonoscopy, Pathology, Radiology and surgery. The central screening laboratory is co- located with the administrative department and Cervical Screening Wales laboratory. Laboratory staff work across both laboratories.

Screening pathway

Date: January 2016 Version: 1 Page: 6 of 27 Screening Division of Public Health Wales BSW Annual Statistical Report 2014/15 Participants are identified on the Welsh Demographic System and invited for screening. Invitation is based on date of birth not geographical location and comprises a letter from the Director of Screening Division and an information pack which contains the test kit. The initial test kit is a Guaiac Faecal Occult Blood (FOBt) test kit which is sent to eligible people by post for completion at home and return to the central screening laboratory by post in the prepaid envelope provided.

People with negative FOBt results are returned to routine recall and invited again for screening two years later if they remain in the eligible age range. Those with equivocal results are sent a more sensitive FOBt called an immunochemical test (FIT).

Participants with positive results are invited for telephone assessment with Specialist Screening Practitioners (SSP) based in Local Assessment Centres (LAC) who assesses fitness for colonoscopy. Most assessments are undertaken by telephone, but face to face appointments are available at request or if considered necessary by the SSP.

If considered fit, colonoscopy is offered to people and, if accepted, this is undertaken in the participants Local Assessment Centre. Depending on the findings at colonoscopy participants are returned to routine recall, referred to the multi disciplinary team with a diagnosis of cancer or put onto a surveillance programme according to the number and size of polyps removed.

If someone is not fit for colonoscopy, a CT scan is usually offered.

More information is available at www.bowelscreeningwales.wales.nhs.uk

2 Headline statistics

 Bowel Screening Coverage on 1st October 2015 was 50.3%, ranging from 48.6% in Cardiff and Vale University Health Board to 51.5% in Powys Teaching Health Board.

 Bowel Screening Uptake for those participants invited between April 2014 and March 2015 was 50.8%, ranging from 48.8% in Cardiff and Vale University Health Board to 52.5% in Powys Teaching Health Board.

 Coverage and uptake figures are higher in females (coverage was 52.9% in females compared to 47.6% in males, uptake was 53.4% in females compared to 48.1% in males).

 Coverage and uptake figures are also higher in those living in the least deprived areas (57.1% and 58.0% respectively in the least deprived areas compared to 41.5% and 41.0% respectively in the most deprived areas).

Date: January 2016 Version: 1 Page: 7 of 27 Screening Division of Public Health Wales BSW Annual Statistical Report 2014/15 For the period April 2014 and March 2015:

 257,368 participants were invited for bowel screening.

 148,093 test kits were validated of which 3.7% were spoilt and could not be tested.

 4.2% of all Faecal Occult Blood (FOB) test kits were validated with an equivocal result, these participants were sent the Immunochemical test kit (FIT).

 136,638 test kits were given a definitive result, 98.6% were negative and 1.4% were positive.

 98.7% of all test kits were validated and a result letter issued to the participant, within a week of receipt by the laboratory.

 Across Wales, 59.0% of participants were offered an index colonoscopy or flexible sigmoidoscopy within four weeks of phoning to make the appointment with a Specialist Screening Practitioner and 90.8% of participants were offered a procedure within eight weeks.

 Attendance at first (index) colonoscopy or flexible sigmoidoscopy was 96.4% with over 1,800 attended index procedures.

 At first (index) colonoscopy or flexible sigmoidoscopy, cancer detection rate was 12.7%, polyp detection rate was 68.4% and the adenoma detection rate was 53.8%. A colorectal polyp is a growth found on the lining of the colon or rectum. A neoplastic polyp (a tissue whose cells have lost its normal differentiation) is called an adenoma, which is a benign growth but in some cases can develop into a cancer.

 236 people diagnosed with cancer and 1269 participants with polyps detected and removed in the year.

 Across Wales, the proportion of booked computer tomography (CT) scans which were attended was 96.8%. 3 Data

Date: January 2016 Version: 1 Page: 8 of 27 Screening Division of Public Health Wales BSW Annual Statistical Report 2014/15 3.1 Coverage and Uptake Table 1a - Bowel Screening Coverage (within 2.5 years) by Health Board of Residence, as at 1st October 2015

Total Female

% Screened % Screened within Cov Health Board Eligible within Eligible Coverage 2.5 years era 2.5 years ge

Abertawe Bro Morgannwg 52. 87617 44506 50.8 23641 42820 UHB 8

52. Aneurin Bevan UHB 97143 48781 50.2 25960 47651 5

52. Betsi Cadwaladr UHB 126816 63600 50.2 34330 61939 9

51. Cardiff and Vale UHB 66381 32255 48.6 17230 32743 2

51. Cwm Taf UHB 48710 24554 50.4 12806 23995 8

54. Hywel Dda UHB 74355 38139 51.3 20685 36560 7

55. Powys Teaching HB 28188 14529 51.5 7921 13963 7

50. Unknown 4084 1893 46.4 1003 1

52. All Wales 533294 268257 50.3 143576 261754 9

For description of uptake and coverage calculations, please see definitions in section 4.

Date: January 2016 Version: 1 Page: 9 of 27 Screening Division of Public Health Wales BSW Annual Statistical Report 2014/15 Graph 1a: Bowel Screening Coverage (within 2.5 years) by Health Board of residence, as at 1st October 2015

Date: January 2016 Version: 1 Page: 10 of 27 Screening Division of Public Health Wales BSW Annual Statistical Report 2014/15 Table 1b - Bowel Screening Coverage (within 2.5 years) by Deprivation Quintile and Health Board of Residence, as at 1st October 2015

Q1 – least Unkno Health Board Q3 Q5 – most deprived deprived wn

Abertawe Bro Morgannwg UHB 57.4 51.2 42.3 0.0

Aneurin Bevan UHB 57.3 51.4 41.9 0.0

Betsi Cadwaladr UHB 56.5 49.6 38.6 0.0

Cardiff and Vale UHB 56.6 44.4 34.8 0.0

Cwm Taf UHB 60.3 51.1 45.4 0.0

Hywel Dda UHB 57.0 51.4 45.1 0.0

Powys Teaching HB 57.0 50.6 46.9 0.0

Unknown 0.0 0.0 0.0 46.4

All Wales 57.1 50.5 41.5 46.4

Date: January 2016 Version: 1 Page: 11 of 27 Screening Division of Public Health Wales BSW Annual Statistical Report 2014/15 Graph 1b - Bowel Screening Coverage (within 2.5 years) by Deprivation Quintile and Health Board of Residence, as at 1st October 2015

Date: January 2016 Version: 1 Page: 12 of 27 Screening Division of Public Health Wales BSW Annual Statistical Report 2014/15 Table 1c - Bowel Screening Uptake by Health Board of residence, 2014/15

Total Female

% Health Up Eligible Responded % Uptake Eligible Responded Eligible Board tak e

Abertawe Bro 53. 41324 21061 51.0 21161 11257 20163 Morgannw 2 g UHB

Aneurin 53. 46417 23651 51.0 23620 12540 22797 Bevan UHB 1

Betsi 53. Cadwaladr 60410 30659 50.8 30793 16499 29617 6 UHB

Cardiff and 51. 31641 15434 48.8 15955 8235 15686 Vale UHB 6

Cwm Taf 51. 23257 11825 50.8 11805 6113 11452 UHB 8

Hywel Dda 55. 35640 18425 51.7 18051 9972 17589 UHB 2

Powys 57. Teaching 13476 7081 52.5 6809 3883 6667 0 HB

54. Unknown 1973 981 49.7 987 542 986 9

53. All Wales 254139 129118 50.8 129181 69041 124957 4

Uptake includes participants invited for bowel screening during April 2014 to March 2015.

Date: January 2016 Version: 1 Page: 13 of 27 Screening Division of Public Health Wales BSW Annual Statistical Report 2014/15 Graph 1c - Bowel Screening Uptake by Health Board of residence, 2014/15

Date: January 2016 Version: 1 Page: 14 of 27 Screening Division of Public Health Wales BSW Annual Statistical Report 2014/15 Table 1d - Bowel Screening Uptake by Deprivation Quintile and Health Board of Residence, 2014/15

Q1 – least Unkno Health Board Q3 Q5 – most deprived deprived wn

Abertawe Bro Morgannwg UHB 57.4 51.2 42.3 0.0

Aneurin Bevan UHB 59.0 52.4 42.1 0.0

Betsi Cadwaladr UHB 57.5 49.7 38.7 0.0

Cardiff and Vale UHB 57.7 44.2 35.3 0.0

Cwm Taf UHB 61.0 51.1 44.8 0.0

Hywel Dda UHB 57.2 51.8 42.3 0.0

Powys Teaching HB 58.6 51.5 40.6 0.0

Unknown 0.0 0.0 0.0 49.7

All Wales 58.0 50.8 41.0 49.7

Date: January 2016 Version: 1 Page: 15 of 27 Screening Division of Public Health Wales BSW Annual Statistical Report 2014/15 Graph 1d - Bowel Screening Uptake by Deprivation Quintile and Health Board of Residence, 2014/15

Date: January 2016 Version: 1 Page: 16 of 27 Screening Division of Public Health Wales BSW Annual Statistical Report 2014/15 Table 1e - All Wales Bowel Screening Uptake - Historical Comparison

Year Eligible Tested % Uptake

2009-10 201842 111537 55.3

2010-11 204291 108175 53.0

2011-12 268727 137366 51.1

2012-13 266693 128583 48.2

2013-14 280192 147378 52.6

2014-15 254139 129118 50.8

Table 1f - All Wales Bowel Screening Uptake by Type of Recall, 2014/15

Prevalent Round - Prevalent Round - 1st Invite Incident Round Subsequent invite(s)

% % % Year Eligible Tested Eligible Tested Eligible Tested Uptake Uptake Uptake

2014-15 41192 18324 44.5 92169 9603 10.4 120778 101191 83.8

3.2 Participants invited

Table 2a - Number of male participants invited for bowel screening – by age and Health Board of residence, 2014/15 Males

60-64 65-69 70-74 Total Health Board years years years Invited

Abertawe Bro Morgannwg UHB 9713 6248 4491 20452

Aneurin Bevan UHB 10959 7025 5128 23112

Betsi Cadwaladr UHB 13534 9646 6915 30095

Cardiff and Vale UHB 7966 4702 3265 15933

Cwm Taf UHB 5456 3561 2587 11604

Hywel Dda UHB 8178 5630 4058 17866

Powys Teaching HB 3049 2137 1598 6784

Unknown 511 303 197 1011

All Wales 59366 39252 28239 126857

Date: January 2016 Version: 1 Page: 18 of 27 Screening Division of Public Health Wales BSW Annual Statistical Report 2014/15 Table 2b - Number of female participants invited for bowel screening – by age and Health Board of residence, 2014/15

Females

Cwm Taf UHB 5593 3627 2691 11911

Hywel Dda UHB 8373 5702 4178 18253

Unknown 489 299 219 1007

All Wales 60196 40161 30153 130510

Date: January 2016 Version: 1 Page: 19 of 27 Screening Division of Public Health Wales BSW Annual Statistical Report 2014/15 Table 2c – Total participants invited for bowel screening – by age and Health Board of residence, 2014/15

Participants

Cwm Taf UHB 11049 7188 5278 23515

Hywel Dda UHB 16551 11332 8236 36119

Unknown 1000 602 416 2018

All Wales 119562 79413 58392 257368

3.3 Validated kits Table 3a - Bowel Screening Kits validated by test result and Health Board of residence – FOB kit Number of kits validated - FOB Eq Health ui Spoilt Negative Positive Total Health Board Spoilt Board vo cal Abertawe Abertawe Bro Bro 10 916 21250 57 23243 Morgannwg 3.9 Morgann 20 UHB wg UHB Aneurin 10 Aneurin Bevan Bevan 1002 23689 61 25820 3.9 68 UHB UHB Betsi 14 Betsi Cadwaladr Cadwaladr 1070 31031 78 33608 3.2 29 UHB UHB Cardiff 74 Cardiff and Vale and Vale 647 15511 36 16938 3.8 4 UHB UHB Cwm Taf 59 511 11823 36 12963 Cwm Taf UHB 3.9 UHB 3 Hywel 83 674 18740 49 20300 Hywel Dda UHB 3.3 Dda UHB 7 Powys 27 Powys Teaching Teaching 250 7232 14 7775 3.2 9 HB HB Unknown 44 29 990 1 1064 Unknown 4.1 59 All Wales 5114 130266 332 141711 All Wales – FOB 3.6 99 Table 3b - Bowel Screening Kits validated by test result and Health Board of residence – FIT kit Number of kits validated - FIT Eq Health uiv Spoilt Negative Positive Total Health Board Spoilt Board oc al Abertawe Abertawe Bro Bro 59 0 741 286 1086 Morgannwg 5.4% Morgann UHB wg UHB Aneurin 56 0 792 284 1132 Aneurin Bevan 4.9% Date: January 2016 Version: 1 Page: 21 of 27 Screening Division of Public Health Wales BSW Annual Statistical Report 2014/15 Bevan UHB UHB Betsi Betsi Cadwaladr Cadwaladr 68 0 1031 415 1514 4.5% UHB UHB Cardiff Cardiff and Vale and Vale 40 0 532 205 777 5.1% UHB UHB Cwm Taf 51 0 433 164 648 Cwm Taf UHB 7.9% UHB Hywel 50 0 626 219 895 Hywel Dda UHB 5.6% Dda UHB Powys Powys Teaching Teaching 15 0 223 58 296 5.1% HB HB Unknown 3 0 23 8 34 Unknown 8.8% All Wales 342 0 4401 1639 6382 All Wales – FIT 5.4% Table 3c – Total Bowel Screening Kits validated by test result and Health Board of residence – Total kits

Number of kits validated – TOTAL Eq Health uiv Spoilt Negative Positive Total Health Board Spoilt Board oc al Abertawe Abertawe Bro Bro 10 975 21991 343 24329 Morgannwg 4.0% Morgann 20 UHB wg UHB Aneurin 10 Aneurin Bevan Bevan 1058 24481 345 26952 3.9% 68 UHB UHB Betsi 14 Betsi Cadwaladr Cadwaladr 1138 32062 493 35122 3.2% 29 UHB UHB Cardiff 74 Cardiff and Vale and Vale 687 16043 241 17715 3.9% 4 UHB UHB Cwm Taf 59 562 12256 200 13611 Cwm Taf UHB 4.1% UHB 3 Hywel 83 724 19366 268 21195 Hywel Dda UHB 3.4% Dda UHB 7 Powys 265 27 7455 72 8071 Powys Teaching 3.3% Teaching 9 HB

Date: January 2016 Version: 1 Page: 22 of 27 Screening Division of Public Health Wales BSW Annual Statistical Report 2014/15 HB Unknown 47 29 1013 9 1098 Unknown 4.3% 59 All Wales 5456 134667 1971 148093 All Wales 3.7% 99

Note: Spoilt rates are calculated as a percentage of the total results.

Equivocal rates are calculated as a percentage of the equivocal, negative and positive results.

Negative and positive rates are calculated as a percentage of negative and positive results only.

3.4 Waiting times for screening results Table 4 - Waiting time for screening test results, (from receipt of test kit to validated result), 2014/15

Number Percentage of total Days validated validated

Same day 65277 44.1%

1 38513 26.0%

2 20466 13.8%

3 10572 7.1%

4 5807 3.9%

5 4224 2.9%

6 1235 0.8%

Date: January 2016 Version: 1 Page: 23 of 27 Screening Division of Public Health Wales BSW Annual Statistical Report 2014/15 7-13 days 1672 1.1%

14 days + 327 0.2%

TOTAL 148093 100.0%

Across Wales in 2014/15 98.7% of all test kits were validated and a result letter issued to the participant within a week of receipt by the laboratory.

3.5 Attendance at colonoscopy Table 5 - Attendance at index colonoscopy/ flexible sigmoidoscopy by Health Board of residence, 2014/15

Booked Attended % Health Board index index Attended procedure procedure

Abertawe Bro Morgannwg 337 320 95.0% UHB

Aneurin Bevan UHB 371 355 95.7%

Betsi Cadwaladr UHB 425 411 96.7%

Cardiff and Vale UHB 240 236 98.3%

Cwm Taf UHB 200 196 98.0%

Hywel Dda UHB 254 246 96.9%

Powys Teaching HB 86 80 93.0%

Unknown 10 10 100.0%

All Wales 1923 1854 96.4%

3.6 Detection rates Table 6 - All Wales Cancer / Polyp / Adenoma detection rates at index colonoscopy/ flexible sigmoidoscopy, 2014/15

Number Total Index Percentage Detected Procedures Detected

Cancer detection rate 236 1854 12.7%

Polyp detection rate 1269 1854 68.4%

Adenoma detection 998 1854 53.8% rate*

3.7 Waiting times for index colonoscopy/ flexible sigmoidoscopy appointment within 4 weeks of Booking SSP Appointment During the April 2014 to March 2015 year, 1853 participants were offered an index procedure and 1094 (59.0%) were offered a procedure date within 4 weeks of booking their Specialist Screening Practitioner (SSP) assessment appointment. A total of 1683 (90.8%) were offered a procedure date within 8 weeks and 170 (9.2%) were offered a procedure date more than 8 weeks after booking their SSP assessment appointment.

3.8 Attendance at CT scans Across Wales, 96.8% of booked CT scans were attended; this varies between 92.5% and 100% across Health Boards for the year April 2014 to March 2015.

4 Definitions

This section provides further detail on the calculations used in this report.

Eligible For coverage calculations, eligible participants are those that are resident in Wales at the time of reporting, that are not currently ceased or suspended from bowel screening invitation following notification of a diagnosed bowel condition, movement or death and are between invite age range 60 to 74 years.

Date: January 2016 Version: 1 Page: 25 of 27 Screening Division of Public Health Wales BSW Annual Statistical Report 2014/15 For uptake calculations, eligible participants are those that were resident in Wales (not deducted on NHAIS in the 6 months following invitation) and invited for bowel screening during the reporting period date range. Participants that were ceased or suspended from bowel screening invitation following notification of a diagnosed bowel condition, movement or death, within six months following invitation were excluded, unless they had returned a used test kit.

Uptake Participants were deemed to have responded to their invitation if the bowel screening programme received a used test kit within six months following their invitation.

Coverage The calculation counts those eligible participants that have had a used test kit validated within two and a half years of the reporting date.

Deprivation Deprivation quintiles were assigned using the Welsh Index of Multiple Deprivation (WIMD) 2008, measured at lower super output area (LSOA) level. LSOAs are ranked into quintiles at an all-Wales level so they can be compared between health boards. This means that there will not be an equal proportion of people in each quintile when you look at each health board e.g. in Monmouthshire, 40% of the population live in the least deprived quintile of Wales, but no areas fall into the Welsh most deprived quintile.

Health Board This is health board of residence.

Spoilt test kit These rates are calculated as a proportion of the total bowel screening test kits validated in the reporting period.

Equivocal test kit These rates are calculated as a proportion of the un-spoilt bowel screening test kits validated in the reporting period.

Negative and positive test kit These rates are calculated as a proportion of the test kits validated in the reporting period as negative and positive results – i.e. those kits that have a definitive result.

Prevalent Round - first invite (table 1f) Prevalent round first invitation is the first time a person is invited to take part in screening. They have not been screened before as they have not been invited before.

Prevalent round - subsequent invite (table 1f) Date: January 2016 Version: 1 Page: 26 of 27 Screening Division of Public Health Wales BSW Annual Statistical Report 2014/15 Prevalent round subsequent invitation is when a person has previously been invited, but has not actually taken part in screening before. They have not been screened before but they have been invited before.

Incident Round (table 1f) Incident round is when people are invited that have previously taken part in the screening programme.

Colonoscopy Colonoscopy is the visual inspection of the interior of the colon with a flexible, lighted tube (colonoscope) inserted through the rectum. During colonoscopy, biopsies (tissue samples of abnormal areas) can be obtained to aid diagnosis.

Flexible Sigmoidoscopy A flexible sigmoidoscopy is the visual inspection of the lower part of the large intestine with a flexible lighted tube inserted through the rectum. During flexible sigmoidoscopy, biopsies (tissue samples of abnormal areas) can be obtained to aid diagnosis.

Attendance and detection rates (Tables 5 and 6) report procedures that are booked in the reporting period. Waiting times were calculated using those participants with an index procedure first offered within the reporting period. This might not be the procedure they attended, due to participant choice or other factors.

Date: January 2016 Version: 1 Page: 27 of 27