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1 – Support Victoria’s efforts to eliminate cervical cancer as a public health problem, in accordance with the Victorian Cancer Plan 2020-2024
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SUPPORT VICTORIA’S EFFORTS TO ELIMINATE CERVICAL CANCER AS A PUBLIC HEALTH PROBLEM, IN ACCORDANCE WITH THE VICTORIAN CANCER PLAN 2020-2024
VCS Foundation is a valued strategic partner to the Victorian Department of Health and delivers on immunisation functions and key initiatives under the Victorian Cancer Screening Framework. We provide leadership and expertise in cancer prevention and screening, including driving the elimination of cervical cancer; a key priority of the Victorian Cancer Plan 2020-2024.
The Liaison Physician team is supporting the Victorian Government’s Cancer Screening Primary Care and Workforce Strategy 2019-2022 by providing education and training sessions on the three cancer screening programs, cervical, breast and bowel. Face to face sessions were deferred due to the pandemic but have been replaced with webinar sessions. Live sessions of the VCS Foundation Cancer Screening Clinical Education, co-presented with Cancer Council Victoria and St Vincent’s Hospital Melbourne were delivered to the North-West Melbourne and Eastern Melbourne Public Health Networks. Those unable to attend could participate by requesting a recording and could still gain their CPD points. VCS Foundation has been working closely with the Victorian Aboriginal Community Controlled Health Organisation (VACCHO) to offer cervical screening education to Aboriginal Community Controlled Health Organisations (ACCHOs) and increase awareness of screening amongst Aboriginal communities. Amongst this work, VCS Liaison Physicians and our education team have participated in two Women’s Health Days at regional Victorian ACCHOs in March and April 2021 to promote cervical screening and self-collection (part of a year-long program of women’s health events for the Beautiful Shawl breast screening initiative). VCS Foundation and VACCHO have consulted widely with ACCHOs on updating our ‘How to take your own HPV sample’ instruction sheet so that it is culturally appropriate and appealing for Aboriginal and Torres Strait Islander women. This work is still in progress.
Genevieve Chappell, DIRECTOR OPERATIONS VCS POPULATION HEALTH With its 30-year background in data management, reporting and registry services, VCS Population Health is providing its expertise to support the Victorian Cancer Screening Framework and to lead the Data and Surveillance Working Group with the aim of improving surveillance of the effectiveness and outcomes of the breast, bowel and cervical screening programs in Victoria through an integrated and consistent approach to data collection, use and reporting.
VCS Foundation commenced working in partnership with Cancer Council Victoria to develop a Gender Inclusive Language Guide for cervical screening in Victoria. The purpose is to ensure transgender men with a cervix (an under-screened group) are explicitly included in education and information resources for healthcare practitioners and consumers to: a) prompt healthcare practitioners to offer screening to this cohort, and b) increase the awareness and engagement of this cohort in cervical screening. These activities and resources are expected to be released in the second half of 2021.
VCS Foundation, Cancer Council Victoria and Healthily have partnered to develop a series of videos featuring cervical screening participants from diverse cultural backgrounds talking about their experiences of screening, colposcopy and a diagnosis of cervical cancer. These will be available on the Go Share platform for healthcare practitioners to view and share with patients. The videos aim to encourage screening participation amongst those who are reluctant or fearful of having a cervical screening test. DATA AND REPORTING TOOLS FOR CERVICAL, BOWEL AND BREAST SCREENING PROGRAMS, IN PARTNERSHIP WITH VICTORIAN SCREENING PARTNERS
In May 2019, the Victorian Department of Health endorsed a Victorian Cancer Screening Framework, a new governance and funding model for Victoria’s cervical, breast and bowel screening programs. A three-year strategy and annual activity plan has been developed by the Victorian Cancer Screening Steering Committee which consist of members from the Victorian Department of Health, VCS Foundation, BreastScreen Victoria, Cancer Council Victoria and the Victorian Aboriginal Community Controlled Health Organisation. The Committee is working together to reach the annual goals and implement the overall strategy. The Victorian Department of Health and the Victorian Cancer Screening Committee have identified the need for a more integrated approach to cancer screening data and surveillance in Victoria for ensuring that screening program partners can better utilise combined screening data to deliver screening system improvements and drive equitable outcomes. The Victorian Cancer Screening Framework Data Dashboard provides a snapshot of key data from the Bowel, Breast and Cervical Screening Programs to screening program partners. The Dashboard includes data on invitations, screening numbers, participation, cervical self-collection, time to colposcopy and time to colonoscopy. Data is grouped and presented in a series of tabs containing tables and charts, stratified by parameters such as time period, Aboriginal and Torres Strait islander status, age group, targeted initiatives and geographical area. The Strategy will ensure timely, accurate and rich data is available to the Department, cancer screening agencies, health service providers, researchers and other stakeholders to: + Inform cancer screening service planning at the local, regional and state level + Develop and evaluate initiatives to improve screening program participation, access and performance + Identify under-screened groups and monitor their participation rates, and + Support research and evaluation to improve Victorians’ cancer outcomes. The key objectives of the Cancer Screening Data and Surveillance Strategy are to: + Ensure access to timely and accurate data to support service planning and program delivery across each program’s cancer screening pathway + Utilise data to establish and monitor baseline participation rates and improvements in screening participation outcomes, and + Develop consistency and integration across cancer screening datasets.
BOWEL/BREAST AND CERVICAL SCREENING BY AGE
160,000 140,000 120,000 100,000 80,000 60,000 40,000 20,000 0 2018 2019 2020 2021 YTD
50-59 60-69 70-74 50-59 60-69 70-74 25-29 30-39 40-49 50-59 60-69 70-74 Bowel Breast Cervical
Example of report from the Cancer Screening Data Dashboard
VCS Population Health, in collaboration with all screening partners, has made significant progress on the establishment activities for 2020/21. Key achievements include: + A three-phase environment mapping exercise of the cancer screening data and reporting environment relating to the Bowel, Breast and
Cervical screening programs. The environment mapping exercise provided insights into the data and reports used (Phase 1), data elements collected (Phase 2) and the data and reporting capability (Phase 3) of screening partners to support the delivery of cancer screening in Victoria including activities of the cancer screening framework.
The environment scanning project involved accessing publicly available material, seeking input from program partners, undertaking desk-based research, and conducting questionnaires. Findings identified data gaps and inconsistencies, areas of strengths and excellence and future opportunities. + A Cancer Screening Data Dashboard to support the work of the Victorian
Cancer Screening Framework
Steering Committee. The Data
Dashboard, delivered quarterly, displays key data from the Bowel,
Breast and Cervical Screening
Programs, providing an at-a-glance view of key metrics, trends over time and a focus on priority areas.
The Data Dashboard includes data relating to invitations, screening numbers, participation, selfcollection, time to colonoscopy and colposcopy and targeted initiatives. + The delivery of more than twenty reports for the Bowel, Breast and
Cervical screening programs.
The reports provide detailed data relating to program participation, number of screens, number of bowel kits returned and invitations sent delivered via a series of tables and charts typically stratified by time (month, quarter, year), gender, geography (postcode, LGA,
PHN, Health Region), Aboriginal and Torres Strait Islander status, country of birth, language spoken at home, socio-economic status and remoteness. WORKFORCE EDUCATION AND INCREASE REACH THROUGH AN ONLINE EDUCATION AND TRAINING MODEL
The VCS Foundation Liaison Physicians provide free accredited medical education and training to general practitioners, nurses, obstetriciangynaecologist (O&G) specialists, general practitioner and O&G registrars, international medical graduates and overseas trained doctors and Aboriginal health workers each of whom play important roles in promoting and undertaking screening pathways. The training aims to advance medical practitioner skills and confidence, ensuring clinical decision-making aligns with the National Cervical Screening Program. In addition to mainstream general practice, clinical training is delivered across a diversity of clinical settings including rural, remote, regional and community health services, and Aboriginal and Torres Strait Islander health services.
Our Liaison Physicians are focused on education around self-collection and are working in partnership with Cancer Council Victoria to actively promote self-collection in Victoria. We know that by advancing local care providers’ knowledge and skills in early detection, we will greatly increase participation in cervical screening.
'JUST WISH TO FEEDBACK THE EXCELLENT SERVICE YOU OFFER IN TERMS OF ANSWERING QUESTIONS REGARDING CST RESULTS & HPV. RAPID, THOROUGH & EXPERT INFORMATION MADE READILY AVAILABLE. VERY FEW SERVICES LIKE IT - THANKYOU'.
DR SAMANTHA HARGREAVES, OBSTETRICIAN-GYNAECOLOGIST
The Liaison team manage approximately 63 phone calls a week, predominantly from clinicians across Victoria, seeking information about the current screening guidelines and management of patients. Queries covered include: + HPV and its role in cervical cancer + Sampling techniques and the new
Cervical Screening Test (CST) + Key practical implications of the renewed NCSP for clinical practice and women + Applying management recommendations from the new
Guidelines (2016) + Co testing and investigation of abnormal vaginal bleeding + Interpreting and explaining results to patients + Accessing and activating the selfcollection pathway. Accredited on-line education and clinical audit activities have been developed and made accessible to health care workers across the country. These activities provide current information on guidelines and screening pathways whilst giving Healthcare providers the opportunity to gain continuing professional development points. SUPPORTING INDEPENDENCE IN NURSE CERVICAL SCREENING PROVIDERS
VCS Foundation has always recognised that nurses play an essential role in the National Cervical Screening Program, particularly in providing screening services for under-screened groups. We have been very fortunate to support the independent practice of Nurse Cervical Screening Providers in Victoria. VCS Pathology receives approximately 13,000 cervical screening tests from Nurse Cervical Cancer Screening Providers each year. In the 2021/22 financial year the funding model for VCS Foundation will change to align VCS Pathology with all other Commonwealth funded laboratories across Australia. This change will require Nurse Cervical Screening Providers to have request forms for cervical screening countersigned by a practitioner with a Medicare Provider number. This change will negatively impact cervical screening locations where nurses are working in mobile or remote locations where there is no general practitioner on site. Over the medium term, VCS Foundation will be working collectively to raise this issue at a national level with the aim of seeking a solution to enable Australian certified nurses to practise cervical screening independently in the future. This will be supported by information sessions to nurses and the collection of feedback through surveys to gather data on the impact this change will have on the national program, particularly in under-screened communities. Whilst a solution is being sought, VCS Pathology will absorb the costs of tests taken by nurses who cannot arrange for a general practitioner or nurse practitioner colleague to co-sign their cervical screening test request forms.
