Step 3: Create a standard list of cancer screening recalls and reminder labels/codes

steps This section covers the following steps:

Step_3.1 Discuss options with your team
Step 3.2 Create a standard list of recall and reminder labels/codes for the bowel, breast and cervical screening programs
Step 3.3 Merge old recall labels/codes into your new list
Step 3.4 Consider locking your recall and reminder list

It is important that the way your practice handles cancer screening recall and reminders is consistent. If you have multiple labels/codes for the same recall reason, it is difficult to accurately undertake recall searches.

Below is an example of what multiple labels/codes might look like:

Breast FOBT HPV
Mam iFOBT Pap smear
Mammography CRC screening Cervical screen
Breast screen Bowel screening Cervical screening

Step 3.1 Discuss options with your team

It is important to get your team on board with using a set of consistent and agreed recall and reminder labels/codes. Your team is more likely to use a set of agreed codes if they are engaged in the following ways:

  • They understand why consistent coding is important. The benefits of using standard codes include the following:
    • It is easier to extract accurate recall and reminder lists (which is important for ensuring no recalls are missed).
    • Screening participation rates are more accurate, which helps your practice assess performance.
    • It is easier to identify under-screened patients.
  • They have the opportunity to offer input and feedback into your practice’s list of codes, either using the example or agreeing local codes. 

Step 3.2 Create a standard list of recall and reminder labels/codes for the bowel, breast and cervical screening programs

  • Once codes are agreed embed them in your cancer screening recall and reminder policy (see Module 3 for more information).
  • ensure they have the codes at their fingertips. Put the printouts in a useful spot for staff, and let them know they are there.

Note: The tables below outline recall and reminder labels/codes for patients in relation to screening results. They do not cover bowel, breast or cervical cancer diagnostic or treatment pathways.

Bowel cancer screening recall/reminder labels (codes)

Screening recommendations from clinical guidelines:

iFOBT every 2 years from age 50 to age 74.1

Practice actions:

  • Advise patient of result, as per process for normal results.
  • Set an iFOBT reminder for the patient’s next even number birthday (up to age 74). (The National Bowel Screening Program sends out iFOBT kits every two years for people aged 50–to74. GP reminder letters are an important motivator for patients to use the test).
  • GPs to remind individuals to re-present if they develop symptoms of colorectal cancer.

Details:

This label is for a negative iFOBT result for a Category 1 patient: Those near average risk1

Category 1 patients1:

  • No first- or second-degree relative with colorectal cancer. OR
  • One first-degree relative with colorectal cancer diagnosed at 55 years or older. OR
  • One first-degree and one second-degree relative with colorectal cancer diagnosed at 55 years or older.

In some instances, familial risk for Category 1 patients may need further consideration. Refer to clinical guidelines for more information.

Screening recommendations from clinical guidelines:

The result of the diagnostic procedure (colonoscopy ) following the positive iFOBT result will determine the next step in the patient pathway

  • Return to iFOBT screening
  • Further surveillance colonoscopy
  • Referral for treatment

Practice actions:

  • Recall patient, as per practice recall policy.
  • Refer for colonoscopy or other bowel examination, as per clinical guidelines.
  • Systematically check patient attendance at follow-up examinations (colonoscopy or other bowel examination).
  • Notify the Program Register of referral/non-referral for colonoscopy or other bowel examination for participants with a positive result. This can be done by returning the Program’s GP Assessment Form by fax, post or electronicallyProvision of information will attract a payment.

Details:

Consider having information relevant to your local area available to support discussion with patients about choosing follow-up examination in the public or private health system.

HealthPathways may provide useful information.

Your PHN can provide HealthPathways login information.

Identifying and managing patients with a family history of colorectal cancer

Key points: 

Recommended screening for asymptomatic patients

  • iFOBT every 2 years from age 40 to age 49.
  • Colonoscopy every five years from age 50 to age 74.

Category 2: Those at moderately increased risk (3 to 6-fold increased risk)2:

Category 2 patients1:

  • One first-degree relative with colorectal cancer diagnosed under 55 years. OR
  • Two first-degree relatives with colorectal cancer diagnosed at any age OR 
  • One first-degree relative and at least two second-degree relatives with colorectal cancer diagnosed at any age.

Refer to clinical guidelines for further information.

  • iFOBT every 2 years from age 35 to age 44.
  • Colonoscopy every five years from age 45 to age 74.

However, Category 3 patients must be referred to a bowel cancer specialist to confirm surveillance intervals.

Referral to a genetic centre for hereditary cancer syndromes should be considered.1

Category 3: Those at potentially high risk (7 to 10-fold increased risk)2

Category 3 patients1:

  • At least three first-degree or second-degree relatives with colorectal cancer, with at least one diagnosed under 55 years. OR 
  • At least three first-degree relatives with colorectal cancer diagnosed at any age.

Refer to clinical guidelines for further information.

Example list of BreastScreen NSW recall and reminder labels/codes

Private provider bilateral mammography uses Medicare Benefit Scheme item numbers 59300/59301. The Department of Health states that MBS item numbers 59300/59301 are “intended for use in the investigation of a clinical abnormality of the breast/s and NOT for individual, group or opportunistic screening of asymptomatic patients”.3

BreastScreen NSW does not offer screening to women with symptoms, these patients should be managed via a diagnostic pathway.

BreastScreen recall/reminder labels (codes)

Next screen due: 2 years

Practice actions: Set a reminder for 2 years after screening data

Criteria: Normal result: No evidence of breast cancer detected.

Details: BreastScreen NSW will advise patient of result. Women should be reminded to screen every two years from age 50–to74.

Next screen due: 1 year

Practice actions: Set a reminder for 12 months after screening data.

Criteria: BreastScreen NSW has advised that your patient should screen annually because she has met criteria that puts her at increased risk.

Details: BreastScreen NSW will explain the reason for annual recall to the patient.

For further information on screening intervals, please visit the BreastScreen NSW website

Next screen due: To be determined

Practice actions: Recall patient, as per practice policy

Criteria:

  1. Symptomatic normal result: No visible evidence of breast cancer detected through the screening/assessment process, but a breast change was reported. GP to follow up.
  2. A BreastScreen NSW Assessment Clinic has determined referral to a surgeon is required. BreastScreen NSW will liaise with the client’s GP in relation to the client’s assessment outcome.

Details: BreastScreen NSW will send your patient a letter advising them:

  • to visit their GP to discuss further investigations of the breast change
  • there is a small chance that an existing breast cancer may not be seen on a mammogram.

Assessment Outcome Reports for clients who have undergone biopsy or who require surgical management will be delivered via post/fax or electronically.

Understanding breast cancer risk factors

In 2018, Cancer Australia launched the ‘Breast cancer risk factors’ webpage.4 This webpage includes the following:

Assessing a patient’s familial risk of breast and ovarian cancer

Assessing a patient’s familial risk of breast and ovarian cancer

The Cancer Australia Familial Risk Assessment - Breast and Ovarian Cancer (FRA-BOC) online too[l5]:

  • is designed for use by health professionals, such as GPs and nurses
  • assists health professionals to reassure the majority of women who are at population risk, based on their family history
  • identifies women who should be referred to a family cancer clinic for further assessment and advice

The FRA-BOC tool categorises women into three levels of risk for breast cancer according to family history. If a woman is confirmed to be in risk Category 1 or 2, she will be offered biennial (two-yearly) screening by BreastScreen NSW.

If a woman is confirmed to be in risk Category 3, and following discussion with her GP wishes to remain with BreastScreen NSW, she will be offered annual screening upon informing the Program of her decision.

A doctor can contact BreastScreen NSW on 13 20 50 if they have further questions about their patient’s screening interval.

Example list of cervical screening recall and reminder labels/codes

Screening recall labels and processes are ONLY for asymptomatic patients

The labels in the table below align to the National Cervical Screening Program (NCSP) screening pathway. For more information about the screening pathway, download Understanding the National Cervical Screening Program Management Pathway: A Guide for Healthcare Providers7 or visit the NCSP website.

Women at any age with symptoms suggestive of cervical cancer require diagnostic testing (co-test and usually a gynaecological assessment) and not ‘cervical screening’. A co-test is where the laboratory performs both the human papillomavirus (HPV) test and the liquid-based cytology (LBC) test at the same time, and on the same specimen. This means that the LBC test is performed irrespective of the HPV test result.6

Cervical recall/reminder labels (codes)

Next screen due: 5 years

HPV test results: No HPV  detected

Reflex LBC Result: N/A

Practice actions:

  • Advise as per process for normal result.
  • Set a reminder for 5 years after screening date.

Details7:

  • Oncogenic HPV was not detected. 
  • Patients at low risk can safely return for a Cervical Screening Test in five years.

Next screen due: 1 year

HPV test result: HPV (not 16/18) detected

Reflex LBC Result: Negative, possible LSIL or LSIL 

Practice actions: 

  • Doctor/nNurse to advise result via phone or, as per practice policy for an abnormal result. If the patient is concerned, invite them to see a doctor.
  • Use ‘A guide to understanding your cervical screening test results’  to support plain English explanation of the result.
  • Manage screening reminder via practice recall policy.
  • Ensure systematic follow- up of referral compliance.

Details7

This result means: HPV is detected, but not types 16/18

A reflex LBC conducted on the same sample showed that the patient has negative or possible low-grade squamous intraepithelial lesion (LSIL), or LSIL abnormal cervical cells.

These patients will be invited to return for a repeat HPV test in 12 months. This is to check if the body has cleared the HPV infection.

12 months after an intermediate result:

  • If HPV (any type) is still present in 12 months, the patient should be referred to a specialist for colposcopic assessment.
  • If HPV (any type) is not detected at 12 months, the patient can now safely return to five-yearly screening.

Next screen due: N/A – refer to specialist

HPV test result: HPV (not 16/18) detected

Reflex LBC Result: Possible HSIL or HSIL

Practice actions:

Details7: This is the first of two reasons why a patient would receive a higher-risk result.

This result means the patient has received the following results:

HPV is detected, but not types 16/18

  • A reflex LBC conducted on the same sample showed that the patient had possible high-grade squamous intraepithelial lesion (HSIL) or HSIL on cytology. 
  • The patient should be referred to a specialist to have a colposcopic assessment because they are at a higher risk of cervical cancer. 
  • A colposcopy will determine if  treatment is required. 

Next screen due: N/A – refer to specialist

HPV test result: HPV 16/18 detected

Reflex LBC Result: Any LBC result

Practice actions:

Details7: This is the second of two reasons why a patient would receive a higher-risk result.

This result means the patient has received the following result:

HPV types 16/18 have been detected

  • HPV types 16/18 are associated with approximately 70% of cervical cancers. 
  • These HPV types are more likely to progress to cervical cancer than other oncogenic HPV types. Regardless of the reflex LBC test result, the patient should be referred to a specialist to have a colposcopic assessment because they are at a higher risk of cervical cancer. 

Next screen due: 6–to12 Weeks

HPV test result: Unsatisfactory for HPV

Reflex LBC Result: Unsatisfactory for LBC

Practice actions:

Details7This result means the sample collected was unsatisfactory for either HPV or LBC. 

If the HPV test was unsatisfactory, the patient should return within 6–to12 weeks for a repeat HPV test.

If the LBC test was unsatisfactory, the patient should return within 6–to12 weeks for a repeat LBC test.

Note: Information provided in the table above is adapted from the National Cervical Screening Program Understanding the National Cervical Screening Program Management Pathway: A Guide for Healthcare Providers.7 

Step 3.3 Merge old recall labels/codes into your new list

Now that you have established your list of recall and reminder labels/codes, the next step is to clean up your recall and reminder list by merging your old list into your new list. Use the links in the table below for the relevant ‘how to’ guide for your practice software.

Software provider How to merge old recall and reminder labels/codes into your new label list
Best Practice Clean up free text reminder reasons
Clean up reminder reasons
Genie N/A
Medical Director Merge clinical lists
ZedMed How to merge recall and reminder labels

 

Step 3.4 Consider locking your recall and reminder list

If your software allows you to lock the list so that practitioners cannot add new free-text labels/codes, you may want to consider locking the list.

Software provider How to lock your list of recall and reminder codes (if possible)
Best Practice Set up reminder reasons and defaults
Genie Not applicable
Medical Director Not applicable