What if having your bowel investigated with a tiny camera – just once – could greatly reduce the risk of dying from bowel cancer and of developing the disease in the first place? Striking new results from an important study show that this is very real possibility.
We don’t often use the word breakthrough – but this is one of those rare occasions. Thousands of people could be saved from developing bowel cancer because of this test and thousands more could be diagnosed early when treatment is most effective.
As Harpal Kumar, our Chief Executive Officer, said, “This is one of the most important developments in cancer research for years.”
For the past 16 years, Professor Wendy Atkin from Imperial College London has been coordinating a trial of a test called flexible sigmoidoscopy or, more commonly, ‘Flexi-Scope’. It involves a tube called an endoscope, which has a tiny camera and light at the end of it.
Cancer Research UK is proud to have supported much of Professor Atkin’s work, including part-funding this trial.
Doctors can use a Flexi-Scope to look for cancers in the bowel – or for early signs of the disease’s development. As with many cancers, early detection is vital for bowel cancer, and over 9 in 10 people will survive their disease for more than five years if it is diagnosed at the earliest stage.
But there’s a lot of potential for preventing the disease too. Most bowel cancers develop from symptomless growths called ‘polyps’ or ‘adenomas’. If doctors can find these, they can remove them before they have a chance to develop into cancer. This is a painless procedure and is usually quick, adding on a matter of minutes to the time needed to do the test itself.
For these reasons, Flexi-Scope could be a great way of screening people for bowel problems, and detecting or preventing cancer. But, as with any screening programme, we needed some hard evidence that it would actually save lives. Professor Atkin’s new results, published in the Lancet, show just that, and they are very promising.
What did the trial show?
Professor Atkin’s team recruited over 170,000 people to the trial, a third of whom were invited for one-off screening using Flexi-Scope. Just over 70 per cent of those invited chose to attend and, all in all, the teams screened 40,674 people.
She found that for people aged between 55 and 64, a one-off Flexi-Scope examination reduced people’s chances of developing bowel cancer by a third, compared to a control group who weren’t screened. It also reduced the death rate from bowel cancer by 43 per cent.
All in all, Prof Atkin showed that for every 1,000 people who are screened, 5.2 cases of bowel cancer can be prevented and two deaths could be avoided. Put another way, you would need to screen 191 people to prevent one case of bowel cancer and 489 people to prevent one death. And these figures can only get better with time.
But the figures are only half the story. We also need to consider the size of the prize. Bowel cancer is the third most common cancer in the UK and more than 100 people are diagnosed every day. Death rates have been falling in the past four decades, but the disease still kills around 16,000 people every year.
The prospect of preventing such a common disease that costs so many lives is extremely exciting. Doing so with a one-off five-minute test, whose benefits last for at least 11 years, is even better.
Based on the data, Prof Atkin conservatively estimates that the one-off screen could prevent at least 5,000 people from being diagnosed with bowel cancer and at least 3,000 people from dying from the disease.
To put that into perspective, official figures from the NHS Breast Screening Programme say that breast screening saves 1,400 lives a year in England. That figure is controversial but even so, adding Flexi-Scope to the existing national bowel screening programme could save twice as many lives.
A different screening programme?
The UK already has a bowel screening programme. It uses a different test called the “faecal occult blood test” or FOBT, which looks for hidden traces of blood in stools. In England and Wales, people are invited for screening between the ages of 60 and 69. They are sent a kit to use in the privacy of their own homes, and results are sent to a lab for testing.
The FOBT is also an effective way of screening for bowel cancer. Trials have found that it can reduce death rates from the disease by around 25 per cent, and countries all over the world have used it as the basis of bowel cancer screening programmes. However, Prof Atkin’s latest results suggest that the Flexi-Scope is even more effective. And, crucially, it can prevent bowel cancer as well as detecting it after it has appeared.
The two tests should complement each other well. The Flexi-Scope can only scan the lower part of the bowel. It won’t be able to detect polyps or cancers in the upper reaches, so the FOBT still has a role in detecting early cancers there.
The Flexi-Scope test is currently available in the UK, but only for people with symptoms or after a referral from a GP or specialist. Based on the new results, this could change in the future.
In fact, Cancer Research UK thinks the findings are so promising that we are calling on the UK governments to incorporate the Flexi-Scope as part of the national screening programme for bowel cancer alongside the FOBT test.
We think the Flexi-Scope test should probably be offered to people from their late 50s. This is because most polyps appear in the lower bowel before the age of 60 and slowly develop into cancer over the next few decades.
Will it be acceptable?
A key question is whether people will accept the new test. The signs suggest they will. In an earlier study of 4,400 people who went through Flexi-Scope screening, Prof Atkin showed that virtually all of them were glad they had the test and were satisfied with the procedure. Meanwhile, 91 per cent reported mild or no pain, and 97 per cent said they felt little or no embarrassment.
The risks of the test appear to be small. Removing a polyp can cause a small amount of bleeding and there is around a 1 in 50,000 chance that the tube can tear the bowel. There isn’t really a risk of a false-positive, because doctors can only detect and remove polyps if they are there.
And to top off the good news, the Flexi-Scope test could be very cost-effective, especially since it only needs to be done once in an 11 year span. The test’s costs would probably be outweighed by the fact that fewer people need to be treated, and treatments are cheaper for early-stage cancers. In 2006, a study commissioned by the UK Department of Health suggested that a Flexi-Scope screening programme would actually save £28 for every person who was screened.
Of course, Prof Atkin says that there are many practical choices that would affect these calculations, and they would need to be repeated using data from the actual trials. There’s also the pressing need to train people with the endoscopes if Flexi-Scope becomes more widely used.
The new results have closed the door on 16 years of research and opened new and exciting ones. The big question now is whether the country will step through them.
Ed
More from Cancer Research UK:
- Information for people affected by bowel cancer
- Video – How to spot bowel cancer early
- Bowel cancer – key facts
- Support a bowel cancer research project
- Our current research on bowel cancer
- Bowel cancer awareness leaflet (pdf)
Reference:
Atkin W et al (2010). Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial The Lancet : 10.1016/S0140-6736(10)60551-X
Comments
Nicky January 6, 2011
My mum died of bowel cancer at age of 46, 17yrs ago now and although I am 40 myself later this year I am terrified of getting this cancer myself. Mum’s was undiagnosed and only detected when undergoing private health care. By time they operated, thinking it was ovarian cancer, it was too late. She died 3 weeks later. Maybe if the doctors at our local surgery had discovered it sooner, over 5month period, she would still be here today. At 35 I went to my doctors asking to be screened, as I was told you could be if it was a parent who had died. On completing various NHS forms and although there is a history of it in both sides of my family, and due to limited info known by myself as other family members have since died, I was declined stating I wasn’t considered to be at risk. It doesnt stop me worrying and anything that is available to help screen people of a younger age in the same position as me,I would welcome. Mum’s my proof that you dont have to be over 50 years of age to become a victim of this awfully cruel disease. But 17yrs on I am so greatful to the advances in medicine for Bowel cancer from cancer research and it’s re-assurring so many more people are now surviving it. I wish everyone well who has ever fought it or whoever is battling it now.
Also, do your research before agreeing to mammograms.
The Nordic Cochrane Institute were so concerned at the lack of real information getting to women that they produced, “The risks and benefits of mammograms” – it’s at their website. A rare and unbiased summary.
Sadly, we get a one-sided promotion of cancer screening tests with no risk information. Although men were fortunate enough to get risk information quickly for prostate cancer screening and doctors were reminded to get informed consent.
That has never happened in women’s cancer screening – we basically get an order to screen with no real information on the risks and actual benefits.
The other way to save money – we over-screen women for rare cervical cancer. Finland has the lowest rates of cervical cancer in the world and just as importantly sends the fewest women for colposcopy/biopsies (fewer false positives) – they offer 5 to 7 tests over your lifetime – 5 yearly from 30. (The Netherlands use the same program)
We over-screen and that greatly increases the risk of a false positive and unnecessary biopsies and treatments – all potentially harmful.
Also, we shouldn’t be screening women under 25, the evidence from the UK is clear, it doesn’t affect the tiny death rate, but causes harm through very high false positive and over-treatment rates.
We crow about having the lowest mortality rate from cervical cancer, but healthy women pay a huge price for that “success” – massive and harmful over-detection and over-treatment with our over-screening policy.
Sadly, cervical screening is very political and emotion drive, light on facts and common sense.
We could save millions and harm fewer women if we adopted the Finnish program. (they send 35%-55% of women for colposcopy/biopsies while we send 77%-78% over their lifetime – almost all are false positives)
It’s the best you’ll do with this unreliable test.
Cervical cancer only affects 1%-1.58% of women in an UN-screened, developed country.
When 99.35% don’t benefit from smears (0.35% false negatives) – that leaves 0.65% who benefit, you wonder whether this is the best use of taxpayer dollars?
We spend $133 million for the cervical screening program every year PLUS the medicare payments for unnecessary colposcopies/biopsies and caring for the women harmed by these procedures.
Women can have health issues after cone biopsies and LEEP (most are unnecessary and caused by false positives)- infertility, high risk pregnancy, more c-sections, miscarriages, premature babies and psych issues.
We could make a huge saving by diverting this money or some of this money to bowel cancer screening.
The Cancer Council of Victoria say that 600 women have been saved over 16/18 years – that’s a very small number when you factor in the massive cost and the negative impact of over-detection and over-treatment of healthy women.
I think the cervical screening campaign is a hugely expensive atomic bomb being used to kill an ant and harms large numbers along the way.
It’s a highly political program and doctors and others make a fortune from it, thus it rarely gets close analysis and any criticism is quickly silenced. Our doctors also get paid financial incentives when they reach targets for pap tests – more money! (Financial Incentives Legislation and PIP scheme) Our doctors are paid to reach targets to screen for the rarest (by miles) of the cancers we currently screen for…
We waste huge sums of money on this screening, it makes no sense when large numbers could be saved elsewhere.
I vote for more bowel screening, let’s drop the political hype and get on with saving more lives.
(My references: Articles and research by Richard DeMay, Angela Raffle, Laura Koutsky & Others at Dr Joel Sherman’s Medical Privacy forum under Womens Privacy Issues.)
dark knight rises October 28, 2010
I have some bowel symptoms like bloating and constipation. I want to diagnose myself but I feel shame for any test like endoscopy or Flexi-Scope, being inserted into the rectum. Is it any alternative method to diagnose polyps.
John October 6, 2010
Will anything be done to help those people who become very nervous and stressed about uncomfortable invasive procedures such as this? In the past 10 years I’ve had a gastroscopy, without sedation, during which I could hardly breathe because of constant gagging. Very unpleasant and traumatic. Also I had an angiogram, during the latter stages of which I became distressed and nearly fainted on the operating table. It’s all very well to say that the colonoscopy is worth a “bit of discomfort” for the benefits, but for a significant number of people (like the 30% who declined the screening trail) it can present a huge psychological barrier. What will be done to help people like these?
PETER GOFF October 6, 2010
I live in France where the FOBT was introduced 5 years ago. My wife and I participated in it and I was found to need an endoscopy. This revealed polyps which could easily have become cancerous and required an operation. 2 years later I had another endoscopy and some small polyps were removed. I am due for another in 6 months time. I strongly urge everyone in the at risk age groups to take these tests. Endoscopy is mildly uncomfortable but without it there is a very good chance that I would not be here today. I am very pleased to here that is now available in the UK.
Fairlee Cooke October 5, 2010
Thankyou for this wonderrful news! I thank all who are involved and I think David Cameron is a blessing to us all lately his decisions have been beneficial to those who really need change in their lives and who really need a fresh, innovative and fair leader. My father and brother died from bowel cancer and it can remain undetected often until it is too late and can be a very painful way to die so the importance and value of this new breakthrough in medical research to be utilised and made accessable to us is undoubtedly huge!
God bless you to all those responsible for helping to save lives.
Christine Curtis July 24, 2010
I have now lost 4 members of my family to cancer, three of which were bowel cancer and two of those aged 61.I have had full tests done about 6 years ago and given the fact that April this year a second brother died I asked my Dr if I should have further tests as I do have unpridictable bowls. I was told there would be no need. It is reasuring that canser reasearch promote these reasearches and I wish them success
Peter Walker June 23, 2010
I am 62 years old. My earliest recollection of anything associated with cancer was the advertising sentence “Cancer Must Yield”. Each and every time I read of the advances in cancer treatments, my heart knows we are indeed forcing it to yield. I congratulate all who are involved with the fight.
Peter Walker
Lou June 21, 2010
My Daddy died the day this article was published. I pray that some day no one ever has to go through what my Daddy went through.
I don’t think there is enough done to highlight the importance of early testing and detection. Dad only found out that he had bowel cancer 5 weeks before he passed away, this was a week and a half after the secondary tumour in his liver was discovered. Smear tests are recommended every 2 years, why can this not be done for bowel screening or cancer screening in general and from an earlier age? I don’t believe that a lot of GPs are well enough experienced at watching for the signs. Looking back, all the signs were there for months and not one GP picked up on it until it was too late.
DLB June 6, 2010
We spend millions on an unreliable test to find a rare cancer. (cervical cancer) This test produces lots of false positives and sends huge numbers for unnecessary treatments and biopsies. I was reading an article by Dr Richard DeMay, an American pathologist, who said 99.35% derive no benefit from smears (incl the 0.35% false negative women) but with 2 yearly screening a whopping 77% will at some time be referred for colposcopy. (and usually some form of biopsy) (L. Koutsky’s research)
We know cone biopsies and LEEP can leave women with infertility, problems during pregnancy, miscarriages, pre-term delivery and premature babies.
Dr Angela Raffle, UK expert, published her research results in the BMJ in 2004, “1000 women need regular screening for 35 years to save ONE woman from cervical cancer”.
Breast cancer screening – there are so many concerns with mammograms – false positives, ductal carcinoma in situ (usually non-progressive, but what to do when it’s detected?) unnecessary surgery, chemo and radiation and new research that suggests a link with more cancer – perhaps, the radiation or compression of delicate breast tissue. Also, the Nordic Cochrane Institute did some research that showed a group of women 55-72 having no screening over 10 years had a 2% drop in mortality from breast cancer whereas a group having screening had a 1% drop in mortality from breast cancer – fewer women died from breast cancer in the unscreened group!
The Institute have put together their own brochure for women, “The risks and benefits of mammograms” available at their website. (a rare unbiased summary)
Now bowel cancer kills far more women than rare cervical cancer…yet we spend millions on cervical screening and keep rolling out more expensive add-ons – HPV testing, liquid paps and now vaccination.
With no screening at all, 1% of women would get this cancer!
Mammograms – their benefits are limited/dubious and the harms a major concern. It’s a worry as this is a common cancer; we desperately need a reliable and effective screening test for breast cancer.
What are we doing? Surely we should spend the most money on tests that will save the most lives (without harming healthy people) – bowel cancer is common and this testing carries fewer risks from false positives, pseudo-disease etc…
Time to put politics aside and silence pressure and self-interested groups and use some common sense.
We’re wasting money that could be used in more effective programs.
I vote to roll out a screening test that actually helps large numbers of people without jeopardizing the health of the majority.
Daniela Woodbridge May 13, 2010
A new approach using a simple divise to save a life – is very good news. A nationwide screening would be a possitive move forward as this is an area people avoid seeing the GPs about. :-)
Henry Scowcroft May 6, 2010
Hi,
Thanks for all your comments.
Unfortunately we can’t offer medical advice on this blog.
If you are concerned about bowel cancer please contact our cancer information nurses on 0808 800 4040, 9am until 5pm Monday to Friday – or via our CancerHelp UK website.
Alternatively, talk to your GP or healthcare professional.
Henry
Tahir Jamil May 6, 2010
I have some bowel symptoms like bloating and constipation. I want to diagnose myself but I feel shame for any test like endoscopy or Flexi-Scope, being inserted into the rectum. Is it any alternative method to diagnose polyps.
Paulette Bury May 6, 2010
I’m really pleased that their is evidence of the benefit of this type of screening.Like so many others I was diagnosed with bowel cancer in my 50s [52]so I feel that the age to start sceening should be 50 at the latest so that treatment can be done before a major operation is needed.
Lilian Webster May 4, 2010
As a survivor of bowel cancer and breast cancer I can only say a big YES to more screening.
bryan Lunt May 3, 2010
I have had faecal occult blood test which came back negative. Is it possible to have Flexi Scope test by GP referral?
tina collister April 30, 2010
my dad died of bowel cancer so this is great news to hear there is a better chance of early detection. If you need any guinea pigs you can count me in!
tina collister April 30, 2010
my father died of bowel cancer so this is great news to hear of a better chance of early deetection. If you need more guinea pigs, you can count me in!
Melanie Lloyd April 30, 2010
My mum had bowel cancer 6 years ago and thankfully is fine now but a test like this could have made all the difference to her. She was 61 when diagnosed with cancer and they believe the polyp had been there a couple of years.
sheila done April 30, 2010
sounds fantastic.my friend was diagnosed early through a private health check some 11/12 years ago. luckily we’ve still got her a very young and active 85 year old. how do we get the test?
Reza April 30, 2010
This sounds like a big step forward in fighting this type of cancer. I think it should be available to anyone over the age of 45. Well done to cancer research team.
jmaraula April 30, 2010
i do hope this is eventually available to younger people,as i have had bowel problems for years and it terrifies me that something could be missed.i would like to be notified if this service becomes available.
Sheona MacLennan April 29, 2010
My father died of bowel cancer 4 years ago aged 65, only 10 months into his longed for retirement. It wasn’t diagnosed until he was rushed into hospital with severe vomiting. His death was a severe shock to my mum and me and my sister and I still miss him terribly.I am a 47 year old wife and mother of three young children and was sent for this test by my GP because of my worries and my family history (my gran and her brother both died of bowel cancer as well).It was done at a day surgery and was no trouble at all. My results were negative and I really hope that this test is made more widely available so that others don’t have to go through what we did with my dad- well done CR for all your work and raising awareness of bowel cancer. I hope the test will be available to younger people as well, in time
Della January 12, 2011
thank you a very interesting article