Bowel screening – it’s working, but we could do even better

Bowel screening looks for traces of blood in a person’s stools

Yesterday, we saw more evidence that the UK’s bowel cancer screening programme is working.

According to new data from the North-East of England, published in the British Journal of Cancer, patients whose disease was spotted via screening had a better chance of beating their disease than those diagnosed after developing symptoms.

This is great news, and shows that bowel screening can make a real difference.

It comes after a Scottish study last year found that bowel cancer death rates were cut by 27 per cent among those who had attended screening compared with those who did not.

But at Cancer Research UK, we’re not ones to rest on our laurels. Although the programme spotted some cancers, it missed others.

We can do even better. And we’ve had our thinking caps on to work out what Governments need to do to make the UK nations’ bowel cancer screening programmes even more comprehensive, and save even more lives.

An overview of the status quo

The bowel cancer screening test offered in the UK uses a test called the faecal occult blood test, or FOBT. It’s done at home, and involves posting a series of stool samples off for testing. The test looks for the presence of traces of blood in the stools – which can be a sign of bowel cancer.

The test is offered every two years. But in terms of who is eligible, the devolved nations of the UK all operate slightly different screening programmes.

• England and Wales offer screening to people aged between 60 and 74.
• Northern Ireland screens people between 60 and 69, but plans to extend this to 70-year-olds by 2015.
• Scotland screens people between 50 and 74.

But across all four nations, only about half of those invited to participate actually do so.

Improving the existing test

Uptake

We would like to see more people participate in the programme. This means more encouragement from GPs, from awareness campaigns and from peer-groups. We need people to know about the programme, and its benefits. Given how effective we now know bowel screening is, and that bowel cancer is among the most common cancers, even a small increase in uptake could make a big difference.

Improved testing method

Researchers have invented a newer, better, simpler version of the screening test. It’s called ‘faecal immunochemical testing’, or FIT, and it doesn’t just detect whether blood is present or not, it detects the amount of blood present. This makes it more sensitive, and requires people to take fewer samples. Evidence suggests that it will also detect more cancers and pre-cancerous growths than FOBT.

It’s unlikely to be more expensive than FOBT, and evidence is emerging to suggest that introducing the FIT test will improve uptake.

So we want the UK’s governments to begin planning for a switch-over from FOBT to FIT right away.

Introducing a new test: flexi-scope

In April 2010, a landmark trial, which we helped fund, showed that a single bowel screen using a tiny camera on a flexible tube (called a flexi-scope) could both prevent and detect bowel cancer. The test not only spots cancers, it can detect and remove pre-cancerous polyps.

In October that year, Prime Minister David Cameron announced that the test would be incorporated into the NHS’s bowel screening programme in England. This would then be followed by stool testing from age 60. This could make a huge difference to bowel cancer rates in the UK.

But 18 months later, we’re still waiting for clarification over where, when and how the programme will be rolled out. So we want to see two things:

Investment in training and capacity

This is absolutely crucial – not just for flexi-scope, but for the whole screening programme, and for spotting bowel cancer early. We’ve heard from experts in the field that the UK’s endoscopy services aren’t what they could be. But the recent Be Clear On Cancer  awareness campaign increased the demand for endoscopies, as more people were referred by their GP with symptoms.

If the NHS is to properly implement flexi-scope screening as well, it needs to make sure it has a world-class endoscopy service – which means more trained and equipped endoscopists.

This is particularly true in England. Last year, the Westminster government earmarked an extra £450m, to be spent over four years, in part to improve endoscopy in the English NHS. But a recent survey by GP Magazine showed that only just over half of local health authorities were actively spending this cash. This needs to change.

Plan for roll-out

We want the Westminster government to update plans for rolling out flexi-scope in the NHS in England and to ensure everything is in place so that they can move forward with implementation. And while high quality roll-out is the top priority, we need to see the detailed plans for how things will be kept moving.

In Scotland, Wales and Northern Ireland, we want the governments to start planning for and piloting flexi-scope. Currently, flexi-scope is proposed to be carried out at age 55.  In Scotland, where screening begins at 50, the government will need to work out how to incorporate flexi-scope into their existing screening programme.

We want to stress – the  existing bowel screening programmes are a success, and we would like to urge people to take part when invited. But we can’t be complacent. As more evidence emerges, we will continue to pressure our politicians to make sure the UK public are getting the very best bowel screening.

Henry

Reference

• Gill, M.D., Bramble, M.G., Rees, C.J., Lee, T.J.W., Bradburn, D.M. & Mills, S.J. (2012). Comparison of screen-detected and interval colorectal cancers in the Bowel Cancer Screening Programme, British Journal of Cancer, 107 (3) 421. DOI: 10.1038/bjc.2012.305