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Fighting FIT – Scotland’s pioneering change to its bowel screening programme

by Heather Walker | Analysis

20 February 2015

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Faecal-Occult Blood-Test
The current kit used for bowel screening

Earlier this week, the Scottish Government celebrated the three-year anniversary of Detect Cancer Early – a programme aimed at improving cancer survival through earlier diagnosis and treatment of the disease.

Since 2012, it’s invested £30 million into cancer awareness and earlier diagnosis initiatives through the programme, with a further £9m committed for the 2015/16 financial year. This is important because the earlier cancer is diagnosed the more likely it can be treated successfully – and more people will survive.

So we were pleased to hear cabinet secretary, Shona Robison, announce that a new test – the Faecal Immunochemical Test (or FIT for short) – will replace the current Faecal Occult Blood Test (FOBT) in Scotland’s bowel screening programme over the coming years.

Why change the test?

The current bowel screening programme is effective, but only about 55 per cent of people invited actually take part – which is lower than both the breast and cervical screening programmes.

The FOBT and FIT tests both look for hidden traces of blood in samples of faeces. And the current FOBT kit involves collecting six small samples of faeces over a few days and posting them to a screening centre, as this video explains:

This isn’t the most practical – or pleasant – way to spend your free time. On top of this, screening with FOBT isn’t perfect – no test is – and it only picks up about half of bowel cancers. This is obviously much better than no screening at all, but there’s plenty of room for improvement.

Scotland’s new test gets around some of these problems. For starters, it’s a better test than FOBT. And the way the samples are analysed means that more bowel cancers could be detected.

It’s also easier to use, requiring only one sample that’s collected with a brush and then put into a small tube of liquid.

This simplicity could be key and experts believe that a simpler test will mean more people are likely to take part in screening. Crucially, this includes men and people from more deprived groups, who are less likely to use the FOBT kit. So there is evidence that FIT will reduce inequalities, which is really important when it comes to diagnosing cancer earlier.

The new FIT test is also more cost-effective – which is always good news for cash-strapped health services (though it will require investment to get the new system up and running).

We would like to see support to ensure that more people from across the country complete their screening kit. And removing barriers such as cost and ease of completing the test have a big part to play.

What about the rest of the UK?

Decisions about health policy are made separately in England, Scotland, Wales and Northern Ireland, which means that the organisation of the screening programmes is a decision for each individual nation’s government.

While we know that the FIT test is better than FOBT in a lot of ways, we also know that introducing a change to a screening programme takes a lot of time, effort and money, so it’s important it is carefully thought through. The good news is that Scotland’s decision means that we will learn more about the practicalities of introducing the test which will help the rest of the UK think about how best they could introduce it too.

In the meantime, it’s important that work continues in each nation to make sure we get the best out of the existing screening programmes. For example, we are working with Bowel Screening Wales to look at ways to increase use of the FOBT test.

Work is already ongoing in England and Northern Ireland to consider whether FIT could replace FOBT as the main bowel screening test, and we know Wales is watching developments with interest. We’d like to see all UK nations follow Scotland’s lead and think about how best they can introduce FIT as soon as is feasible.

Scoping out improvements

There is also work to introduce another test into the bowel screening programme in England: bowel scope – which we have written about before, and which we helped develop.

This is a one-off test that uses a flexible tube with a camera and a light on the end to look into your lower bowel for early-stage cancers and pre-cancerous growths (called polyps) which can be removed on the spot.

It can cut deaths in those who have it by over 40 per cent, and – thanks to the removal of those polyps – can actually prevent a third of bowel cancers among those screened.

It’s being added to the current screening programme, so people will still receive their kit to complete at home but they will also be invited to have a bowel scope test too.

Scotland is also testing out bowel scope, and we would like to see all nations of the UK consider how best to introduce the test so that more lives can be saved.

Increasing participation

Building up the evidence and trying out new ways of screening is crucial for making a case to adopt a new test more widely. And it’s great that Scotland is leading the way with FIT.

It’s also important to remove practical barriers, and increase the number of people taking part in bowel screening, as this figure remains stubbornly low.

But it’s really important that any work done to boost screening comes with clear information so people are aware of both the harms and benefits of taking part in screening. That’s the only way people can make an informed choice about whether to take part. We work closely with the NHS and GP practices to encourage this and test various initiatives to encourage constant improvement.

We hope the plans to introduce FIT – along with other efforts to improve earlier diagnosis – will lead to more people being treated successfully, so that as many people as possible are fighting fit for the future.

Heather Walker is a policy manager at Cancer Research UK