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Experts call for efforts to boost bowel cancer screening uptake

Survival rates from bowel cancer could be improved if more people over 60 took up the offer of screening, according to the authors of the latest national bowel cancer audit.

They called for efforts to raise awareness of the national bowel screening programme, to help detect more cancers at an earlier, more easily treatable stage.

It comes after Government advisors on the Cancer Research Taskforce called for NHS England to incentivise GPs to ‘take responsibility for driving increased uptake’ of bowel cancer screening, aimed at boosting average uptake from current levels of around 60% to 75% by 2020.

The audit showed that survival rates after surgery for colorectal cancer have improved, with 96% of patients alive at 90 days after major surgery to remove their cancer in 2013-14, compared with 94% four years earlier.

However, two-year survival stayed the same at around 67% over the period 2009-10 to 2011-2012, and the report highlights that only a fifth of people with bowel cancer in the age group eligible for screening – 60-74 years – had their cancer detected through screening.

Lead author of the audit Mr James Hill, consultant colorectal surgeon at Manchester Royal Infirmary, said ‘patients whose cancer is diagnosed early are more likely to respond to curative treatment than those who are admitted to hospital as an emergency’ and that ‘this is why it is so important that we raise awareness of the national Bowel Cancer Screening Programme’.

National Bowel Cancer Audit Report 2015

Readers' comments (3)

  • Vinci Ho

    I wonder if the take up rate in this screening varies between relatively more affluent and deprived areas as the overall , total number of emergency presentation of colorectal cancer was stuck at about 20% according to this audit and the consequence of this pattern of colorectal cancer admissions, 16 per cent of patients having major surgery had an urgent or emergency procedure. There was some variation by Trust, with less than ten per cent of major resections carried out as urgent/emergency in 23 Trusts and over 30 per cent carried out as urgent/emergency in six Trusts .

    May be some regions should be targeted and even more has to be done to publicise and increase the uptake of the screening.

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  • GPs definitely best placed to do this work

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  • Interestingly, in the context of uptake of bowel cancer screening tests, screening in Scotland encompasses ages 50-74 years, as per European guidelines, so that individuals do have more opportunities to participate. Further, those aged 75 years or over can opt in to continue participating in screening.

    Importantly for uptake, Scotland have decided to evolve from the traditional faecal occult blood test to an automated faecal immunochemical test for haemoglobin. Such FIT have many advantages being more sensitive, free from interference from dietary constituents and much more specific for lower GI bleeding. Perhaps the most telling advantage is that one only faecal specimen is required rather than the traditional two samples from each of three bowel motions. The single sample required is taken into a hygienic user-friendly specimen collection device. For this reason, and perhaps others, uptake with FIT has been shown in many studies to be higher than with FOBT, especially in the "hard to reach" groups, the younger, the more disadvantaged and men. It is to be hoped that the current exercise being carried out by the UK National Screening Committee encourages roll out of FIT across all four countries of the UK sooner rather than later.

    Additionally, as discussed on the Pulse website recently, use of FIT, at low cut-off concentrations, is an excellent tool for use in assessment of those patients presenting in primary care with lower abdominal symptoms. FIT are very good at ruling-in cancer - a positive test result needs (as detailed in the controversial NICE NG12 guideline) urgent referral for colonoscopy. More importantly, perhaps, a negative test results provides considerable reassurance that significant colorectal disease (cancer plus higher-risk adenoma plus IBD) is absent. Use of FIT in assessment of the symptomatic would direct colonoscopy to those who would most benefit. This would allow the available resources to be used for the increased numbers expected to have positive bowel screening test results with FIT as well as for the increased number of bowel cancers to be expected from our ageing population.

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