This site is intended for health professionals only

At the heart of general practice since 1960

pul jul aug2020 cover 80x101px
Read the latest issue online

Independents' Day

GP invitations to bowel cancer screening 'increases uptake by 40,000'

Practices sending headed letters inviting patients for bowel cancer screening can increase uptake and enhance cancer detection, a study has found.

The research, published in the British Journal of Cancer, found that nearly 40,000 extra people would be screened if practice invites were sent out nationally.

This could enable an additional 61 people with cancer and 165 people with intermediate or high risk polyps to be identified and referred for treatment.

Researchers concluded that GP practice names should be added to invitations given out by the NHS bowel screening programme, given the ‘high level of agreement by GPs to endorse it’ and the increased screening uptake.

It comes after it was found in an audit last year that survival rates of bowel cancer could be improved if more people took up the offer of screening.

Researchers believe that a ‘lack of GP involvement could be a barrier’ for screening uptake, with one patient involved in the study saying: ‘if the letter had come from my GP, I would have taken it more seriously.’

The new style of invitations would require practices to agree to their name being put on the screening letter and researchers believe that this approach means there is ‘no effort required from primary care other than an agreement to have their practice name on a letter’.

It concluded: ’Given the exceptionally high level of agreement by general practices to endorse the bowel cancer screening programme (BCSP), the small one-off cost to modify the standard invitation letter, and the overall increase in uptake, we suggest that the BCSP consider adding GP endorsement to the screening invitation letter.’

Overall, the headed invitations only increased uptake by 0.7%, but the researchers calculated that this would still result in 39,766 additional people being screened if the system was put in place nationally.









Readers' comments (7)

  • Since many of us didn't send out a fourth letter (they'd already had 3 from the service so why send another)and actually got the patients to engage by discussing this with them when they attended opportunistically, I fail to see how adding the GP details to the screening invite will change anything. The only thing this will do will encourage the patients to contact their GP practice instead of the hospital or screening service. I think the current process of alerting the GP to non-attenders is sufficient and is obviously working so why change it.

    Unsuitable or offensive? Report this comment

  • The study showed that General Practitioner Endorsement (GPE) did not improve the uptake socioeconomic gradient, although it was said to offer a low-cost approach to enhancing overall screening uptake within the NHS BCSP. Of course, it has been shown in both England and Scotland that use of FIT as a first-line test for colorectal cancer screening, although rather more expensive for sure, does increase uptake more than GPE. Of more relevance perhaps were the findings that uptake did increase by a greater amount in the "hard to reach" groups - younger people, males and the more deprived. Let us hope that FIT as a first-line test gets going sooner rather than later in the NHS BCSP.

    Unsuitable or offensive? Report this comment

  • Labs appear to have stopped FOBs. Reinstate forthwith.

    Unsuitable or offensive? Report this comment

  • Laboratories have ceased doing traditional guaiac faecal occult blood tests (gFOBT) and discouraged their use in wards, clinics and primary care due to their many problems in performance and because they generate false positive and false negative results. Indeed, most now consider gFOBT, like AST and CK for assessment of acute coronary syndromes (think troponin), to be obsolete.

    The NICE Quality Standard on suspected cancer currently out for consultation actually uses the term “tests for the presence of occult blood in faeces”. This descriptor clearly includes the newer faecal immunochemical tests for haemoglobin, usually termed FIT. As discussed previously on this Pulse news forum, there is now considerable evidence that FIT are not only much more useful than gFOBT in asymptomatic population-based programmatic screening for colorectal cancer, but are also very useful in assessment of patients with symptoms presenting in primary care.

    FIT, at very low faecal haemoglobin concentration cut-off, have high sensitivity for colorectal cancer – a positive FIT results should stimulate urgent referral. More importantly, perhaps, this simple, inexpensive investigation has high negative predictive value for significant colorectal disease (cancer plus advanced adenoma plus IBD) - a negative FIT result provides considerable reassurance that significant colorectal disease is absent and further investigation probably not required.

    Although no test, including FIT, is perfect, the evidence is that this is useful for assessment of patients in primary care, as advocated in the NICE NG12 guidelines. It is hoped that GP will put pressure on laboratories to begin to offer FIT (definitely not FOBT) to help direct the scare colonoscopy resource to those who would benefit most. Moreover, it is hoped that laboratories will accept the challenges of GPs’ requests and that funding will be made available for this evolving investigation.

    Unsuitable or offensive? Report this comment

  • Vinci Ho

    Thank you , Professor Fraser, informative and definitive as in our last discussion on this platform

    Unsuitable or offensive? Report this comment

  • Vinci Ho

    FIT for colorectal cancer
    Faecal Calprotectin for inflammatory bowel disease
    That will do me for valuable non invasive investigations .

    Unsuitable or offensive? Report this comment

  • Some really good news relevant to the above.

    On 15 January, 2016, the following statement was issued. The UK National Screening Committee recommends a change to the test used in the Bowel Cancer Screening Programmes. The use of Faecal Immunochemical Test as the primary test for bowel cancer should replace guaiac Faecal Occult Blood Test.

    As colonoscopy capacity grows or screening uptake increases, the UK NSC and programmes should review and recommend alteration of the cut offs to increase the number of cancers detected.

    See -

    Maybe that widely promulgated recommendation will help focus minds on the other use for FIT - the assessment of patients presenting in primary care with lower abdominal symptoms.

    One test - two very different clinical applications.

    Unsuitable or offensive? Report this comment

Have your say