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Bowel cancer test ‘should be added to national screening programme’

By Emma Wilkinson

A one-off screen using flexible sigmoidoscopy in people in their 50s should be added to the national bowel cancer screening programme, say leading UK researchers.

In a trial of 170,000 men and women aged between 55 and 64, a single test reduced the incidence of colorectal cancer by a third and deaths from the disease by 43%.

Over an 11-year follow-up period the incidence of distal colorectal cancer fell by half, the Lancet reported.

The researchers, who carried out the trial in 14 UK centres, said 191 patients needed to be screened to prevent one colorectal cancer diagnosis and that very few cases were detected after screening, suggesting a lasting protective effect. They also pointed out that such screening would be cost-saving.

Professor Jane Wardle, from the health behaviour research centre at University College London and one of the study authors, said she believed flexible sigmoidoscopy should be used in addition to the current faecal occult blood test (FOBT).

‘We believe that the ideal is to do a flexible sigmoidoscopy in a person’s 50s before the faecal occult blood screening starts after 60 because that will bring a double benefit.’

She said the FOBT would still pick up proximal cancers which tend to develop in later life but that modelling of the best option may show it does not have to be done as often.

‘There will have to be some detailed calculations but it will be a lot cheaper because much of the cost associated with the faecal occult blood test is around the recall and colonoscopy.’

Primary care experts welcomed the findings and said GPs should consider offering the screening should the new government agree to the calls for flexible sigmoidoscopy screening.

Dr Willie Hamilton, senior research fellow in primary health care at the University of Bristol, said the results were ‘impressive’ and if introduced had the potential to reduce pressure on colonoscopy services.

‘Introducing flexible sigmoidoscopy will be a major challenge. It’s a different age group, different test, and may well be stationed in a different health care setting.’

‘That said, if the economics stack up, it would be a great initiative for whatever government emerges next month to take up.’

An NHS Cancer Screening Programmes spokesperson said the findings were very encouraging and added: ‘This is the first study to demonstrate a reduction in both incidence of and mortality from bowel cancer.’

Dr Willie Hamilton: Test has the potential to reduce pressure on colonoscopy services Dr Willie Hamilton: Test has the potential to reduce pressure on colonoscopy services