Our briefing highlights the lack of surveillance screening for younger people at higher risk of bowel cancer.
Genetic factors contribute up to 30% of bowel cancer cases, an estimated 8,000-12,000 cases each year.
Genetic factors mean a strong family history of bowel cancer, or genetic conditions such as familial adenomatous polyposis (FAP) or Lynch syndrome. People with long-term inflammatory bowel disease are also at higher risk.
People in higher risk groups are likely to develop bowel cancer much younger than the general population. Clinical guidance recommends that people in high-risk groups should be in a surveillance screening programme, which is proven to reduce deaths in these groups.
Recent evidence shows that:
- People diagnosed are not routinely tested for genetic conditions, and only a third of centres identify and manage high-risk patients through a registry.
- Even when they are in a surveillance programme, patients may have to wait a long time for their screening colonoscopy. Thirty-five hospitals offering a surveillance programme have a waiting time of over 26 weeks (6 months) for people at higher risk.
- More than half of centres do not have a programme for managing high-risk groups.
- 64% of clinicians believed that someone else should be carrying out the surveillance work.
Our briefing, “Never too young: Supporting people at higher risk of bowel cancer”, has five recommendations to improve services for people in high risk groups:
- Better surveillance screening for those at high risk of developing bowel cancer.
- Clear information should be made available for GPs and the public on who may be at higher risk of bowel cancer.
- As people with a genetic condition such as Lynch syndrome typically develop bowel cancer at a young age, anyone diagnosed with bowel cancer under the age of 50 should have a genetic test for these conditions, so they and their families can be included in a surveillance programme.
- Adequate endoscopy service capacity to ensure that people at high risk do not have a long wait for their colonoscopy.
- Designation of a single named lead person in each hospital trust with responsibility for a registry of people at higher risk.
Full details of our findings and recommendations are in our full report available here.
Gut (journal) (Photo credit: Wikipedia)
Outcomes of the Bowel Cancer Screening Programme (BCSP) in England after the first 1 million tests
Introduction The Bowel Cancer Screening Programme in England began operating in 2006 with the aim of full roll out across England by December 2009. Subjects aged 60–69 are being invited to complete three guaiac faecal occult blood tests (6 windows) every 2 years. The programme aims to reduce mortality from colorectal cancer by 16% in those invited for screening.
Methods All subjects eligible for screening in the National Health Service in England are included on one database, which is populated from National Health Service registration data covering about 98% of the population of England. This analysis is only of subjects invited to participate in the first (prevalent) round of screening.
Results By October 2008 almost 2.1 million had been invited to participate, with tests being returned by 49.6% of men and 54.4% of women invited. Uptake ranged between 55–60% across the four provincial hubs which administer the programme but was lower in the London hub (40%). Of the 1.08 million returning tests 2.5% of men and 1.5% of women had an abnormal test. 17 518 (10 608 M, 6910 F) underwent investigation, with 98% having a colonoscopy as their first investigation. Cancer (n=1772) and higher risk adenomas (n=6543) were found in 11.6% and 43% of men and 7.8% and 29% of women investigated, respectively. 71% of cancers were ‘early’ (10% polyp cancer, 32% Dukes A, 30% Dukes B) and 77% were left-sided (29% rectal, 45% sigmoid) with only 14% being right-sided compared with expected figures of 67% and 24% for left and right side from UK cancer registration.
Conclusion In this first round of screening in England uptake and fecal occult blood test positivity was in line with that from the pilot and the original European trials. Although there was the expected improvement in cancer stage at diagnosis, the proportion with left-sided cancers was higher than expected.
Significance of this study
What is already known about this subject?
Randomised trials of colorectal (bowel) cancer screening have indicated that a biennial guaiac-based faecal occult blood test has the potential to reduce colorectal cancer mortality by about 25% in those accepting screening and by 16% in those offered screening.
In the UK trials and pilot studies uptake was between 50% and 60%.
Factors such as age, ethnic background, deprivation and gender are known to influence uptake.
What are the new findings?
Overall uptake in this first round of screening was 55–60% in the provinces in keeping with previous studies but was much lower in the London area at only 40%.
Uptake of the offer of colonoscopy in those with an abnormal test was high but only 83% of those with abnormal tests underwent colonoscopy.
Early cancer (Dukes A or B) was found in 70% of those with cancer.
The proportion of screen-detected cancers that were found in the right colon was lower than expected.
How might these impact on clinical practice in the foreseeable future?
If these early results are maintained the Bowel Cancer Screening Programme will achieve the intended 16% reduction in overall bowel cancer mortality.
Different screening strategies may be required to effectively screen for right-sided bowel cancer.
via Outcomes of the Bowel Cancer Screening Programme (BCSP) in England after the first 1 million tests — Logan et al. 61 (10): 1439 — Gut.
Historic BSG logo 1990-2010 (Photo credit: Wikipedia)
Core is the only charity in the UK that funds research into the entire range of gut, liver, intestinal and bowel illnesses. We are called Core because the digestive system is at the core of our body and a good digestive system is the core of good health.
The charity was established in 1971 with the help and support of the British Society of Gastroenterologists and today it supports Clinical Research Fellows and Research Scientists at hospitals and universities throughout the UK, investigating conditions such as pancreatitis, hepatitis, ulcerative colitis, irritable bowel syndrome, Crohn’s disease and digestive cancers. All research that we fund is rigorously peer-reviewed. Core is a member of the Association of Medical Research Charities.
We have a major interest in providing patients with good, accurate information about their illness. We publish 25 patient information leaflets and 15 fact-sheets explaining the nature of various gut illnesses and their treatment. Some 200,000 are distributed annually.
- More than £5.5 million invested in research since 2000
- Finding cures for diseases from Crohn’s disease and IBS, to liver disease and bowel cancer.
- Working with leading gastroenterologists across the UK
- Funding research in the UK’s leading hospitals and research centres