https://phescreening.blog.gov.uk/2017/01/18/gps-can-help-patients-engage-with-bowel-cancer-screening/

GPs can help patients engage with bowel cancer screening

Bowel cancer is the third most common cancer in the UK and the second leading cause of cancer deaths.

Screening reduces the chance of dying from bowel cancer by detecting the disease earlier when treatment is more likely to be effective.

As GPs, it’s important we stay up to date with developments in the NHS Bowel Cancer Screening Programme so we can help patients make truly informed decisions about whether to take part in screening.

Data shows that survival rates are best for patients whose bowel cancer is detected by screening – better than those diagnosed via a 2-week wait referral or any other diagnostic route. It's therefore important that we encourage our patients to engage with the bowel cancer screening programme.

Recent Public Health England guidance wants to see fewer people develop bowel cancer and encourage more eligible people to come forward for screening, to achieve an uptake target of 75%.

Chart showing relative survival rates from bowel cancer between 2006 and 2013
Survival rates for colorectal cancer 2006 to 2013: screen-detected cases had significantly higher survival compared to all other routes (National Cancer Registration and Analysis Service short report, May 2016: PHE publications number: 2016061)

Bowel scope screening

Current developments with the national programme include the roll-out of bowel scope screening to all men and women in England aged 55. This is in addition to the existing faecal occult blood (gFOBt) test which is the primary screening test offered routinely every 2 years to men and women aged between 60 and 74.

Bowel scope, or, more properly, flexible sigmoidoscopy (‘flexi-sig’) screening helps prevent cancer by finding and removing polyps that could eventually turn into cancer.

A specially trained nurse or doctor at an NHS bowel cancer screening centre uses a flexible sigmoidoscope to look at the lower part of the large bowel. If they find any polyps, they usually remove them straight away.

A letter explaining the results is sent to the patient and their GP in the 2 weeks after the appointment.

For every 300 people screened, it is estimated bowel scope screening stops 2 people from getting bowel cancer and saves one life.

About 14 out of every 300 people screened will be offered another test, usually a colonoscopy, because of the type of polyps found while one person will be found to have bowel cancer already.

In rare cases bowel scope screening can cause harm to the bowel. About one person in every 3,000 may have serious bleeding caused by bowel scope screening.

Everyone aged 55 registered with a GP and living in an area where bowel scope is offered should automatically receive an invitation. The invitation letter includes an enema and instructions for using it.

Anyone who decides not to have bowel scope screening when they are first invited can still have it at any time up until their 60th birthday. They just need to call the freephone helpline number 0800 707 60 60 to ask for an appointment.

Infographic showing barriers to participation in bowel screening
GPs can help address cultural taboos and other reasons why some groups are put off participating in bowel cancer screening

Faecal immunochemical test (FIT)

In another exciting development, a new bowel cancer home testing kit will soon replace the gFOBt test as the primary bowel cancer screening test.

The faecal immunochemical test (FIT) was given the go-ahead by ministers in June 2016.

FIT has many advantages over the FOB test. It:

  • is easier to use than gFOBt and can be measured more reliably by machine than by the human eye
  • is sensitive to a much smaller amount of blood and can detect cancers more reliably and at an earlier stage
  • has increased sensitivity that enables the detection of more pre-cancer lesions
  • needs just one tiny faecal sample from a single bowel motion compared to 2 samples from 3 different motions for gFOBt

Perhaps most importantly, a trial of FIT in 2014 showed a 7% increase overall in the uptake of screening.

It’s therefore predicted that FIT will mean 200,000 more people will take part in bowel cancer screening every year once it is implemented from spring/summer 2018 onward.

By explaining the benefits of FIT, GPs can play an important part in increasing uptake and therefore increasing the number of bowel cancers prevented or detected early.

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7 comments

  1. katrehman

    Hmmmm. ..I can't help feeling there's a nudge element here..
    And informed consent ...by sending out a pre booked appointment plus an emema you're automatically assuming that the patient will "accept " their "invitation "...while you have a 75% target. I don't feel the message about screening being elective will reach pepole while targets pre booked appointments and enemas are sent. Isn't sending the enema a waste of money when you haven't even established the person wants to go? I really wish screening was opt in and not opt out!

    Link to this comment Reply
    • Mike Harris

      Thank you for your email,
      The NHS Bowel Cancer Screening Programme only sends out enema kits to people who have confirmed that they wish to take part in bowel scope screening. This happens during the pre-invitation and invitation stage. The programme contacts potential participants telling them they are going to be invited for screening. It then sends an invitation is sent asking them to confirm whether or not they wish to take part in bowel scope screening. If this is received back to the programme hub, with the ‘yes box’ ticked, then an appointment slot is booked and an enema kit dispatched.

      Link to this comment Reply
  2. Oliver Stovin

    i thought there were also plans to make the invites for FOB or FIT much more personal and appear to be from the GP rater than like a circular you would put in the bin. Also that there was evidence that that also significantly increased uptake

    Link to this comment Reply
    • John Davy

      thank you for your comment.
      Work is under way to include GP endorsement on all invitation letters sent to potential participants of the NHS Bowel Cancer Screening Programme. This is a significant piece of work and requires the GP practice to agree to its name being included as well as ensuring the information it supplies to the programme is correct and up to date.
      The GP endorsement pilot showed an increased uptake of around 0.7%.

      Link to this comment Reply
      • oliver stovin

        thanks
        any idea of timescale ?

        Link to this comment Reply
        • John Davy

          Dear Oliver,
          Commissioners across England are working to ensure that GP practices have agreed for their details to be shared with the NHS Bowel Cancer Screening Programme and for these details to be used as an endorsement to the screening invitation.
          No timescale is set for this to be completed, although local teams are encouraged to facilitate this as soon as possible.

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  3. katrehman

    Thanks for that!

    Link to this comment Reply

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