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%.
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.
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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