A national bowel screening programme: what needs to be done

Cancer Research UK

The Government needs to resolve a number of issues to ensure the health service can cope with a national bowel screening programme, a leading Cancer Research UK scientist will tell conference delegates.

Speaking at the charity's second Senior Researchers' Meeting in Harrogate, Yorkshire, Dr Wendy Atkin will say that a national programme to detect the disease is feasible and can save lives.

But she believes there is an urgent need to address the training and resource requirements of the NHS so the service is not over-stretched and patients do not suffer from delays in diagnosis.

Cancer Research UK scientists have played a leading role in providing the Government with evidence on the effectiveness of bowel cancer screening. A nationwide screening programme is likely to be introduced within the next five years, following evidence on which screening technique will be the best to use.

The two screening options under consideration are the faecal occult blood test (FOBT) followed by colonoscopy and flexible sigmoidoscopy (FS).

Dr Atkin is running the Flexi-Scope trial, funded by the Medical Research Council, NHS R & D, and Cancer Research UK, to examine the effectiveness of flexible sigmoidoscopy in detecting early bowel cancer.

Unless there is a drive towards training staff to perform the extra investigations, however, she believes the health service will be over-burdened by a programme that involves either screening method.

She says: "Over the past 15 years dramatic reductions in incidence rates of bowel cancer in the US have been attributed to screening. During this same period in the UK incidence rates have remained unchanged in women and have even increased in men.

"There is now no doubt that screening for bowel cancer can save lives but the Government will have to ensure the NHS is ready for its implementation. Both FS and FOBT will put pressure on an already over-stretched colonoscopy service so it is essential to address this issue now."

"Nurses and non-specialist medical endoscopists as well as gastroenterologists can perform flexible sigmoidoscopy but they are currently in short supply," she adds.

Dr Atkin will say that targets for training should build up an endoscopy capacity for all patients invited for screening and those that present with symptoms to their doctor and are referred for screening.

She believes that as well as training new endoscopists, established endoscopists should be provided with additional training, to meet the rigorous standards required of a screening programme.

In a recent study, a team led by Dr Atkin looked at the performance of endoscopists on the Flexi-Scope trial to see if satisfactory adenoma detection rates were being achieved in all trial centres. Adenomas are precancerous growths.

They found wide variations in detection rates between endoscopists with similar levels of experience, screening populations with the same average age and proportion of men, using the same type of equipment and the same protocol.

Even when variations in the population characteristics such as smoking and family history were taken into account there were still differences in adenoma detection rates between centres.

She says: "Our study shows that if flexible sigmoidoscopy is introduced into the screening programme, systems would need to be in place to monitor detection rates and give feedback to endoscopists.

"The government needs to consider how best to monitor and maintain performance levels whichever mode of screening is selected."

Professor Robert Souhami, Director of Clinical and External Affairs at Cancer Research UK, says: "Bowel cancer is the second highest cause of cancer death in the UK. A national bowel cancer-screening programme will present a significant challenge but we know the rewards will be great. Studies in the US and Europe suggest that deaths from bowel cancer could be reduced by 15 to 20 per cent a year in the target age range.

"Making sure that the NHS is ready for the implementation of a bowel screening programme in terms of staffing, resources and access to services should be high priority for the Government."

ENDS

Notes to Editor

Flexible sigmoidoscopy, allows for the detection of polyps and adenomas - pre-cursors to cancer. Doctors insert a long, thin tube, fitted with a miniature camera, into the lower part of the bowel. Small growths can be removed on the spot, while patients with larger growths may be given a whole-bowel examination, called a colonoscopy. Studies have shown that flexible sigmoidoscopy could prevent some 5,000 cases of the disease each year in the UK and 3,000 deaths.

The Faecal Occult Blood Test (FOBT) tests for hidden blood in the stool and is a test for early cancer. A positive FOBT is followed by a colonoscopy to confirm the diagnosis. Trials have shown that it cuts deaths from the disease by up to 20 per cent if used every 2 years from age 50.