Bowel cancer diagnosis and treatment statistics

Routes to diagnosis

'Two-week wait' is the most common route to diagnosing bowel cancer

Screening Uptake

People who have bowel screening within 6 months of invitation, UK

 

Surgery Rate

Bowel cancer patients receiving major surgical resection, 2006-10, England

 

Patient Experience

Bowel cancer patients rating their care very good or excellent, 2014, England

Almost a third (30%) of bowel cancer cases in England are diagnosed via the ‘two-week wait’ referral route.[1] More than 4 in 10 (44%) of these cases with known stage are diagnosed early (stage I or II).[2]

Around a quarter (24%) of bowel cancer cases in England are diagnosed after presenting as an emergency.[1] Around 7 in 10 (68%) of these cases with known stage are diagnosed late (stages III or IV).[2] Around two thirds (66%) of emergency presentation cases are via Accident and Emergency (A&E), with the other cases coming via an emergency GP referral, inpatient referral or outpatient referral.[3]

There are variations in routes to diagnosis by sex, age, deprivation and ethnicity.[4]

Around a quarter (24%) of bowel cancers cases in England are diagnosed following a routine or urgent GP referral (but not under the ‘two-week wait’ referral route).[1] Around half (49%) of these cases with known stage are diagnosed early (stage I or II).[2] 

A tenth (10%) of bowel cancer cases in England are diagnosed by screening.[1] Almost two thirds (63%) of these cases with known stage are diagnosed early (stage I or II).[2]

Bowel Cancer (C18-C20), Percentage of Cases by Route to Diagnosis, Adults Aged 15-99, England, 2012-2013

Bowel Cancer (C18-C20), Percentage of Cases by Stage for each Route to Diagnosis, Adults Aged (15-99), England, 2012-2013

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'14-day / Two-week wait'

England meets the standard for their country on the percentage of patients first seen by a specialist within two weeks of urgent GP referral for suspected cancer.[1]

'Two-week wait' supports early diagnosis as spotting cancer early is important for improving survival, so it is important that patients with potential cancer symptoms are referred promptly.

'31-day wait'

England, Scotland and Ireland all meet the standard for their country on the percentage of patients that receive their first cancer treatment within 31 days of a decision to treat, while Wales does not meet the standard for their country.[1-4]

The speed at which patients receive their first treatment can have a positive outcome on their clinical outcome, so it is important that patients with cancer symptoms are treated promptly.

'62-day wait'

None of the countries in the UK meet the standard for their country on the percentage of patients receiving their first definitive treatment for cancer within two months of a GP referral for suspected cancer.[1-4]

The speed at which patients receive their first treatment can have a positive outcome on their clinical outcome, so it is important that patients with cancer symptoms are treated promptly.

Cancer waiting times coding and standards are different in each country and so comparisons should not be made between countries, only each country against their own measures.

Lower Gastrointestinal Cancers, Waiting Times, UK countries, 2014-15

    England Wales Scotland (bowel cancer only) Northern Ireland
'14-day wait': seen by specialist following referral Performance 93.5%      
Standard 93%      
Performance against standard Meets standard      
'31-day wait': receipt of first treatment following decision to treat Performance 98.1% 97.1% 98.1% 98.9%
Standard 96% 98% 95% 98%
Performance against standard Meets standard Does not meet standard Meets standard Meets standard
'62-day wait': receipt of first treatment following referral Performance 73.3% 75.3% 90.5% 66.1%
Standard 85% 95% 95% 95%
Performance against standard Does not meet standard Does not meet standard Does not meet standard Does not meet standard

Data not available for '14-day wait' in Wales, Scotland or NI.
Data not available for '31- or 62-day wait' in England.
Data for Scotland for bowel cancer only.

References

  1. NHS England. Cancer waiting times.  Accessed May 2015.
  2. StatsWales. Cancer waiting times. Accessed May 2015. 
  3. ISD Scotland. Cancer Waiting Times. Accessed June 2015. 
  4. Department of Health, Social Services and Public Safety. Cancer Waiting Times. Accessed June 2015.
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More than 6 in 10 (62%) bowel cancer patients receive a major surgical resection as part of their cancer treatment.[1

The proportion of bowel cancer patients receiving a resection varies with age, with fewer resections in the oldest age group (39% in those aged 85+) compared with the youngest (64% in those aged 15-54).[1]

Bowel (C18-C20), Proportion of Patients Receiving a Major Surgical Resection, by Age, England, 2006-2010

 

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89% of bowel cancer patients rate their care as ‘excellent’ or ‘very good’.[1] Patient experience varies with individual needs and concerns, which are influenced by many aspects of personal background, disease characteristics and the care environment.

88% of patients were given the name of a Clinical Nurse Specialist in charge of their care.[1] Being given the name of a Clinical Nurse Specialist in charge of a patients’ care is the factor most likely to be associated with high patient satisfaction scores.[2]

58% said they saw their GP once or twice before being told they had to go to hospital.[1] How often a patient sees their GP before being referred to hospital varies by cancer type depending on ease of diagnosis.[3]

For bowel cancer the proportion that said they saw their GP once or twice before being told they had to go to hospital is lower than the average for all cancer patients.[1]

Spotting cancer early is important for improving survival so it is important that patients with potential cancer symptoms are referred for tests promptly.

Bowel Cancer (C180-C20), Patient Experience Survey, by Sex, England, 2014

Female Male Persons
Percentage of patients treated for cancer who visited their GP once or twice about the health problem caused by their cancer 54.3% 59.7% 57.6%
Percentage of patients treated for cancer who said they were given the name of a Clinical Nurse Specialist in charge of their care 87.1% 88.1% 87.7%
Percentage of patients treated for cancer who rated their overall care as excellent or very good 86.5% 90.9% 89.2%

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Around half (50-58%) of people in the UK who are invited for bowel cancer screening are screened adequately (with a definitive usable result) within 6 months of invitation.[1-5] Uptake is higher in females than males. Eligible age groups and frequency of invitation to screening vary between the UK constituent nations so comparison is inadvisable.

Bowel Cancer Screening Coverage and Uptake, UK, FY2012-2015

Coverage (% of eligible people screened adequately in past 2.5 years) Uptake (% of invited people screened adequately within 6 months of invitation)
Country Male Female Persons Male Female Persons
England 57.9 55.1 60.6 57.9
Wales 47.5 52.5 50.0 50.2 54.9 52.6
Scotland 54.7 60.3 57.6
Northern Ireland 49.8

Data not available for coverage in Scotland or Northern Ireland, or for coverage by sex in England.
Data not available for uptake by sex in Northern Ireland.
 

Uptake in England meets the minimum standard set by the Department of Health (52%).[6] Uptake in the other UK countries is below the minimum standards set by the countries themselves: 60% in Scotland and Wales, and 55% in Northern Ireland.[3,5-7] Bowel cancer screening uptake is lower than the minimum standard in more than a quarter of England CCGs (FY2013/14).[1]

References

  1. Public Health England. National General Practice Profiles. Data for FY 2014/15, persons aged 60-69, "screened for bowel cancer". Accessed April 2016.
  2. England bowel screening data for FY 2014/15, persons aged 60-6974, "Percentage of people adequately screened out of those invited for FOBt screening" were provided by Public Health England (PHE) Screening on request April 2016.
  3. Information Services Division Scotland. Scottish bowel screening programme. Data for 1 Nov 2012 - 31 Oct 2014, persons aged 50-74, "defined as: with a final outright screening test result". Accessed April 2016.
  4. Bowel Screening Wales. Bowel Screening Wales Annual Statistical Report 2013-14. Data for FY2013/14, persons aged 60-74, "defined as: bowel screening programme received a used test kit within six months following their invitation". Cardiff: Public Health Wales; 2015.
  5. Public Health Agency Northern Ireland. Northern Ireland Bowel Cancer Screening Programme Inaugural Report. Data for FY2012/13, persons aged 60-69, "defined as: with a complete screening test result available [six months after the initial invitation pack is issued]". Belfast: HSCNI; 2014.
  6. Department of Health and Public Health England. NHS public health function agreement 2015-16. Service specification no.26 Bowel Cancer Screening Programme. London: Department of Health; 2014.
  7. Public Health Wales. Screening Division of Public Health Wales, Annual Report. Cardiff: Public Health Wales; 2014.
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Bowel cancer screening uptake in England is lowest in the youngest screening age groups (FY2014/15).[1] Uptake is higher in females than males in every age group, though the gap narrows with increasing age.

Bowel Cancer Screening Uptake by Age at Test, England, FY2014/15

References

  1. England bowel screening data for FY 2014/15, persons aged 60-74, "Percentage of people adequately screened out of those invited for FOBt screening" were provided by Public Health England (PHE) Screening on request April 2016.
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Bowel cancer screening uptake within 6 months of invitation has fluctuated in England,[1] increased steadily in Scotland and Northern Ireland,[2,3] and overall decreased in Wales (though FY2013/14 showed an increase on the previous year).[4]

Bowel Cancer Screening Uptake, Persons, UK, FY2009/10-FY2013/14

Blank cells indicate no data available.

References

  1. National Cancer Intelligence Network. Cancer Commissioning Toolkit General Practice Profiles. Data for persons aged 60-69, "screened adequately". Accessed April 2016. 
  2. Information Services Division Scotland. Scottish bowel screening programme. Data for two financial years combined e.g. data for FY2014 is from 1st April 2012 to 31st March 2014, persons aged 50-74, "with a final outright screening test result". Accessed April 2016
  3. Public Health Agency Northern Ireland. Northern Ireland Bowel Cancer Screening Programme Inaugural Report. Data for FY2012/13, persons aged 60-69, "with a complete screening test result available [six months after the initial invitation pack is issued]". Belfast: HSCNI; 2014.
  4. Bowel Screening Wales. Bowel Screening Wales Annual Statistical Report 2013-14. Data for FY2013/14, persons aged 60-74, "bowel screening programme received a used test kit within six months following their invitation". Cardiff: Public Health Wales; 2015.
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2-3% of people who have bowel cancer screening in the UK have a definitive positive (abnormal) result, in any given screening round.[1-5]

Positivity rates are slightly higher in first (prevalent) screens than in subsequent (incident) screens.[5,6] There is more time for tumours to develop before the prevalent screen (e.g. any time before that first screening episode) than before the incident screen (e.g. between the previous and current screening episode).

Where the initial faecal occult blood test (FOBT) result is not definitive, a definitive result is sought through either up to two repeat FOBTs (England) or a faecal immunochemical test (FIT) (Wales, Scotland, and Northern Ireland).[7-10]

Around 8 in 10 (79-83%) people who have an abnormal bowel cancer screening result in England or Scotland have a colonoscopy.[1,2] The remainder do not have a colonoscopy either because a specialist screening practitioner decides colonoscopy is not necessary/appropriate, or the screened person fails to book or attend a colonoscopy.[1]

Bowel cancer is found in 12-15% of men and 8% of women who have colonoscopy or other investigation following an abnormal bowel cancer screening result in England and Scotland.[1,2]

Bowel adenomas are found in 48% of men and 35% of women following colonoscopy in England, and up to two-thirds (59% in women and 66% in men) of these are intermediate-risk or high-risk.[1] No abnormality is found in around 24% of men and 38% of women following colonoscopy in England.[1]

References

  1. Logan RF, Patnick J, Nickerson C, et al. Outcomes of the Bowel Cancer Screening Programme (BCSP) in England after the first 1 million tests. Gut 2012:1439-46.
  2. Information Services Division Scotland. Scottish bowel screening programme. Data for two financial years combined e.g. data for FY2014 is from 1st April 2012 to 31st March 2014, persons aged 50-74, "with a final outright screening test result". Accessed April 2016. 
  3. Public Health Agency Northern Ireland. Northern Ireland Bowel Cancer Screening Programme Inaugural Report. Data for FY2012/13, persons aged 60-69, "with a complete screening test result available [six months after the initial invitation pack is issued]". Belfast: HSCNI; 2014.
  4. Bowel Screening Wales. Bowel Screening Wales Annual Statistical Report 2013-14. Data for FY2013/14, persons aged 60-74, "bowel screening programme received a used test kit within six months following their invitation". Cardiff: Public Health Wales; 2015.
  5. England bowel screening data for FY 2014/15, persons aged 60-74, "Percentage of people adequately screened out of those invited for FOBt screening" were provided by Public Health England (PHE) Screening on request April 2016.
  6. NHS Bowel Cancer Screening. Bowel Cancer Screening Programme Eastern Hub. Biennial Report 2012-2013. Nottingham: Nottingham University Hospitals NHS Trust; 2014. 
  7. NHS England. NHS public health functions agreement 2015-16. Service specification no.26, Bowel Cancer Screening Programme. London: NHS England; 2014.
  8. Information Services Division Scotland. Summary of the Key Performance Indicators (KPI's) used to monitor and evaluate the Scottish Bowel Screening Pilot. Edinburgh: ISD Scotland; 2012.
  9. Public Health Agency Northern Ireland. Northern Ireland Bowel Cancer Screening Programme Patient Pathway. Belfast: HSCNI; 2013
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Bowel cancer screening could save around 2,000 lives in the UK per year by 2025, reducing the bowel cancer mortality rate by 12-15% in females and 13-17% in males, it is estimated.[1]

It takes around 10 years before one bowel cancer death is prevented for 1,000 patients screened, a meta-analysis showed.[2]

Bowel cancer 3-year relative survival is higher among people diagnosed via screening than those diagnosed via any other route, data for 2006-2013 show.[3]

For faecal occult blood testing (FOBT), sensitivity (true positive rate) is 6-83%, and specificity (true negative rate) is 65-99%, a systematic review showed.[4] For faecal immunochemical testing (FIT), sensitivity is 5-63% and specificity is 89-99%.[4] Both test types are more sensitive for bowel cancer than for bowel adenoma.[4]

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Cancer Statistics Explained

See information and explanations on terminology used for statistics and reporting of cancer, and the methods used to calculate some of our statistics.

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