Bowel cancer diagnosis and treatment statistics

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

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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, 2014-2015

66% of patients diagnosed with colon cancer and 63% of patients diagnosed with rectal cancer in England during 2013-2014 had surgery to remove their tumour, as part of their primary cancer treatment.[1] This includes patients who had surgery alone, and those who also had other treatments such as radiotherapy or chemotherapy. Surgery not intending to remove the tumour, including biopsies or other palliative surgery, is not included in this figure.

The proportion of colon cancer and rectal cancer patients having surgery to remove their primary tumour is strongly influenced by stage at diagnosis. 

Other factors are also important, such as whether the patient is generally well enough to tolerate the treatment, the patient’s age, and their own treatment preference.

Colon Cancer (C18-C19) and Rectal Cancer (C20), Percentage of Patients Having Surgery to Remove Their Tumour as Part of Their Primary Treatment, Persons, All ages, England, 2013-2014

3% of patients diagnosed with colon cancer and 41% of patients diagnosed with rectal cancer in England during 2013-2014 had curative or palliative radiotherapy, as part of their primary cancer treatment.[1] This includes patients who had radiotherapy alone, and those who also had other treatments such as surgery to remove the tumour, or chemotherapy.

The proportion of colon cancer and rectal cancer patients having radiotherapy is strongly influenced by stage at diagnosis. 

Other factors are also important, such as whether the patient is generally well enough to tolerate the treatment, the patient’s age, and their own treatment preference.

Colon Cancer (C18-C19) and Rectal Cancer (C20), Percentage of Patients Receiving Radiotherapy as Part of Their Primary Treatment, Persons, All ages, England, 2013-2014

31% of patients diagnosed with colon cancer and 42% of patients diagnosed with rectal cancer in England in 2013-2014 had curative or palliative chemotherapy, as part of their primary cancer treatment.[1] This includes patients who had chemotherapy alone, and those who also had other treatments such as tumour removal surgery or radiotherapy.

The proportion of colon cancer and rectal cancer patients having chemotherapy is strongly influenced by stage at diagnosis. 

Other factors are also important, such as whether the patient is generally well enough to tolerate the treatment, the patient’s age, and their own treatment preference.

Colon Cancer (C18-C19) and Rectal Cancer (C20), Percentage of Patients Receiving Chemotherapy as Part of Their Primary Treatment, Persons, All ages, England, 2013-2014

The National Cancer Patient Experience Survey monitors patients’ self-reported satisfaction with each step of the cancer pathway in England, providing information to drive improvements in cancer care.[1] The survey has been conducted annually since 2010.

Overall, most cancer patients in England report positive experiences of cancer care. However patient experience varies along the cancer pathway, and by gender, ethnicity, age, deprivation, and cancer type. Satisfaction scores tend to be higher for experiences with Clinical Nurse Specialists and other hospital staff, and lower for experiences with GPs and general practice staff. Patients who report more positive experiences of cancer diagnosis and treatment tend to be male, white, older, and less deprived.

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

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]

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

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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

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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]

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]