April is Bowel Cancer Awareness Month, which again offers us the opportunity to further publicise all aspects of bowel cancer screening, diagnosis and prevention. It is the UK’s second biggest cancer killer. However, if detected early, this cancer is eminently treatable and curable and almost all people diagnosed at the earliest stages will survive.
The best way to detect cancer early in people without any symptoms is for them to participate in the bowel screening programmes in the four countries of the UK. Further early detection is achieved if any symptoms suggestive of bowel cancer are quickly reported to a general practitioner.
But, first, the bad news. Participation rates in our bowel screening programmes are very low in some parts of the UK and in some groups.
Further, general practitioners are faced with difficult decisions when patients report lower abdominal symptoms: the symptoms of serious bowel disease overlap considerably with those in less serious diseases, so many referrals for invasive and unpleasant examination of the bowel, usually colonoscopy, are made to reach a conclusive diagnosis. The current colonoscopy resource just cannot keep up with the ever-growing demand.
But now, the really good news. 2017 is going to be THE year for major advances in both screening for bowel cancer and for the assessment of patients presenting in primary care.
It has been announced that FIT, faecal immunochemical tests for haemoglobin, will become the first line test in our bowel screening programmes, not only in Scotland, but also in England and Wales. FIT have many advantages in that they are very sensitive for blood in the bowel motions, very specific for colorectal bleeding and not interfered with by dietary constituents. The biggest advantage is that only one small sample of faeces is needed and this is collected in easy to use, hygienic devices. Use of such FIT has been shown to increase uptake considerably in both Scotland and England, especially in the hard to reach groups of younger people, men and the more deprived in our society.
Perhaps more importantly, it has now become very widely appreciated that FIT are excellent diagnostic investigations for people with lower abdominal symptoms. A “negative” test result means that it is unlikely, although not impossible, that serious colorectal disease is present and the patient may not need referral for further investigation. A “positive” test result does not necessarily mean that serious colorectal disease is present, but should stimulate referral for further investigation. In Scotland, efforts to reduce demand on colorectal cancer services are being prioritised, with FIT in assessment of symptomatic patients currently being examined for national roll-out. In England, the National Institute for Health and Care Excellence (NICE) have a guideline in development (GID-DG10005), expected to be published in June 2017, on FIT in primary care. The draft guideline states: FIT are recommended for routine adoption in primary care to guide referral for suspected colorectal cancer in people who have symptoms but are at low risk. Already, the use of FIT in this clinical setting is being established in parts of Scotland and England.
There will undoubtedly be many challenges associated with the introduction of FIT in the very different clinical settings of screening and assessment of the symptomatic. These can surely be solved and the huge advantages of FIT gained through increasing screening uptake and through helping to decide which patients presenting in primary care would benefit most from colonoscopy.
For more information, see:
Bowel Cancer Awareness Month
Bowel cancer is the second biggest cancer killer in Scotland but it is treatable and curable especially if diagnosed early. Taking part in bowel cancer screening is the best way to get diagnosed early which is why the UK’s leading bowel cancer research charity, Bowel Cancer UK, is using Bowel Cancer Awareness Month to focus on screening.
Screening saves lives but at the moment in some areas of the UK only a third of those who receive a test in the post complete it. Thousands of people are missing out on the best way to detect bowel cancer early when it is easier to treat and there is the greatest chance of survival.
“The decision to complete the screening test was the best decision I have ever made in my life. Had I not taken that course of action, there is no doubt in my mind I would not be alive today. Just do it!”
Over 50? Take the test when you receive it in the post. If you are younger, tell the people over 50 in your life, to take the test.
For more information about screening visit http://www.bowelcanceruk.org.uk/screening/.