To all those using, or planning to use, faecal immunochemical tests for haemoglobin (FIT) in bowel cancer screening programmes, there was some disturbing news last week. In British Columbia (BC), Canada, use of FIT ceased due to a problem with a reagent used in analysis of the samples. On the official website, it is stated that work to resolve this as quickly as possible is underway and the organisers will have a better idea of timing in the next few weeks: however, it could take a number of months for FIT analyses to resume. The details and consequences are very well documented.
I am 71 years old and have enjoyed reasonably good health all my life, although osteoarthritis of the knees and cataracts are now two of the joys of growing older. I have taken part in the Scottish Bowel Screening Programme every two years since the first pilot back in 2000. These are facts. The following story is fictional, but the scenario is likely to become a real conundrum for many in the not too distant future.
On the 7th June 2016, the Westminster Government approved the recommendation of the UK National Screening Committee (UK NSC) to replace the current test used in the NHS Bowel Cancer Screening Programme (BSCP) in England with a newer test, the Faecal Immunochemical Test for haemoglobin (FIT). The Scottish Government had already announced the change from the traditional guaiac-based faecal occult blood test (gFOBT) to FIT on 18th February 2015. The rationale for these advances have been very well documented, as have the many advantages of FIT over gFOBT.
As part of Bowel Cancer Awareness month, we’re running a series of mini-blogs from bowel screening experts from the University of Dundee’s Centre for Research into Cancer Prevention and Screening. Here’s the first instalment, from Professor Callum G. Fraser.
I would like the wider public to be made much more aware of faecal immunochemical tests for haemoglobin (FIT). FIT, which are easy for patients with symptoms to do using single-sample hygienic collection devices, provide inexpensive means to decide whether they have serious colorectal disease or not.
This month SCPN has invited regular SCPN newsletter contributors to tell us about what they have been reading on cancer prevention during 2015. We asked for one paper they thought valuable to share. Professor Callum Fraser has contributed a NICE guideline for your enjoyment.
Title: Suspected cancer: recognition and referral
The media continues to draw considerable attention to individual cases where screening has either been unavailable (e.g. young people with colorectal cancer) or unsuccessful (e.g. cases of colorectal cancer occurring where the screening test has been negative). In addition, there are constant pleas, requests and demands from a number of high-profile individuals and the many charities involved in screening to both broaden the spectrum of programmes available and expand the age range of those invited to participate in currently available programmes.
The many charities involved in increasing public awareness of bowel cancer achieve excellent results. The symptoms of bowel cancer are documented in simple terms, such as: bleeding from your bottom or blood in your poo, a change in bowel habit lasting for three weeks or more, unexplained weight loss or extreme tiredness for no obvious reason and severe abdominal pain. They also suggest that, if concerned about such symptoms, an appointment should be made with the GP. They, and the “Detect Cancer Early” and “Be Clear on Cancer” campaigns, emphasise that getting checked is not a waste of time, particularly because the earlier a bowel cancer is detected, the better the outcome.
Most cancers are detected or suspected in primary care after consultation with a GP. NICE published “Referral guidelines for suspected cancer” (CG27) in 2005. There have been many advances in the last decade and NICE prepared a document on “Suspected cancer: recognition and management of suspected cancer in children, young people and adults” in November 2014. This has been out for consultation and is expected in May 2015.