Bowel cancer screening

Guidance for providers of bowel scope screening within the NHS Bowel Cancer Screening Programme in England | Public Health England

The UK National Screening Committee recommended the addition of bowel scope screening alongside the existing guaiac faecal occult blood test (gFOBT) following a clinical trial and 11 years of follow-up. These standard operating procedures (SOPs) help commissioners and providers in establishing and implementing bowel scope screening.

Full detail at Public Health England

Aspirin: a cure for bowel cancer?

University of Edinburgh |  June 2018 | Aspirin’s anti-cancer effects revealed

Researchers at the University of Edinburgh have discovered aspirin blocks a key process linked to tumour formation. Although aspirin  is recognised for its ability to reduce an individual’s risk of developing colon cancer-if taken regularly- its tumour fighting properties have been little understood. The team looked at the impact of taking aspirin to fight bowel cancer; focusing on a structure found inside cells called the nucleolus. They tested aspirin tumour biopsies removed from patients with colon cancer, and cells grown in the lab. Their research discovered that aspirin blocks TIF-IA a key molecule essential to the functioning of the nucleolus (via University of Edinburgh).
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Full press release from University of Edinburgh here 

The full article is available to read from Nucleic Acids Research

Chen, J. et al |2018|  Identification of a novel TIF-IA–NF-κB nucleolar stress response pathway| Nucleic Acids Research| gky455| https://doi.org/10.1093/nar/gky455

In the media:

BBC News Aspirin ‘helps block tumour formation’

 

 

 

Bowel Cancer Awareness Month

Bowel Cancer UK  |  Bowel Cancer Awareness Month 2018

April 2018 is bowel cancer  awareness month and Bowel Cancer UK has produced a range of resources to raise awareness. Their mission is to ensure that by 2050, no-one will die of bowel cancer.

Bowel cancer is the UK’s second biggest cancer killer however it shouldn’t be because it is treatable and curable especially if diagnosed early. Nearly everyone diagnosed at the earliest stage will survive bowel cancer but this drops significantly as the disease develops. (Bowel Cancer UK)

Bowel Cancer
Image source: bowelcanceruk.org.uk

The resources including more information about the symptoms of bowel cancer are available at Bowel Cancer UK

 

The poster can be downloaded from Bowel Cancer UK here

 

Related:

NIHR | Three-month course of chemotherapy as effective as six months following surgery for bowel cancer

 

In the media:

BBC News  | Ex-health secretary being treated for bowel cancer

 

Three-month course of chemotherapy as effective as six months following surgery for bowel cancer

NIHR   | March 2018  |Three-month course of chemotherapy as effective as six months following surgery for bowel cancer

NIHR and MRC in partnership  have funded international clinical trial, which has evaluated the effectiveness of a three-month course of adjuvant oxaliplatin/fluoropyrimidine combination chemotherapy for colorectal cancer versus the standard six-month treatment regimen. The trial’s findings indicate that the shorter duration treatment leads to similar survival outcomes with better quality of life for patients and therefore might represent a new standard of care.

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The research team led by the Cancer Research UK Clinical Trials Unit in Glasgow, recruited more than  6,000 patients with high-risk stage II or stage III colorectal cancer from 244 centres across Europe, Australia and New Zealand. The participants in the trial  received either a three or six month course of chemotherapy and were followed up for a minimum of three years.

Three years later, 76.7% of patients who received treatment over three months were disease free compared to 77.1% of patients treated over six months. Patients treated over three months had fewer side effects and reported a better quality of life as well as reduced peripheral neuropathy.

Chief Investigator Dr Tim Iveson, Consultant Medical Oncologist at University Hospital Southampton NHS Foundation Trust and Honorary Associate Professor at the University of Southampton, said: “Bowel cancer is the fourth most common cancer in the UK with 41,000 new cases each year. Bowel cancer can be cured by surgery and chemotherapy. Approximately 2,500 patients per year currently receive up to six months of post-operative chemotherapy. Reducing chemotherapy duration to three months will save the NHS £5000 per patient – a total saving to the NHS of £12.5 million pounds per year.

Dr Iveson added: “The impact on patients is important, as by having a shorter course of chemotherapy patients have fewer side effects.  Based on these results, three months of post-operative chemotherapy should be considered as the new standard care for many patients with bowel cancer.”

The full unedited news item is available from NIHR  here

Summary

Background

6 months of oxaliplatin-containing chemotherapy is usually given as adjuvant treatment for stage 3 colorectal cancer. We investigated whether 3 months of oxaliplatin-containing chemotherapy would be non-inferior to the usual 6 months of treatment.

Methods

The SCOT study was an international, randomised, phase 3, non-inferiority trial done at 244 centres. Patients aged 18 years or older with high-risk stage II and stage III colorectal cancer underwent central randomisation with minimisation for centre, choice of regimen, sex, disease site, N stage, T stage, and the starting dose of capecitabine. Patients were assigned (1:1) to receive 3 months or 6 months of adjuvant oxaliplatin-containing chemotherapy. The chemotherapy regimens could consist of CAPOX (capecitabine and oxaliplatin) or FOLFOX (bolus and infused fluorouracil with oxaliplatin). The regimen was selected before randomisation in accordance with choices of the patient and treating physician. The primary study endpoint was disease-free survival and the non-inferiority margin was a hazard ratio of 1·13. The primary analysis was done in the intention-to-treat population and safety was assessed in patients who started study treatment. This trial is registered with ISRCTN, number ISRCTN59757862, and follow-up is continuing.

Findings

6088 patients underwent randomisation between March 27, 2008, and Nov 29, 2013. The intended treatment was FOLFOX in 1981 patients and CAPOX in 4107 patients. 3044 patients were assigned to 3 month group and 3044 were assigned to 6 month group. Nine patients in the 3 month group and 14 patients in the 6 month group did not consent for their data to be used, leaving 3035 patients in the 3 month group and 3030 patients in the 6 month group for the intention-to-treat analyses. At the cutoff date for analysis, there had been 1482 disease-free survival events, with 740 in the 3 month group and 742 in the 6 month group. 3 year disease-free survival was 76·7% (95% CI 75·1–78·2) for the 3 month group and 77·1% (75·6–78·6) for the 6 month group, giving a hazard ratio of 1·006 (0·909–1·114, test for non-inferiority p equal to 0·012), significantly below the non-inferiority margin. Peripheral neuropathy of grade 2 or worse was more common in the 6 month group (237 [58%] of 409 patients for the subset with safety data) than in the 3 month group (103 [25%] of 420) and was long-lasting and associated with worse quality of life. 1098 serious adverse events were reported (492 reports in the 3 month group and 606 reports in the 6 month group) and 32 treatment-related deaths occurred (16 in each group).

Interpretation

In the whole study population, 3 months of oxaliplatin-containing adjuvant chemotherapy was non-inferior to 6 months of the same therapy for patients with high-risk stage II and stage III colorectal cancer and was associated with reduced toxicity and improved quality of life. Despite the fact the study was underpowered, these data suggest that a shorter duration leads to similar survival outcomes with better quality of life and thus might represent a new standard of care.

Funding

Medical Research Council, Swedish Cancer Society, NETSCC, and Cancer Research UK.

 

Full reference:
Iveson, T. J., et al  |    2018  | 3 versus 6 months of adjuvant oxaliplatin-fluoropyrimidine combination therapy for colorectal cancer (SCOT): an international, randomised, phase 3, non-inferiority trial The Lancet Oncology  |  Vol. 19  | 4 | P.562–78

The full article can be read in The Lancet here

Bowel cancer screening programme: standards

Public Health England | March 2018 | Bowel cancer screening programme: standards 

Public Health England (PHE)  has published screening standards for the NHS bowel cancer screening programme (BCSP). 

Screening standards ensure that stakeholders have access to:

  • reliable and timely information about the quality of the screening programme
  • data at local, regional and national level
  • quality measures across the screening pathway without gaps or duplications

 The most recent standards apply to data collected from 1 April 2018 and replace previous versions.

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The sceening standards can be found at PHE
Bowel cancer screening programme standards valid for data collected from 1 April 2018 can be accessed from PHE 

 

Prevention of bowel cancer

Bowel Cancer UK has published Finding the Key to the Cures: a plan to end bowel cancer by 2050.

Bowel cancer is the UK’s second biggest cancer killer with 16,000 people dying from the disease, and the fourth most common cancer with over 41,200 people diagnosed each year. The key to reducing the numbers of people dying from this condition is early diagnosis. This report examines ways and methods of increasing earlier detection methods which could transform survival rates and ultimately benefit thousands of people in the future.  

Bowel cancer screening

Public Health England is calling on all men and women, aged over 60, to get screened for bowel cancer after the latest figures show over 40% are not getting tested. Embarrassment over providing a stool sample is one of the reasons, among men in particular, behind thousands being unnecessarily at risk of dying.

Bowel cancer screening is offered to all men and women aged 60 to 74, who are sent a home test kit to provide stool samples.  There were over 3,000 bowel cancers diagnosed as a result of screening in 2016 to 2017. In over 90% of these cases, cancers were found at an early stage, where treatment is more likely to be successful.

nhs screening
Image source: http://www.gov.uk

Bowel cancer is the fourth most common cancer in England, but the second leading cause of cancer deaths, with around 13,000 people dying from it every year.

If detected early, bowel cancer is very treatable which is why screening is vital and it has been shown to reduce the risk of dying from bowel cancer by 16%.

The latest NHS Screening Programmes in England annual report details the progress and activities of the NHS population screening programmes.

PHE press release: Men and women asked not to miss out on bowel screening