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.

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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

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NHS England action to save lives by catching more cancers early

NHS England announces the scaling up of an innovative scheme that catches lung cancer early by scanning patients, along with new details of a more sensitive bowel cancer test that could save thousands of lives.

NHS England is now funding scanners in other areas as part of a national programme to diagnose cancer earlier, improve the care for those living with cancer and ensure each cancer patient gets the right care for them. This follows the success of the Manchester scanner scheme, where mobile scanners are detecting four out of five cases of lung cancer in the early stages when it is easier to treat. The mobile scanning trucks have picked up one cancer for every 33 patients scanned over the course of a year.

Plans for ‘FIT’, a more sensitive bowel cancer test that could see as many as 1,500 more cancer caught earlier every year have also been confirmed.

‘FIT’ is an easy to use home testing kit which predicts bowel cancer, following the introduction of the test almost a third of a million more people are expected to complete screening. The sensitivity level determines the number of people who should go on for further cancer testing.

 

Cervical screening coverage rates in England fall

This report presents information about the NHS Cervical Screening Programme in England in 2016-17. It includes data on the call and recall system, on screening samples examined by pathology laboratories and on referrals to colposcopy clinics | NHS Digital

Key Facts:

• At 31 March 2017, the percentage of eligible women (aged 25 to 64) who were recorded as screened adequately within the specified period was 72.0 per cent. This compares with 72.7 per cent at 31 March 2016 and 75.4 per cent at 31 March 2012.

• A total of 4.45 million women aged 25 to 64 were invited for screening in 2016-17, representing an increase of 5.6 per cent from 2015-16 when 4.21 million women were invited.

• In total, 3.18 million women aged 25 to 64 years were tested in 2016-17, an increase of 2.9 per cent from 2015-16 when 3.09 million women were tested.

• Of samples submitted by GPs and NHS Community Clinics, 94.8 per cent of test results were returned Negative.

• 8.8 per cent of patients did not attend colposcopy appointments and gave no prior warning.

Full detail at NHS Digital: Cervical Screening Programme, England – 2016-17

Radiation risk with digital mammography in breast screening

This review estimates the risks and benefits of breast screening in terms of deaths due to radiation-induced cancers and lives saved by digital mammography in the NHS Breast Screening Programme in England.

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A radiation risk model, patient dose data and data from national screening statistics were used to estimate the number of deaths due to radiation induced breast cancers in the NHSBSP in England. The breast cancer mortality reduction in the invited population due to screening, and the percentage of women diagnosed with symptomatic breast cancer who die from that cancer, were collated from the literature. The number of lives saved due to screening was calculated.

The main findings are that:

  • the risk of a radiation-induced cancer for a woman attending full field digital mammographic screening (2 views) by the NHSBSP is between 1 in 49,000 to 1 in 98,000 per visit
  • if a woman attends all 7 screening examinations between the ages of 50 to 70, the risk of a radiation-induced cancer is between 1 in 7,000 to 1 in 14,000
  • it is estimated that about 400 to 800 cancers are detected by the NHSBSP for every cancer induced
  • the mortality benefit of screening exceeds the radiation-induced detriment by about 150:1 to 300:1
  • for the small proportion of women with breasts thicker than 90mm who receive higher radiation doses, the benefit will exceed the risk by about 100:1 to 200:1

Full report at Public Health England

Cancer screening: informed consent

Public Health England has updated the Cancer Screening: Informed consent guidelines.

These guidelines give commissioners, providers and healthcare professionals in cancer screening information on consent to screening and procedures.

The document covers information and advice on:

  • breast screening
  • cervical screening
  • bowel cancer screening
  • mental capacity and consent

It also provides several template letters for patients withdrawing from programmes.

Making cervical screening more accessible

Attendance for cervical screening has been falling year on year. This professional resource from Public Health England aims to address this decline in attendance by presenting recommendations that can help increase access to screening and awareness of cervical cancer.

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Download the infographics, references and a shorter version of this publication here

Reducing the socioeconomic gradient in uptake of the NHS bowel cancer screening Programme

The aim of this study was to determine whether a supplementary leaflet providing the ‘gist’ of guaiac-based Faecal Occult Blood test (gFOBt) screening for colorectal cancer could reduce the socioeconomic status (SES) gradient in uptake in the English NHS BCSP | BMC Cancer

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The trial was integrated within routine BCSP operations in November 2012. Using a cluster randomised controlled design all adults aged 59–74 years who were being routinely invited to complete the gFOBt were randomised based on day of invitation. The Index of Multiple Deprivation was used to create SES quintiles. The control group received the standard information booklet (‘SI’). The intervention group received the SI booklet and the Gist leaflet (‘SI + Gist’) which had been designed to help people with lower literacy engage with the invitation. Blinding of hubs was not possible and invited subjects were not made aware of a comparator condition. The primary outcome was the gradient in uptake across IMD quintiles.

In November 2012, 163,525 individuals were allocated to either the ‘SI’ intervention (n = 79,104) or the ‘SI + Gist’ group (n = 84,421). Overall uptake was similar between the intervention and control groups (SI: 57.3% and SI + Gist: 57.6%; OR = 1.02, 95% CI: 0.92–1.13, p = 0.77). Uptake was 42.0% (SI) vs. 43.0% (SI + Gist) in the most deprived quintile and 65.6% vs. 65.8% in the least deprived quintile (interaction p = 0.48). The SES gradient in uptake was similar between the study groups within age, gender, hub and screening round sub-groups.

Providing supplementary simplified information in addition to the standard information booklet did not reduce the SES gradient in uptake in the NHS BCSP. The effectiveness of the Gist leaflet when used alone should be explored in future research.

Full reference: Smith, S.G. et al. (2017) Reducing the socioeconomic gradient in uptake of the NHS bowel cancer screening Programme using a simplified supplementary information leaflet: a cluster-randomised trial. BMC Cancer. 17:543