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Consultant Laparoscopic Colorectal and General Surgeon

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Bowel cancer screening takes a big step forward

Bowel cancer is one of the most common cancers in the UK. Despite the fact that more than nine out of ten cases can be successfully treated if diagnosed early enough, bowel cancer remains the second biggest cancer killer in both men and women.

Part of the problem is the poor uptake rates for NHS bowel cancer screening. However, a new test that could change all that is now being introduced in England. This has been shown to deliver ‘a markedly increased uptake’ and leading medical experts hope that it will increase early detection rates.

The new bowel cancer screening test

NHS bowel cancer screening is offered every two years to everyone aged between 60 and 74. The testing is done by post, with a kit sent out to the patient for them to prepare test stool samples from the privacy of their own home, returning them for analysis in a package that is provided with the kit.

Up until now, this has involved a test called a guaiac-based faecal occult blood test (gFOBt), which uses two samples from three separate stools. Despite the risks from bowel cancer, the uptake of this test has been relatively low, with an average of just 58% of people returning the test. Responses from men are particularly low.

New test increases both response and cancer detection rates

To try to increase uptake of bowel cancer screening, a new test, called the faecal immunochemical test (FIT) will soon be introduced. With just one stool sample required, this test is much easier to complete.

A study of 40,000 patients found that the simplicity of the FIT produced a 7% increase in overall uptake, and was much more acceptable to patients who had previously failed to respond. The new test also significantly increased the response rate from ‘hard to reach groups’, including most men.

FIT is specific to human haemoglobin, a key constituent of blood. The test can detect haemoglobin at a much lower concentration that the old gFOB test. So not only is the test more likely to be used, it is also able to detect early stage bowel cancers more accurately. In the study, the new FIT doubled the detection rates of all bowel cancers and increased detection of adenomas by as much as 500%.

A game changer for beating bowel cancer

The UK government has now adopted the new bowel cancer screening test and FIT will be rolled out across England in the coming months. The UK National Screening Committee said that they were “keen to see this new improved kit made fully available as soon as possible”.

If the response rates shown in the study are replicated across the country, this will increase the number of tests returned by around 200,000. This is expected to deliver a corresponding increase in early detection and successful treatment, potentially saving hundreds of lives.

Jane Ellison, the Public Health Minister, described the FIT as a “game changer in helping to beat bowel cancer”, while Deborah Alsina, the Chief Executive of Bowel Cancer UK, described it as “an important and crucial step forward in saving more lives”.

The independent Cancer Taskforce predicts that the new test will play a significant role in increasing uptake of bowel cancer screening from the current 58% to much closer to 75% by 2020.