Colorectal cancer – commonly known as colon cancer, or bowel cancer – is any cancer that affects the last section of the digestive system. This usually means the colon (large bowel) or rectum.
Policy Position:
Bowel cancer screening using testing for faecal occult blood (FOB) should be offered to people in their sixties, with those who are older entitled to request a kit.
This policy was last reviewed in 2009 but no significant changes were made. This policy is currently being reviewed as part of the UK NSC's regular review cycle of all policies.
The UK NSC invited comments and feedback on the expert review.
COMMENTS ON UK NATIONAL SCREENING COMMITTEE
BOWEL CANCER SCREENING USING FLEXIBLE SIGMOIDOSCOPY
The Royal College of Physicians of Edinburgh is pleased to respond to the UK National Screening Committee on Bowel cancer screening using flexible sigmoidoscopy.
Several of our expert Fellows have been consulted, and the overall tenor of the responses has been positive and in favour of this form of screening, although a number of reservations have been expressed. These reservations are principally around equity across social categories, adequate provision of personnel, estate and equipment, and issues which complicate the analysis such as the changing epidemiology of the disease and the effect of the current screening programme using FOB testing and colonoscopy.
Lower social groups are at higher risk of colorectal cancer (CRC) and the current screening programme has found that uptake within these sections of the population has been less than in the higher social categories. It is therefore felt that any further screening initiatives such as flexible sigmoidoscopy (FS) would require significant public education and targeting of those higher risk groups to achieve more effective penetration with the screening test.
It is felt that effective quality assurance and staff accreditation programmes are already in place to ensure that standards are maintained if FS screening was to be implemented. There would, however, be significant demands made upon an already overstretched service and further resource would be essential for the provision of additional personnel, equipment and estate. As nurse endoscopists are already well established in the UK, it is suggested that recruitment of further numbers to this cadre would be the most cost-effective way forward. A vital part of planning this additional resource would be the acknowledgement that some of the positive tests would generate additional surgical, endoscopic, histopathological, radiological and oncological workloads in a national setting where currently there is no spare capacity.
It is noted that FS only picks up around two thirds of CRC, as the remaining tumours are beyond the reach of FS. This proportion of unvisualised tumours may actually be higher, as the number of right-sided tumours has been shown from epidemiological studies to be rising. Lastly, it was observed that a national screening programme within Scotland has now been in place for several years. The cumulative effect of superimposing a second form of screening has not been examined, and this might present an opportunity to formally pilot the additional modality and compare with single screening alone.