Have large increases in fast track referrals improved bowel cancer outcomes in UK?

Association of Coloproctology of Great Britain and Ireland response to: “Have large increases in fast track referrals improved bowel cancer outcomes in the UK?”

“…Symptomatic FIT testing seems likely to provide a directional change, compared with the previous initiatives described by Thompson and colleagues,1 thus helping to reverse the overwhelming tide of referrals. Ultimately the effect of this intervention in the assessment of people with bowel symptoms will be defined by its ability to improve the stage of diagnosed cancers and create a shift in UK bowel cancer survival from its current lowly position 8…”

“…Thompson and colleagues raise concern that a series of UK Department of Health policies have led to an inexorable rise in referrals of people with bowel symptoms rather than an improvement in survival from colorectal cancer 1. The small percentage of people with serious disease are hidden in this tsunami of referrals, which overwhelms the investigative processes and weakens the ability to improve survival rates.…”

Combining faecal immunochemical testing with blood test results to identify patients with symptoms at risk of colorectal cancer: a consecutive cohort of 16,604 patients tested in primary care

“…Diagnosing colorectal cancer in patients who present to primary care can be challenging because many of the symptoms of colorectal cancer are shared with other, less serious causes. Colonoscopy is the definitive test to diagnose colorectal cancer, but referring all patients with symptoms of possible colorectal cancer for colonoscopy would cause significant strain on health care resources and present unnecessary risks to patients 1 . In 2017, the faecal immunochemical test (FIT) was recommended by the National Institute for Health and Care Excellence (NICE) as a triage test for patients presenting to primary care with low risk symptoms of possible colorectal cancer 2 .…”

Effect of COVID-19 on the detection and management of colorectal cancer in England

“…The effect of the COVID-19 pandemic on referral and diagnostic services has highlighted the previously voiced concerns that the 2WW referral system is, in the context of colorectal cancer, not fit for purpose. 4 Only 3% of such patients are diagnosed with a colorectal cancer; additionally, referrals for colonoscopy because of symptoms exceed referrals through the bowel cancer screening pathway by seven-times, overwhelming endoscopy services. This implies a hugely inefficient way of managing patients with a focus on exclusion and defensive practice at the expense of the actual individual needs of patients.…”