The NHS Bowel Cancer Screening Program: current perspectives on strategies for improvement

Abstract

Colorectal cancer (CRC) is the third most common cancer in the UK. The English National Health Service (NHS) Bowel Cancer Screening Program (BCSP) was introduced in 2006 to improve CRC mortality by earlier detection of CRC. It is now offered to patients aged 60–74 years and involves a home-based guaiac fecal occult blood test (gFOBt) biennially, and if positive, patients are offered a colonoscopy. This has been associated with a 15% reduction in mortality. In 2013, an additional arm to BCSP was introduced, Bowelscope. This offers patients aged 55 years a one-off flexible sigmoidoscopy, and if several adenomas are found, the patients are offered a completion colonoscopy. BCSP has been associated with a significant stage shift in CRC diagnosis; however, the uptake of bowel cancer screening remains lower than that for other screening programs. Further work is required to understand the reasons for nonparticipation of patients to ensure optimal uptake. A change of gFOBt kit to the fecal immunochemical tests (FIT) in the English BCSP may further increase patient participation. This, in addition to increased yield of neoplasia and cancers with the FIT kit, is likely to further improve CRC outcomes in the screened population.

Long-term colorectal cancer incidence after adenoma removal and the effects of surveillance on incidence: a multicentre, retrospective, cohort study

“…Our findings suggest that surveillance is warranted for high-risk patients (n=2719) and the higher-risk subgroup of intermediate-risk patients (n=7114) (34% of our cohort), but not for the lower-risk subgroup of intermediate-risk patients (n=4738) or low-risk patients (n=14 401) (66% of our cohort), who could instead be managed by screening. In the BCSP in England, surveillance is recommended for intermediate-risk and high-risk patients only 23. In this setting, numbers of surveillance colonoscopies could be reduced by a third if the lower-risk subgroup of intermediate-risk patients forewent surveillance.…”

Non-Invasive Colorectal Cancer Screening: An Overview

“…To increase detection accuracy, the screening guidelines have shifted from guaiac faecal occult blood test (gFOBT) to faecal immunochemical test (FIT) since April 2018. Moreover, the NHS also offers a one-off flexible sigmoidoscopy at the age of 55 [8].…”

A Fragile Balance: The Important Role of the Intestinal Microbiota in the Prevention and Management of Colorectal Cancer

“…Secondary prevention of CRC is mainly through screening. The main screening test used is colonoscopy, which is the most common screening method, also allowing for the biopsy and excision of polyps [33]. Colonoscopy has improved survival rates drastically and is recommended for adults between the ages of 50 and 75 years [33].…”

“…The main screening test used is colonoscopy, which is the most common screening method, also allowing for the biopsy and excision of polyps [33]. Colonoscopy has improved survival rates drastically and is recommended for adults between the ages of 50 and 75 years [33]. However, colonoscopies can be quite costly, and recent statistical evidence shows that due to the invasive nature of colonoscopies, compliance is quite low, since 50–60% of adults in the USA prefer non-invasive screening tests [11].…”