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Bowel Scope Screening: modern care of colorectal cancer

Dr Ana Wilson, Mr Lee Dvorkin and Mr Jonathon Wilson are members of The Wellington Hospital GI Unit treating patients with a variety of gastroenterology diseases. Here they present 'Bowel Scope', a new screening initiative to help reduce deaths from colon cancer


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Colorectal cancer (CRC) affects approximately 1 in 18 people in the UK, making it the third most common cancer. In addition to this, statistics show that CRC causes more than 16,000 deaths every year, making it the second leading cause of cancer related mortality. The vast majority of CRCs develop from polyps, which can be removed through a polypectomy. This treatment has been shown to reduce the incidence of CRC by 75-90 per cent.

What are the current screening methods in the UK?

The NHS Bowel Cancer Screening Programme is fully rolled out across England for people aged 60 to 75. Those eligible for screening receive a faecal occult blood test (FOBT) for completion at home, which analyses the patients’ faeces for the presence of blood. The completed kit is then posted back to one of the five screening ‘hubs’ in England, which each have between 5 and 17 screening centres attached to them. Patients with a positive FOBT are invited for a colonoscopy, which is performed by nationally accredited colonoscopists. The aim of colonoscopy is to detect cancers but also to reduce the incidence of colorectal cancer through polypectomy. The test is repeated every two years and the evidence suggests that it reduces the CRC fatality risk by 16 per cent.

What is ‘Bowel Scope’ Screening (BSS)?

A large randomised controlled trial (Atkin et al, 2010*) has shown that a one-off flexible sigmoidoscopy at the age of 55 reduces the incidence of CRC by 33 per cent and mortality by 43 per cent. It is estimated that this BSS would prevent about 3,000 cancers every year. The Department of Health has committed to investing £60 million to incorporate flexible sigmoidoscopy into the current screening programme, and aims to make BSS available to all 55 year olds in England by 2016.

Since March 2013, patients in six endoscopic excellence pilot geographical areas have been invited for BSS around the time of their 55th birthday.

The pilots are run in 6 centres of endoscopic excellence:

• South of Tyne (Queen Elizabeth & South Tyneside)

• West Kent & Medway

• Norwich

• St Marks (London)

• Wolverhampton

• Surrey (Guildford)

What does BSS involve?

The hub invites those who are eligible eight weeks in advance of the appointment date. Once the appointment is confirmed, enemas are posted to patients and should be self-administered an hour before leaving home for their procedure. During the examination itself, patients are offered ‘Entonox’, but not sedation, and the bowel is examined only as far as comfort allows. Polyps smaller than 10mm in size are removed during the examination. The majority of patients will have a normal test and be discharged with reassurance. Almost five per cent of patients will be referred for colonoscopy because of the type or number of polyps found. One in 300 patients will present with colorectal cancer at this stage.

What are the challenges to the implementation of BSS?

Bowel Scope translates into approximately 80 additional flexible sigmoidoscopies and four colonoscopies per week for the regional BSS unit. This large increase in demand clearly requires innovative ways of working, including weekend and evening lists, especially as the majority of invited population will be in full-time employment. All currently accredited screening colonoscopists are automatically accredited for BSS, but there will be a need to further increase the pool of endoscopists to cope with the extra demand. Nurse endoscopists, specialist registrars and allied health care professionals will be allowed to accredit for BSS providing they meet the required key performance indicators (a minimum of 300 flexible sigmoidoscopies or colonoscopies including quality parameters) and have passed the formal assessment. They will also be expected to undertake a minimum of 400 flexible sigmoidoscopies per year.

Currently, the UK falls behind our European neighbours in colorectal cancer survival rates. As these figures show, although there are significant challenges ahead in regards to the successful implementation of BSS, any further reduction in the incidence of colorectal cancer is greatly needed.


Keywords

Bowel Screening, Bowel Cancer, Dr Ana Wilson, Mr Jonathan Wilson, Mr Lee Dvorkin, GI Unit, Polyps, Polypectomy, NHS, Flexible Sigmoidoscopy, BSS, 55 year olds,



Issue
Number:
15
Title:
Bowel Scope Screening
Published:
February 2014
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Contributor/s
Mr Lee Dvorkin

Consultant Colorectal Surgeon

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Mr Jonathan Wilson

Consultant Laparoscopic Colorectal Surgeon

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