Screening for colorectal cancer

Current situation 

  • Colorectal cancer is amenable to screening due to its prolonged premalignant phase.
  • After the UK Colorectal Cancer Screening Pilot was completed, a national screening programme was due to be rolled out in April 2006.
  • The deadline for the screening programme of April 2006 could not be met as by this time no funding had been provided (BMJ 2006; 332: 742).
  • As part of the programme, people aged 60-69 will perform faecal occult blood (FOB) tests at home every two years.

What is the evidence?

  • The National Screening Committee estimates that the programme could save the lives of around 1,200 people a year in England alone. This represents a reduction of about 9 per cent in the 13,000 annual death toll.
  • In a demonstration pilot, the UK Colorectal Cancer Screening Pilot Group used FOB testing to screen 478,250 people aged 50-69 living in England and Scotland (BMJ 2004; 329: 133). They found that 57 per cent of those invited took part; 1.9 per cent had positive results, and the rate for detecting cancer was 1.62 per 1,000 people screened. The cost of screening was about £5,900 per life year saved. A third of cancers tend to be missed if only FOB tests are used for screening.
  • Contacting patients by telephone improves attendance for screening from 39 per cent to 63 per cent (Ann Int Med 2006; 144: 563-71).
  • Colonoscopic screening for advanced neoplasia has a higher rate of detection in men than in women, according to a recent Polish study (NEJM 2006; 355: 1,863-72).

Implications for practice

  • GPs feel that screening for colorectal cancer will substantially increase their workload (BJGP 2005; 55: 20-5). This is after most practice staff said that they spent less than 2 per cent of their time during the screening period on pilot-related activities.
  • Assuming that 60 per cent of those offered screening take it up, the programme will generate an extra 30,000 colonoscopies in an already overstretched service.
  • Building on a successful pilot programme in the West Midlands, the government plans to roll out the screening in phases to achieve complete coverage of the English population by 2010. Men and women aged 60-69 will be offered screening initially.

Further reading

Dr Louise Newson is a GP in the West Midlands and author of 'Hot Topics for MRCGP and General Practitioners' PasTest 2006

KEY POINTS

  • Colorectal cancer screening will be implemented in the near future.
  • Screening will increase pressure on endoscopy services and is likely to increase GPs' workload.
  • Complete coverage of target UK population should be by 2010.

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