Better bowel cancer screens in Scotland

The Scottish approach to bowel cancer screening will be more efficient and better received by patients than that being rolled out in England and Wales, experts say.

Under the Scottish programme, which will be rolled out to all aged 50–74 from June, patients with a weakly positive guaiac faecal occult blood test (FOBT) will undergo the more sensitive faecal immunochemical test (FIT) before colonoscopy.

In England, which began roll-out of its screening programme in April 2006, a weakly positive FOBT is followed by a repeat FOBT. Colonoscopy then follows.

Wales plans to begin roll-out of a similar scheme in April. Northern Ireland is working towards introducing a screening programme in 2009.

Last year, researchers from the Scottish Bowel Cancer Screening Laboratory in Dundee showed that using FIT in this way could reduce the need for colonoscopy by 30 per cent (GP, 13 January 2006).

The latest research showed similar results for a form of FIT that uses a card, rather than a sample tube to collect the samples.

In the study of 558 patients who submitted samples for initial FOBT, the two-tier approach to follow-up had sensitivity of 96 per cent and specificity of 59 per cent.

Lead researcher Professor Callum Fraser said the card is ‘more convenient and more stable’ than the tube method. The samples are stable for up to 30 days, rather than seven or eight days.

Costs will also be halved when postage and packing is taken into account, said Professor Fraser.

Chairman of the Primary Care Society for Gastroenterology Dr Richard Stevens said: ‘Colonoscopy is not without pain for the patient.’

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