Journals Club - Colorectal cancer screening

Dr Louise Newson brings us up to date with the latest research and guidance on colorectal cancer screening.

Rectal adenicarcinoma (Photograph: SPL)

Curriculum statement 5 - Healthy People: promoting health and preventing disease.

Key trials

  • The incidence of colorectal cancer (CRC) has increased in recent decades. Screening for CRC is important because it is a disease with high prevalence, has recognised precursors and early treatment is beneficial (Best Pract Res Clin Gastroenterol 2010; 24: 417-25).
  • One study showed that screening could save up to 2,400 lives every year in the UK by 2025. This means home testing kits could reduce deaths by about 16 per cent (J Med Screen 2008; 15: 163-74).
  • Testing for faecal occult blood and measurement of serum tumour markers, such as carcinoembryonic antigen, are not useful in the investigation of suspected colorectal cancer (BMJ 2007; 335: 715-8).
  • There have been technical advances in stool DNA testing so this may be used for screening in the future (J Clin Gastroenterol 2010 Sep 17. Epub ahead of print).
  • However, the new technologies of stool DNA testing (CT colonography and capsule endoscopy) are not yet cost-effective compared with the established screening (Best Pract Res Clin Gastroenterol 2010; 24: 439-49).

Evidence base

  • National guidelines for patients with IBD recommend that colonoscopic surveillance should begin after eight to 10 years for pancolitis and 15 to 20 years for left-sided disease. (Gut 2002; 51(Suppl V): v10-v12).
  • However, a Cochrane review did not find conclusive evidence that surveillance colonoscopy prolongs survival in patients with colitis (Cochrane Database Syst Rev 2006; (2): CD000279).
  • Following a colonoscopy after screening, about five in 10 people who have a colonoscopy will have a normal result, about four in 10 will be found to have a polyp, which if removed may prevent cancer developing, and about one in 10 people will be found to have cancer (NHS bowel cancer screening programme


Useful websites

Visit the Curriculum Centre for hundreds of  articles linked to key topics in the RCGP curriculum

Key Points
  • Colorectal cancer is common.
  • If bowel cancer is detected at the earliest stage there is more than a 90 per cent chance of survival.
  • Patients with IBD have an increased risk of bowel cancer.
  • Newer tests, for example stool DNA testing, may be introduced in the future.
  • Colorectal cancer screening is effective in the UK.

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins


Already registered?

Sign in

Just published

X-ray sign

Spike in TB cases prompts public health warning

Cases of TB in England have risen by 7% compared with last year, prompting a warning...

COVID-19 vaccine

GPs demand investigation as winter vaccine 'mismanagement' risks patient safety

GP leaders in England have demanded an investigation into 'mismanagement' of this...

Medical centre sign

GP 'engineering' fears as small practice contracts offered on branch-only basis

GP leaders have raised concerns over the 'engineering' of general practice after...

Close up of BMA official picket armband

SAS doctors in England to hold indicative ballot on strike action

Specialist, associate specialist and specialty (SAS) doctors in England could join...

BMA sign

BMA to oppose expansion of physician associate roles amid safety concerns

Doctors' leaders will oppose government plans to expand use of physician associates...

Doctor strikes

Public strongly back talks and new pay offer to end doctor strikes

The general public believe the government should reopen talks to end doctor strikes...