Bowel cancer is the second most common cause of cancer deaths in the United Kingdom. Research has shown that screening for bowel cancer can help reduce death rates by finding and treating bowel cancer early. It is predicted that deaths from bowel cancer could drop by 15% as a result of screening. Nationally, screening for bowel cancer could save approximately 1200 lives each year (33).
Research looking at screening for colorectal cancer has demonstrated that guaiac-based testing of faecal occult blood is the only screening test that has been shown to be effective in reducing mortality for colorectal cancer. The most important studies for the UK were those carried out in Nottingham and Denmark which showed reductions in death from colorectal cancer of 15% and 18% respectively after screening (34, 35).
As a result the national screening committee carried out a pilot study to test the feasibility of a national screening programme for colorectal cancer. The rate for detecting cancer was 1.62 per 1000 people screened. This was higher in Scotland than in England, higher in men than women and increased with age. In conclusion, screening for colorectal cancer by faecal occult blood testing was found to be feasible within the UK (36).
UK bowel cancer screening programme
Following the pilot screening programme the national screening programme for colorectal cancer will start in 2006. The first local screening centre will be in Wolverhampton. It is expected that 14 local screening centres will be operating by March 2007 (out of a total of 90 to 100 for full national coverage). Participants in the trial will be sent 3 faecal occult blood testing kits. If the tests are positive, people will be invited to attend for colonoscopy.
Cancerbackup is working closely with the NHS bowel screening programme to produce information for patients about faecal occult blood testing and on information for those who are referred for a colonoscopy.
Screening in people at higher risk of bowel cancer
People who have had bowel cancer have a 5% risk of developing a second primary cancer of the colon and so do need surveillance. Scolefield and Steel recommend a colonoscopy five years after surgery and thereafter at five yearly intervals up to the age of 70 years (37).
There are two rare genetic conditions that can significantly increase a person's risk of developing bowel cancer: familial adenomatous polyposis (FAP) and hereditary non- polyposis colorectal cancer (HNPCC). Family members should see a clinical geneticist to determine their risk of developing cancer and have appropriate screening arranged.
Some bowel diseases (eg ulcerative colitis, Crohn's disease) can lead to an increased risk of developing bowel cancer. People with these conditions can discuss with their specialist what screening programme would be suitable for their individual situation.