PTU-067 The positive impact of the bowel cancer screening programme on colorectal cancer diagnoses and outcomes

Abstract

Introduction The impact of bowel cancer screening programmes (BCSP) on down-staging colorectal cancer (CRC) at presentation is well established and national screening is largely thought to be a success. Uptake of screening remains less than 60%, screening age has been expanded to ages 60–75 and Bowel Scope screening is being rolled out. Despite BCSP, the number of UK CRC cases has increased by approximately 5% in the last decade. We aim to evaluate the impact of BCSP on the stage of colorectal cancer cases at presentation. Methods Between 2013 & 2016, approximately 700 new cases of CRC were discussed at the colorectal cancer multi-disciplinary team (MDT) meeting at Kettering General Hospital. The BCSP screening practitioners have collated demographic data, CRC stage, engagement with BCSP (at any time including prior FOBt negative return), emergency presentation, and whether surgery was performed open or laparoscopically. 681 cases have had a full dataset collated and analysed, we report on this data. It is noted that elderly patients over 70 may not have received BCSP invite (though are able to opt in), patients under 55 are not eligible for BCSP (a small number of cases). Results In 681 analysed cases, 306 patients (44.9%) had engaged with a BCSP invite (previously and/or at time of diagnosis), 375 had not (55.1%), p ≤0.01. CRC is known to be more common in males and in the BCSP engaged cohort the male to female ratio is 1.9:1. In the non-BCSP engaged cohort, the ratio is 1.2:1, p≤0.0001. In the BCSP cohort, 57.8% of CRC cases were staged as Dukes’ A or B (hence likely to be cured from CRC), in the non-BCSP cohort 55.5% of CRC cases were Dukes’ C or D (likely non-curable/palliative), p≤0.05. In the BCSP cohort, there were 20 CRC presentations via an emergency admission (6.5% of cases), 81 (21.6%) in non-BCSP cohort, p≤0.001. Of the surgeries undertaken, 173 (56.5% of CRC cases) were performed laparoscopically in the BCSP cohort, 167 (44.5%) in the non-BCSP cohort, p≤0.05. Conclusions This data illustrates the protection engagement with BCSP (at any time – even previous FOBt negative returns) confers to the profile of CRC case presentation. CRC cases were significantly fewer from the screened cohort – which were significantly less likely to present as an emergency, significantly more likely to undergo laparoscopic surgery, and significantly more likely to be cured. BCSP appears to protect female patients more than males with a significantly higher proportion of females diagnosed with CRC in the non-screened cohort when compared to the BCSP cohort.