National Bowel Cancer Screening Program Research Articles

Outcome of 3 year surveillance colonoscopy in patients with intermediate risk adenomas: analysis of the NHS Bowel Cancer Screening Programme National Database

<h3>Introduction</h3> The NHS Bowel Cancer Screening Programme (BCSP) commenced in England in August 2006. Patients are offered colonoscopy if they have a positive FOB test. If a patient is found to have 3 to 4 small (&lt;10 mm) adenomas or 1 to 2 adenomas of which at least one is 10 mm or greater in size, they are defined as being at ‘intermediate risk’ of having advanced adenomas or cancer in the future.1 Such patients are offered a surveillance colonoscopy three years after their screening colonoscopy.2 <h3>Methods</h3> The aim of the study was to assess the findings at, and hence appropriateness of 3-year surveillance colonoscopy for intermediate risk patients. Data regarding each patient entering the screening programme is contemporaneously recorded on the National BCSP database. The database was interrogated for individuals who underwent screening colonoscopy between August 2006 and September 2007 and who were classified as intermediate risk. Details of the endoscopic and histological findings at 3-year surveillance colonoscopy were ascertained. Findings at surveillance colonoscopy were classified according to the BSG Adenoma surveillance guidelines. Patients with incomplete datasets were excluded. <h3>Results</h3> 352 patients underwent 3-year surveillance colonoscopy. This accounts for 10.3% of all patients undergoing screening colonoscopy in that time period. The mean age of patients was 67.1 years. 243/352 (69.0%) were male. At 3-year surveillance, 13 patients (3.7%) were categorized as high risk, 42 (11.9%) intermediate risk, 86 (24.4%) low risk and 202 (57.3%) had normal colonoscopies (i.e., no adenomas detected). No cancers were detected. 9 (2.6%) had incomplete data. <h3>Conclusion</h3> Approximately 40% of intermediate risk patients had one or more adenomas detected. A small proportion of individuals undergoing 3-year surveillance colonoscopy have multiple or large adenomas. In this group, no surveillance cancers were detected. Although the number of individuals in this study is relatively small, these data suggest that the 3-year interval for surveillance may be unnecessary for many intermediate risk individuals. Further work on larger datasets may help identify individuals at high risk of having advanced adenoma at surveillance. This may allow the criteria for determining surveillance interval to be refined.

Getting evidence into policy: The need for deliberative strategies?

Getting evidence into policy is notoriously difficult. In this empirical case study we used document analysis and key informant interviews to explore the Australian federal government’s policy to implement a national bowel cancer screening programme, and the role of evidence in this policy. Our analysis revealed a range of institutional limitations at three levels of national government: within the health department, between government departments, and across the whole of government. These limitations were amplified by the pressures of the 2004 Australian federal election campaign. Traditional knowledge utilisation approaches, which rely principally on voluntarist strategies and focus on the individual, rather than the institutional level, are often insufficient to ensure evidence-based implementation. We propose three alternative models, based on deliberative strategies which have been shown to work in other settings: review of the evidence by a select group of experts whose independence is enshrined in legislation and whose imprimatur is required before policy can proceed; use of an advisory group of experts who consult widely with stakeholders and publish their review findings; or public discussion of the evidence by the media and community groups who act as more direct conduits to the decision-makers than researchers. Such deliberative models could help overcome the limitations on the use of evidence by embedding public review of evidence as the first step in the institutional decision-making processes.

Equity of colorectal cancer screening: which groups have inequitable participation and what can we do about it?

The National Bowel Cancer Screening Program (NBCSP) offers population-based screening for colorectal cancer (CRC) across Australia. The aims of this paper were to highlight the inequities in CRC screening in South Australia (SA) and the system-related barriers and enablers to CRC screening from the perspective of participants identified as having inequitable participation. First, de-identified data for the SA population of the NBCSP were statistically analysed and then mapped. Second, 117 in-depth interviews were conducted with culturally and linguistically diverse (CALD) groups, Indigenous and Anglo-Saxon Australians. Participation rates in the NBCSP were geographically and statistically significantly different (P < 0.0001) on the basis of gender (higher for women), age (higher for older people) and socioeconomic status (higher for more affluent people). The main system-related barriers were the lack of awareness of CRC or CRC screening within these groups, the problems with language due to most of the information being in English and the lack of recommendation by a doctor. This study revealed that inequity exists in the NBCSP participation in SA, and we identified both barriers and facilitators to CRC screening that require action at the level of both policy and practice. There is a large role in primary health care of both recommending CRC screening and facilitating equitable participation.

The national bowel cancer screening programme (BSCP); do the findings of one local screening centre match the predicted national detection rates? – The results of the first 500 screening colonoscopies at Frimley Park Hospital, Surrey

The national bowel cancer screening programme (BSCP); do the findings of one local screening centre match the predicted national detection rates? – The results of the first 500 screening colonoscopies at Frimley Park Hospital, Surrey

Equity of colorectal cancer screening: cross‐sectional analysis of National Bowel Cancer Screening Program data for South Australia

The National Bowel Cancer Screening Program (NBCSP) is a population-based screening program based on a mailed screening invitation and immunochemical faecal occult blood test. Initial published evidence from the NBCSP concurs with international evidence on similar colorectal cancer screening programs about the unequal participation by different population sub-groups. The aim of the paper is to present an analysis of the equity of the NBCSP for South Australia, using the concept of horizontal equity, in order to identify geographical areas and population groups which may benefit from targeted approaches to increase participation rates in colorectal cancer screening. De-identified data from the NBCSP (February 2007 to July 2008) were provided by Medicare Australia. Univariate and multivariate statistical analyses were undertaken in order to identify the predictors of participation rates in the NBCSP. The overall participation rate was 46.1%, although this was statistically significantly different (p<0.001) by gender (42.6% for males and 49.5% for females), socioeconomic status (40% in most deprived quintile through to 48.1% in most affluent quintile) and remoteness (45.6% for metropolitan, 46% for remote and 48.6% for rural areas). These findings were confirmed in multivariate analyses. Of the NBCSP participants, 0.24% (CI 95% 0.20-0.30) identified themselves as Indigenous and 8% (CI 95% 7.7-8.3) reported speaking a language other than English at home. Findings from this study suggest inequities in participation in the NBCSP on the basis of gender, geographical location, Indigenous status and language spoken at home.

Faecal occult blood testing in areas of high incidence and mortality; the effect of screening the population aged 50 to 59

In central Liverpool, the incidence of colorectal cancer (CRC) is 119% of the national average. Currently, screening is offered to those aged 60-70 through the National Bowel Cancer screening programme. A theoretical model showing the effect of the introduction of biennial screening in individuals aged 50-59 has been applied to the population of central Liverpool. The impact of screening using faecal occult blood testing (FOBT) in individuals aged 50-59 in central Liverpool (n = 47,440; males 23,312) was assessed by a model based on three levels of compliance. After modelling, the positive FOBT result for increased incidence of CRC, the positive predictive value for adenoma and cancer detection was calculated using age-specific positivity rates. The results indicate that between 120 and 162 new diagnoses of CRC per 100,000 population aged 50-59 could be detected by biennial screening, dependent on compliance rates. Screening individuals aged 50-59 can identify early cancers and significant adenomas, which may contribute to a reduction in the expected high mortality rate found in this geographical area.

Fifteen years of bowel cancer screening policy in Australia: putting evidence into practice?

Bowel cancer kills over 4000 Australians each year. From the late 1980s to October 2005, research evidence guided the development of bowel cancer screening policy proposals, but political, financial and institutional constraints restricted implementation options. Since 2006, the Australian Government has provided a limited bowel cancer screening program, based on what the government deems it can afford, rather than on evidence of what is required to implement a successful population-based screening program. Even a partial program can be implemented in an evidence-based way, and failure to do so threatens to undermine the potential public health gains of a national bowel cancer screening program. To realise the expected public health gains from a national bowel cancer screening program, bowel cancer screening policy should return to its evidence-based beginnings, starting with an analysis of Australian age-specific cost-effectiveness data.

Australia's national bowel cancer screening program: does it work for indigenous Australians?

BackgroundDespite a lower incidence of bowel cancer overall, Indigenous Australians are more likely to be diagnosed at an advanced stage when prognosis is poor. Bowel cancer screening is an effective means of reducing incidence and mortality from bowel cancer through early identification and prompt treatment. In 2006, Australia began rolling out a population-based National Bowel Cancer Screening Program (NBCSP) using the Faecal Occult Blood Test. Initial evaluation of the program revealed substantial disparities in bowel cancer screening uptake with Indigenous Australians significantly less likely to participate in screening than the non-Indigenous population.This paper critically reviews characteristics of the program which may contribute to the discrepancy in screening uptake, and includes an analysis of organisational, structural, and socio-cultural barriers that play a part in the poorer participation of Indigenous and other disadvantaged and minority groups.MethodsA search was undertaken of peer-reviewed journal articles, government reports, and other grey literature using electronic databases and citation snowballing. Articles were critically evaluated for relevance to themes that addressed the research questions.ResultsThe NBCSP is not reaching many Indigenous Australians in the target group, with factors contributing to sub-optimal participation including how participants are selected, the way the screening kit is distributed, the nature of the test and comprehensiveness of its contents, cultural perceptions of cancer and prevailing low levels of knowledge and awareness of bowel cancer and the importance of screening.ConclusionsOur findings suggest that the population-based approach to implementing bowel cancer screening to the Australian population unintentionally excludes vulnerable minorities, particularly Indigenous and other culturally and linguistically diverse groups. This potentially contributes to exacerbating the already widening disparities in cancer outcomes that exist among Indigenous Australians. Modifications to the program are recommended to facilitate access and participation by Indigenous and other minority populations. Further research is also needed to understand the needs and social and cultural sensitivities of these groups around cancer screening and inform alternative approaches to bowel cancer screening.

The principles of decontamination in gastrointestinal endoscopy

Modern endoscopes can be used to examine the whole of the gastrointestinal (GI) tract. During these examinations, biopsies may be taken, or treatment provided via working channels in the endoscope. Demand for GI endoscopy is increasing because of the National Bowel Cancer Screening Programme and a rise in dyspepsia. Endoscopes are complex and expensive, so are reused. To prevent cross-infection and cross contamination, endoscopes need to be adequately decontaminated between patients; there are specific concerns around transmission of variant Creuztfeldt-Jakob disease. Endoscopes are sensitive to heat and cannot be autoclaved, so other methods of decontamination are needed. This article looks at endoscope decontamination processes, and the systems and management that need to be in place.

Downstaging of colorectal cancer by the national bowel cancer screening programme in England: first round data from the first centre

Data from randomized controlled trials of Colorectal Cancer (CRC) screening in Nottingham, UK and Funen, Denmark and pilot data from the English and Scottish arms of the National Bowel Cancer Screening Programme (NBCSP) have demonstrated predominantly early-stage disease amongst the screened population. The aim of this study was to investigate whether downstaging of cancers occurred in the NBCSP in Wolverhampton. A case-control study was performed to compare the staging of CRC diagnosed in the NBCSP-screened population during the prevalent round (2 years) of screening, with cancers diagnosed prior to the introduction of the NBCSP. The total population in the screening area is 899 000. A total of 108 346 FOB kits were sent out of which 55 931 were returned (51.6% uptake), A total of 1039 colonoscopies were performed with a 94.75% unadjusted caecal intubation rate. There were three complications (haemorrhages 3) and no perforations. The NBCSP in Wolverhampton identified 106 (75% male) CRC in the first 2 years with 45.3% Dukes A, 21.7% B, 29.2% C and 3.8% D. Two hundred and fifty-six (61% male) CRC were identified in the control group, 10.1% Dukes A, 50.0% B, 36.3% C and 3.5% D. There was a highly significant shift towards earlier stage disease in the screened group (P < 0.0001). The 2-year data from the first English centre to start bowel cancer screening demonstrates significant downstaging of cancer, consistent with both the RCT and pilot data.

Beliefs about bowel cancer among the target group for the National Bowel Cancer Screening Program in Australia

To assess awareness of and intentions and self-reported participation in the National Bowel Cancer Screening Program (NBCSP) in Australia and the program's impact on knowledge of and beliefs about bowel cancer. Cross-sectional, computer-assisted telephone surveys of Western Australians aged 55-74 years conducted in April 2007 (n = 505) and June 2008 (n = 500) measured beliefs about the prevalence of bowel cancer, its preventability, impact of early detection on life expectancy, knowledge of the symptoms and tests for bowel cancer, and awareness of and participation in the NBCSP. In 2008, awareness of the Program was 58%. Seventy-seven per cent of those invited to participate in the program agreed to do so. The vast majority believed bowel cancer to be preventable (83%), with early treatment making 'a great deal of difference' to life expectancy (85%). Awareness of blood in faeces as a sign of bowel cancer increased from 64% in 2007 to 75% in 2008 (p<0.01). Awareness of FOBT as a test for bowel cancer increased from 54% in 2007 to 70% in 2008 (p<0.01). The NBCSP appears to have increased knowledge of bowel cancer. Education and screening campaigns are required to further increase perceived prevalence of bowel cancer and to increase knowledge of symptoms and risk factors.

S1394: Comparing Performance Between Screening Colonoscopists of Varying Backgrounds in the National Bowel Cancer Screening Programme: Experience of One UK Tertiary Centre

All UK endoscopists have to undergo a validated endoscopic accreditation process to become bowel cancer screeners. The St. Mark's Bowel Cancer Screening Centre (BCSC) has five accredited screening colonoscopists of varying backgrounds-3 UK trained consultant gastroenterologists, one UK trained consultant nurse endoscopist and a Japanese trained consultant endoscopist.

PTH-016 Prevalence of post-discharge symptoms following colonoscopy and possible causal associations: quality assurance audit with telephone survey in 514 patients

<h3>Introduction</h3> Focus on quality assurance in colonoscopy intensified as a prequel to the launch of the UK National Bowel Cancer Screening Programme. Previous research has examined auditable standards such as caecal intubation rate, adenoma detection and major complications but much less is known about the prevalence of post-discharge symptoms which may be self-limiting and not require readmission or formal medical input. <h3>Aim</h3> To determine the prevalence of post-discharge symptoms in patients that underwent colonoscopy and the possible causal associations. <h3>Methods</h3> As part of our Quality Assurance audit programme, a structured telephone survey was administered to 514 patients who had undergone colonoscopy (with air insufflation) at our University Hospital (July 07–Oct 08). The survey consisted of questions regarding overall experience, procedure comfort, intravenous cannula site problems, and post-discharge symptoms of; bleeding, nausea and vomiting, bloating and pain. Demographics, colonoscopy details and interview responses were collated. Characteristics of a “symptomatic group” (reporting any pain, bloating or n/v) (“SympGp”) were compared with “asymptomatic group” (“AsympGp”) and results expressed as either per cent or mean (SD). <h3>Results</h3> Overall prevalence: IV site symptoms: 6%; PR bleeding: 5.4%; Nausea or Vomiting: 0.6%; Bloating: 11%; Pain: 9.5%. 100 patients (19.5%) reported one or more symptoms of pain, bloating, nausea or vomiting (SympGp). Predictably, SympGp rated their overall experience (1–10 point scale: 10=best score) less favourably (7.5 (2.4) vs 8.1 (2.3), p=0.04) and their comfort during procedure (1–5 scale; 1=best score) was lower (2.4 (1.3) vs 1.9 (1.1), p=0.001). SympGp were more often female (55% vs 43.5%) and were younger (58 vs 64 years, p&lt;0.0001). However, the ASA score, trainee involvement, therapy rates and procedure times were not significantly different from the AsympGp (p&gt;0.05). Midazolam doses used were higher in the SymptGp (2.1 mg (1.3) vs 1.7 mg (1.2), p=0.03), but Fentanyl doses were similar (p=0.18). <h3>Conclusion</h3> Post-discharge symptoms are not uncommon with almost 1:16 experiencing cannula site symptoms, 1:20 bleeding and 1:5 symptoms of nausea/vomiting, pain or bloating. These latter patients had more procedure discomfort and less favourable overall experience despite larger doses of sedation. Younger, female patients were more likely to report post-discharge symptoms but trainee involvement, therapy, IV opiate administration and procedure time had no effect. Given the prevalence of these symptoms, repeating a similar audit using CO2 insufflation would be interesting.

PTH-077 Screening colonoscopy in patients with a family history of colorectal cancer: time to tighten our practice?: Abstract PTH-077

<h3>Introduction</h3> With 18 weeks pathways as the maximum for NHS treatment, pressures on initial diagnostic intervention has increased enormously. Endoscopy is a key part of the gastroenterology service and is the main diagnostic tool for gastrointestinal cancers. At the same time busy units have now embraced the National Bowel cancer Screening programme, providing additional services and high quality through the Global Rating Scale. Increased service levels, and high demand for rapid investigation are focusing minds on efficient effective practice. In our departments we evaluate our practice and screening colonoscopy has been a recent area of analysis. <h3>Methods</h3> We retrospectively interrogated endoscopy databases in two typical district general hospitals. We selected out colonoscopic investigations with a “family history of colorectal cancer” as the only indication. Data on age, polyp detection, cancer detection, and site were recorded. A sampling of approximately 10% of the notes was undertaken to understand the indication, and reason for colonoscopy. These data were scrutinised against the gold standard British Society of Gastroenterology guidelines, and publications leading to this. Our population findings were compared using a χ² statistic. <h3>Results</h3> We analysed 298 colonoscopies, 49 patients (16%) had polyps detected, and 1 patient had a rectal cancer. Age ranged from 15 to 83 years old. 55 polyps were detected, 16 rectal, 23 sigmoid, 2 descending, 3 transverse, 6 ascending, and 5 caecal polyps. Modelling population finding from the BSG guidelines, we would expect a polyp detection rate of 24%. Our findings demonstrate a significantly different outcome, and confirms our practice or population is significantly different from the populations informing the guidelines. (χ² statistic 7.73, 1 degree of freedom, two tailed p=0.005). Twenty-four referral letters were assessed as an indicative sample of criteria leading to colonoscopy. Only 11 (46%) documented family history consistent with strict adherence to BSG guidelines, suggesting at least our practices contribute to the differing outcomes (Abstract 077). <h3>Conclusion</h3> Screening for a family history of bowel cancer detects significant numbers of adenomatous polyps and cancer at an earlier stage than symptomatic referral. In our population pathology was found in 17%, significantly lower than the populations informing current BSG guidelines. Strict adherence to BSG guidelines may reduce the colonoscopy workload by 33%, and free up 25 colonoscopy lists. These finding across 2 separate hospitals may indicate a wider application in other regions.

OC-079 Do patients who failed to attend their first bowel cancer screening clinic visit warrant further follow-up?

<h3>Introduction</h3> The second round of the national bowel cancer screening pilot found that 17% of those with positive faecal occult blood testing did not attend for colonoscopy.1 Some of these individuals may have good reasons for non-attendance (eg, under colonoscopic screening already or electing for private colonoscopy). However, the question remains whether non-attenders harbour the same pathology and need to be pursued. The aim of our study was to assess the incidence of adenomas and cancers in those who did not attend for their first screening clinic visit as part of the Bowel Cancer Screening Programme. <h3>Methods</h3> We prospectively collected data from the Bolton screening area between 1 March 2007 and 30 September 2009. The Bolton Screening Centre (BSC) covers a population of approx 800 000 and started screening in Feb 2007. Those who failed to attend their initial clinic visit were sent a second appointment and we identified the proportion where colonoscopy was indicated and the subsequent incidence of adenoma and cancer. <h3>Results</h3> One hundred and twenty-four thousand and five individuals were invited for stool testing. 67 420 were returned and 1321 were positive with a subsequent invitation to a bowel cancer screening clinic visit. One hundred and ten patients (8.3%) did not attend their initial appointment. In the early stages of the programme some patients were not offered a second appointment. However, ninety-seven were offered a second appointment. Seventy-eight (80%) attended and 60 went on to colonoscopy. Adenomas were identified in 23 individuals (38% of those investigated) and six patients were found to have colourectal cancer (10%). Two cancers were Dukes A, one was Dukes B and two were Dukes C. One patient was not classified because of his poor general health limiting the indication for staging/surgery. The proportion of patients with colourectal cancer was slightly higher in this group than our overall figures (8.6%) but the proportion of patients with adenomas was slightly lower compared to our overall figures (56%). <h3>Conclusion</h3> Although, it might be speculated that non-attenders are self-selecting as those without significant pathology, our data would suggest otherwise. The majority of those offered a second screening visit took up the opportunity. Colonoscopy was indicated in most and the incidence of adenomas and cancer in this group was significant. We conclude that second appointments should be offered to individuals who fail to attend their initial visit as part of the National Bowel Cancer Screening Programme.

The bowel cancer screening programme: Understanding the rationale

The National Bowel Cancer Screening Programme is currently being rolled out across the UK. With 100 people diagnosed with bowel cancer every day (Cancer Research UK, 2009), the screening programme aims to recognize bowel cancer in its early stage in as many people as possible. While there is agreement as to the age group to be screened, pilot studies have shown that the target population has demonstrated some reluctance to undergo testing due to the methods of collecting samples. With April being bowel cancer awareness month, Alison Coutts argues that nurses need to reassure and encourage eligible participants.

PTU-004 Incidental findings in the UK Bowel Cancer Screening Programme

<h3>Introduction</h3> The UK National Bowel Cancer Screening (BCS) Programme aims to identify individuals between the ages of 60 and 70 years at risk for bowel cancer. Those with a positive faecal occult blood test (FOBT) are offered screening colonoscopy. We aimed to quantify and characterise the incidental findings in individuals attending for colonoscopy. <h3>Methods</h3> We audited the St George9s Hospital BCS database from Nov 2006 to Sep 2009. We determined the various incidental findings and symptoms in this cohort. Case notes of patients under local follow-up were reviewed. <h3>Results</h3> 1286 patients have been screened (744 male, 542 female). Colorectal cancer was diagnosed in 128 cases (9.95%). 61 patients had findings other than colonic adenoma or colorectal cancer. 31 individuals (50.8%) were found to have inflammatory bowel disease (IBD) (21 Male, 10 Female). Out of them nine had ulcerative colitis (29%), 11 Crohn9s disease (35.4%) and in 11 cases IBD was of indeterminate subtype (35.4%). Colitis was a pre-existing diagnosis in eight (25.8%) patients, none of who were receiving treatment at the time of colonoscopy. 11 cases of radiation proctitis and one radiation enterocolitis was found (19.6%). All radiation proctitis was due to radiotherapy for prostate cancer and the enterocolitis due to radiotherapy for lymphoma. We identified three cases of neuroendocrine tumours (4.9%) and one granular cell tumour. Three neuroendocrine tumours were found in the rectum and the granular cell tumour in the caecum. We found seven cases of angiodysplasia (11.5%), and their distribution was 2 in rectum, 2 in caecum, 2 in right colon and 1 in transverse colon. Other incidental findings were: 3 solitary rectal ulcer syndrome, 1 Peutz-Jeghers syndrome, 1 threadworm infection, 1 lipoma and 1 case of lymphoid polyp. None of the cases had coexisting colorectal cancer. <h3>Conclusion</h3> The relative risk of having IBD in the BCS cohort is approximately nine times greater than in the background population. The majority of IBD patients seemingly had not been investigated previously. These findings suggest that a small but significant group of patients with IBD remain undiagnosed into the seventh decade of life. Radiation colitis and angiodysplasia are also significant cause of positive FOBT. The risk of neuroendocrine tumour (0.23%) in the BCS cohort is hundred times more than the background population. Our findings suggest there has been, prior to the BCS programme, a significant proportion of Colonic tumours other than colorectal cancer that were not identified.

Initial impact of Australia's National Bowel Cancer Screening Program

To examine the initial impact of the National Bowel Cancer Screening Program (NBCSP), which was launched in May 2006 and offers faecal occult blood testing to Australians aged 55 or 65 years. Review of data on colorectal cancer (CRC) cases diagnosed between May 2006 and June 2008 from a prospective database used at 19 Australian hospitals, linked and analysed by BioGrid Australia. Number of CRC cases detected through the NBCSP or symptomatic presentation, and differences by sex, stage at diagnosis, tumour location and level of socioeconomic disadvantage. 1628 cases of CRC were identified; 1268 had information on the patients' test status as part of the NBCSP, and 40 of these (3.2%) were recorded as being detected by the NBCSP. Of 75 CRC cases in patients aged 55 or 65 at diagnosis, 22 were NBCSP-detected. Overall, there was no difference in NBCSP-detected cases by sex. The distribution of tumour locations was similar between NBCSP-detected cases and symptomatic cases, but NBCSP-detected cancers were diagnosed at an earlier stage than symptomatic cancers (stage I, 40% v 14%; stage IV, 3% v 15%, respectively). Of patients diagnosed through the NBCSP, 63% were from areas of least socioeconomic disadvantage (deciles 8-10) and 18% were from the most disadvantaged areas (deciles 1-4) (P=0.0375). Initiation of the Australian NBCSP has had a measurable impact on CRC stage at diagnosis, and an improvement in survival would be anticipated. The lower uptake among people from disadvantaged areas is of concern.

Faecal immunological test blues: is there a psychiatric morbidity associated with the National Bowel Cancer Screening Program?

Internal Medicine JournalVolume 39, Issue 10 p. 709-709 Faecal immunological test blues: is there a psychiatric morbidity associated with the National Bowel Cancer Screening Program? L. Wigg, L. Wigg Rural and Remote Mental Health Service, Glenside Hospital andSearch for more papers by this authorJ. Chaudary, J. Chaudary Rural and Remote Mental Health Service, Glenside Hospital andSearch for more papers by this authorA. J. Wigg, A. J. Wigg Department of Gastroenterology and Hepatology, Flinders Medical Centre, Adelaide, South Australia, AustraliaSearch for more papers by this author L. Wigg, L. Wigg Rural and Remote Mental Health Service, Glenside Hospital andSearch for more papers by this authorJ. Chaudary, J. Chaudary Rural and Remote Mental Health Service, Glenside Hospital andSearch for more papers by this authorA. J. Wigg, A. J. Wigg Department of Gastroenterology and Hepatology, Flinders Medical Centre, Adelaide, South Australia, AustraliaSearch for more papers by this author First published: 14 October 2009 https://doi.org/10.1111/j.1445-5994.2009.02026.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume39, Issue10October 2009Pages 709-709 RelatedInformation

Making every colonoscopy count: Ensuring quality in endoscopy

The last few years have seen a burgeoning interest in the measurement of clinical performance and its impact on quality standards. The advent of the National Bowel Cancer Screening Program has highlighted the many deficiencies that exist in the provision of colonoscopy services in Australia. These include the absence of an agreed tool to measure the quality of colonoscopy on either an individual, departmental or regional basis and the absence of an endoscopic or colonoscopy training curriculum or an agreed standard for colonoscopy trainers. This review will discuss the current status and shortfalls of measuring quality in colonoscopy, highlight some recent initiatives by the Gastroenterological Society of Australia and articulate a direction for the future.