National Bowel Cancer Screening Program Research Articles

Variation in caecal intubation rates between screening and symptomatic patients.

The caecal intubation rate (CIR) is an important quality standard for endoscopists, as well as for national bowel cancer screening programmes; however, individuals undergoing colonoscopy for bowel screening and symptomatic patients represent different groups, and their characteristics may affect colonoscopy performance. To compare colonoscopists' performance, as assessed by the CIR, in symptomatic patients compared to individuals undergoing colonoscopy for bowel cancer screening. Retrospective audit of CIRs for all patients undergoing colonoscopy at our institution during the year 2008. We retrieved the data from an endoscopy reporting software database and from the local bowel cancer screening programme database. Demographic data was extracted, as well as details of known factors that may affect completion of colonoscopy, such as poor bowel preparation, presence of diverticular disease, polyps, tumour and strictures. The unadjusted CIRs for colonoscopists participating in the screening programme were compared between the bowel screening and the symptomatic patient groups. Five screening colonoscopists performed 1056 colonoscopies, of which 488 were bowel screening procedures. The overall CIR was significantly lower in the symptomatic, compared to the screening, individuals (88.5% versus 93%, P < 0.02). No significant differences were observed between the two groups for risk factors that could impair the CIR. The CIR was <90% for two of the five colonoscopists in symptomatic patients, and just under 90% for one colonoscopist in screening individuals. Multivariate analysis revealed that non-screening colonoscopy was an independent predictor for an incomplete procedure (OR 1.8; 95% CI 1.2-2.8). The CIR, a key quality performance indicator for colonoscopy, is lower in symptomatic patients compared to individuals undergoing colorectal cancer screening. These results suggested that CIR should be monitored independently in screening and non-screening colonoscopies.

Novel radiation techniques for rectal cancer.

The concepts for management of rectal cancer have changed drastically over the past few years. Through national bowel cancer screening programmes in the Western countries and the increasing use of endoscopic procedures as diagnostic tool, there is increase in detection of rectal cancer in early stages. There is increase in ageing population worldwide but more so in Western countries. In addition, there is realisation of harm from extirpative surgical procedures which are directed towards managing advanced rectal cancer in the past. Increase in cost of health care burden has also led the investigators to seek alternative treatment options which are effective, safe and cost effective. There are several modern radiation techniques which fits this bill and we need to be aware of newer novel radiation techniques to fulfil this gap.

PWE-060 Polypectomy Practices In The English Bowel Cancer Screening Programme

IntroductionMost polyps are <10 mm in size and a range of polypectomy techniques are available with wide variations in practice. We aimed to examine the techniques employed for removal of...

PWE-052 Bowelscope Screening – The South Of Tyne And Wear Experience

IntroductionThe National Bowel Cancer Screening Programme has been extended to include a one-off flexible sigmoidoscopy (FSIG) to all aged 55, after a large UK study demonstrated reduction in colorectal cancer...

PWE-056 Delivery Of Bowelscope Screening – Experience From The Pilot Sites

IntroductionThe NHS Bowel Cancer Screening Programme (BCSP) is being expanded to include a single flexible sigmoidoscopy (FSIG) called BowelScope, offered to all 55 year olds in addition to biannual faecal...

OC-047 Adenoma Surveillance In The National Nhs Bowel Cancer Screening Programme – Is The High/intermediate Risk Stratification Appropriate?

IntroductionThe NHS Bowel Cancer Screening Programme (BCSP) guidelines advocate surveillance of high and intermediate risk subjects with adenomas, due to the risk of developing future advanced neoplastic lesions. This study...

Impact of bowel cancer screening on the management of colorectal cancer

The National Bowel Cancer Screening Programme (NBCSP) was introduced in the West Midlands in 2006. Studies, including the UK Bowel Cancer Screening Pilot, have reported an 18% reduction in mortality. This regional study assesses the impact of screening on elective and emergency colorectal cancer (CRC) surgery. Data were extracted from the West Midlands cancer registration database for CRC diagnosed in residents of the West Midlands between 1998 and 2010. Screen-detected cancers were identified by matching to the NBCSP database. Mode of admission and intervention was obtained by matching to Hospital Episode Statistics and the classification of Interventions and Procedures code. Of 42,082 patients diagnosed with CRC, 30,309 received surgical treatment. From 1998 to 2005, the number of patients who underwent emergency surgery increased from 4362 to 18,357, with the proportion each year remaining constant (23.85 ± 0.95% each year). In the screening age group (60-69 years) over the same period, emergency surgery was performed in 918 of 4831 patients (19.15 ± 1.65% each year). Following the introduction of screening, the emergency surgery rate decreased each year, reaching 16% (406/2520) in all patients and 12% (101/829) in the screening age group in 2010 (P < 0.001). These changes in emergency surgery were mirrored by increases in elective surgery. The NBCSP has had a positive impact on elective and emergency surgery for CRC in the West Midlands.

Cost-effectiveness of family history-based colorectal cancer screening in Australia.

BackgroundWith 14.234 diagnoses and over 4047 deaths reported in 2007, colorectal cancer (CRC) is the second most common cancer and second most common cause of cancer-related mortality in Australia. The direct treatment cost has recently been estimated to be around AU$1.2 billion for the year 2011, which corresponds to a four-fold increase, compared the cost reported in 2001. Excluding CRCs due to known rare genetic disorders, 20% to 25% of all CRCs occur in a familial aggregation setting due to genetic variants or shared environmental risk factors that are yet to be characterised. A targeted screening strategy addressed to this segment of the population is a potentially valuable tool for reducing the overall burden of CRC.MethodsWe developed a Markov model to assess the cost-effectiveness of three screening strategies offered to people at increased risk due to a strong family history of CRC. The model simulated the evolution of a cohort of 10,000 individuals from age 50 to 90 years. We compared screening with biennial iFOBT, five-yearly colonoscopy and ten-yearly colonoscopy versus the current strategy of the Australian National Bowel Cancer Screening Programme (i.e. base case).ResultsUnder the NBCSP scenario, 6,491 persons developed CRC with an average screening lifetime cost of AU$3,441 per person. In comparison, screening with biennial iFOBT, colonoscopy every ten years, and colonoscopy every five years reduced CRC incidence by 27%, 35% and 60%, and mortality by 15%, 26% and 46% respectively. All three screening strategies had a cost under AU$50,000 per life year gained, which is regarded as the upper limit of acceptable cost-effectiveness in the Australian health system. At AU$12,405 per life year gained and an average lifetime expectancy of 16.084 years, five-yearly colonoscopy screening was the most cost-effective strategy.ConclusionThe model demonstrates that intensive CRC screening strategies targeting people at increased risk would be cost-effective in the Australian context. Our findings provide evidence that substantial health benefits can be generated from risk-based CRC screening at a relatively modest incremental cost.

Changes in cancer patterns from widespread testing - colorectal cancer (CRC) screening

Aim Earlier stage at diagnosis of CRC is now evident. To assess the impact of the National Bowel Cancer Screening Program (NBCSP) on this we undertook a cohort comparison of CRC patient data from the NBCSP register and the South Australian Cancer Registry. Records of those invited to take part in the NBCSP, those who participated in the program, and those with positive test results were compared with those of the rest of the study population. Results Of 3481 eligible patients, 221 had been invited to the NBCSP. Invitees were more likely to have stage A lesions compared with all others (34.8% versus 19.2%; p 0.001), and half as likely to have stage D (5.4% versus 12.4%; p p 0.001). Conclusions CRCs were diagnosed at a significantly earlier stage in people invited to the NBCSP compared with those who were not invited, regardless of participation status or test result.

Missed opportunities in educating Aboriginal Australians about bowel cancer screening: Whose job is it anyway?

Background: A culturally relevant educational flipchart targeting Aboriginal people was distributed across Western Australia to support education on bowel cancer screening and encourage participation in the National Bowel Cancer Screening Program. Methods: Respondents sampled from the flipchart distribution list were surveyed on the appropriateness, usefulness, and the extent to and manner in which they used the flipchart for educating Aboriginal clients. Results: Despite praising the resource, few respondents used the flipchart as intended for various reasons, including the view that Aboriginal health education was the responsibility of Aboriginal health workers. Conclusions: Greater recognition by all health service providers is needed of their potential role in Aboriginal health education. Promoting a national health program of under-appreciated importance for a marginalised population is challenging. Effective utilisation of an educational tool is predicated on factors beyond its production quality and wide dissemination. Intended users require awareness of the underlying problem, and adequate time for and specific training in implementation of the tool.

Impact of the Scottish Bowel Cancer Screening Programme on patient and tumour characteristics at a single centre

The Scottish National Bowel Cancer Screening Programme aims to detect asymptomatic colorectal carcinomas and improve outcomes by identifying tumours at an earlier stage. We describe the characteristics of bowel cancers diagnosed through the screening programme since it was established in June 2007 by comparison with colorectal carcinomas from all other referral sources. All patients with colorectal cancer discussed by our regional colorectal multidisciplinary team (MDT) from June 2007 to August 2011 were included. Patient and tumour characteristics were collated prospectively from MDT records. The database was then reviewed retrospectively. During the study 209 916 (58%) of 364 759 invitations to participate in screening were accepted yielding 3895 (1.9%) positive results. The 255 (17%) screening-detected (SD) patients and 1232 (83%) other referrals (ORs) were discussed at the MDT within this period. Median age at diagnosis was 65.5 years for SD vs. 71.6 in OR (P < 0.001) with 64% vs. 53% male [SD vs. OR (P < 0.001)]. There were more left-sided tumours in SD (P = 0.005). Tumours were less advanced in SD group (P = 0.02) and more likely to undergo a laparoscopic resection (P = 0.003). Thirty (11.7%) of SD patients were dead at last follow-up compared with 458 (37.2%) of those from other sources (P < 0.001). This cohort from a centre with an established screening programme supports the effect of screening in detecting earlier stage. Those with screen-detected tumours were more likely to survive than patients from the OR group.

Management of the malignant colorectal polyp: ACPGBI position statement

*Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK, †Torbay Hospital, Torquay, UK, ‡Department of General Surgery, Manchester Royal Infirmary, Manchester, UK, §Royal Infirmary, Glasgow, UK, ¶Department of Histopathology, Royal Bolton NHS Foundation Trust, Bolton, UK, **Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK, ††The Royal Marsden Hospital, London, UK, ‡‡Salisbury NHS Foundation Trust, Salisbury, UK and §§Department of Histopathology, University Hospital of South Manchester, Manchester, UK

Variations in surgical management from a national bowel cancer screening programme

ObjectivePopulation screening for colorectal cancer (CRC) was introduced to Wales in October 2008. The aim of this study was to evaluate the early impact of screening on CRC services.DesignProspectively collected...

Contact radiotherapy for elderly patients with early low rectal cancers

The National Bowel Cancer Screening Programme hopes to diagnose early bowel cancer. The dilemma is how best to treat it. The standard of care for rectal cancer is surgery, but not all patients are fit or keen to undergo extirpative surgery. A national guideline for the management of screen-detected malignant polyps is urgently needed.

COST-EFFECTIVENESS OF AN ADVANCE NOTIFICATION LETTER TO INCREASE COLORECTAL CANCER SCREENING

The aim of this study is to evaluate the cost-effectiveness of a patient-direct mailed advance notification letter on participants of a National Bowel Cancer Screening Program (NBCSP) in Australia, which was launched in August 2006 and offers free fecal occult blood testing to all Australians turning 50, 55, or 65 years of age in any given year. This study followed a hypothetical cohort of 50-year-old, 55-year-old, and 65-year-old patients undergoing fecal occult blood test (FOBT) screening through a decision analytic Markov model. The intervention compared two strategies: (i) advance letter, NBCSP, and FOBT compared with (ii) NBCSP and FOBT. The main outcome measures were life-years gained (LYG), quality-adjusted life-years (QALYs) gained and incremental cost-effectiveness ratio. An advance notification screening letter would yield an additional 54 per 100,000 colorectal cancer deaths avoided compared with no letter. The estimated cost-effectiveness was $3,976 per LYG and $6,976 per QALY gained. An advance notification letter in the NBCSP may have a significant impact on LYG and cancer deaths avoided. It is cost-effective and offers a feasible strategy that could be rolled out across other screening program at an acceptable cost.

PWE-032 What is the Impact of the Introduction of the NHS Bowel Cancer Screening Programme on the Workload of a Colorectal Surgery Unit at a District General Hospital?

IntroductionA study to assess the impact of the introduction of the National Bowel Cancer Screening Programme (BCSP) on the workload of a colorectal unit in a medium-size general hospital covering...

PWE-003 Colorectal Cancers Arising in Adenomas (“Polyp Cancers”) Discovered and Resected during Bowel Cancer Screening Colonoscopy

IntroductionThe national bowel cancer screening programme (BCSP) was rolled out in 2006. Screening is based on a guaiac FOBt strategy, positive tests are offered colonoscopy. In January 2008 implementation commenced...

OC-055 A Novel Technique for full Thickness Laparoendoscopic Excision of Colonic Lesions: an Experimental Pilot Study

<h3>Introduction</h3> Introduction of a National Bowel Cancer Screening Program in England has resulted in an increasing number of patients diagnosed with endoscopically irresectable colonic polyps. A significant proportion of these patients is referred for hemicolectomy and is subject to a significant risk of morbidity and mortality. Therefore, a less invasive treatment option is required and to address this, we modified a previously reported full thickness laparo-endoscopic excision (FLEX) technique. <h3>Methods</h3> Surgery was performed in five 70-kg pigs. A simulated colonic polyp was created by endoscopic injection of Spot® and the clearance margin delineated by circumferential placement of mucosal argon plasma coagulator (APC) marks. Full thickness eversion of the colonic wall, including the lesion, was achieved by endoscopic placement of prototype BraceBars (BBs). The everted section was excised using a linear laparoscopic stapler placed below the BBs. The first pig was terminated immediately and others were sacrificed 8 days after surgery. <h3>Results</h3> The median procedure duration, defined from placement of mucosal APC marks to specimen excision, was 26 min (range 20–31 min). All excised specimens contained three pairs of BBs, included the APC marks and had a median diameter of 5.1 cm (range 4.5–6.3 cm). Postoperative recovery in survival animals was uneventful. Post-mortem evaluation demonstrated well-healed resection sites with no evidence of intra-abdominal infection or inadvertent organ damage. Endoscopic evaluation of anastomoses at post-mortem demonstrated a widely patent lumen without evidence of stenosis at excision sites. Histological examination of the anastomoses showed primary closure by mucosal abbutal and regeneration, with repair and restoration of submucosal continuity. <h3>Conclusion</h3> This proof-of-concept study has demonstrated the feasibility and safety of a novel full thickness colonic excision technique that is now ready for translation as an alternative to hemicolectomy. The excision size will accommodate most colonic polyps that currently come to surgery. Accurate placement of endoscopic BBs ensures complete excision, reducing the risk of residual disease and recurrence, while laparoscopic overview avoids collateral damage. The ability to preserve mesenteric vasculature and colonic length is likely to result in less morbidity and mortality, better functional outcomes and the approach should reduce treatment costs. <h3>Disclosure of Interest</h3> None Declared

PWE-012 Assessment of Bacterial Diversity in Colorectal Adenomatous Polyps

IntroductionThe human intestinal tract is a complex microbial ecosystem unique to every individual and contributing sufficient metabolic equivalents to be considered an organ in its own right. Dysbiosis is thought...

PTH-069 Does Diverticulosis Protect Against Sigmoid Cancer?

IntroductionWith the advent of the English National Bowel Cancer Screening Programme (BCSP), a higher proportion of left-sided cancers than expected has been documented1. A high incidence of diverticular disease in...