Bowel cancer champions briefing
Priorities for improving patient outcomes in Northern Ireland
About us
We're the UK's leading bowel cancer charity. We're determined to save lives and improve the quality of life of everyone affected by bowel cancer. We support and fund targeted research, provide expert information and support to patients and their families, educate the public and professionals about the disease and campaign for early diagnosis and access to best treatment and care.
Introduction
Bowel cancer is the fourth most common cancer in the UK and is the second biggest cancer killer. More than 1,100 people are diagnosed every year in NI and sadly over 450 die from the disease. The scale of the issue is only growing larger and it's estimated that by 2035 around 332,000 more lives could be lost to the disease in the UK. This shouldn't be the case as bowel cancer is preventable, treatable and curable, especially if diagnosed early. To improve survival rates it's vital that people with bowel cancer are diagnosed early and those at high risk of bowel cancer are effectively identified.
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Key asks
To address these issues the NI Assembly and senior health colleagues must:
- Ring-fence funding for the NI Cancer Strategy in the next mandate. Without funding, the cancer strategy can't realistically be implemented and thus creates a financial drain by continuing the status quo of cancer care for an ever-increasing demand for services
- Reduce the age and sensitivity threshold of the faecal immunochemical test (FIT), rolled out in early 2021 in the Bowel Cancer Screening Programme, committing to action 12 of the recently published NI Cancer Strategy, which says: 'we will ensure that all UK National Screening Committee recommendations are implemented within an agreed timeframe'
- Ensure the endoscopy recommendations in the Elective Care Framework – Restart, Recovery and Redesign are implemented to support the UK National Screening Committee recommendations as highlighted above
Improving early diagnosis
Nearly everyone will survive bowel cancer if diagnosed at the earliest stage. However, only around 15% of people are diagnosed at this early stage. This is due to poor participation in the current screening programme, inadequate diagnostic capacity and a lack of awareness of symptoms.
The Bowel Screening Programme, which currently sends all men and women aged 60-74 (50 in Scotland) a home test kit that looks for traces of blood in poo, every two years, has been shown to be the most effective method of detecting bowel cancer early. Yet just over half of those invited actually take part, meaning opportunities to detect cancer early are being lost.
In Northern Ireland, the new faecal immunochemical test (FIT) test was rolled out in early 2021. This test has the potential to detect twice as many cancers than the previous test. It's proven to significantly increase uptake, particularly for previous non-responders and first-timers, as well as hard to reach groups, such as ethnic and deprived groups.
One of the major advantages of FIT is that it is a quantitative test and so, unlike the previous test the cut-off level, or sensitivity, for detecting blood in poo can be adjusted to make it a more or less accurate at detecting bowel cancer.
It's vital that the NI Assembly, Department of Health and Public Health Agency work together to ensure that time frames for implementing vital improvements to the bowel cancer screening programme are adhered to and that there's sufficient capacity in diagnostic services to deal with the increasing demand.
This must include:
- Lowering the screening age from 60 to 50 as set out in the UK National Screening Committee recommendations
- Urgently addressing how current endoscopy services will cope with improving the sensitivity of the test and lowering the screening age
Barriers to improving early diagnosis: Endoscopy workforce
A colonoscopy and flexible sigmoidoscopy are the key diagnostic tests for bowel cancer. These tests can detect bowel cancer at the earliest stage of the disease when it's more treatable, as well as prevent the disease through the removal of pre-cancerous polyps. However, a lack of capacity to carry out these tests is the root cause for many of the challenges facing the disease right now. It's impacting on initiatives that are vital to ensuring more people are diagnosed with bowel cancer at an earlier stage. With demand for endoscopy services increasing dramatically, units are struggling to keep up. This is resulting in hospitals breaching waiting time targets and could having a detrimental impact on the sustainable reduction of age within the screening programme.
The NI Assembly and Department of Health must address the issues raised regarding staff shortages facing endoscopy units. With many units already struggling to cope, this plan must be fully funded and outline how capacity will be increased to support the implementation of screening from 50.
Personal story
Neil, who is a bowel cancer survivor, says:
I want to live to 100, I want to see my seven grandchildren grow up and so when the bowel cancer screening test came through a few days before my 60th birthday, there was little hesitation to take the test. I didn't have any symptoms and so I was surprised that I was diagnosed with stage one bowel cancer. I'm so pleased I did the screening test as if I had ignored the test it could've been so much worse.
For further information please contact our Operations Manager NI, Sarah Christie, sarah.christie@bowelcanceruk.org.uk
