Change of surveillance guidance for people who have an increased risk of bowel cancer

The British Society of Gastroenterology (BSG), Association of Coloproctology of Great Britain and Ireland (ACPGBI) and the UK Cancer Genetics Group have updated their guidelines to consider the care of people who have a higher risk of bowel cancer, published in GUT journal.

This guidance is for people with an increased risk of bowel cancer, including people who have a genetic condition such as Lynch syndrome or a strong family history of the disease. It also includes, for the first time, recommendations on the surveillance management for people diagnosed under 50.

The guidelines include the use of surveillance or ‘check-up’ colonoscopies. This is one of the main tests that can diagnose bowel cancer. It’s a camera on a thin, flexible cable inserted through the anus to look at different parts of the bowel. The test can also remove polyps, which can lower the risk of bowel cancer. The earlier bowel cancer is detected, the more successful the treatment is and the greater chance of surviving.

If a patient has a higher risk of bowel cancer, the updated guidelines state:

• For people diagnosed with Lynch syndrome: Depending on the type of Lynch syndrome they have (MLH1, MSH2, MSH6 and PMS2) they will be invited to have a colonoscopy every two years from the age of 25 or 35 until they’re 75.
• For people who have a strong family history of bowel cancer: If those with a family history of bowel cancer are deemed high risk they will have a colonoscopy at the age of 40, and then have a repeat colonoscopy every five years until they’re 75. Those at moderate risk will have a single colonoscopy at 55. If they have close to an average lifetime risk of developing bowel cancer, they will be invited to participate in the national bowel cancer screening programme.  
• For patients diagnosed with bowel cancer under 50: They will be invited to have a colonoscopy one year after their diagnosis, then another one two years later, then every five years until they reach screening age (60 in England, Wales and Northern Ireland, and 50 in Scotland).  They will have improved access to genetic testing under the new guidelines, to help rule out inherited conditions which may have led to their diagnosis of cancer.

The updated guidelines also give recommendations about medications, lifestyle advice, surgery and genetic testing. It aims to make ‘check ups’ more personalised for people who have a higher risk of bowel cancer. This will also reduce unnecessary colonoscopies for those who won’t benefit from them, and give better access to better care including specialist care and genetic investigations.

Dr Lisa Wilde, Director of Research and External Affairs at Bowel Cancer UK, says: “Finding better, more personalised ways to prevent bowel cancer developing in the first place is crucial. This is especially important for those who have a much higher risk of a diagnosis, such as those with Lynch syndrome.

“We know that some people with a higher risk of bowel cancer have difficulties accessing ‘check-up’ colonoscopies, we hope these updated guidelines will make this easier for patients.

“These guidelines are being applied retrospectively, therefore for some people this means that their already planned ‘check-up’ colonoscopies will change. If you’ve been affected by these changes, please speak to your GP or medical team.”

• Find out more about the risk factors of bowel cancer
• Read about how you can reduce your risk of the disease
• Learn more about tests that can diagnose bowel cancer