New risk tool to help GPs decide if patients under 50 have serious bowel condition

The University of Exeter, in partnership with our Never Too Young campaign, Durham University and North Tees and Hartlepool NHS Foundation Trust, today (Tuesday 28 March) publish new research and a risk assessment tool to support GPs to identify the symptoms of a serious bowel condition for patients aged under-50.

This research comes ahead of Bowel Cancer Awareness Month in April.

The assessment tool will calculate the risk of the patient’s bowel symptoms allowing the GP to decide whether they need further tests. This is the first of its kind for younger people and aims to speed up the diagnosis of patients under 50 who often experience significant delays.

Every year in the UK over 2,500 under-50s are diagnosed with bowel cancer, a 45% increase since 2004. Across all ages 13,000 people are diagnosed with inflammatory bowel disease, of which many are under 50, and both of these diagnoses are increasing worldwide, including in the UK.

Symptoms of these conditions are common and account for one in 12 GP appointments, but given that most of the symptoms won’t be caused by cancer, it can be difficult for GPs to determine which patients need further tests. As a consequence young people often face a delay in their diagnosis, reducing their chance of survival significantly.

Nearly 98% of people will survive bowel cancer for five years or more if detected at stage 1 compared with less than one in ten people diagnosed at stage 4. In addition, Bowel Cancer UK research shows that nationally, 3 out of 5 people diagnosed under the age of 50 will be at stages 3 or 4, with a third (34%) being diagnosed in an emergency situation, for example in A&E. This means that many younger people have a lower chance of survival than they should.

The bowel cancer and inflammatory bowel disease risk assessment tool, published in the British Journal of General Practice and funded by the Department of Health, aims to support GPs to determine which patients need further tests by predicting the level of risk depending on the patient’s symptoms. Using symptoms, a physical examination and blood test results, the tool calculates the risk of a serious disease with a percentage, as well as suggesting next steps:

• 3 per cent risk or more: The GP should refer the patient for an urgent colonoscopy (a test to examine the inside of the bowel) or refer the patient to a specialist for further assessment.
• 1-3 per cent risk: The GP should recommend the patient for a faecal calprotectin test (which shows if there is any inflammation in the bowel). This can help rule out a non-serious condition like Irritable bowel syndrome (IBS).
• Less than 1 per cent risk: The GP should monitor the patient’s progress, but at this stage no further tests are needed.

Willie Hamilton, Professor of Primary Care Diagnostics at the University of Exeter Medical School, who led the research says:  “The risk assessment tool should be used as a reminder to GPs to consider the likelihood of an individual patient having a serious bowel condition given the symptom or combination of symptoms they present with. The tool does not replace clinical judgement but provides more information to base a referral decision.”

Deborah Alsina MBE, Chief Executive, Bowel Cancer UK, says: “As the numbers of under-50s affected by bowel cancer and bowel disease continues to rise, research is fundamental in finding better ways to diagnose people early when treatment is likely to be more successful.

“We launched our flagship Never Too Young campaign in 2013 to highlight the experiences of young people for the first time and to improve their diagnosis, treatment and care so that more lives are saved. Delayed diagnosis is all too common for young patients with both bowel cancer and inflammatory bowel disease therefore finding quicker, more effective ways to identify and diagnose these patients earlier is crucial. Our research shows that one in five young patients have to visit their GP five times or more before they get their diagnosis and this is simply not acceptable.  

“This important research has the potential to help GPs to decide which of their young patients need a referral for further tests and which have less serious bowel conditions. However this is just the start, the next step is to ensure that all GPs across the UK have access to this potentially life-saving tool as part of their day to day practice”

Greg Rubin, Professor of General Practice and Primary Care at the School of Medicine, Pharmacy and Health at Durham University, says: “Bowel symptoms are common in younger people and it is crucial to develop tools that help GPs identify those who need to be referred for further investigations. Our findings will support them to do this more effectively.”

Matt Rutter, Professor of Gastroenterology at North Tees and Hartlepool NHS Foundation Trust, says: “We hope that this risk assessment tool will make the journey from GP to referral for younger patients with potentially serious bowel conditions much quicker. At the moment, we know that younger people often have to visit their GP many times before a referral for further tests. This delay is costly to their health, wellbeing and the NHS.”

Deborah James, 35 from South-West London shares her story: “Despite being reassured by my GP on numerous occasions that I must have IBS, haemorrhoids or worse case colitis, my blood tests and stool sample came back ‘normal’ so everything must be fine. And yet I was still losing weight, passing blood, going to the loo what felt like 100 times per day and feeling shattered. I knew there was something wrong with me, a sixth sense if you will.

“I was blind-sided at 7pm on Thursday 15th December 2016, when having refused the sedative and having researched what cancerous tumours would appear like in a colonoscopy, I stared my ugly 5.5cm cancerous, ulcerated tumour in the face. I was diagnosed with Stage 3 bowel cancer.”

• Find out more about our Never Too Young Campaign 
• Learn more about the symptoms of bowel cancer 
• Read the full paper on the British Journal of General Practice website