Beating bowel cancer together

NHS release new interim cancer screening review

Today NHS England published the interim report of Professor Sir Mike Richards’ independent review of national cancer screening programmes in England. The review aims to overhaul cancer screening in England as part of the NHS Long Term Plan’s renewed drive to improve cancer care and save lives.

In April we submitted evidence to the review, highlighting the current issues with the Bowel Cancer Screening Programme and made recommendations for immediate and future improvements.

We stressed that in order to improve bowel cancer survival rates, NHS England (NHSE) and Public Health England’s (PHE) top priority must be the implementation of an optimal bowel cancer screening programme, committed to by the Government last year. This involves:

-          Using the simpler, more accurate quantitative faecal immunochemical test (FIT) at a high sensitivity level in order to prevent more bowel cancers from developing or to diagnose bowel cancer earlier when it is more easily treated.

-          Reducing screening age to 50 in line with Scotland and international best practice.  Currently bowel cancer screening is from 60 – 74 in England plus a one off bowel scope test at the age of 55 which hasn’t been fully rolled out yet.

In our response we also highlighted the need to address the shortages in workforce capacity, which are holding back implementation of an optimal bowel cancer screening programme, as well as the governance of the programme and working arrangements between NHS England, Public Health England and the Department of Health. 

We also called for progress to be made on providing targeted screening for people at higher risk of bowel cancer, such as those with Lynch syndrome.

We were therefore delighted to see these points were addressed within Professor Richard’s interim review. 

In response to the interim review, Deborah Alsina MBE, Chief Executive of Bowel Cancer UK said:

“We warmly welcome this interim report from Professor Sir Mike Richards and agree that it is essential that there is a focus on improving uptake of all cancer screening programmes.  Currently uptake of bowel cancer screening in England is 57% but this masks huge variation with the numbers taking part in areas of England being as low as 30%.  We know that screening uptake is lowest in specific groups such as people from black and minority ethnic communities or from more economically deprived communities and clearly this must be addressed so that we do not seen a further widening of health inequalities.

However as Professor Richards highlights we also know that the implementation of the new easier to use and potentially more sensitive Faecal Immunochemical Test (FIT) will help to address this.  Research and a year of use in Scotland as part of the screening programme has proven that it can increase uptake of bowel cancer screening across all socio-economic groups by up to 10% on average.  However its implementation has been significantly delayed in England due to two key factors – the poor governance and working relationships of the arms-length bodies which has caused huge confusion, frustration and delays and so must finally be addressed and also due to a lack of diagnostic workforce. 

The capacity crisis in our diagnostic workforce and the lack of a clear plan to address it also means that when FIT is implemented, it will continue to be used sub-optimally, at a low level of sensitivity, which ultimately means thousands of cancers that could be prevented won’t be and others will simply be missed which is completely unacceptable. It is akin to screening just one breast in breast cancer screening – that wouldn’t be acceptable in that programme so why is it acceptable for bowel cancer? It is therefore essential that these issues are addressed as part of this important review of screening

We also fully support and agree with Professor Richards that it is essential that we develop a clear mechanism for ensuring that people at the highest risk of developing bowel cancer, such as people with Lynch syndrome, receive the screening they require.  Currently, we are too frequently providing the worst service to the people at highest risk and this is surely in contradiction to the NHS aim of diagnosing people earlier so we can save more lives. 

We look forward to working with Professor Richards, NHSE and PHE to shape the final recommendations of the review and to supporting its implementation in due course.”


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