One in five bowel cancer patients are diagnosed in an emergency setting, new National Bowel Cancer Audit finds

A fifth of bowel cancer patients continue to be diagnosed with the disease in A&E or another emergency setting, a new report for England and Wales has revealed.

Emergency patients were much more likely to be diagnosed at an advanced stage of the disease, when it’s more difficult to treat, with just half of these people likely to survive the disease.   

The National Bowel Cancer Audit (NBOCA) annual report also highlights the importance of the national bowel cancer screening programme. 10% of people are diagnosed with bowel cancer in this way, and nine out of ten of these are likely to survive the disease.

The audit report comes on the same day waiting time figures are published by NHS England, showing more than 100,000 patients are waiting for more than six weeks for tests which can diagnose bowel cancer.

Bowel Cancer is the UK’s fourth most common cancer and the second biggest cancer killer. But it doesn’t have to be, as it’s treatable and curable, especially when it’s diagnosed early.

Findings from the NBOCA audit are published annually, measuring and comparing outcomes across diagnosis, treatment, and care for more than 30,000 bowel cancer patients across England and Wales. The audit makes recommendations to health bodies to enable them to understand where variations in care exist across the bowel cancer pathway, and where key improvements can be made. 

The 2020 report – the 11th to date – includes data on patients diagnosed with bowel cancer between 1 April 2018 and 31 March 2019. The data and findings are therefore unaffected by the COVID-19 pandemic.  

The report also found:

• Over half (54%) of people were diagnosed via a GP referral, seven in ten of whom were likely to be cured
• More than a third (36%) of emergency patients were diagnosed with advanced bowel cancer, compared to 22% via their GP and 11% via screening
• Overall, 39% of patients were recorded as presenting with stage 1 or 2 disease (ranging from 24% to 49%)
• Two thirds (67%) of all bowel cancer patients survive beyond two years, a figure which has remained stable since 2014/2015

The NBOCA audit also shines a light on the considerable variation in the use of surgery performed with the intent to cure the patient of cancer. Around a quarter (24%) aged 75 and over are not receiving surgery with a view to being cured, compared to around 95% of those under 75. 

It also found variations in the use of adjuvant chemotherapy – when chemotherapy is offered alongside other treatments, such as surgery – and big geographical differences in the use of keyhole surgery, which is less invasive and tends to have a shorter recovery time (ranging between 38% and 76% in England). 

Testing for Lynch syndrome, an inherited condition which puts people at a much higher risk of developing bowel and some other cancers, was patchy. Only 58% of hospitals, trusts and other healthcare settings offer tests for mismatch repair, which helps identify Lynch syndrome to all bowel cancer patients, in line with NICE guidance. A further 36% were offering testing, but only to particular age groups. Just 13% of all bowel cancer patients had data collected on whether they had been offered this simple test. The report highlighted that data collection on this test is too inconsistent across England and Wales to be able to produce a full picture of Lynch testing in bowel cancer patients. 

Genevieve Edwards, Chief Executive at Bowel Cancer UK, said: “This report provides really important insights, and shines a light on the sad reality that many bowel cancer patients are still being diagnosed as an emergency presentation, when their likelihood of surviving the disease is vastly reduced.

“Bowel cancer is treatable and curable, especially if it’s diagnosed early, which makes these findings all the more heart-breaking. More needs to be done to fully understand why the number of people diagnosed in A&E have remained consistent over a number of years, so this picture can be improved.   

“We can clearly see that bowel screening programmes in England and Wales are by far the best route to early diagnosis, with nine out of ten people diagnosed in this way likely to be cured of the disease. Screening can detect bowel cancer before symptoms appear, so if you’re invited for screening, please do it take part, as it could save your life.”

We’re delighted that NBOCA is now including data on how many people are being offered a test, which can help identify people with Lynch syndrome, when diagnosed with bowel cancer.

Genevieve added: “The lack of testing has been a major concern for us for a number of years, with our Time to Test report showing shockingly low levels of testing across England and Wales. However, it’s hugely disappointing that the report concludes data collection is not yet complete enough to be able to report meaningful results on this testing, which we hope to see in next year’s report.”   

A key ambition in the NHS Long Term Plan for Cancer is that, by 2028, 75% of cancer patients will be diagnosed with stage 1 or 2 disease. The detection of earlier, more treatable cancers is also a key focus of the Cancer Delivery Plan for Wales.