Update of surveillance guidance for people who have a higher risk of bowel cancer

The British Society of Gastroenterology (BSG) have updated their guidance for endoscopy services during the COVID-19 pandemic for people who have a higher risk of bowel cancer.

This update of the existing guidelines, which were first published in January this year, is for people who have surveillance or 'check up' colonoscopies because of their increased risk of bowel cancer. People who have a higher risk include those who have a genetic condition such as Lynch syndrome, a strong family history of the disease, some people with inflammatory bowel disease and those who have recently finished treatment for bowel cancer.

A colonoscopy is an examination to look at the lining of your large bowel and is the main test for detecting polyps or cancer. A long flexible tube with a bright light and a tiny camera on the end is inserted through the anus to look at different parts of the bowel. Sometimes during the test, polyps can be removed, which can lower the risk of bowel cancer.

The coronavirus pandemic has resulted in delays to surveillance colonoscopy. However, it's vitally important that people are able to access these procedures in order to diagnose bowel cancer early, when it is treatable and curable. Nearly everyone survives bowel cancer if diagnosed at the earliest stage but this drops significantly as the disease develops.

The updated guidelines recommend:

• For patients due surveillance colonoscopy at an interval of less than three years, the colonoscopy should be performed within six months of the original due date
• For patients due surveillance colonoscopy at an interval of three or more years, a surveillance procedure should be performed within 12 months of the original due date. This may include other modes of surveillance other than colonoscopy, if appropriate

The BSG also recommends that the faecal immunochemical test (FIT), which is used in the bowel cancer screening programme, can also be considered for patients on surveillance waiting lists who are overdue. This will help prioritise people who may need a colonoscopy urgently.

Dr Lisa Wilde, Director of Research and External Affairs at Bowel Cancer UK, says: "We know that some people with a higher risk of bowel cancer have difficulties accessing 'check-up' colonoscopies even before the COVID-19 crisis hit. The pandemic has hugely affected many bowel cancer services, including surveillance for those at higher risk.

"While the NHS has worked incredibly hard to keep essential bowel cancer services running throughout the crisis, there is no doubt that bowel cancer patients – and those experiencing symptoms of the disease – have been disproportionately affected by disruptions, and may face poorer outcomes as a result.

"We hope these updated guidelines will make access to surveillance services easier, particularly for those who urgently need it most."

• Find out more about the risk factors of bowel cancer
• Read about how you can reduce your risk of the disease
• Read our blog highlighting the devastating impact of coronavirus on bowel cancer treatment and care in England