What must the new Cancer Plan for England include to change the tide on bowel cancer?

Bowel cancer is the second biggest cancer killer, but it doesn’t need to be if diagnosed early. The Government’s aim of the upcoming Cancer Plan is to reduce the lives lost to cancer. To do this it must address the issues faced by bowel cancer patients.

This new plan presents an important opportunity to transform diagnosis, treatment and care of bowel cancer and make a difference to patients and their loved ones. We want to ensure the plan reflected your needs, so we asked for your input. Thank you so much to the 400 people who replied. You’ve told us that your priorities are:  

• Earlier diagnosis of cancer 

• Improving the access to and quality of cancer treatment, including meeting the cancer waiting time standards 

• Reducing inequalities in cancer incidence, diagnosis and treatment 

To help us understand how to achieve these, we spoke to clinical experts and reviewed further evidence. This helped us produce our set of key asks for the Cancer Plan. 

Preventing more bowel cancers by improving bowel screening  

In the last few years, there have been significant changes to the bowel screening programme. With the age being lowered to 50, millions more people have access to this lifesaving test. This will help detect bowel cancers earlier, even before symptoms begin.

Yet, screening can also prevent bowel cancer from developing, by finding precancerous growths that can be removed. Stopping more bowel cancers from developing, will reduce the demand on bowel cancer services. This means patients who need to be diagnosed and treated, can be seen quickly.  

To do this, the test needs to be made more sensitive. So, this is what we’re calling for. However, this will mean more people needing follow up colonoscopies which the NHS doesn’t have the capacity to deliver. It’s important that the ambitions of the new cancer plan aren’t prevented by issues in capacity or workforce, so these must also be urgently addressed. 

Increasing access to tests and earlier diagnosis by expanding the use of symptomatic FIT 

After a change in guidance in 2023, more people can be given an at-home test (FIT) after speaking to their GP about their symptoms. This test helps to identify those who need to be seen urgently for a colonoscopy to either confirm, or rule out, bowel cancer. However, people are finding it difficult to get an appointment with their GP. This at-home test presents an opportunity to think outside of the box.  

As people can seek medical support and advice through different routes there is potential to offer these at-home tests in pharmacies or through NHS 111 to people who are experiencing bowel cancer symptoms. By unlocking a new way to deliver care it would help widen access for patients. In turn this would reduce demand on GPs and support efforts to increase earlier diagnosis. We’re asking the Government to explore this option. It would first need to be trialled by the NHS to understand how this could be done safely and effectively, before being rolled out across the country.  

Reducing bowel cancer deaths by addressing emergency presentations 

Right now, almost one in five of bowel cancer patients are diagnosed as an emergency when the disease has very likely progressed to late stage, when outcomes are poorer. It isn’t clear why patients end up being diagnosed as an emergency. However, we do know that it doesn’t impact all patients equally, with some groups more likely to be diagnosed as an emergency than others.  

To be able to change this, we’re asking the Government to investigate how and where people are seeking help before they’re diagnosed. Then, solutions can be developed and tested to change things. By tackling emergency presentations, we can reduce inequality in bowel cancer diagnosis and diagnose people sooner. More than this, it would improve the experience of trying to get tested and diagnosed.  

What’s next? 

The new Cancer Plan will set out the direction of policy for the next decade, but we know that the Government and NHS cannot deliver the changes we need to see in bowel cancer diagnosis, treatment and care by themselves.  

This is why we have commissioned research to understand how many more bowel cancers could be prevented with improvements to the screening programme and later in the year we’ll start the work on understanding what we know about emergency presentations.   

You can read our full submission to the Cancer Plan here.