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Screening for colorectal cancer halves the number of emergency admissions to hospital and postoperative mortality associated with the condition, the five year results from a pilot study in England show.
The pilot tested the feasibility of using faecal occult blood testing by post every two years to screen for bowel cancer in people aged 50-69 years. One of its aims was to determine the effects on the emergency and elective cancer workload at University Hospitals Coventry and Warwickshire NHS Trust, the largest trust in Coventry and north Warwickshire, one of the two regions used in the pilot.
The study compared validated data on admissions to hospital for bowel cancer in the year before screening was introduced (1999) with those for the five years of the screening programme (2000-4) (Gut doi: 10.1136/gut.2007.120253).
The results showed that 1236 new cases of bowel cancer were managed during the study period, equivalent to 200 cases a year. The percentage of all admissions for bowel cancer that were emergency admissions fell from 29.4% in 1999 to 15.8% in 2004 (Pearson correlation −0.98; P=0.001). The number of emergency procedures for bowel cancer fell over the same period (Pearson correlation −0.86; P<0.05), as did the rate of stoma formation (Pearson correlation −0.85; P=0.065).
In the pre-screening year almost half of patients (48%) who underwent emergency surgery died within 30 days of the operation. By 2004, five years into the programme, mortality at 30 days after the operation had fallen to 13% (Pearson correlation −0.84; P<0.05).
The number of Dukes’s type C, or stage III (relatively advanced), bowel cancers halved from 38 in 1999 to 16 in 2004. However, no significant change was shown over the duration of the programme in the proportion of cancers in emergency presentations that were of Dukes’s type C.
The authors of the study, led by Steve Goodyear, of the Clinical Sciences Research Institute at University Hospitals Coventry and Warwickshire NHS Trust, wrote that after the UK bowel cancer screening pilot began there was “a significant decline in emergency colorectal cancer workload, with a marked improvement in 30 day mortality and decreased stoma formation.”
They say that the size of the improvement over a short time period was the result of better detection of asymptomatic malignancies through the screening programme, greater awareness among the public of the symptoms of colorectal cancer, and quicker referrals by GPs in the area.
The authors concluded that screening for bowel cancer is effective, but they noted that take-up of the test fell from 59% in the first round of the pilot to 52% in the second (BMJ 2007;335:1115, 1 Dec doi: 10.1136/bmj.39413.623009.DB).
The government has decided to limit the target age group in the NHS bowel cancer screening programme, which started this year, to people aged 60 to 69 years, rather than 50 to 69, which may reduce the overall effectiveness of the programme, the Coventry group warned.
However, in its new cancer reform strategy the government has announced that it will extend the upper threshold to include those aged 70 to 75 years by 2012 (see News doi: 10.1136/bmj.39420.370046.DB).