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Finding new methods for bowel cancer screening

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Dr Afsana Elanko

Director of Education, British Association of Surgical Oncology, (BASO-The Association for Cancer Surgery) 

Mr Edmund Leung

Consultant Surgical Oncologist, 
International Ambassador, 
BASO-The Association for Cancer Surgery 

Faecal immunochemical testing (FIT) for bowel symptoms reduces need for colonoscopy. 

Incidence of bowel cancer in Europe is estimated to be increasing by about 4% every decade, largely due to a growing and aging population. Early diagnosis is key to cancer cure.  

Despite advances in improved diagnostic imaging, colonoscopy remains gold-standard (very specific in excluding bowel cancer and allows tissue sampling and removal of polyps). However, colonoscopy requires intolerable bowel cleansing, often sedation, time off work and has a risk of bowel injury. Furthermore, waiting times in the public health system are overwhelming, adding worry to patients with symptoms. In the era of the COVID-19 pandemic, the aerosol effect is deemed a significant risk for COVID spread between patients and healthcare workers. 

UK bowel cancer screening programme using FIT 

Not everyone can undergo a colonoscopy. In 2017, the new faecal immunochemical testing (FIT) was introduced. It quantitatively measures blood in stool and colonoscopy is offered only above certain level of positivity. Therefore, it is more sensitive and fewer people are being referred for a colonoscopy. FIT is one stool sample only and comes with a simple collection kit, so it is more acceptable to end-users and has seen a 10% increase in screening uptake compared to the previous faecal occult blood testing. 

The introduction of FIT for symptomatic patients has been welcomed by professionals and patients alike as it potentially avoids the need for colonoscopy.

Patients with bowel symptoms 

There are many conditions accounting for bowel symptoms other than bowel cancer. Healthcare resources remain limited and waiting times are overwhelmed. The introduction of FIT for symptomatic patients has been welcomed by professionals and patients alike as it potentially avoids the need for colonoscopy in >50% of patients.  

Population will continue to grow and live longer. Healthcare spending is unlikely to be able to keep up with increasing demand and health technology cost. Hence, this has been a revolutionary innovation in early prediction of having pre-cancerous polyps and cancer, streamlining and quantitively prioritising the colonoscopy services. 

Innovating for the future 

FIT costs less compared to colonoscopy. It is a safe, acceptable test to patients and easily repeatable. FIT will prove a significant reduction in colonoscopy referrals. Thus, it can also broaden the age range for the asymptomatic screening group. Studies are underway looking into feasibility of FIT as an initial adjunct in family history screening, previous polyp or bowel cancer surveillance and high-risk symptomatic patients. 

The ultimate goal is to achieve an efficient early bowel cancer detection system, thereby improving cancer survival; or early reassurance to those exonerated of bowel cancer. 

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