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New screening tests for bowel and cervical cancer are to be piloted in NHS

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e8455 (Published 12 December 2012) Cite this as: BMJ 2012;345:e8455
  1. Nigel Hawkes
  1. 1London

New cancer screening tests are to be piloted in the NHS in England, the health secretary announced this week at the Britain against Cancer conference in London.

Condemning the variation in outcomes among people who develop bowel cancer, with five year survival from bowel cancer ranging from 68% of patients in the best areas to 40% in the worst, Jeremy Hunt said, “This cannot be right.”

He announced that pilot schemes using flexible sigmoidoscopy to screen for bowel cancer would be launched next March by trusts in five areas of England: Norwich, South of Tyne, northwest London,, Surrey, West Kent, and Wolverhampton. All people aged over 55 would be invited.

Deborah Alsina, chief executive of the charity Bowel Cancer UK, welcomed the announcement. She said, “This simple test can help to prevent bowel cancer from developing and can also help detect cancer at an early stage. Early diagnosis is vital if we are to save lives from bowel cancer. We strongly recommend people take part in the programme when it becomes available in their area.”

Hunt also announced changes to screening for cervical cancer. Some areas will pilot the introduction of tests that detect the presence of human papillomavirus (HPV), the cause of the great majority of cases. Under the existing cervical smear screening programme women over the age of 25 are tested every three years, but the more sensitive HPV test means that screening could take place every 6-10 years.

The test will be piloted in Liverpool, Manchester, northwest London, Bristol, Sheffield, and Norwich. The bowel screening pilot is expected to cost £2m (€2.5m; $3.2m), the HPV pilot £1.2m.

Research published in the British Journal of Cancer earlier this year showed that testing for HPV, followed by a smear test in women who tested positive, was the most effective approach.1 Using this combination approach would mean that only women at the highest risk would be referred for further testing, reducing unnecessary examinations and picking up more serious changes in cervical cells.

Hunt spoke to a sceptical audience, which in a vote earlier in the day had shown little enthusiasm for the changes—three quarters saying that they would not lead to better cancer outcomes, only a quarter that they would. Hunt said that his ambition was to make the country “among the best places in Europe” for treatment of cancer, heart disease, respiratory diseases, and liver disease.

Labour’s shadow health secretary, Andy Burnham, speaking earlier in the day, said that he regretted that the government had failed to build on the progress made by Labour in tackling cancer. “Cancer networks, which were instrumental in driving improvements, now face reduced funding,” he said, citing the responses to a series of freedom of information requests made by the Labour Party.2 More than three quarters of the networks had responded, reporting cuts in spending of around 25% and a loss of 73 staff since 2009.

“What has been a real NHS success story could be an unforgiveable casualty,” he said, challenging Hunt to maintain spending on the networks. Burnham also warned of the lack of clarity over the future commissioning of specialised services and said that it was “shocking” that a quarter of cancers were diagnosed as emergencies.

He called for Hunt to cooperate in three areas: the encouragement of greater physical activity, the introduction of plain packaging of cigarettes, and a food labelling scheme to indicate levels of fats and sugar in foods.

Notes

Cite this as: BMJ 2012;345:e8455

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