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New bowel cancer screening test is recommended for England

BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i273 (Published 18 January 2016) Cite this as: BMJ 2016;352:i273
  1. Jacqui Wise
  1. 1London

A simpler, more sensitive home screening test for bowel cancer has been recommended for use in the NHS bowel cancer screening programme in England.

The UK National Screening Committee has recommended that the faecal immunochemical test (FIT) should replace the current guaiac faecal occult blood test, as it allows for detection and prevention of more cancers and is easier to use. Last year Scotland committed to adopting FIT, which is also recommended in the European guideline for colorectal cancer screening.

Currently more than 235 000 people in the United Kingdom have bowel cancer, and over 40 000 people get a diagnosis each year. If diagnosed at the earliest stage bowel cancer can be treated successfully, and nine in 10 patients survive for more than five years.

The NHS bowel cancer screening programme offers screening every two years to all people aged 60 to 74. A kit is sent out with instructions for collecting samples at home, which are then sent to a laboratory.

The FIT home screening kit simplifies the sample collection process, as it asks participants for just one bowel motion sample instead of the three needed for the faecal occult blood test. This is expected to improve the uptake of screening. Results from a recent pilot study showed that overall participation using the FIT test was 61%, compared with 50% using the faecal occult blood test.

The FIT test is an immunoassay specifically for human haemoglobin and so can measure very low concentrations of stool blood. It is more sensitive than the faecal occult blood test. Research has shown a twofold increase in detecting colorectal cancer and a fourfold increase in advanced adenomas when compared with faecal occult blood testing.

The announcement was welcomed by Bowel Cancer UK. The charity’s chief executive, Deborah Alsina, said, “The introduction of the new test will save lives—it is proven to be more accurate and easier for people to complete.” However, she added that the government must increase the capacity of colonoscopy services.

“We know that introducing FIT will have an impact on already struggling colonoscopy services as it will increase uptake,” she said. “There is also an opportunity to introduce the test at a more sensitive level so that more cancers can be detected early.

“However, without additional investment in colonoscopy services this opportunity will be lost, and people will continue to die needlessly.”

The National Screening Committee also recommended that testing for human papillomavirus (HPV) should be used as the primary test in the NHS cervical screening programme. This test is currently used as a secondary measure in women needing further investigation after cytology testing.

The Department of Health is expected to make a decision soon about whether to follow the recommendations.

Notes

Cite this as: BMJ 2016;352:i273

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