Intended for healthcare professionals


Too early to introduce colorectal screening, say specialists

BMJ 2000; 320 doi: (Published 20 May 2000) Cite this as: BMJ 2000;320:1361
  1. Annabel Ferriman
  1. BMJ

    Mass screening for colorectal cancer should not be introduced before the results of ongoing clinical trials because of the lack of diagnostic facilities for the investigation of symptoms, a statement from colorectal specialists said this week.

    The statement, issued jointly by the British Society of Gastroenterology (BSG), the Royal College of Physicians (RCP) and the Association of Coloproctology of Great Britain and Ireland, concedes that evidence shows that some form of screening “should substantially reduce the death rate from colorectal cancer.” But it says that the introduction of mass screening should nevertheless be delayed.

    The statement continues: “Mass screening for normal risk individuals should await the results of ongoing trials, particularly the NHS pilot study of occult blood testing and the MRC/NHS trials of flexible sigmoidoscopy.

    “There is already a serious deficiency in the provision of diagnostic facilities for the investigation of symptoms which are suggestive of colorectal cancer.

    “These facilities will be stretched still further by the current and rapidly increasing provision of screening to high risk individuals and the pressure for and likely provision of screening ‘on demand’ to normal risk individuals over the next five to 10 years.”

    The statement, which is published in the June issue of the BMJ specialist journal Gut (2000;46:746-8), advises doctors that those at high risk of bowel cancer should be offered screening by some combination of colonoscopy, flexible sigmoid-oscopy, and barium enema and that such screening should already be available.

    It says: “When individuals at low risk of bowel cancer request screening, they should be informed about the limitations and possible risks of the tests. Occult blood testing should only be offered when there are agreed protocols between primary and secondary care that are backed by the necessary resources for further investigation of individuals with a positive tests.”

    Professor Jonathan Rhodes, professor of medicine at the University of Liverpool and chairman of the joint RCP/BSG specialty committee in gastro-enterology, said: “Screening procedures are relatively unpleasant, and there is probably quite a fine balance between benefit and risk for the average person.

    “Screening [for bowel cancer] is already considered standard in the United States, however, and seems likely to follow here.”

    View Abstract

    Log in

    Log in through your institution


    * For online subscription