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Friday, November 30, 2007

Screening for Bowel Cancer halves emergencies and cuts deaths

Fifth year results from a UK study shows that bowel cancer screening halved emergency hospital admissions due to the disease and significantly cut death rates in Coventry and North Warwickshire, one of the UK's first pilot sites.

The study is the work of Steve Goodyear, Clinical Sciences Research Institute, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, and colleagues, and will be published online ahead of print in the BMJ journal Gut in the next few days.

The scope of the study covers Coventry and Warwickshire in the Midlands, the only UK region to pilot the feasibility of using a home screening kit to collect and post fecal occult blood test samples from subjects aged 50 to 69.

A fecal occult blood test looks for blood in the stool, a prime indicator of cancerous and pre-cancerous changes in the gut.

Bowel cancer is the second leading cause of cancer deaths in the UK, where it kills more than 16,000 people a year and estimates from Cancer Research UK show one in 20 people is likely to get it.

187,777 individuals aged 50-69 years, who were registered with a general practitioner (GP) in the Coventry and Warwickshire region were asked to collect and post stool samples twice a year using a home screening kit. The study has recently finished its third round of screening in advance of the roll out at national level.

Nearly 57 per cent of invited participants completed the first round of screening tests. Those whose results tested positive (1.9 per cent) were invited to a pre-assessment for colonoscopy. In the first 2 years of the study, about 1,700 colonoscopies were carried out as a result of a positive fecal occult blood test from the home kit.

In the first round, the overall detection rate for colorectal cancer was 1.62 per 1,000 screening colonoscopies. Figures for the second round were comparable, uptake was 52 per cent, positive tests were found 1.8 per cent of 127,746 participants, around 1,000 screening colonoscopies were performed, with an overall colorectal cancer detection rate of 0.94 per 1000.

The researchers also traced the emergency admissions and deaths within 30 days due to bowel cancer between 1999 and 2004 in the largest Midlands hospital trust that serves the region where the pilot screening was being carried out. In that time 1,236 new bowel cancer cases were diagnosed, or around 200 a year. This is in line with national incidence rates, as estimated by Cancer Research UK, said the researchers.

The figures showed that in 1999, a year before the postal testing system was introduced, nearly 30 per cent of bowel cancer patients had to be admitted to hospital as an emergency case. But by 2004, this figure had dropped to just under 16 per cent.

This drop in emergency bowel cancer cases led to a 50 per cent reduction in emergency operations and a fall in deaths within 30 days from 48 per cent in 1999 to 13 per cent in 2004.

The number of stage 3 or Dukes C (relatively advanced) bowel cancers also went down from 38 in 1999 to 16 in 2004, although the same proportion still required emergency care, said the researchers.

The researchers concluded that while bowel cancer screening was proved to be effective, the take up rate of the home kit test by those who should be screened regularly appears to be falling.

They also warned that by reducing the target group to those aged between 60 and 69 (the pilot covered 50 to 69), the national plan when rolled out may not be as effective as people might hope.

All patients and family doctors should be aware of the benefits of screening said the authors.

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