Presented by Nicola Nye, SSP and Theresa Ayres Lead SSP to Mid Sussex Bowel Cancer Support Group 17th July 2018
The Sussex Bowel Cancer Screening Programme was introduced in 2008 to lower the mortality rate of those people with CRC and bring it in line with the rest of Europe. We serve a screening population of approximately 978,000 people which incorporates two Trusts – Brighton and Sussex University NHS Trust and East Sussex Healthcare NHS Trust. Under the umbrella of Bowel Cancer Screening there are 2 screening Programmes
Bowelscope – once in a life-time Flexible Sigmoidoscopy offered to all those aged 55 years old in our catchment area. This test looks at the left side of the bowel and can remove polyps which means you are less likely to get bowel cancer as we know that 70 -80% of bowel cancers start in this area.
Faecal Occult Blood test (FOBt) – 60-74 year olds
Presently participants complete a home sampling kit called a Faecal Occult Blood test, sending off a sample of faeces to the Screening Hub laboratory in Guildford. The kits are sent out every 2 years and If the sample is positive for a pigment found in blood the participant is offered a clinic appointment with a Specialist Screening Practitioner for review. They are then assessed for suitability for a colonoscopy. In some instances a CT scan of the Colon may be discussed instead.
Colonoscopy is the gold standard procedure offered because it allows us to diagnose and treat certain abnormalities. A colonoscopy will identify 98% of abnormalities whereas a CT scan of the colon is comparable but could mean a colonoscopy is still required to remove any polyps or take tissue samples.
The stool test kits are sent out from a central booking hub in Guildford. At a national level there are plans for the FOBt test to be changed to a more sensitive and specific test namely, the Faecal Immunochemical test (FIT). . The age group offered FIT may be extended to include younger patients possibly from 55 years; this is not confirmed at present.
Due to the more accurate outcomes of FIT and the fact that the home test will be easier to undertake the suggested impact on screening will be an increase in uptake. This will result in more referrals for colonoscopy and increasing support services, in particular the pathology service. The new test will be easier to undertake at home so it is expected that uptake will increase resulting in more of the Sussex population taking up screening with the benefits of early detection of any abnormality.
At present after the age of 74, people can choose to opt in to Bowel Cancer screening by phoning the Guildford programme hub on 0800 7076060 and requesting to be sent out a test kit.
Those diagnosed with bowel cancer within the screening programme who remain within the age range are offered an FOB test 2 years after diagnosis. At this time, they may still be under the care of the cancer services and may choose not to participate in screening at that time; those overage can also request a test kit by phoning the Hub.
We promote awareness of symptomatic changes in health. Sometimes there are no symptoms of bowel cancer in the early stages. We encourage people to report any rectal bleeding, change in the frequency of their bowel habit and any abdominal pain to their GP rather than waiting for the next round of bowel cancer screening. We encourage people to be aware of life style changes that can influence their health and reduce the risk of bowel cancer; Such as stopping smoking, reducing alcohol intake, increasing physical activity and increasing intake of fruit and vegetables.
The Specialist Screening Practitioners have completed extra training to undergo this role, they are qualified senior nurses who also offer support when a patient is first identified with a suspected cancer and who coordinate the progress of the patient from presenting the patient at the Multi-Disciplinary Meeting (MDM), liaising with the Cancer Nurse Specialists, and organising any further investigations or informing the patient of our suspicions.
Some facts and figures from the FOBt programme
In 2017 in the Sussex programme the uptake was 59.55% (uptake is the number of eligible participants who return the FOBt kit)
The positivity in 2017 was 1.18% (positivity is the number of kits testing positive, from all those returned)
In 2017 the Sussex programme undertook the following investigations:-
44 CT colonogram
20 limited colonoscopies /flexible sigmoidoscopies
Cancers detected since the start of the programme in Nov 2008 to date = 558
The BCSP nationally, since inception in 2006 has detected 29,134 cancers to date.
In Sussex since 2008, left sided cancers detected = 453
In Sussex since 2008, right sided cancers detected = 103
Endoscopic 79 – removal of polyp cancers
Non-invasive 49 – includes chemo/radiotherapy
If you have any questions or would like further information please email BCSP@bsuh.nhs.uk