NHS bowel cancer screening programme
Asymptomatic general population is screened by faecal occult blood testing
Individuals with a normal population risk.
People 60y to 74y are screened every 2 years (to commence at 50y in the near future)
[People >74y can request a screening kit every 2 years by calling 0800 707 60 60]
Faecal occult blood screening test
Faecal immunochemical test (FIT)
If positive, patient undergoes colonoscopy or CT colonography
Note: FIT test is positive in colorectal cancer, colorectal polyps, inflammatory bowel disease and diverticulosis.
Background
FIT tests for faecal occult blood (non-visible blood in faeces).
FIT targets the globing component of haemoglobin, which degrades as it travels through the gastrointestinal tract, so these tests are less likely to detect globin from upper GI bleeding.
FIT replaces previously used guaiac faecal occult blood test, gFOBT.
Use of faecal occult blood testing outside of NHS national screening programme
Low-risk are patients, 50y-60y, without rectal bleeding, who have unexplained bowel symptoms (CIBH, abdominal pain), but do not meet the criteria for a suspected cancer referral pathway.
New development: screening by flexible sigmoidoscopy
People at age 55 undergo one-off bowel scope (flexible sigmoidoscopy or ‘flexisig’)
Targeted Surveillance for high-risk groups
Previously treated for colorectal cancer or colorectal adenomas (polyps)
Inflammatory bowel disease (UC and Crohn’s disease)
Genetic syndromes: familial adenomatous polyposis (FAP), hereditary non-polyposis colon cancer (HNPCC), Juvenile polyposis and Peutz-Jeghers syndrome
Strong family history (first-degree relative developed cancer<50yr)
Acromegaly (increased risk of colon cancer and thyroid cancer)
Current recommendations state that if a patient has a first degree relative with bowel cancer, or one first degree relative with bowel cancer before the age of 50 that they should be screened with a once-only colonoscopy at age 35 years with no follow-up if normal. [SIGN 2011]