Screening has had a bit of a bad press in recent years. When I was training to be a GP in the late 1980s, health promotion and disease prevention were pretty much confined to 'don't smoke, have your smears and immunise your babies'. These days we have national programmes for checking blood pressure, cholesterol, diabetes, breast andbowel cancer and aortic aneurysm.
But in 2012 new research into breast cancer screening revealed a downside. While the national breast screening programme is estimated to save 1,300 lives a year in the UK, it also results in three times that number being treated unnecessarily for a cancer that would never have done them any harm. Suddenly I was inundated by women having doubts about whether they should take up their invitation for a mammogram. Personally, I feel the benefits far outweigh the risks, and I shall have every mammogram I'm offered. But my answer to my patients is always the same - I can give you the facts, but you need to decide how to weigh those facts up for yourself.
One of the most recent national screening programmes is bowel cancer, offered every two years from 60-74 in England, Wales and Northern Ireland, and from 50-74 in Scotland. Bowel cancer is the second biggest cancer killer in the UK, with someone succumbing to it every half an hour. If everyone invited took up NHS bowel cancer screening, it could cut the number of people dying from bowel cancer by an impressive 16% - that's over 2,000 lives saved a year by 2025. And that's just the start. Currently, only about one in seven people are diagnosed at an early stage, when long-term survival rates are over 90%. But early diagnosis also means less drastic treatment will probably work, so side effects and complications are cut, too.
The downside seems to be that patients are just too embarrassed to take the two tiny samples of three separate poos and send them off in a pre-paid, hygienically sealed envelope. The kit comes with everything you need, and takes only a few minutes. Yet more than two in five people never return their screening test, putting themselves at risk of late diagnosis.
But bowel screening is about to get simpler. After a successful pilot of 40,000 people, Public Health England has just recommended that the new Faecal Immunochemical Test (FIT) test should be rolled out to everyone currently eligible for screening. The new test, like the current one, looks for minute traces of blood. But it only needs a single sample. In the pilot, uptake rates were increased by 10% - meaning up to 200,000 more people screened, and potentially hundreds of lives saved.
Like breast screening, the FIT test will pick up some 'false positives' - people with a borderline or positive result who turn out not to have cancer. But this doesn't mean you'll need major unnecessary surgery; 96% of people will get the all clear, 2% will be asked to repeat the test, and 2% will have a clearly positive result. If this happens to you, you'll be invited for a further test called a colonoscopy, which involves taking strong laxatives to clear your bowel before it's examined with a flexible telescope. It's a simple day case procedure that takes only half an hour or so. Most of these will be told there's no cause for concern.
The independent Cancer Taskforce aims to get 75% of people taking up cancer screening in England by 2020. Further news this week from Jo's Trust that one in three women over 50 don't believe they need a smear makes this target a challenge. But this new test may just give their target a boost - and that means lives saved.
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