Bowel Cancer UK emphasizes issues relating to diagnostic tests for bowel cancer

In response to comments made by Mike Richards at the National Cancer Research Institute

Bowel Cancer UK welcomes the comments made by Mike Richards at the National Cancer Research Institute highlighting the lack of access to diagnostic tests for bowel cancer. Bowel Cancer UK has been campaigning on this issue for some time. The latest report from the charity, “Diagnosing bowel cancer early: right test, right time,” highlights their concerns in more detail.

In particular, Bowel Cancer UK found that:

  • One in five people have to see their GP more than three times before being referred for a crucial diagnostic test for bowel cancer
  • Only half of people diagnosed with bowel cancer present with the ‘high risk’ symptoms that would qualify for an urgent referral
  • There is a stark regional variation in waiting times between providers in England - ranging from 42 per cent people waiting for more than six weeks in Plymouth NHS Trust to 6 per cent of people waiting for a colonoscopy at the North West Hospital Trust. This variation extends to the rest of the UK.
  • Many endoscopy units across the UK do not meet the standards set out by the accreditation body, Joint Advisory Group (JAG)

A colonoscopy or flexible sigmoidoscopy, are key diagnostic tests for bowel cancer. They can detect cancer at the earliest stage of the disease, when it is more treatable, as well as prevent cancer through the removal of polyps.

Between now and 2016/17, the demand for these diagnostic tests is expected to increase dramatically by 350,000, from 1,116,000 in 2013/2014 to 1,482,000 in 2016/17, yet the number of tests being carried out is one of the lowest in Europe with many patients not being seen on time.

Deborah Alsina, Chief Executive of Bowel Cancer UK, said:

In order to meet this predicted increase in demand, it is imperative to increase the capacity of endoscopy units now through greater investment. There is a lack of leadership to address this issue in England. Since the re-structuring of the NHS, the responsibility for endoscopy services seems to fall between all the new bodies and yet it requires a joined up approach which must be addressed urgently.

The current national guidelines for GPs on referral of urgent suspected cancer are restricted to those with ‘alarm’ or ‘high risk’ symptoms, such as rectal bleeding. Yet only half of people diagnosed with bowel cancer present with the ‘high risk’ symptoms that would qualify for an urgent referral.

Deborah Alsina continued:

We are calling for GP guidelines to be liberalised so that GPs can use their judgement and refer patients even when their symptoms do not point directly to bowel cancer. It’s a tragedy that more people are not referred for endoscopy sooner. After all, early diagnosis saves lives.

The picture for patients at higher risk of developing bowel who require regular testing, or “surveillance screening”, is equally alarming.

  • 60 per cent of units in Wales were judged inadequate for surveillance waiting times
  • No units in Scotland received the top level (level A) for timeliness and only 29 per cent of units in Northern Ireland, the majority of units requiring improvement
  • In England 20 per cent of units need to make improvements.

Deborah Alsina commented:

Waiting times for some patients in parts of the UK, such as Wales, are bordering on scandalous. We can’t increase waiting times as many people are already waiting too long, so CCGs need to commission more endoscopy capacity and endoscopy units need to ensure they are running efficiently so they can perform more endoscopies. As we do more endoscopies, it is also vital that quality of service is not compromised in any way, to ensure that people have the right test first time and the test is of the highest quality.

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