Bowel cancer screening programme (BSCP); a service for the asymptomatic or a pathway acting as a safety net?

Introduction

Colorectal cancer (CRC) is the fourth most common cancer in the UK. The Bowel Cancer Screening Programme (BCSP) was designed to screen an asymptomatic middle-aged population to reduce the incidence and mortality rates from CRC. Whilst the programme is considered a success, approximately 40% of those diagnosed with CRC are still found to have advanced disease which is non-curable. When informing patients of a CRC at diagnosis, it is not uncommon to hear that they have had symptoms for many months. We aim to evaluate the proportion of patients who attend BCSP, who have symptoms suggestive of CRC.

Methods

In this retrospective study, data from patients who took part in the Northamptonshire BCSP between 2015–2021 were collected from the Exeter reporting database and analysed. The endoscopy findings of each participant were collated and categorised as: CRC, large colorectal adenomas (>10 mm in size); small colorectal adenomas (<10 mm in size); or normal (non-adenoma/non-CRC) studies. Data on symptoms recorded at pre-endoscopy assessments for patients attending for BCSP were analysed. Symptoms were also sub-classified using current cancer two week wait pathway referral criteria as red flag; change in bowel habit, rectal bleeding, weight loss, abdominal pain. (Non-red flag; chronic diarrhoea, constipation, mucous discharge, urgency of defecation, rectal irritation).

Results

Data were analysed from 635 patients. 316 diagnosed with CRC, 110 with large adenomas, 109 with small adenomas, and 100 normal studies. 1. 373 males (58.7%)/254 female (40.0%)/8 unrecorded • Mean/median age = 67.3/68.3 years

Conclusions

This analysis highlights that the significant majority of subjects attending for BSCP are symptomatic, with over half displaying red flag symptoms when finding cancer, large adenomas, or small adenomas. Interestingly even in normal (non-adenoma/non-CRC) examinations, a third had red-flag symptoms. Symptomatic patients should have been managed on symptomatic pathways, especially those with red flag symptoms – in a time critical manner. Despite the BCSP being aimed at an asymptomatic population, it is possibly acting as a safety net for many with suggestive symptoms for weeks/months. The BCSP is a success overall, however patient education, and effectiveness of symptomatic pathways in identifying and managing patients with CRC, needs to improve.