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Bowel Cancer Screening in Wales

Cancer Research Wales welcomes the reduction in the age of eligibility for bowel cancer screening to 51, announced on 4th October 2023.

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There are around 60 people diagnosed with bowel cancer each year in Wales between the ages of 51–54, meaning the newly lowered screening age will hopefully allow many of these cases to be detected and treated earlier. Furthermore, many more people in this age group will have polyps, which have the potential to develop into cancer. Identifying these people early and removing pre-cancerous polyps will help to prevent bowel cancer from developing and so save even more lives.

However, following a positive screening result patients must have follow-up tests, typically a colonoscopy. There are already over 8300 people waiting for colonoscopy in Wales, with almost half of these having waited over 14 weeks. With the newly lowered screening age inevitably leading to more colonoscopies being ordered, the NHS must ensure that there is a simultaneous investment to increase in diagnostic capacity, which is clearly already struggling to meet demand.

Studies previously funded by Cancer Research Wales showed that bowel cancer patients in Wales wait the longest before diagnosis and treatment when compared to developed countries with similar healthcare systems. In large part this was due to limited access to timely diagnostics. The Covid-19 pandemic exacerbated these issues, leading to the concerning waiting list figures above.

The bowel cancer screening test (faecal immunochemical test or FIT) is based on the detection of blood in the stools. The test specifically detects haemoglobin, a key protein in red blood cells. In Wales, the threshold for a positive FIT result for screening has very recently been reduced to 120μg/g of haemoglobin in the stool, which is the higher than Scotland (80μg/g) but in line with England. This means the test is more sensitive in Scotland and so is more likely to detect bowel cancer or advanced polyps.

When the current test was rolled out in Wales in 2019, the stated aim was to reduce the threshold to 80μg/g by 2023. Since this is yet to be enacted, we call on the Welsh NHS to put in place the 80μg/g threshold as soon as possible.

Whilst there is no doubt that bowel cancer screening saves lives and we encourage everyone to participate when they receive an invite, current screening tests do result in a large number of colonoscopies being needed. Since around 90% of these people will not have bowel cancer, an improved screening test could reduce the strain on an already over-stretched system.

Through our funded researchers at Swansea University, we are currently working with Public Health Wales and Bowel Screening Wales to see if we can increase the accuracy of bowel cancer screening using the Raman blood test.
The Raman blood test is designed to identify specific “molecular fingerprints” for bowel cancer in the blood. Studies already undertaken in primary care have shown that the blood test can detect 80% of Stage I and II bowel cancers and 100% of all Stage III and IV cancers in patients who have symptoms.

Cancer Research Wales are now funding the COLOSPECT study, in which blood samples will be analysed from 2000 people who are referred for a colonoscopy following a positive screening test. The aim is to assess how accurately the Raman blood test detects cancer in these patients, but also to determine how many colonoscopies could be avoided by ruling out the presence of bowel cancer.

If successful, this test has the potential to transform the bowel cancer screening programme in Wales by detecting more bowel cancers, whilst reducing the number of unnecessary colonoscopies and ensuring patients on the waiting list can be seen more quickly.

While the announcement of the lowered bowel cancer screening age is very welcome, the potential impact of this change is blunted by the pressures within the health system in Wales. Investment in diagnostic capacity and workforce will be vital moving forwards to ensure that patients can receive timely results.

Research can provide many of the solutions to the biggest cancer challenges and that is why are pushing forward with funding the best quality research across Wales. None of our work would be possible without the generosity of our supporters, to whom we are immensely grateful.