Major NHS Bowel Cancer Screening Overhaul to Boost Early Detection
NHS England is implementing a significant enhancement to its national bowel cancer screening programme, with the ambitious goal of identifying thousands more cases at an earlier, more treatable stage. This strategic move represents a crucial step forward in the fight against one of the UK's most prevalent cancers.
Lowering the Detection Threshold
From next month, the national health service will reduce the detection threshold for its home-screening stool kits, known as the faecal immunochemical test (FIT). This adjustment brings England's screening protocol into alignment with the established practices already operational across Scotland and Wales.
The FIT test, offered to everyone aged 50 and over, works by detecting microscopic traces of blood in stool samples. It measures micrograms of human haemoglobin per gram of faeces, with individuals simply collecting a sample at home and returning it by post for NHS analysis.
Projected Impact and Benefits
This change is projected to identify an additional 600 bowel cancer cases early each year, marking an impressive 11 per cent increase on current detection figures. Furthermore, approximately 2,000 more people with high-risk polyps – growths in the bowel that can potentially develop into cancer – are expected to be identified through this enhanced screening approach.
Consequently, the NHS anticipates conducting 35 per cent more colonoscopies annually, equating to around 34,000 additional procedures each year to help diagnose or rule out bowel cancer. Once fully implemented, testing at the lower threshold is expected to reduce late-stage diagnoses and deaths from bowel cancer in England by approximately 6 per cent, potentially saving the NHS £32 million annually.
Aligning with Devolved Nations
The FIT screening threshold has been set at 80µg Hb/g in Scotland and Wales, while England and Northern Ireland previously maintained a higher threshold of 120µg Hb/g. The changes from NHS England now mean the FIT threshold in England has been reduced to 80µg/g, creating consistency across Great Britain.
In Northern Ireland, however, the FIT threshold will remain at 120µg for the time being, creating a divergence in screening protocols across the UK nations.
Expert Endorsements and Future Directions
Peter Johnson, national clinical director for cancer at NHS England, emphasised the importance of this development: "This is a major step forward in bowel cancer detection and will help save hundreds more lives from this devastating disease. Testing at a lower threshold will now provide a better early-warning system for bowel cancer, helping us to spot and treat cancers earlier, often picking up problems before symptoms appear."
Genevieve Edwards, chief executive of Bowel Cancer UK, welcomed the news: "This is great news for people living in England. Increasing the sensitivity of the test means more cancers will be prevented and found earlier, saving more lives from the UK's fourth most common cancer."
Michelle Mitchell, chief executive of Cancer Research UK, added: "This vital step from NHS England to lower the threshold for further tests after bowel screening will save lives. It means more cancers will be detected at an earlier stage, when treatment is more likely to be successful, while also preventing some from developing in the first place."
Operational Changes and Uptake Initiatives
Currently, around 2 per cent of people who take the FIT test require further investigation. With the new threshold, this figure is expected to rise to 3 per cent, reflecting the increased sensitivity of the screening programme.
NHS England has also announced it will launch new digital alerts to notify people when their testing kits are in the post, aiming to boost participation rates in the screening programme. This initiative comes as the Government prepares to publish its National Cancer Plan next week, which will outline how it plans to transform cancer care by 2035.
Long-Term Aspirations
The UK National Screening Committee (NSC) recommends that the optimal threshold for bowel cancer screening is 20µg/g. However, recognising the increased demand this would place on NHS services such as colonoscopy and pathology departments, the UK NSC has recommended working towards this optimal threshold gradually over time.
This measured approach balances the need for enhanced early detection with the practical considerations of healthcare service capacity, ensuring that improvements can be implemented sustainably while maximising patient benefit.
