Bowel Cancer Awareness Month: the limitations of screening and the importance of identifying the symptoms

Posted: 14/04/2020

Bowel Cancer UK is the UK’s leading bowel cancer charity. The organisation has many crucial roles, including raising awareness of the disease, offering support to patients and their families and providing advice and targeted funding to assist health professionals in saving lives. April 2020 is Bowel Cancer Awareness Month, and the charity has many initiatives to help achieve its goals. More information can be found on the charity’s website: www.bowelcanceruk.org.uk

It may come as a surprise to most of us that every 15 minutes, someone in the UK is diagnosed with bowel cancer, with around 268,000 people currently living with the disease nationally. Bowel cancer is said to be the UK’s ‘second biggest killer’, with an estimated 16,000 people sadly passing away due to the disease each year - and this is despite the high survival rates associated with early diagnosis and treatment. The high mortality rate is because the survival rates decrease significantly as the disease develops, so the importance of early diagnosis and treatment cannot be emphasised enough.

Knowing the symptoms of bowel cancer and then subsequently seeking advice from a GP without delay if you have any concerns is critical. The symptoms of bowel cancer can include:

• a persistent and unexplained change in bowel habit;
• bleeding from the bottom and/or blood in the stools;
• unexplained weight loss;
• a pain or lump in the tummy; and
• extreme tiredness for no obvious reason.

While the disease can affect people of all ages, statistics show that it is more prevalent in the over 50s, and in men than women. Due to being at a higher risk of developing the disease, people aged over 60 in England, Wales and Northern Ireland, and those aged over 50 in Scotland, are invited to take part in a national bowel cancer screening programme. It is the government’s ultimate aim to bring the remainder of the UK in line with Scotland’s current minimum screening age of 50.

The majority of the screening programmes in the UK are carried out by home testing, which means that a screening kit is sent to those eligible under the programme so that the individual can provide and send a stool sample for testing at a specialist laboratory. The specialists will then test the samples to see if there is any hidden blood within the stool, as in some cases there may be blood present in the stool that is not visible to the naked eye.

Experts advise that traces of blood will be found in approximately 2% of the screened population, and those patients will be invited for a procedure known as a colonoscopy. A colonoscopy is a procedure whereby a telescopic camera is used to look inside the large bowel to see if there are any signs or symptoms of cancer that are affecting the bowel. It is estimated that approximately half of those 2% who test positive from the home screening tests will have a diagnosis of bowel cancer confirmed and subsequently receive treatment. Many of these cases will have received a diagnosis at an early stage, and will make a full recovery after treatment.

The remaining 98% of those who have undergone the home screening tests will receive confirmation that the screening test has been negative for any blood in the stool sample taken, and will be advised that no further investigation is needed. They will then be invited for further testing some two years later. However, it is important to understand that these home screening tests are not 100% accurate, as not all cancers will ‘bleed’ on the day that the stool sample is taken. Consequently, there is a very small risk that some of those 98% who test negative may actually have bowel cancer, but may not have had any blood in the stool samples tested. Likewise, the screening tests do not prevent bowel cancer from developing.

However, experts are conducting further research so as to be able to roll out more sensitive testing, and it is hoped that once these tests are available, they will reduce the risk and incidence rates of bowel cancer – especially for those individuals whose cancers are missed at the initial screening stage.

Naomi Holland, senior associate in the clinical negligence team at Penningtons Manches Cooper, comments: “Raising awareness of bowel cancer, and indeed any form of cancer and serious disease, is extremely important and we wholeheartedly support this month-long campaign. As stressed by Bowel Cancer UK, it is essential that people are aware of the signs and symptoms of bowel cancer and if there is any concern, that they seek advice from their GP immediately. Some people may feel uncomfortable about seeking advice on their bowel habits, but they should be reassured that health professionals are sensitive and understanding to patient concerns. Ultimately their role is to help patients get better and save lives. The direction to seek advice if concerned also applies to those who have undergone a home screening test and have received a negative result, because bowel cancer can develop at any stage, and the home screening tests are not 100% sensitive: regrettably, there will be cases that slip through the net.”

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