The UK’s leading bowel cancer charity is calling for the Scottish government to begin a process to reduce the threshold for when positive bowel cancer screening tests are investigated.

Earlier this month, members of the Scottish parliament heard that as many as four in ten stool samples containing blood are not followed up because of a shortage of colonoscopy capacity across NHS Scotland.

Giving evidence to Holyrood’s Health, Social Care and Sport Committee during a session on NHS waiting times, Professor Farhat Din, a Council Member at the Royal College of Surgeons of Edinburgh, said patients are being falsely reassured when they are not followed up even when their test sample was positive.

The UK’s National Screening Committee has suggested a threshold of 20 micrograms of haemoglobin per gram of faeces for further diagnostic procedures to kick in. In Scotland, people are called in if their sample is over 80 micrograms – four times the 20 micrograms trigger point.

Head of Policy & Influencing for the devolved nations for Bowel Cancer UK, Gerard McMahon, says people’s lives are being put at risk and real opportunities to catch their cancer early are being missed by the threshold being set too high.

“We know that earlier diagnosis is key with bowel cancer. We know that if you're diagnosed at the earliest possible stage, over nine in ten people survive the next five years.

“By contrast, if you're diagnosed at the later stage – so when you are showing symptoms, perhaps when you’ve gone to A&E – it flips, and that survival is around one in ten people.”

In fact, Scotland has in place the lowest trigger point of any of the UK nations, which currently set a threshold of 120 micrograms for further investigation.

Scotland also tests from a younger age than other UK nations.

Wales has now begun a phased programme to match Scotland by reducing the age when people are sent sampling kits to 50 years, and to bring the threshold for further investigation to 80 micrograms.

Mr McMahon says Bowel Cancer UK recognises the pressures on services and that change cannot happen overnight, which makes it all the more important for Scottish ministers to set a roadmap now for how it will invest in the staff and infrastructure to take bowel screening into a much more preventative space:

“Earlier diagnosis is something that the Scottish government included in the cancer strategy that are published last year.

“We need to unlock the potential of this screening programme.

“We need to see a change to the 20 micrograms, because that should actually move us into more preventative space. We would then pick up polyps, that haven't developed into cancer yet, which can be removed when the colonoscopy is taking place.”

Following reporting of Professor Din’s evidence to the health committee, MSP Edward Mountain raised an urgent question in the Scottish parliament asking how many additional colonoscopies would be required, and at what cost, if the threshold were to be brought down to 20.

Minister for Public Health, Jenni Minto replied that she recognised the importance of people doing their tests – saying her own father was diagnosed with bowel cancer. Ms Minto also did not rule out lowering the threshold:

“Colonoscopy capacity in the national health service is continuously monitored and the bowel programme board will continue considering lowering the FIT—faecal immunochemical test—threshold.

“In the meantime, patients who are, via the Scottish bowel screening programme, referred with an urgent suspicion of cancer will continue to be prioritised for scope-based diagnostic tests, based on their level of clinical need.”

Ms Minto added that any evaluation has to take into account that reducing the threshold would subject more people to potentially unnecessary diagnostic tests, while impacting on waiting times for symptomatic patients.

Gerard McMahon from Bowel Cancer UK says the main message in the meantime must continue to be for anyone, whatever their age, to report bowel cancer symptoms to their GP, and for those between 50 and 74 to complete and return the tests they receive in the post – and not to dismiss any symptoms thereafter even when they have been given the okay:

“Be aware that if something changes in your bowel habits, if you notice pain or a lump in your tummy, if you notice visible bleeding from your back passage or blood in your poo, if you're noticing extreme fatigue or weight loss that you can't put down to a change in your own lifestyle - then speak to your GP.”

 

Read more: A third of positive bowel tests not followed up; ‘Substantial’ drop in cancer deaths; Major investment in Scotland’s cancer research; Double testing improves bowel cancer detection

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