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LEARNING TO MAKE A DIFFERENCE
CANCER CHALLENGE
PILOTING A SCREENING PROGRAMME IN THE NORTH EAST OF SCOTLAND FOR THE DETECTION OF COLORECTAL CANCER WHICH WILL STUDY THE PUBLIC'S WILLINGNESS TO BECOME INVOLVED, WILL DETERMINE HOW BEST TO SCREEN THE GENERAL POPULATION AND, IF FEASIBLE, WILL BE DEVELOPED INTO A NATIONAL SCREENING PROGRAMME.
About Cancer Challenge
Colorectal (bowel) cancer is the second most common cause of cancer deaths in men and third most common for women in Scotland. Around 3,400 cases of colorectal cancer are diagnosed in Scotland every year and approximately 1,750 Scots die from this disease each year.
Cancer Challenge is the Scottish arm of the UK Colorectal Cancer Screening pilot which is being run as a feasibility study in Tayside, Grampian and Fife Health Board areas. The aim is to determine whether a national screening programme would be feasible, acceptable and practical. The English arm of the pilot is running in Coventry and Warwick. The pilot is being independently evaluated by a team from the Universities of Edinburgh, Warwick and Essex and the findings of the evaluation will be considered by the UK National Screening Committee.
Key achievements
In Scotland, the pilot began in March 2000 and is targeting approximately 290,000 men and women aged 50-69 years over two and a half years. Colorectal cancer screening will be offered to apparently healthy people in order that a small number who have developed the disease might be diagnosed and receive effective treatment at an earlier stage when it is easier to treat and cure. All men and women aged between 50-69 years in the three Health Board areas will receive a self-administered Faecal Occult Blood (FOBt) test to complete at home. All positive tests will be followed up with colonoscopy or further investigations.
Challenges faced
There are a number of challenges to be addressed if a decision is taken to introduce a national screening programme including:
the development of a national IT call/recall system
development of Quality Assurance procedures and publication of standards
follow-up protocols for non-cancerous polyps
the impact of screening on cancer services and in particular on colonoscopy services
resource issues, including training and skill requirements.
Informing health policy and practice
Research has already shown that screening for bowel cancer can save lives. The main reason for piloting the programme is to find out if the public is happy to be involved in doing these tests themselves and how best to screen the general population. The results of the full evaluation of the pilot are not expected until spring 2003. Subject to the evaluation findings and recommendations of the UK National Screening Programme, the aim is to develop the colorectal cancer pilot into a national screening programme.
Early lessons
Interim evaluation findings are being considered by the Department of Health. The pilot is progressing well and evaluation to date suggests that FOBt screening is generally acceptable to the population in the target age range. The pilot sites, if continued beyond the first screen, would provide an opportunity to carry out further research and evaluate alternative screening strategies. Careful consideration will need to be given to resource and capacity issues if a national programme is to be introduced.
Looking to the future
The pilot is due to finish in February 2003. While the outcome of the pilot and recommendations of the UK National Screening Committee cannot be pre-empted, preliminary consideration is being given to the resource implications of a national screening programme for colorectal cancer.
Cancer in Scotland - Action for Change gave a commitment to introduce colo-rectal cancer screening for people in Scotland aged between 50-69 years, if the pilot is shown to have a significant impact and the UK National Screening Committee recommends its adoption.
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