I was recently asked to apply for the post of lead for colorectal cancer research in Kent, Surrey and Sussex. The National Institute of Health Research (NIHR) has recently created this post and is an organisation about which I knew very little. After some Internet searching and asking around I discovered that it was set up in 2005/6 in response to a number of concerns about the way in which health care research was being undertaken in England. These included, money for R&D in the NHS not being focused where it was needed and locked into historical allocations to Trusts. The NHS R&D programme did not appear to have sufficient capacity or flexibility to generate all the evidence needed to deliver high-quality health services.
Last month I was asked to give talk at the 34th annual GP meeting at the Royal Society of Medicine in London on the topic of screening for colorectal cancer. The presentation highlighted the advances in screening for bowel cancer. Following the publication of the 2010 paper in The Lancet “Once only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial” by Wendy Atkin et al it has become clear that a single flexible sigmoidoscopy (FS) performed at the age of 55 can significantly reduce the incidence of colorectal cancer.
The study looked at 113,195 patients who underwent a FS compared with a control group of 57,525 and followed them up for over 11 years. Although uptake was just under half of those invited 5% of patients had high-risk polyps identified on FS and were invited for a colonoscopy. The remaining 95% had no polyps or small low risk polyps that were removed and discharged. At the end of follow up the incidence of distal colorectal cancer (sigmoid and rectal disease) was 50% that of the control group and 33% lower for bowel cancer overall.
Importantly colorectal cancer mortality appears to be reduced by 43% in the screened group a finding that appears to continue with further follow up. This landmark study has encouraged the Department of Health to roll out the “Flexi-scope” programme, inviting all patients to undergo a FS when they turn 55. Currently pilot sites including West Kent and Medway have commenced screening that will run alongside the existing faecal occult blood-testing programme. Uptake is running at around 50% but polyps and early cancers are being detected. Although to early to measure the impact this programme should prove to significantly reduce the morbidity caused by bowel cancer and the number of lives lost to it.
Every effort should be made to improve the number of people accepting the invite to participate to fully maximise its effect.