Introduction The National Bowel Cancer Screening Programme (NHSBCSP) aims to reduce mortality from bowel cancer in a defined population, by detecting cancer in asymptomatic individuals between 60 and 74 years. Current Government strategies are aimed at raising awareness of symptoms, to bring survival from cancer in England up to the average for Europe.¹ This study aims to identify whether individuals with a FOBt +ve screening test are asymptomatic?

Methods Data were extracted from the Bowel Cancer Screening System (BCSS) on FOBt +ve individuals diagnosed with cancer from commencement of the programme in 2006 to December 2011. This included all symptoms (one or more) reported at colonoscopy pre assessment, as captured by BCSS. The same data were extracted on a control group of FOBt +ve, colonoscopy negative individuals. In addition to examining trends in reported symptoms, data sets were also interrogated to look at those significant symptoms that if reported prior to the screening episode should have triggered a cancer two week wait (2WW) referral.²

Results 10 211 patient episodes with cancer (Male=6825, Female=3837) and 30 249 without cancer (Male=14 991, Female=15 259) were included in the analysis. Symptom data could not be verified with regard to recency, frequency or severity of symptoms or whether previously reported. Anxiety caused by a +ve screening test may itself heighten awareness of some symptoms however, the percentage reporting significant symptomsⁱ.

Conclusion Although the NHSBCSP aims to detect asymptomatic cases, a large proportion of individuals were symptomatic at the time of screening, some were eligible for referral under the DH guidance for high risk symptoms of colorectal cancer. The Government's drive to increase awareness of symptoms is necessary to prompt individuals to seek medical advice at an earlier stage. Standardising how data are captured at pre assessment will improve the quality and usefulness of the data strengthening future analysis on the impact of awareness campaigns on screening.

Competing interests None declared.

ⁱMaking them eligible for referral as a cancer 2WW is higher in those FOBt +ve individuals found to have cancer at screening colonoscopy than in those with FOBt +ve negative colonoscopy.

References 1. http://www.dh.gov.uk/en/Healthcare/Cancer/Earlydiagnosis/index.htm#jumpTo1 (accessed 10 Jan 2012).

2. NICE. Referral Guidelines for Suspected Cancer. London: NICE, 2011.