Introduction Bowel screening aims to identify bowel cancer early to achieve a lower mortality. We looked at whether patients diagnosed with cancer on a bowel screening list have disease at an earlier Dukes stage and thus better prognosis than those with symptoms.
Methods 176 patients with an endoscopic diagnosis of bowel cancer were identified retrospectively, 63 patients from the Bowel Screening Wales (BSW) list and 137 from all other lists. All patients underwent colonoscopy in Glangwili Hospital between Jan 2009 and Dec 2011. All cases had a histological diagnosis of bowel cancer and subsequent staging using the Dukes classification.
Results Results showed similar M:F ratios of 73:27% (BSW cohort) and 63:37% (symptomatic cohort). The median ages were 66 yrs (BSW) and 67 yrs (symptomatic).The age range for both groups was 60–72 yrs.
The table below compares the no. of patients (%) with each Dukes stage of disease and its statistical significance.
A fishers analysis was carried out. Using a P value < 0.05 there was a significant difference in the number of patients presenting at stages A (p = 0.019) and D (p = 0.01) and no statistical difference at stages B (p = 0.19) and C (p = 0.26).
In the BSW cohort 4 patients (6.4%) had advance disease and were not fit for surgery compared to 12 patients (8.6%) in the symptomatic cohort. The number of patients cured by polypectomy was 7 (11.1%) in the BSW cohort and 1 (0.7%) in the symptomatic group. 52 patients (82.5%) had bowel resection in the BSW group and 124 (90.5%) in the symptomatic group. The only group with a significant difference statistically was the number of patients treated with polypectomy (p value = 0.0014). The number of patients in each group that were inoperable due to advanced disease or that went on to have bowel resection did not differ statistically with p values of 0.78 and 0.16 respectively.
Data was also collected identifying the number of patients in each group by the site of bowel cancer. The distribution was similar in both groups.
Conclusion Our study demonstrates that more patients are identified with Dukes stage A (p = 0.019) disease through the bowel screening programme and that significantly more patients are managed by polypectomy alone (p = 0.0014). It also demonstrates that significantly less patients are diagnosed with Dukes stage D (p = 0.01) disease through bowel screening. This supports the role of bowel screening and its clinical role in reducing mortality from bowel cancer.
Disclosure of Interest None Declared.
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