Introduction National BCSP screening for all 60–69 year olds commenced in 2006, and was extended to 60–74 year olds in 2010. The first site open was in Wolverhampton in July 2006. Previous trials had demonstrated the efficacy of population screening with the use of faecal occult blood test. We have previously shown that in the first two years of the BCSP downstaging of colorectal cancer in the screened group was demonstrated (45.3% Dukes A and 21.7% Dukes B).1
Method Retrospective analysis of data from the first 7 years of the programme (August 2006 to December 2013) included demographics, screening outcomes (neoplasia and adenoma detection), pathological staging of cancers and colonoscopy quality indicators. Surveillance outcomes were reported on those patients eligible in the study period.
Results During the study period (2006–13) 4506 colonoscopies were undertaken (63.4% Male; n = 2855). Mean caecal intubation rate was 97.1% and mean withdrawal time for normal procedures was 7.3 min. 355 cancers were detected (65.3% Male; n = 232). 62.5% of cancers were ‘early’ (23% Dukes A, 31.5% Dukes B) and 71.5% were left-sided (28% rectal, 37.4% sigmoid). 3699 adenomas were detected and the mean number of adenomas per procedure was 0.82. 37% (n = 1366) of these were 1 cm. The mean adenoma detection rate per colonoscopist was 43.25%.
The high risk (n = 420) and intermediate risk (n = 768) adenomas were surveyed as per national guidance. In those high risk surveillance cases (n = 420) the detection of adenoma was seen in 31.4% (n = 132) of which 13.6% (n = 18) of them had adenomas greater than 1 cm. 0.47% (n = 3) of surveillance cases were found to have cancer suggestive of a potential post colonoscopy missed cancer.
Conclusion These data confirm that a high quality screening colonoscopy service has been maintained since inception of the BCSP. Despite high quality indicators for endoscopic performance, surveillance has demonstrated missed adenoma and cancer still occur. Cancer staging data suggest a diminished benefit in the latter 5 years of the BCSP.
Disclosure of interest None Declared.
Ellul P, Fogden E, Simpson CL, et al. Downstaging of colorectal cancer by the national bowel cancer screening programme in England: first round data from the first centre. Colorectal Dis. 12:420–422
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