Research backs benefits of new bowel cancer test

Tuesday 31 January 2012

A test being introduced by the Government is effective at detecting bowel cancer, a US study has confirmed.

Repeated screening using flexible sigmoidoscopy – or ‘Flexi-scope’ – increased the number of cancers detected according to data from a prostate, lung, colorectal and ovarian (PLCO) cancer screening trial, analysed by Professor Joel Weissfeld and colleagues at the University of Pittsburgh.

The NHS is introducing a one-off Flexi-scope test to its bowel screening programme for all men and women when they reach 55. The test uses a camera and light at the end of a flexible tube to detect pre-cancerous growths in the lower parts of the bowel.

This will be in addition to the current Faecal Occult Blood Testing (FOBT), looks for hidden traces of blood in stools – a possible symptom of bowel cancer.

Almost 40,000 people in the UK are diagnosed with bowel cancer each year, and more than 15,900 die from the disease. It is hoped that adding Flexi-scope to the current programme will cut this number and save more lives.

The research, reported in the Journal of the National Cancer Institute, found that a second Flexi-scope test increased how many cancers and benign tumours were detected by 26 per cent in women and by 34 per cent in men, compared with a single test.

The US researchers analysed results from people aged between 55 and 74 who had a Flexi-scope test when they joined the study and then a follow-up screening at three years and five years. Of the 77,447 people who took part, 67,073 had at least one Flexi-scope test and 39,442 had two Flexi-scope tests.

Commenting on the findings, the researchers said that although repeated tests increases the number of cancers detected, it also increases the costs of screening, the need for follow-up tests, and the risks of complications.

Sarah Williams, health information officer at Cancer Research UK, said: “Scientists already know that one-off screening with flexible sigmoidoscopy can reduce the number of bowel cancers, detect cancer at an early stage and save lives. Following the results of a 16 year long trial, co-funded by Cancer Research UK, the UK government announced in 2010 that one-off flexible sigmoidoscopy would be incorporated into the national bowel screening programmes. Decisions are still being made about how best to do this.

“These interim trial results from the US are interesting and show that a second round of screening improved the detection of bowel cancer. But we don’t yet know whether extra screening rounds can further reduce the number of bowel cancer cases or the number of people dying from the disease. The overall balance between the risks and benefits of additional rounds of screening will also need to be considered,” she added.

“We look forward to seeing the next results from this trial, which should start to answer these important questions.”

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Article source: http://info.cancerresearchuk.org/news/archive/cancernews/2012-01-31-Research-backs-benefits-of-new-bowel-cancer-test?rss=true

Responding to the interim decision by NICE not to recommend bevacizumab (Avastin) as a treatment for metastic colorectal cancer, Mike Hobday, Head of Policy at Macmillan Cancer Support, said:

‘We think this is devastating news for cancer patients with metastic colorectal cancer, especially as this drug could have a significant impact on peoples’ quality of life. Although a few extra weeks or months might not sound much to some people it can mean an awful lot to a family affected by cancer. 

‘Again this reiterates just how important it is that the government’s cancer drug fund comes into place sooner rather than later. On behalf of people living with cancer, Macmillan will hold the government to their £200 million commitment in order to ensure people with rarer cancers have fair access to clinically effective drugs.’

For more information and support call Macmillan free on 0808 808 00 00 or visit www.macmillan.org.uk/accesstotreatment|.

For further information, please contact:

Julie Wills, Assistant Media PR Officer, Macmillan Cancer Support
JWills@macmillan.org.uk|
020 7840 4933

Note to editors:

About Macmillan Cancer Support

Macmillan Cancer Support improves the lives of people affected by cancer, providing practical, medical, emotional and financial support.  Working alongside people affected by cancer, Macmillan works to improve cancer care. One in three of us will get cancer. Two million of us are living with it. If you are affected by cancer Macmillan can help.

Call the Macmillan Support Line on 0808 808 00 00, Monday to Friday, 9am to 8pm. Calls are free, including from mobiles, or visit www.macmillan.org.uk|.

Article source: http://www.macmillan.org.uk/Aboutus/News/Latest_News/MacmillansresponsetoNICEsinterimdecisionnottorecommendcolorectalcancerdrug.aspx

The Government’s first ever national cancer campaign to raise awareness of the signs and symptoms of bowel cancer is launched today.

Public awareness of the symptoms of bowel cancer is low. But spotting the signs early and getting medical advice could save people’s lives.

Featuring real GPs, the ‘Be Clear on Cancer’ bowel cancer campaign encourages people who have had blood in their poo or loose poo for more than 3 weeks to see their doctor.

The new adverts aim to make people aware of the symptoms of bowel cancer and make it easier for them to discuss this with their GP.

Care Services Minister Paul Burstow said:

“No one likes talking about their poo – it’s embarrassing. But bowel cancer is the second biggest cancer killer so we need to get over the embarrassment and talk to someone about it.

“The “Be Clear on Cancer” campaign uses simple messages to make people aware of the key symptoms of bowel cancer and to give them the confidence to talk to their GP if they notice the symptoms.

“No matter how embarrassing it is, talking to your GP can help save your life.”

The ‘Be Clear on Cancer’ campaign

The Be Clear on Cancer campaign adverts will appear on TV, radio, online and in newspapers in England for 9 weeks from today until the end of March.

The campaign was piloted in the South West and East of England in January 2011.  In those areas, GPs saw the number of people over the age of 50 presenting with the relevant symptoms increase by 48% – about one extra patient per practice per week.

Part of the National Awareness and Early Diagnosis Initiative run in partnership with Cancer Research UK, the campaign aims to improve England’s cancer survival rates.

Campaign materials

Leaflets and posters can be ordered free from the DH Orderline or by calling 0300 123 1002.

More information about all Department of Health campaigns can be found on the online Campaign Resource Centre. It is the one-stop shop for all Department of Health public health campaigns and provides all the public health information and resources needed for anyone who works directly with the public.

• To find out more visit the Campaign Resource Centre and sign up for updates.
• Read about the launch of the Campaign Resource Centre.

Key facts about bowel cancer

• Bowel cancer is the second biggest cancer killer.
• It affects 33,000 people every year in England with the majority of cases occurring in people over the age of 55.
• There are 13,000 deaths a year but it can be less deadly if spotted and diagnosed early.
• More than 90% of people diagnosed with bowel cancer at an early stage survive for at least 5 years compared with only 6% of those diagnosed at a late stage.
• If England’s bowel cancer survival rates matched the best in Europe an additional 1,700 lives would be saved every year.
• Around 14,600 cases were diagnosed in women and 18,000 in men in England in 2008.
• Two thirds of bowel cancer develop in the colon, while the remaining third developing in the rectum
• Bowel cancer is also referred to as colorectal cancer. It includes both cancer of the colon and cancer of the rectum.

Other bowel cancer stats are available on the CRUK website.

The symptoms of bowel cancer

The main symptoms are blood in poo for 3 weeks or looser poo for 3 weeks or more.

Other symptoms include:

• a pain or lump in your tummy
• feeling more tired than usual for some time
• unexplained weight loss

The Government’s priorities

The Government’s priorities for cancer as set out in Improving Outcomes: A Strategy for Cancer include the ambition to save an additional 5,000 lives per year by 2014/2015.

The Government’s strategy is backed with more than £750m over 4 years to implement a range of actions that will improve cancer outcomes. £450m of this is to focus on improving early diagnosis including the extra costs for diagnostic tests and treatment.

• More on bowel cancer and its symptoms from NHS Choices
• Read the press release

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Article source: http://www.dh.gov.uk/health/2012/01/bowel-cancer-campaign/

Government launches bowel cancer campaign

Monday 30 January 2012

The Government has today launched a new campaign to help people spot the warning signs of bowel cancer.

The ‘Be Clear on Cancer’ initiative aims to raise awareness of the main symptoms of the disease, including blood in stools or looser stools for three weeks or more.

Care Services Minister Paul Burstow said public awareness of bowel cancer symptoms remains low, despite the fact that it is one of the most common forms of cancer.

Around 33,000 people are diagnosed with bowel cancer in England each year and 13,000 people die from the disease.

More than 90 per cent of people who are diagnosed at an early stage survive for at least five years, compared with just six per cent of those diagnosed in the later stages of the disease. Most people diagnosed with bowel cancer are over the age of 55.

Figures suggest that an extra 1,700 lives could be saved every year if England’s bowel cancer survival rates matched the best in Europe.

The new campaign seeks to make people more aware of the symptoms and to make it easier for them to discuss with their doctor.

It features real GPs, who urge people to visit their doctor if they have had blood in their stools or loose stools for more than three weeks.

Adverts will appear on TV, radio, online and in newspapers in England for nine weeks from today (Monday 30 January) until the end of March.

The scheme was piloted last year in the South West and East of England. It resulted in a 48 per cent increase in the number of over-50s visiting their doctor with the relevant symptoms – the equivalent of around one extra patient per practice every week.

Minister Paul Burstow said: “No one likes talking about their poo – it’s embarrassing. But bowel cancer is the second biggest cancer killer so we need to get over the embarrassment and talk to someone about it.

“The Be Clear on Cancer campaign uses simple messages to make people aware of the key symptoms of bowel cancer and to give them the confidence to talk to their GP if they notice the symptoms. No matter how embarrassing it is, talking to your GP can help save your life.”

Dr Harpal Kumar, Cancer Research UK’s chief executive, said: “Detecting bowel tumours early, before they’ve had a chance to spread, can significantly stack the odds in the patient’s favour.

“Bowel cancer is currently the UK’s second biggest cancer killer. If people respond to this campaign – and take up bowel screening when invited to do so – we have a chance of pushing bowel cancer well down the league table of killers.

“We urge people to overcome their fear. For most, any symptoms will turn out to be nothing to worry about. But for those people with cancer, the earlier they go to their doctor, the more likely they are to survive.”

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Article source: http://info.cancerresearchuk.org/news/archive/cancernews/2012-01-27-Government-launches-bowel-cancer-campaign?rss=true

A short factsheet to support GPs in the first NHS national bowel cancer symptom awareness campaign in England are available. These factsheets provide GPs with further information about the campaign and suggest how they can prepare for it.

The aim of this national campaign is to raise public awareness of the symptoms of bowel cancer and to encourage those with persistent symptoms to present promptly. Although the great majority of people may not have bowel cancer, some may. By catching the cancer earlier it should be more treatable. This is part of the programme aimed towards  improvement of cancer survival rates.

How GPs can prepare for Be Clear on Cancer factsheet is in support of the campaign which launches on 30 January and runs until the end of March 2012. Advertisements are featuring on TV and the radio and in other national media. The campaign message is that ‘loose poo’ and ‘blood in poo’ for more than three weeks can be symptoms of bowel cancer and that people with these symptoms should go to see their doctor.

Further information about the national bowel cancer campaign and additional resources are available for GPs on Bowel Cancer UK.

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Article source: http://www.dh.gov.uk/health/2012/01/bowel-cancer-factsheet/

Poor men more likely to die from bowel cancer

Sunday 6 November 2011

National Cancer Research Institute Press Release

Deprived men are more likely to die from bowel cancer than men from the most affluent section of society, new research presented at the NCRI Cancer Conference in Liverpool this week shows.

The study, funded by the NHS in Scotland1, found that a link between deprivation and bowel cancer deaths was mainly seen in men rather than women. 

Bowel cancer includes both colon and rectal cancers – and researchers in Scotland found that, in addition to the effects of deprivation on bowel cancer deaths, deprived men were also at greater risk of developing rectal cancer.

Using data from the Scottish Cancer registry, researchers analysed the incidence rate and death rate for five different socio-economic sections of society from 2004 to 2009.2

The study looked at a total of around 12,000 colon cancer cases and more than 6,000 cases of rectal cancer.

Researchers said that the link between rates of rectal cancer in men and deprivation was a recent trend – one that has only become more evident since the mid-1990s.

While the relationship between bowel cancer mortality and deprivation is already well established – this study found that the link is stronger among men.

Study author Professor Robert Steele, based at the University of Dundee, said: “People’s knowledge of bowel cancer risks, screening uptake and lifestyles tend to differ depending on their socio-economic background – these factors may play an important role in why deprivation has more of an effect on men and is more apparent for rectal cancer.

“Bowel cancer is the third most common cancer in the UK – around 40,000 people are diagnosed with the disease each year. Most bowel cancers are in the large bowel (colon), with about 1 in 3 cancers in the rectum.”

Alongside family history of bowel cancer and getting older, obesity and diets high in red and processed meat and low in fibre have an important influence on risk of bowel cancer.

Dr Jane Cope, director of the NCRI, said: “We know from previous studies that people from more deprived areas are more likely to smoke or to be very overweight. They are also less likely to be screened for bowel cancer or to be aware of the signs and symptoms of the disease contributing to later diagnosis and potentially to poorer outcomes.

“We need new approaches to address these disparities if we are to reduce inequality in cancer survival.”

Hazel Nunn, head of health information at Cancer Research UK, said: “When it comes to bowel cancer people can help stack the odds in their favour by eating a diet high in fibre and low in red and processed meat, not smoking, cutting down on alcohol, maintaining a healthy bodyweight, keeping physically active and seeing a GP as soon as possible if they notice anything unusual about their body.”

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Article source: http://info.cancerresearchuk.org/news/archive/pressrelease/2011-11-06-poor-men-more-likely-to-die-from-bowel-cancer?rss=true

Tuesday 8 November 2011

National Cancer Research Institute Press Release

NEW research shows that bowel, oesophageal and pancreatic cancers have seen the greatest improvement in the time it takes from when a patient first visits their GP with symptoms to when they are diagnosed with the disease.

The data – being presented at the National Cancer Research Institute (NCRI) Cancer Conference in Liverpool this week – was collected for breast, bowel, lung, pancreatic, oesophageal and stomach cancers for 2001-2 and for 2007-8.

Information was collected from the General Practice Research Database on more than 14,400 patients aged 40 or over who had been diagnosed with any of the six different cancers and who had previously shown potential cancer symptoms. These symptoms were predetermined by an expert group. An example of symptoms for bowel cancer included things such as constipation, diarrhoea or rectal bleeding.*

In 2001-2 bowel (colon and rectal) cancer was on average diagnosed 96 days after patients first reported a symptom to a GP to when they were diagnosed. This dropped significantly to 75 days in 2007-8.

For oesophageal cancer in 2001-2 the average time to diagnosis after first GP visit was 59 days. This fell to 48 days in 2007-8. For pancreatic cancer in 2001-2 the average time to diagnosis after first GP visit was 63 days. This fell to 52 days in 2007-8.

Breast, stomach and lung cancers did show a drop, though not a significant one.

Breast cancer times to diagnosis fell from 27 days in 2001-2 to 25 days in 2007-8. Stomach cancer diagnosis times reduced from 88 days in 2001-2 to 77 days in 2007-8, and for lung cancer from 106 days in 2001-2 to 102 days in 2007-8.

Midway between these two time periods was the release of the 2005 NICE referral guidance for suspected cancer cases. These guidelines provide GPs with details of symptoms that should prompt them to send a patient for further tests.

Dr Richard Neal, lead researcher based at the North Wales Centre for Primary Care Research, Bangor University, said: “We found that diagnostic intervals can and do change over time. The reduction between 2001-2 and 2007-8 may in part be due to the roll out of the 2005 NICE referral guidance for suspected cancer. This gives clear guidance on which symptoms should prompt a doctor to refer a patient for further investigation. But there is considerable variation between cancers, with diagnostic intervals highest in those cancers which are more difficult to diagnose.

“Diagnostic intervals were longer for patients with harder to diagnose cancers and for those presenting with symptoms that did not qualify for an urgent referral. But diagnostic intervals remain long in most cancers, with considerable potential for further reduction. In particular, the diagnostic intervals for the 10 per cent of patients who are diagnosed most slowly remain very long for most cancers. And we do not fully know the effect of the reduction of diagnostic intervals on improvements in stage at diagnosis and long term survival.”

Sara Hiom, Cancer Research UK’s director of information, said: “It’s very encouraging to see that patients are, on average, being diagnosed more quickly for some cancers, offering a better chance of successful outcome. It’s clearly vital for GPs to have access to good quality information to make the best decisions for their patients. There is still room for considerable improvement though, and reducing the time to diagnose and treat is a critical part of improving outcomes for people with cancer.”

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As part of the National Awareness and Early Diagnosis Initiative (NAEDI) and funded by the Department of Health (England) the researchers compared diagnostic intervals for different cancers before and after the introduction of the 2005 referral guidelines for suspected cancer produced by the National Institute for Clinical Excellence (NICE). These guidelines provide GPs with details of symptoms that should prompt them to send a patient for further tests.

The role of NAEDI is to coordinate and provide support to activities and research that promote the earlier diagnosis of cancer. These results will provide partners in the initiative a benchmark of current practice.

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Article source: http://info.cancerresearchuk.org/news/archive/pressrelease/2011-11-08-bowel-oesophageal-pancreatic-cancers-show-biggest-improvement-in-diagnosis-time?rss=true

Wednesday 9 November 2011

National Cancer Research Institute Press Release

Bowel screening reduces the number of deaths from bowel cancer in Scotland by more than 25 per cent, according to research* presented at the National Cancer Research Institute (NCRI) Cancer Conference in Liverpool this week.

Researchers in Scotland found that bowel cancer deaths were cut by 27 per cent among those who had attended screening compared with those who did not.

Bowel cancer screening uses the faecal occult blood test (FOBt) which is mailed to people to carry out at home. People post a series of small stool samples to a lab to be tested for traces of hidden blood which could be an early sign of bowel cancer.

The study, funded by the Scottish Government Health Department, is the first to show the real impact of using the FOBt in a population-based screening programme.

The results confirmed the findings of randomised controlled trials which were conducted when FOBt was proposed as a method of screening for bowel cancer.**

Study author Professor Robert Steele, based at the Bowel Screening Research Centre in Dundee, said: “For the first time, we can see the effects of a FOBt-based colorectal cancer screening programme in the real world of the NHS.”

More than 370,000 people aged 50-69 from three of Scotland’s 14 health boards were invited to take part in a population-based pilot study of bowel screening, before a national programme was introduced.

FOBt kits were sent to these people through the post and returned to a lab for analysis.

Researchers studied this screening group alongside a control group of the same size who were from health boards not taking part in the pilot study but had similar bowel cancer death rates.

The results showed that among those invited for screening, there was a 10 per cent reduction in bowel cancer deaths compared with those not invited.

But researchers pointed out that this is an underestimate since 40 per cent of those invited for screening did not actually take up the invitation – the reduction in bowel cancer deaths rose to 27 per cent when looking at those who actually completed the cancer test.

When bowel cancer is found at the earliest stage, there is an excellent chance of survival with more than 90 per cent of people surviving the disease at least five years. But if the tumour has spread to other parts of the body when it is diagnosed, just over six per cent survive their disease this long.

Bowel cancer is the third most common cancer in the UK – around 40,000 people are diagnosed with the disease each year in the UK.

Dr Jane Cope, director of the NCRI, said: “These figures are evidence that the bowel cancer screening programme is helping to lower the number of deaths from the disease.

“It’s expected that when all of the national screening programmes across the UK have been up and running for a couple of years, that similar results will be seen for the whole of the UK.”

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*Gillian, L – The impact of population-based faecal occult blood screening on colorectal cancer mortality: A matched cohort study, 2011

View the conference abstract here.

**Randomised controlled trials (RCTs) of guaiac faecal occult blood testing (gFOBT) have shown a combined overall reduction in bowel cancer (CRC) mortality of 16 per cent in those invited for screening, and a 23 per cent reduction in those who took part in screening. This study showed that the reduction seen in RCTs matched the impact on a population-based screening programme.

The population-based pilot guaiac FOBt screening study took place in Scotland from 2000 to 2007. People involved in the study were followed up until the end of 2009, or until the date of their death if before this.

Bowel screening was rolled out in England in 2006 for men and women aged 60 to 69. Screening is now offered to men and women from ages 60 to 74 in England. A kit is sent out to people every two years.
In Scotland men and women aged between 50 and 74 years are sent a FOBt kit every 2 years.
In Wales the NHS is sending out stool testing kits to people between the ages of 60 and 69 every two years. They hope to roll the service out to people aged between 50 and 74 by 2015.

The UK government has committed to adding the Flexi-Scope test bowel screening test from next year in England. The new test uses a camera and light at the end of a flexible tube to detect and remove pre-cancerous growths from the lower parts of the bowel.

Cancer Research UK scientists led the trial which showed that the Flexi-Scope test has the potential to prevent a third of bowel cancer cases in people screened, as well as picking up the disease earlier.

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Article source: http://info.cancerresearchuk.org/news/archive/pressrelease/2011-10-09-Bowel-screening-reduces-cancer-deaths-by-more-than-25-per-cent?rss=true

National audit shows bowel cancer care is improving

Wednesday 30 November 2011

An in-depth report about bowel cancer surgery in England and Wales has found that care is improving for the disease.

But patients who receive emergency surgery continue to fare less well than those whose operations are pre-planned.

Emergency surgery tends to be more common in people who are diagnosed late, when the disease is more advanced.

The latest report from the National Bowel Cancer Audit – published by the NHS Information Centre and others – looked at the management of more than 28,000 cases of bowel cancer in England and Wales from August 2009 to July 2010.

The findings show that mortality rates have continued to improve among patients who undergo less urgent elective or scheduled operations.

Almost one in three patients received keyhole surgery – a less invasive operation performed through a small cut in the belly – an increase from one in four the previous year.

This is thought to be the result of a national training programme that’s been underway in recent years to update the skills of bowel surgeons.

But the report found that patients who received urgent and emergency surgery had a higher death rate in the 30 days after their operation.

Researchers also looked in detail at surgery for two of the main types of bowel cancer – rectal cancer and colon cancer.

They found that there was a higher death rate among colon cancer patients within 30 days of major surgery, with 4.2 per cent dying compared with 2.5 per cent of rectal cancer patients.

Rectal cancer patients were also less likely to undergo a major surgical procedure or emergency surgery than colon cancer patients, partly because rectal cancer is often detected at an earlier stage.

Responding to the audit, Nigel Scott, President of the Association of Coloproctology of Great Britain Ireland, said: “We welcome the increasing success of colorectal surgeons, specialist nurses, oncologists and other medical specialties.

“However, advanced emergency presentation of bowel cancer remains a concern. All too often worries are locked behind the bathroom door because of embarrassment until the problem is too advanced to be retrievable.

Sarah Woolnough, Director of Policy at Cancer Research UK, also welcomed the report. She said: “Bowel cancer is the third most common type of cancer in the UK, so it’s encouraging to see that care is improving.

“But this report also highlights the importance of people knowing the potential symptoms of bowel cancer, such as loose stools or blood in stools, as when the disease is diagnosed at the earliest stage there is a good chance of survival.

“Raising awareness about bowel cancer symptoms could also encourage people to take up their invitation for bowel screening and improve early detection of the disease.”

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Article source: http://info.cancerresearchuk.org/news/archive/cancernews/2011-11-29-National-audit-shows-bowel-cancer-care-is-improving?rss=true