Bowel Cancer Screening Age

Jane Ellison Excerpts

Tuesday 8th March 2016 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. The quite extraordinary level of participation in this half-hour debate speaks volumes about the level of interest in and engagement with this issue from parliamentarians. I congratulate my hon. Friend the Member for Eastbourne (Caroline Ansell) on securing the debate. I am grateful that I had the opportunity to speak to Lauren at the Beating Bowel Cancer reception here in the House in January and to have heard her story in person. My officials and I enjoyed that conversation. As my hon. Friend said, she is a remarkable young woman.

Bowel cancer is one of the most common types of cancer. The statistics around the number of people who die from it each year have been eloquently explained. We accept that we as a country want to do better. That is why, looking at cancer in the round, NHS England set up the independent cancer taskforce, which produced the new strategy “Achieving world-class cancer outcomes”. That was widely welcomed when it was published last July. The Government are committed to implementing the recommendations of the taskforce, and that will see improvements right across the cancer pathway, including in screening. The strategy sets a clear ambition for a further improvement in survival rates. They have improved, as my hon. Friend said, but we want to go further.

Today’s focus is very much on screening, which is a crucial part of diagnosing bowel cancer early. We know that outcomes are significantly better for people diagnosed at stages 1 and 2 as compared with stages 3 and 4. When deciding whether to undertake bowel cancer screening, we have to remember that it is a choice for each individual, so it is important that people are provided with the information they need to make an informed decision. I will go on to talk a little about how many people either decide not to do it or do not get round to doing it. Screening is a significant challenge, and I welcome attention being given to it.

On the advice of the UK National Screening Committee, the expert body that advises Ministers and the NHS in the four UK countries about all aspects of screening policy, bowel cancer screening using the faecal occult blood self-sampling test is offered in England. The bowel cancer screening programme offers screening using the kits every two years to men and women aged 60 to 74 who are registered with a GP. Men and women aged over 74 can self-refer for screening every two years if they wish. People eligible for screening receive an invitation letter explaining the programme, along with an information leaflet explaining the benefits and risks of bowel cancer screening. By the end of January 2016, nearly 29 million men and women in England had been sent a home testing kit and more than 17.5 million had returned a kit and been screened. More than 24,000 cancers have been detected, and nearly 70,000 patients have been managed for high or intermediate-risk adenomas, or polyps, including polyp removal.

The age issue has been the focus of much of the comment today. The NHS bowel cancer screening programme began in 2006, with full roll-out completed in 2010. The programme initially offered screening to men and women aged 60 to 69 because the risk of bowel cancer increases with age. More than 80% of bowel cancers are diagnosed in people aged 60 or over. In the pilot, which was conducted in Coventry and Warwickshire and in Scotland in the late 1990s and early 2000s, more than three times as many cancers were detected in people aged over 60 than in those aged under 60, and people in their 60s were most likely to use a testing kit. Only 47% of men aged 50 to 54 completed a kit, compared with 57% of men aged 60 to 64.

There are also issues of capacity, particularly for endoscopy services, as has been mentioned. The roll-out of screening required that the NHS bowel cancer screening programme take into account and help balance the increasing workloads and pressures placed upon services providing diagnosis and treatment to all people with bowel cancer, not just those found through the screening programme. I emphasise that point to the House, because it is important. The latest routes to diagnosis figures from Public Health England show that in 2013, only 9% of bowel cancers were diagnosed through screening. That 9% is important, but it compares with the more than 50% of bowel cancers that were diagnosed following a GP referral. Sadly, 25% were diagnosed via emergency routes, and those have very poor survival rates because the cancers tend to be at a later stage. The programme has to be able to respond. The skills and the clinicians we need to respond to those GP referrals have to be available, so there is always a difficult balance in terms of the resource we need.

The programme was also required to consider possible changes to it. One such change—this is an important point that has not quite come out in the debate so far—is bowel scope screening, also known as flexible sigmoidoscopy, for people in their 50s. It is a one-off examination that is an alternative and complementary bowel screening methodology to the self-testing kit. It aims to find polyps before they turn into cancer, so it actually prevents cancer ever developing. Evidence has shown that men and women aged 55 to 64 attending a one-off bowel scope screening test could reduce their individual mortality from the disease by 43% and their individual incidence of bowel cancer by 33%.

In 2011, the UK National Screening Committee recommended offering bowel scope screening for bowel cancer. The NHS bowel cancer screening programme is currently rolling it out to men and women around their 55th birthday. They will be invited to take part in the self-testing part of the programme from age 60. Although Scotland is piloting bowel scope screening for some people in its programme, England is the only UK country committed to a full roll-out. Some 77% of bowel scope screening centres in England are currently operational. The Secretary of State is committed to rolling out bowel scope screening to all screening centres in England by the end of 2016, and we are on track to deliver that commitment.

As of the end of January, more than 230,000 invitations had been issued and more than 85,000 bowel scope screening procedures performed. Although that is very good, Members who can do the maths quickly will realise that uptake is currently running at 44%, compared with nearly 60% for the self-sampling part of the programme. If, on the back of this debate, Members can do anything to raise awareness in their constituencies and to empower men and women to make informed decisions about taking up these free tests, I encourage them to do so.

[Margaret Ferrier]

Will the Minister give way?

[Jane Ellison]

I am afraid that I cannot take any interventions because there were so many in the opening speech. I do apologise, but I really want to get through my response.

So far, nearly 3,500 people have attended colonoscopy following bowel scope screening, with 125 cancers detected, and 1,688 people with high or intermediate-risk polyps and 1,270 people with low-risk polyps have had them detected and managed or removed.

Delivering the bowel scope screening programme will obviously place huge demands on endoscopy services, but it can be safely delivered by members of the hospital team other than trained doctors, such as nurses. That is why we announced in September last year that Health Education England is developing a new national training programme for an additional 200 non-medical staff to get the skills and expertise to carry out endoscopies by 2018. The first cohort began training at the end of January. In addition, NHS England’s sustainable improvement team is working intensively with trusts that have significant endoscopy waiting lists, in order to improve performance. That learning will then be shared widely. NHS England is also exploring ways to improve endoscopy performance through pricing changes.

I have already mentioned low uptake rates. We know uptake is lower in more disadvantaged groups, in men—as has been referred to—and in some black and minority ethnic groups. Public Health England is providing support and technical advice to its partners in the NHS on reducing the variation in coverage and uptake. Local screening providers are working with commissioners to address that, which is really important, because some of the variation in these important programmes is astonishing. Again, if any Member can do anything to reduce the variation, it would be greatly appreciated.

The Independent Cancer Taskforce has also recommended an ambition for 75% of people to participate in bowel screening by 2020. To facilitate that change, it recommended a change to a new test, the faecal immunochemical test—FIT—which is more accurate and easier to use than the current FOB test and also improves uptake. I encourage Members with an interest to compare the two tests and try to understand how different they are and why they are likely to have such different effects.

My hon. Friend the Member for Eastbourne will be aware that in November last year the UK National Screening Committee recommended that the FIT test should be used as the primary test for bowel cancer screening instead of FOB. We are currently considering that important recommendation. If it is accepted, it is worth remembering that it will be a major change to a programme that saves hundreds of lives, so we will have to ensure that it is rolled out in a safe and sustainable way, which will include the procurement of cost-effective kits and IT systems.

In any debate about cancer screening it is important to underline the difference between population screening programmes and people going to see their GP with the symptoms of cancer. Information for the public on the signs and symptoms of bowel cancer is available on the NHS Choices website. The Department advises people who are concerned about their risks to speak to their GP. Many of the cancers we have heard about in the debate were found at a very late stage. It is probable that there were some symptoms that could have led to a GP referral.

Since 2010-11, the Department and Public Health England have run 10 national “Be Clear on Cancer” public awareness campaigns, including two national campaigns to promote the early diagnosis of bowel cancer. The first campaign ran from January to March 2012, raising awareness of blood in poo as a sign of bowel cancer. It was the first ever national TV campaign to raise awareness of the symptoms of this cancer and to encourage people with relevant symptoms to go to their doctor without delay. A second campaign ran later that year.

The National Institute for Health and Care Excellence has guidelines on the recognition and referral of suspected cancer, which were updated in June 2015. That is important because in updating them NICE urged GPs to lower the referral threshold when they are assessing whether a referral is appropriate and to think of cancer sooner when examining patients. Switching the way we think and lowering the referral threshold is a critical change that NICE estimates will save many thousands of lives. Of course, professional advice is also available through the various expert bodies.

I emphasise that all screening programmes are kept under review, and the UK National Screening Committee will always look at new evidence. I will of course make sure that our expert advisers are aware of the significant parliamentary interest that has been demonstrated today. In responding to this short debate, I have been trying to illustrate the interaction between the two different parts of the programme—bowel scope screening and the original screening. I have also been trying to underline the point about take-up. Of course it is about individuals making an informed decision, but beyond rolling screening out to different ages, we must ensure that people in the highest risk groups, particularly the over-60s, are aware that they can choose to be screened. Many lives could be saved, so it is really important that we get that message across. We can do more.

In conclusion, I thank my hon. Friend the Member for Eastbourne again for securing this debate and drawing the important issue of bowel cancer screening to the attention of the House. I assure her and the families of all those affected—including, of course, Lauren, who started the petition—that preventing premature death from cancer is of the utmost priority for the Government. I hope I have set out how we are responding to that vital challenge.

Question put and agreed to.