Bowel Cancer Screening

Paul Burstow Excerpts

Wednesday 23rd November 2011 Commons Chamber

[The Minister of State, Department of Health (Paul Burstow)]

I congratulate my hon. Friend the Member for Hexham (Guy Opperman) on securing the debate and on setting out the issues so clearly. Let me just confirm the answer that he gave to his hon. Friend the Member for West Worcestershire (Harriett Baldwin)—it is the case that the NICE guidance has been changed in the way that he said. I hope that helps her. I look forward to reading the Hansard report of his description of his tie and the removal of certain items that would have made a noise in the debate had he pressed the button.

My hon. Friend the Member for Hexham has used this opportunity very well to raise awareness of these issues further. There has been good progress in bowel cancer survival over the past 30 years, with the survival rates for men and women doubling, but it remains a devastating disease. In 2009, some 32,751 people were diagnosed with the cancer and 12,691 people died from it. In the vast majority of cases, the earlier a cancer is diagnosed, the sooner the treatment can begin and the better the outcomes are likely to be. That is why early diagnosis of cancer is central to the Government’s cancer outcome strategy and that is why it is vital that we do more to diagnose cancers earlier and improve survival rates as a result.

We are focusing on survival rates because they are a much more effective way of addressing and assessing NHS performance, as they show how good the NHS is, compared with other countries, at diagnosing and treating people with cancer. Measures such as cancer mortality figures are not a good way of assessing the NHS’s performance as they are an indicator of both incidence and survival. They indicate more about societal changes than about what the NHS has done.

Screening is one of the most important means by which cancer—and in the case of bowel cancer, of abnormalities that may lead to cancer—can be detected earlier. Research undertaken in Nottingham and Denmark in the 1980s showed that screening men and women aged 45 to 74 for bowel cancer using the faecal occult blood test could reduce the mortality rate from bowel cancer by 16%. An independently evaluated pilot in Warwickshire and Scotland showed that this research could be replicated in an NHS setting. Based on the final evaluation report of the pilot and a formal options appraisal, the programme in England began screening men and women aged 60 to 69 in July 2006, and I am pleased to say that full roll-out was achieved last August.

Experts have estimated that by 2025, about 2,400 lives could be saved every year by the current NHS bowel cancer screening programme. However, I agree with my hon. Friend that there may be more we could do through occupational health interventions. As at 31 October this year, more than 12.2 million kits had been sent out and more than 6.9 million had been returned. We have to do more to get more returns, but from those returns 10,785 cancers were detected and 53,616 patients underwent polyp removal. As my hon. Friend said, polyps that are left untreated can develop into bowel cancer. Men and women over the age limit can request a testing kit every two years, and more than 145,000 have self-referred to the screening programme in just that way.

As some 15% of bowel cancers—4,893 in 2009—are diagnosed in men and women aged 70 to 74, the NHS bowel cancer screening programme is currently being extended to men and women aged from 70 up to their 75th birthday. As at the end of October this year, 33 of the 58 local screening centres had implemented the extension of that programme. When the extension is fully rolled out by next year, about 1 million more men and women will be screened each year.

We know that the evidence for faecal occult blood test screening starts at 50, as shown by the trials that have been mentioned. The original programme invited only people in their 60s because the risk of bowel cancer increases with age. Nearly 85% of bowel cancers arise in people over the age of 60. In the pilot, more than three times more cancers were detected in people aged over 60 than in those under 60, and people in their 60s were most likely to complete the testing kit. In addition, there was not enough endoscopy resource to begin the wider age roll-out. To underline a point that my hon. Friend made, in terms of cost, the 2004 working group report on NHS cancer screening programmes, which assessed a number of models for bowel cancer screening, found that starting at age 50 ranked fifth—bottom—in terms of cost-effectiveness.

The national endoscopy training programme has allowed us to begin extending the programme to people up to age 75. However, this extension to the current programme, the planned introduction of flexible sigmoidoscopy screening, which I will come back to in a moment, and the move to more investigations of symptomatic patients mean that a key priority is to increase endoscopy activity. We have begun from a low level, as my hon. Friend suggested, with much lower rates of endoscopy than many other comparable countries. For example, colonoscopy rates in England are eight per 1,000 population, compared with Scotland, where they are 12 per 1,000 population, and Australia, where the rate is 21 per 1,000.

The Department has undertaken further modelling work to estimate the demand for endoscopy services up to 2015-16. That analysis shows that the NHS will need to increase lower GI endoscopic capacity by 15% a year over the next five years to meet underlying growth and the commitments set out in the Government’s cancer outcomes strategy. In response to my hon. Friend’s question, that is how the issue about the work force and making sure that there is a sufficient supply of nurse endoscopists is being addressed.

Funding for an increased number of endoscopies has been put into primary care trust baselines, and that is part of the £750 million over four years that accompanies the cancer outcomes strategy. While it is primarily for the NHS to take the necessary steps to increase endoscopy activity, we are looking at the scope for central support, for example, through service improvement work led by NHS Improvement. However, we are making a huge investment in our bowel screening programme for people in their 50s, in response to my hon. Friend’s fifth question about funding. In September 2010, we announced £60 million of funding for the introduction of a life-saving new screening method—flexible sigmoidoscopy—in the programme.

Flexible sigmoidoscopy is an alternative, and a complementary bowel screening methodology to faecal occult blood. New evidence shows that men and women aged 55 attending a one-off flexible sig screening test for bowel cancer can reduce the risk of mortality from the disease by 43%, and it can reduce the incidence of bowel cancer by 33%. Flexi sig involves a thin, bendy tube, which the doctor uses to look at the inside wall of the bowel and remove any growths—polyps—that are present. Bowel cancer usually develops very slowly from polyps, which are called adenomas. By removing them at an early stage, it is possible to prevent bowel cancer from developing.

My hon. Friend referred to the randomised controlled trials conducted by Cancer Research UK, the Medical Research Council and NHS R&D in 14 UK and six Italian centres. The study concluded that flexi sig is a safe and practical test and, when offered only once between the ages 55 and 64, it confers a substantial and long-lasting benefit. Based on the trial figures, experts estimate that we could prevent as many as 3,000 cancers every year and save thousands of lives.

In 2011, pathfinder sites tested organisational arrangements for the operation of flexi sig screening, with particular attention to the invitation and appointment process. That will enable optimal strategies to be applied in the national pilots. The pathfinder sites were in the Tees, south of Tyne and Wear, and Derbyshire local screening centres. We have formal agreements in place to develop the IT system for flexi sig—I hope that that answers my hon. Friend’s first question—and local screening centres will be invited to bid to become pilot sites early in 2012.

In response to my hon. Friend’s third and fourth questions, the bowel cancer screening advisory committee has advised that people should be invited at age 55, with two reminders, before they become eligible for the faecal occult blood test programme at 60. People from the original trial are being followed up to gain information about the most appropriate faecal occult blood test policy for people who have undergone flexi sig screening. We do not have the answer yet, but we are working to make sure that we do have a clear answer to assist physicians.

The coalition Government’s cancer strategy set out our aim to achieve 30% coverage of flexi sig screening across England by 2013-14, and 60% by 2014-15. It is envisaged that full roll-out will be achieved by 2016. We are also looking at other ways in which we can improve bowel cancer screening. Our cancer outcomes strategy sets out how NHS cancer screening programmes will look at how more accurate and easier-to-use immunochemical faecal occult blood tests—those are words that one can struggle with, and I hope Hansard will be kind to me—can be introduced into the programme, potentially to increase uptake and to provide more accurate results. A protocol has been devised to pilot such testing within the programme to assess the feasibility, practicality and cost-effectiveness of moving to this new technology.

To date our awareness activity has focused on bowel cancer, lung cancer and breast cancer, and we have spent nearly £11 million supporting 59 cancer awareness campaigns and trialling a national bowel cancer campaign. That campaign is about making sure that people do not die of embarrassment when it comes to bowel cancer, and that, if they think there is blood in their poo or if they have loose stools, they will go and see their GP and get a referral for a diagnosis. It is also about Ministers, as much as anyone else, overcoming their embarrassment about talking about it. The more we are prepared to start talking about these embarrassing subjects, the less people will die of embarrassment as a result.

We know that the pilot, the Be Clear on Cancer campaign, which we launched in January this year and ran for seven weeks in the east of England and in the south-west, made a real difference in the number of people being referred into the programme. The evaluation of the Be Clear on Cancer campaign to date has shown that people have become much more aware of the signs and symptoms of bowel cancer, people have been very supportive of such campaigns by the Government, and there has been an increase of about 50% in people over 50 with the relevant symptoms going to see their GP. This increase will lead to people being saved.

I hope this debate has reassured people that the Government take bowel cancer screening as a serious priority. We are determined to save more lives in future and I congratulate my hon. Friend on securing this important debate.

Question put and agreed to.