Wilson and Jungner Criteria for Screening 1968 Knowledge of disease: The condition should be important. There must be a recognisable latent or early symptomatic stage. Natural course of condition, including development from latent to declared disease, should be adequately understood. Knowledge of test: Suitable test or examination. Test acceptable to population. Case finding should be continuous (not just a "once and for all" project). Treatment for disease: Accepted treatment for patients with recognised disease. Facilities for diagnosis and treatment available. Agreed policy concerning whom to treat as patients. Cost considerations: Costs of case finding (including diagnosis and treatment of patients diagnosed) economically balanced in relation to possible expenditures on medical care as a whole.

Bowel Cancer Screening By Alex Pearce-Smith

Why Screen for Bowel Cancer? 1 in 20 of UK population will develop bowel cancer. 3rd most common cancer. 2nd biggest cancer mortality – 16,000 deaths from bowel cancer per yr in UK. Screening has been shown to decrease mortality by 16%.

What is the purpose of screening? Early (pre-symptom) detection at time when more likely to be curable. Polyp detection and excision can reduce incidence of future cancers.

How is the screening organised? Nationwide coverage since 2010. All 60-69yr olds every 2 yrs – over 70s can request test. Program hubs organise call and recall and co-ordinate with local screening centres. Piloted in North Warwickshire (2006-7). Approx ½ Million residence with 57% uptake Approx 2% postive and 1.6/1000 dx Bowel Ca Higher rates in men and in Scotland. 552 cancers detected. 92 (16.6%) Polyps. 48% Dukes A 1% Metastasised Cost £76.2 Million per yr.

The Test Bowel Cancer – the facts leaftlet sent out. Kits opposite sent out a week later. Sample smeared from paper on to 6 test areas. Positive: 5-6 samples positive. Unclear: 1-4 samples positive. Negative: All samples negative.

What Happens? Majority of people approx 98% have normal result and will be invited back in 2 yrs. Approx 2% will have a positive result and will be called for discussion re colonoscopy. Approx 4% will have equivocal result and have further test sent – most of these will be normal.

Colonoscopy 5 of 10 will have a normal colonoscopy. 4 of 10 will have a polyp – which if removed will reduce the risk of cancer. 1 of 10 will have bowel cancer. Risks:- 1 in 150 heavy bleeding. 1 in 1,500 perforation. 1 in 10,000 – death.

Predicted Outcomes and The Screening Pathway outcome-flowchart.pdf screening-pathway.pdf

References www.cancerscreening.nhs.uk/bowel www.patient.co.uk