1. March 2010 Having a Bowel Test Professional Pack

2. March 2010 Having a Bowel Test A Guide for Health Professionals This guide has been developed for use in conjunction with the :- Having a Bowel Test Bowel Information Pack for People with a Learning Disability

3. March 2010 Aims of the Guide To provide health professionals and teachers with a background knowledge of the bowel screening programme To assist in the provision of education on bowel screening Provide useful website links to access further information as required

4. March 2010 Before undertaking a teaching session work through this professional pack The pack allows you to develop your own knowledge base at your own pace Each slide provides the key messages relating to bowel screening For more detailed information follow the relevant website links To open the links right click and select open hyperlink. N.B Hyperlinks will only be active when you are using the pack online How to use this Guide

5. March 2010 About Bowel Screening Wales Bowel Screening Screening Wales (BSW) is the organisation that manages the bowel screening programme in Wales It is part of Public Health Wales NHS Trust, Screening Division The programme was established in 2008 The aim of bowel screening is to reduce the number of people dying from bowel cancer in Wales by 15% by 2020 All men and women resident in Wales will be eligible for bowel screening when they reach 50 years of age Bowel Screening Wales Website

6. March 2010 Public Health Wales NHS Trust Screening Division Breast Test Wales Cervical Screening Wales Newborn Hearing Screening Antenatal Screening Bowel Screening Wales Organisation

7. March 2010 What is Screening? Screening provides an opportunity to reduce the risk of contracting a disease or suffering its complications The bowel screening programme reduces the risk of dying from bowel cancer The UK National Screening Committee (NSC) assesses screening programmes to ensure they do more good than harm www.nsc.nhs.uk

8. March 2010 Definition of Screening UK National Screening Committee “A public health service in which members of a defined population, who do not necessarily perceive they at risk of, or already affected by a disease or its complications, are offered a test to identify those individuals who are most likely to be helped than harmed by further tests or treatment to reduce the risk of disease or its complications”

9. March 2010 Principles of Screening 1.The condition screened should pose an important health problem 2.The natural history of the condition should be well understood 3.Recognisable latent or early stage 4.Treatment of the disease at an early stage should be more beneficial than treatment at a later stage

10. March 2010 Principles of Screening 5.There should be a suitable test or examination 6.It should be acceptable to the population 7.Screening should be repeated at intervals determined by the natural history of the disease

11. March 2010 Principles of Screening 8.There should be adequate diagnostic and treatment facilities 9.The cost – should be economically balanced against the benefit it provides 10. The chance of physical or psychological harm should be less than the chance of benefit Jungner, J.M.G., Wilson, G. (1968) Principles and Practice of Screening for Disease. World Health Organisation

12. March 2010 Informed Choice UK National Screening Committee “ The public should be given a realistic view of the merits and flaws of screening so that they can make an informed choice and decline an invitation if they wish ” BMJ 14.10.2000

13. March 2010 Disadvantages of bowel screening Bowel screening does not pick up every abnormality Bowel screening is not 100% effective Not all cancers bleed and the screening test is looking for blood Bowel screening can produce false positive results

14. March 2010 Advantages of bowel screening Regular screening reduces the risk of developing bowel cancer by 16% By detecting bowel cancer at an early stage there is a 90% chance of successful treatment Bowel screening may detect polyps which are non cancerous but may develop into cancer if left untreated

15. March 2010 What does the bowel do? The bowel is part of the digestive system and is divided into the small and large bowel Food passes from the stomach to the small bowel Any undigested food then passes into the large bowel The large bowel is made up of the colon and rectum

16. March 2010 What is bowel cancer ? Bowel cancer is a malignant tumour which affects the lower part of the digestive system, ( the large bowel and rectum) Bowel cancer is also called colon, rectal or colorectal cancer

17. March 2010 How common is bowel cancer ? Bowel cancer is the third most common cancer in Wales 2,000 new cases are diagnosed each year in Wales 1,000 people die from bowel cancer each year in Wales Bowel cancer is more common in people over 50 About 1 in 20 people over the age of 50 will develop bowel cancer during their lifetime

18. March 2010 What causes bowel cancer ? The exact cause is unknown About 1% of all bowel cancers are family history related Certain families have an increased risk of developing bowel cancer due to a variety of reasons The risk of developing bowel cancer increases with age

19. March 2010 What is bowel screening ? The purpose of bowel screening is to look for bowel cancer at an early stage when treatment is more likely to be effective It is a population based screening programme aimed at the well population Bowel Screening Wales does not screen people who have symptoms

20. March 2010 Why screen for bowel cancer ? Regular screening reduces the risk of developing bowel cancer If bowel cancer is detected early enough there is a 90% chance of treating the disease successfully It has been shown that a bowel screening programme can reduce deaths from bowel cancer by 16%

21. March 2010 What does the screening test look for? The screening test looks for hidden blood in the bowel motion which may suggest a risk of bowel cancer It is called a Faecal Occult Blood (FOB) test The test can also detect polyps. Most polyps are harmless but some can lead to bowel cancer The test does not diagnose bowel cancer but will indicate if further investigations are needed

22. March 2010 Who will be invited for bowel screening in Wales ? Men and women aged 60 – 74 who are registered with a GP and resident in Wales will be invited. They will be invited every 2 years.

23. March 2010 What does the test involve ? A home screening test kit will be sent in the post Small samples from 3 separate bowel motions need to put onto the test kit It is then returned in the post using the envelope provided

24. March 2010 How are results received ? Results will be posted out within 2 weeks Most people (98 out of 100) will have a normal result (no blood found in sample)

25. March 2010 What might the results show ? If the test is unclear it will be necessary to do a repeat test If blood is detected in the sample the person will be referred for an assessment with a Specialist Screening Practitioner The assessment may result in being offered further investigation which may include colonoscopy

26. March 2010 What is colonoscopy ? Colonoscopy is an investigation that directly examines the lining of the large bowel A thin flexible tube with a camera attached (colonoscope) is passed into the rectum and guided around the bowel A colonoscopy is the most effective way to diagnose bowel cancer

27. March 2010 How accurate is bowel screening ? Like all screening tests, the FOB test is not 100% reliable Not all cancers bleed and the FOB test is looking for blood However bowel cancer screening has been shown to reduce the risk of dying from bowel cancer by 16% Cancer Research Website

28. March 2010 What if a bowel test is declined ? If the test kit is not returned within 6 weeks a reminder and repeat test kit will be sent If there is no response in 6 weeks the recall date will be reset and the person invited again in 2 years time It is important that any unusual symptoms are reported to the GP

29. March 2010 Advice to reduce the risk of bowel cancer? Take part in the bowel screening programme every 2 years Eat a high fibre diet with plenty of fruit, vegetables and carbohydrates such as wholegrain pasta, bread and rice Stop smoking Moderate amounts of exercise Report any unusual symptoms to your GP

30. March 2010 What are unusual symptoms ? Rectal bleeding or flecks of blood in the bowel motion A change in regular bowel habits, such as constipation or diarrhoea, for a period of 6 weeks Abdominal pains that are severe, continual and started recently, especially after eating Unexplained weight loss Unexplained anaemia N.B.These symptoms may be caused by a range of conditions

31. March 2010 How can you help ? Update your knowledge and skills regularly Ensure you are giving the correct information Provide appropriate resources – leaflets, picture books, factsheets If you need any further help or advice please contact us……

32. March 2010 For further information…. Screening Promotion Department Breast Test Wales Maes Du Road Llandudno LL30 1QZ Tel: 01492 860888. Contact :- Bowel Screening Wales Unit 6 Greenmeadow Pontyclun Llantrisant CF72 8XT Tel: 0800 294 3370