1. 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.

2. Bowel Cancer Screening
By Alex Pearce-Smith

3. 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%.

4. 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.

5. 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.

6. 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: samples positive.
Unclear: samples positive.
Negative: All samples negative.

7. 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.

8. 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.

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

10. References