Scottish Bowel Screening Programme Roll Out

The roll out of the national programme began in June 2007 in Tayside, Grampian and Fife NHS Boards inviting all eligible men and women aged 50-74 years to be screened every two years.  All other Health Boards are due to join the programme in a phased roll out by the end of 2009.  Information about the roll out can be found in the Bowel Screening Manual http://www.bowelscreening.scot.nhs.uk/. Appendix 2 contains detail of the Health Board roll out plan.

Bowel Cancer in Scotland

Bowel cancer (or colorectal cancer) is a major public health problem in Scotland, which has a higher rate of bowel cancer than most other countries in the Western world. In Scotland it is the third most commonly diagnosed cancer in both men and women with approximately 3,400 new cases diagnosed each year.  Ninety-five percent of cases occur in people aged over 50 years. Currently, the incidence rate in Scotland is stable amongst men and falling in women whilst the mortality rate is falling for both sexes.  However, bowel cancer is still the second most common cause of cancer death for men and the third for women with around 1,600 people dying of the disease in Scotland each year. The five year relative survival rate is approximately 50% for both sexes.

Bowel cancer screening can identify pre-cancerous signs in men and women who otherwise have no symptoms, and thus abnormalities can be investigated and treated. Treatment, at this stage, is usually very effective.

Scottish Bowel Screening Pilot

The Scottish Bowel Screening Pilot commenced in April 2000 in Tayside, Grampian and Fife NHS Boards.  All men and women registered with a GP Practice aged 50-69 years were invited to participate and to be screened every two years.  The pilot programme finished in May 2007.

Eligible men and women were posted a guaiac-based faecal occult blood test kit (FOBT). The kit is completed at home and involves collecting 2 samples from each of 3 separate bowel movements. The kit is returned in a pre paid envelope to the central screening centre in Dundee and tested for hidden traces of blood in the stool.

Individuals who had a positive FOBT result were referred to their local hospital for assessment and, where appropriate, offered a colonoscopy as the first line of investigation.

The pilot was split into three rounds, each round encompassing a two yearly screening cycle. The screening algorithm (procedure) evolved over the three rounds. The initial algorithm is detailed in the full evaluation report  www.cancerscreening.nhs.uk/bowel/finalreport.pdf.  In the second round, dietary restriction for the repeat test was not required. In the third round, repeat testing of those who had a negative test following a weak positive initial test was not undertaken.

Figure 1.0 Numbers invited to the Scottish Bowel Screening Pilot by Round and Health Board

Over 300,000 individuals were invited to each round of the Bowel Screening Pilot. Around 410,000 were invited to all three rounds.

Scottish Bowel Screening Pilot Key Performance Indicators

 The key performance indicators for all rounds of the pilot are available to view in SBSPKeyPerformanceIndicators.pdf.

Key Points

• Uptake was higher in women than in men
• Uptake was lowest in deprived areas
• Men were more likely than women to have a positive FOBT result
• More cancers were detected in men than in women

It is estimated that once the bowel screening is established mortality from bowel cancer will decrease by 16%, preventing approximately 150 premature deaths per year.  

Information about bowel cancer

Detailed information on bowel cancer in Scotland and links to UK publications can be found on the colorectal cancer statistics page.

More general information on bowel cancer can be found at www.bowelcanceruk.org.uk;  www.cancerbackup.org.uk; www.cancerresearchuk.org and www.beatingbowelcancer.org.