Data from this manuscript were presented at the ASGBI 2011 International Surgical Congress in Bournemouth.
Impact of the bowel-screening programme on the diagnosis of colorectal cancer in Ayrshire and Arran
Article first published online: 20 DEC 2012
© 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland
Volume 15, Issue 1, pages 34–41, January 2013
How to Cite
Roxburgh, C. S. D., McTaggart, F., Balsitis, M. and Diament, R. H. (2013), Impact of the bowel-screening programme on the diagnosis of colorectal cancer in Ayrshire and Arran. Colorectal Disease, 15: 34–41. doi: 10.1111/j.1463-1318.2012.03100.x
- Issue published online: 20 DEC 2012
- Article first published online: 20 DEC 2012
- Accepted manuscript online: 25 MAY 2012 09:57AM EST
- Received 23 December 2011; accepted 27 March 2012; Accepted article online 25 May 2012
- Colorectal cancer;
- referral category;
- TNM stage
Aim Bowel screening aims to reduce colorectal-cancer mortality by the detection and treatment of early-stage asymptomatic disease and the removal of precancerous adenomas. Bowel screening started in Ayrshire and Arran in September 2007. We report the impact of this screening on the diagnosis and stage of colorectal cancer and characterize screen-detected cancers in comparison with those diagnosed through other pathways.
Method Diagnoses were identified from an audit database. Referrals were grouped into screen detected, routine, urgent and emergency presentations.
Results Between January 2001 and December 2010, 2289 diagnoses of colorectal cancer were made. From 2001 to 2006, the mean (range) number of new colorectal-cancer diagnoses per year was 210 (198–220). Between 2007 and 2010, the mean (range) number of diagnoses per year was 256 (239–274), a significant (P = 0.008) increase. Since September 2007, 877 colorectal cancers have been diagnosed: 17% were screen detected; 11% were detected as a result of routine GP referral; 51% were detected after urgent GP referral; and 21% were emergency presentations. TNM stage increased with urgency of referral. Approximately two-thirds (66%) of screen-detected colorectal cancers were node negative vs 25% of emergency presentations (P < 0.001). Most screen-detected cancers were distal to the splenic flexure (75%). Screened cancers had favourable pathology; lower T and N stages (both P < 0.001), less venous invasion (P < 0.001) and better differentiation (P < 0.05). Similar results were seen after stratification for TNM stage. Screening has not yet resulted in a significant shift towards early-stage disease since 2007.
Conclusion Screening has been associated with an increase in the numbers of both new and early-stage colorectal cancers. Screen-detected cancers are predominantly early-stage disease with favourable pathology. At present, it remains to be seen whether screening will ultimately translate into an overall reduction in advanced-stage disease.