IBMS Congress

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Bowl cancer screening programme (outcome & implications for patient management)

Prognostic Markers

Cellular Pathology

Dr Paul Simcock, Mid Cheshire Hospital

Colorectal cancer is the third commonest cancer and 2nd commonest cause of cancer death in the UK.  The bowel cancer screening programme began in 2006 and pilot schemes have shown that screening can reduce the incidence of colorectal cancer by 16%. 

Following the introduction of the NHS bowel cancer screening programme in the UK, malignant colonic polyps are being detected with increasing frequency. Almost all of these malignant polyps are stage I cancers and would therefore be expected to have a very good prognosis.

Screening involves testing for occult blood within stool samples and identifying patients who would benefit from colonoscopy. Colonoscopy not only aims to identify cancers at an early stage but also pre-malignant adenomatous polyps from which invasive tumours are known to develop. Histopathology plays a key role not only in the diagnosis of these polyps but their histological features also provide important prognostic information that is used to stratify patients into risk categories and determine appropriate surveillance.

This lecture covers the principles behind all cancer screening programmes in the UK, the pathology of colorectal polyps and cancer, and how this is used to determine patient surveillance in the bowel cancer screening programme. It concludes with some data on uptake rates, positivity rates and rates of polyp and cancer detection illustrating our experience at the Cheshire Bowel Cancer Screening Centre.