Introduction
Bowel cancer is the 4th commonest type of cancer in the UK with 42,900 new cases a year and is common in both men and women, with approximately 23,900 and 19,000 new cases a year respectfully. The England age standardised bowel cancer incidence rate in 2015-2019 was 69.4/100,000, and slightly lower in North Tyneside with an age standardised incidence rate of 68/100,000 for the same period. Both nationally and locally, this varies considerably between men and women, with the disparity being greater in North Tyneside than what is seen nationally. The age standardised incidence rate per 100,000 for bowel cancer for men in North Tyneside is 90.2 compared to 84.4 in England whilst for women it is 51.5 in North Tyneside compared to 56.7 in England.
There are multiple risk factors for bowel cancer, some of which are unpreventable such as ageing, family history and adult attained height whereas others such as alcohol, tobacco, diet and physical activity are modifiable risk factors. Modifiable risk factors are considered with ongoing work through the relevant lifestyle alliances in the borough and region. JSNAAs for these factors are available.
As with other cancers, the earlier bowel cancer is detected and diagnosed, the better the prognosis . If bowel cancer (including colon, colorectal and rectal) is diagnosed at Stage 1, age-standardised 1-year net survival is approximately 97.8% for all persons, compared to 45% if diagnosed at Stage 4 . This pattern continues at 5-year survival, if diagnosed at Stage 1, age standardised 5-year net survival is 91.5% compared to 10.5% if diagnosed at Stage 4 . That is, if diagnosed at Stage 1, 9 out of 10 will survive for 5 years compared to 1 out of 10 if diagnosed at Stage 4.
Within North Tyneside, between 2013-2019 approximately 16% of bowel cancers (colon and rectum) were diagnosed at Stage 1, with about 25% being diagnosed at Stages 2 and 4 and the majority (30%) diagnosed at Stage 3.
Meeting the 2028 NHS Long Term Plan goal of 75% of all cancers being diagnosed early will be missed in North Tyneside unless there is a substantial shift in the Stage at which cancer is diagnosed.
The screening programme was introduced in 2006 and aims to both diagnose bowel cancer early and also prevent bowel cancer (by the removal of incidental findings such as polyps during colonoscopy).
All screening programmes are a choice as they carry some risk. It is estimated that around 2 out of every 100 people participating in the bowel screening programme will need further tests, usually a colonoscopy. Most people requiring a follow up colonoscopy will not go on to receive a diagnosis for bowel cancer, instead it is common for polyps to be found and removed, which further reduces the risk of developing bowel cancer.
The aim of the bowel cancer screening programme is to reduce bowel cancer morbidity and mortality by preventing and diagnosing bowel cancer early. The bowel cancer screening programme is available to all those aged 60 – 74, with those 74+ able to opt in to continue to be screened. The age is being reduced to 50 from 2020 following an evidence review. In North Tyneside this began with 56-year-olds in 2021- 22 and will be fully extended to all those 50-60 by 2025. The bowel cancer screening programme aims to find bowel cancers at an early stage when it is not yet creating detectable signs or symptoms. The screening is carried out at home, using a Faecal Immunochemical test (FIT) which detects blood in faeces. Healthy adults with no symptoms aged 60-74 should be invited to screen every 2 years.