Bowel screening 'is not feasible'

Screening is highly skilled

The NHS could not cope with a national bowel cancer screening programme as planned by ministers, warn scientists.

They say services for diagnosing gut disorders are already overstretched - and would be sunk by increased demand.

More than 30,000 new cases of bowel cancer are diagnosed every year, and early treatment is vital.

But the Gut study, led by London's Royal Free Hospital, found doctors were already carrying out diagnostic procedures without proper training.

The researchers conclude: "Unless there is a dramatic increase in manpower and resources available for lower gastrointestinal investigations, the introduction of a national screening programme would rapidly overburden already inadequate facilities."

The government announced in February last year that it intended to introduce a national screening programme as a way to cut deaths from the disease.

Colonoscopy

Results of colonoscopy audit Normal results in only 40% of patients Polyps, which can lead to cancer, found in around 40% of patients Cancer found in less than 4% of patients Other most common diagnoses included diverticular disease and inflammatory bowel disease

The study focused on a procedure called a colonoscopy in which a long flexible tube with a camera is inserted into the bowel to look for abnormalities.

It is a difficult procedure to learn, and can lead to bleeding, a perforated bowel, or even death, if carried out incorrectly.

The researchers analysed a total of 9,223 colonoscopies carried out over a four month period at hospitals in North East Thames, West Midlands, and East Anglia.

One in five procedures failed to view the top of the bowel, an area called the caecum.

In one in three cases, this was because the patient found it too painful. But in the remainder, inexpert handling of the colonoscope or inadequate bowel preparation were responsible.

Lack of training

Only 17% of those carrying out the procedure had received supervised training for their first 100 colonoscopies, as recommended, and only four out of 10 had received formal training.

A national bowel cancer screening programme presents significant challenges, but is worth striving for Richard Winder

The bowel was perforated in 12 patients; 13 bled after the procedure, six of whom required admission to hospital, as a result; and 10 patients died within a month - although the procedure was thought to have contributed in only six of these cases.

The researchers say demand for colonoscopy has quintupled in 15 years. In 1987, there were an estimated 160 colonoscopies for every 100,000 of the population.

The latest estimates from the British Society of Gastroenterology now put the figure closer to between 800 and 1,000.

It has been estimated that the introduction of a national bowel screening programme would require at least six extra colonoscopies a week in district general hospitals, say the authors.

"While there are centres where practice is of the highest quality, considerable effort is required to raise the overall quality of colonoscopy," they conclude.

Dr Jeremy Sanderson of the British Society of Gastroenterologists said there were "real and worrying problems" with current screening.

He said: "The wide variation of good and bad practice in investigation units is unacceptable.

"We are urging government to sit round the table with specialists to thrash out what resources will be needed to implement the national bowel cancer screening programme - so it is not placed in jeopardy."

Pilot schemes

Pilot bowel screening projects are currently being carried out by the NHS Cancer Screening Programmes.

Deputy director Richard Winder said: "A national bowel cancer screening programme presents significant challenges, but is worth striving for as research has shown that it can help reduce death rates by finding and treating bowel cancer early.

"It is predicted that deaths from bowel cancer could drop by 15% as a result of screening, equating to approximately 2,500 lives nationally each year."

However, the charity Colon Cancer Concern issued a statement saying it "disagreed strongly" with the conclusion that diagnostic services would not be able to cope with the introduction of a national screening programme.

It said the government had pledged to ensure resources were in place to meet the extra demand the programme would generate.

Chief executive Jola Gore-Booth said: "Bowel cancer is the second highest cause of cancer death in the UK and yet the disease is very treatable if caught early, which is why screening is vital if we are going to reduce the numbers of people affected by the disease."

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