A new initiative is underway in NHS Greater Glasgow and Clyde (NHSGGC) to help speed up the diagnosis of bowel cancer, as part of a UK-wide programme funded by Cancer Research UK.
Scotland has one of the highest rates of bowel cancer, also known as colorectal cancer, in the UK, with around 4,200 people diagnosed each year. It remains the second most common cause of cancer death in Scotland claiming around 1,700 lives annually and finding more effective ways to tackle the disease is crucial.
The pilot, which is part of Cancer Research UK’s Test Evidence Transition (TET) programme, is refining the use of Faecal Immunochemical Tests (FITs) which are available to people with symptoms of bowel cancer through their GP, allowing them to take a poo sample at home and return it by post.
Traditionally, patients with a result showing 10 micrograms of blood per gram of poo or more were referred for further investigation.
Under this new pilot, the threshold for the most urgent referral is being raised to 20 micrograms in line with changes to the Scottish national guidelines. This is based on evidence that patients with results between 10 and 20 micrograms have a very low chance of having bowel cancer.
The project provides an opportunity to pilot these national changes, whilst also implementing safety-netting measures for patients below the new threshold to help reduce the risk of delayed or missed bowel cancers.
These measures include referring people with FIT results between 10-20 micrograms at a lower priority and offering patients below the new threshold, who continue to show symptoms or have iron deficiency anaemia, a second FIT.
Project Lead Dr Stephen McSorley, Consultant Colorectal Surgeon at NHSGGC and Senior Clinical Research Fellow at the University of Glasgow, said: “This pilot will help us improve how we assess and investigate patients who present to their GP with symptoms that could be caused by bowel cancer.
“By refining the FIT threshold and improving communication between primary and secondary care, we aim to ensure the fastest possible diagnosis for those at highest risk, while maintaining safety nets for others. For the first time, patients will also receive written communication outlining their next steps, helping them feel more informed and supported.”
The evaluation of the pilot will be supported by research teams at the Universities of Oxford and Cambridge. If successful, the approach could be adopted by other health boards across Scotland and the wider UK.
Associate Professor Brian Nicholson of the University of Oxford said: “The safety measures that the team have put in place for their patients will reduce the risk of delayed or missed bowel cancer diagnoses. We are working together to understand how their approach would best be introduced in other regions”.
Despite a national target for 95% of patients to begin treatment within 62 days of an urgent suspected cancer referral, screening referral or direct referral, this has not been met since 2012. The NHSGGC pilot aims to address this by streamlining the diagnostic pathway and prioritising those most in need of urgent care.
Whilst the pilot is for symptomatic patients, screening for bowel cancer remains one of the most effective tools for early detection. The NHS Scotland National Bowel Screening Programme invites everyone aged 50 to 74 to take part in regular screening every two years.
TET is a major Cancer Research UK programme which aims to accelerate the adoption of innovation in the health system while reducing inequalities in access to best practice cancer care. Previously, the scheme has focused on reducing waiting times for people with suspected breast and prostate cancer.
Naser Turabi, Director of Evidence and Implementation at Cancer Research UK, said: “We’re proud to support NHS Greater Glasgow and Clyde in this innovative pilot. Tackling diagnostic delays is critical to improving cancer outcomes, and this project has the potential to make a real difference for patients in the region and beyond.”
The TET programme has received £2 million in funding from Cancer Research UK and the Bowelbabe Fund, established in memory of Dame Deborah James. It supports NHS-led projects across the UK that aim to improve cancer diagnosis and care through innovation and research.
