NHSE looks to match Scotland on cancer tests

At the moment the threshold for a follow-up scan after a faecal immunochemical test (FIT) screen in England is 120 micrograms of blood per gram of faeces, compared to 80 north of the border. This means cases which would trigger investigation in Scotland do not in England.

But NHSE is now looking at lowering the bar, and a first wave of sites piloting the change will begin in October, its director of electives, cancer and diagnostics Ed Rose announced at HSJ’s Cancer Forum this month.

NHSE says current research and modelling suggests lowering the threshold across England would see 1,000 more bowel cancers picked up in screening every year. The most recent data for the national screening programme, for 2021-22, showed 85,000 people referred on for further tests, out of 4.1 million tested.

Once a “comprehensive” evaluation has been carried out, NHSE will support “a gradual, sustainable drop to [a bar of] 80ug/g across the country”, it said.

Financial modelling for the additional diagnostics and follow-ups is at an early stage, but the extra costs are expected to be less than £100m annually.

The Royal College of Radiologists welcomed the move but said it would place more pressure on already understaffed teams carrying out colonoscopies

RCR president Katharine Halliday said: “The FIT test [is] a more accurate measure for selecting people for colonoscopy than reviewing their symptoms on their own, and undoubtedly lowering the threshold will pick up more patients. However, the influx of additional images without a proportional increase in clinical radiologists will inevitably exacerbate pressure on an already stretched workforce…

“To prevent a bottleneck in both current and future healthcare services, the government must prioritise creating capacity for doctor training, while retaining the doctors we have.”

The current median waiting time for a colonoscopy in the NHS was 3.1 weeks in January 2024, the latest data, compared with two weeks in January 2019.

NHSE director of vaccinations and screening Steve Russell said: “As part of our commitment to expand the bowel cancer screening programme and catch more cancers at an early stage, we are launching a pilot scheme to increase the sensitivity of home testing FIT kits for eligible people, which could prevent more cancers from developing in the first place.”

The change was recommended in Cancer Research UK’s November manifesto for bringing Britain’s cancer outcomes up to the standard of other wealthy nations by 2040.

The charity’s director of evidence and implementation Naser Turabi said: “It’s great news… “We hope this pilot phase paves the way for a full roll-out across the programme that will reach more eligible people.

“To ensure everyone gets timely access to follow-up tests, the UK government must invest in endoscopy services and additional capacity across the cancer pathway.”