GHA specialists to assess demands on service before lowering bowel cancer screening age

GHA specialists are actively looking into lowering the age of bowel cancer screening, but before doing so, the team are assessing whether this would strain the current service offered.

In Gibraltar, bowel cancer screening is offered to those aged 60 to 74 years and the GHA is considering lowering the age to match the NHS which recently announced it was expanding the service to include all over-50s.

But the service locally is currently assessing whether this would impact patient safety and exacerbate waiting times.

Director of Public Health Dr Helen Carter and GHA Gastroenterologist Dr Gareth Latin told the Chronicle that there is a good evidence base that lowering the age will detect more cancers early.

The concern is that lowering the age could result in doubling the demand for screening and overstretch the service.

In response, steps are being made to fine-tune the screening programme before any decisions are made about changing the age criteria.

GHA figures show that 25 patients were diagnosed with bowel cancer last year and, of those, 37.5% patients were under the age of 60 years.

Three cases of bowel cancer were found last year through the screening programme.

Over the past 11 years of the screening service in Gibraltar, some 31,000 kits have been sent out with a response rate of around 42%.

Some 36 cancers have been detected in 11 years of the screening programme and a significant number of pre-cancerous lesions have been identified.

The GHA is currently working on increasing this response rate, which is low due to an issue with “ghost patients”.

Dr Carter said the GHA has the issue whereby there are cross-frontier workers who are entitled to healthcare locally and receive kits, but their addresses are not updated in the system.

In response, the GHA has sent out 2,600 letters to those eligible for bowel cancer screening in an attempt to “clean up the list”.

So far, the GHA has had 370 responses from patients, who have either opted in or out for the screening programme.

Dr Carter said this indicates that a lot of people are not responding to the letter, so response rates are not just low because people do not want to take part in the screening.

She reminded the public to update their addresses to ensure they are included in screening programmes.

“This is not unique to the bowel screening programme. This is across all our screening programmes,” Dr Carter said.

In her view, the response rate to the screening programme is much higher than 42% but is difficult to estimate due to these “ghost patients”.

Dr Latin added that one of the key benefits of the bowel cancer screening programme is that cancer is identified early and is significantly easier to treat with a much higher success rate.

“But actually, what's better than identifying cancer early is stopping it from happening in the first place,” he said.

Dr Latin explained that as part of the bowel cancer screening programme, patients who return a positive result will have a colonoscopy and, more times than not, this will identify polyps.

“Polyps are small growths within the bowel and many polyps are premalignant. They are pre-cancerous lesions that, given enough time, have a higher risk of developing into a cancer,” he said.

Last year, 93 polyps were removed from patients’ bowels, each having the potential to develop into a cancer.

“Once we've removed it, that potential is gone so those patients left that endoscopy room with a lower risk of cancer down the line,” Dr Latin said.

He underscored the crucial work of the screening service to find these pre-cancerous lesions, adding that the benefit will be seen in years to come in reducing the number of bowel cancers.

“Remove 100 of those lesions and that's a significant reduction in cancer down the line,” he said.

“That's why we are very focused on detecting these lesions, removing them safely and we are following up those lesions.”

“If you have multiple polyps that we have to take off, we will then look and repeat that procedure in maybe three years or five years’ time, because if you're prone to growing polyps we want to keep a closer eye on it. We want to take off any new polyps that you may have developed in that intervening period of time.”

Dr Latin added that the endoscopy team has finite resources so increasing screening could prove difficult.

“We have one endoscopy room, we're a small unit as you might expect for a place like Gibraltar and there are many demands on that unit,” Dr Latin said.

“The bowel cancer screening programme is one of those demands and what we need to balance out is if we expand down to say 50 that potentially translates into a doubling of the number of colonoscopies we need to do as part of our screening programme and even if I have the clinical time to do that, the room, the endoscopy unit itself, may not have the space or the time so it's about trying to ensure we don't overload one part of the pathway.”

Waiting times for a colonoscopy are around 12 days, which Dr Latin said is significantly shorter and better than the UK.

He said any extension of the bowel screening programme would need to ensure that wait times are not adversely affected.

“It's about carefully expanding the age, making sure we don't overwhelm our service and other services when you have a finite resource to work with,” Dr Latin said.

He added that most patients who receive a positive result will agree to a colonoscopy, but there are cases where people refuse.

He said the rate of refusal is much higher in the UK and put this down to the personal service the GHA offers.

Dr Latin said that refusals happen between five and seven times a year and, in those cases, he will call the patient directly and reassure them.

In most cases, the patient will then agree for a colonoscopy.

He believes this personal touch to the service locally is what has yielded higher responses locally when compared to the UK.

Dr Latin added that smoking, diet and lifestyle can increase the likelihood of bowel cancer.

Bowel cancer symptoms include blood in the stools, weight loss, unexplained fatigue, changes in appearance of consistency of bowel movements, change in bowel habits including diarrhoea, and blood in urine.

Those aged 60 to 74 years old who have not been screened should contact the GHA’s bowel screening administrator on tel: 20007025