21 Aug Study Examines Ways to Reduce Demand for Colonoscopies
MedicalResearch.com Interview with:
Professor Stephen Duffy
Director of the Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis
Centre Lead, Centre for Prevention, Detection and Diagnosis
Queen Mary University of London
MedicalResearch.com: What is the background for this study?
Response: The NHS Bowel Cancer Screening Programme provides 2 yearly screening to men and women aged 60-74, and it is in the process of reducing the starting age to 50 years. The screening method is faecal immunochemical testing (FIT), in which the screenee places a small sample of faeces in a container and mails this back to the lab, which tests the sample for haemoglobin, as bleeding can be a sign of cancer. The screenee is invited for colonoscopy if the level of haemoglobin is higher than 120 micrograms per gram. The system is under considerable pressure as there are limited colonoscopy resources, the programme is working towards a lower age at starting screening and we are still dealing with the backlog caused by the COVID-19 pandemic, and there may be a need to reduce the intensity of screening in order that the colonoscopy services can cope.
MedicalResearch.com: What are the main findings?
Response: The main finding was that one can reduce the demand for colonoscopies by either screening less frequently than two years or by increasing the haemoglobin threshold for colonoscopy. Our results suggest that increasing the threshold would cause a lesser reduction in early detection than screening less frequently.
MedicalResearch.com: What should readers take away from your report?
Response: In these extraordinary times, when we are recovering from the pandemic and trying to expand the target population for screening, it may be that something has to give. All possible options should be explored, including changing the haemoglobin threshold.
MedicalResearch.com: What recommendations do you have for future research as a results of this study?
Response: The continuous measure of haemoglobin provided by the FIT tests offers an opportunity to have multiple thresholds with different actions for each threshold. For example, low to medium levels might trigger a repeat FIT test to check for persistence of bleeding, whereas high levels might indicate immediate colonoscopy. There is a need to research tactics like these.
Impact of changes to the interscreening interval and faecal immunochemical test threshold in the national bowel cancer screening programme in England: results from the FIT pilot study.
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