Showing posts with label sigmoidoscopy. Show all posts

Wednesday, 12 January 2011

Early testing at heart of survival cancer drive

reposted from: http://www.bbc.co.uk/news/health-12170331

crabsallover highlights, key points, comments / links.

By Nick Triggle

Health reporter, BBC News 12 January 2011

Click to play

Andrew Lansley: "If we were to achieve the European average on outcomes we would save 5,000 lives a year"

The access GPs in England have to a series of tests to detect cancer are to be improved under new plans being set out by ministers.

More than £450m is being earmarked for chest X-rays, ultrasounds and MRI brain scans over the next four years.

The move forms the central plank of the government's cancer strategy.

The aim is to save an extra 5,000 lives a year to bring survival rates up to European averages.

Setting out the plans, Health Secretary Andrew Lansley said: "Our ambition is simple, to deliver survival rates among the best in Europe and this strategy outlines how we will make our first steps towards this."

At the moment, patients are guaranteed to see a cancer specialist within two weeks if they get an urgent referral from their GP.

The coalition government has promised to keep this target, which was set by Labour, as they say it is clinically justifiable.

Testing

However, they believe GPs should have better direct access to testing for those patients who are not classed as urgent but could benefit from further investigation.

To achieve this they are freeing up money to improve access to a range of tests.

“Start Quote

The government now needs to ensure that this new investment flows through and is quickly taken up by front-line services”

Harpal KumarCancer Research UK

Doctors can already send patients for these tests, but there are often delays in the system.

The strategy also contains details on a number of initiatives already announced.

These include the plans to roll out sigmoidoscopy screening for bowel cancer, the £200m cancer drugs fund for treatments not routinely funded by the NHS and increasing the number of cancer specialists.

There will be a £10m advertising campaign to raise awareness about the signs and symptoms of some of the most common cancers as well.

The strategy also sets out a range of measures which the NHS will be judged on. These includes things such as the number of late diagnoses, whether cancer survivors get back to living independently and - if of working age - back into jobs.

Measures such of these have been set out for other conditions and are part of the government's wider attempts to move away from what they consider to be blunt targets to a more intelligent system of measuring performance.

Harpal Kumar, chief executive of Cancer Research UK, said the strategy was a welcome move.

But he added: "The government now needs to ensure that this new investment flows through and is quickly taken up by front-line services."

Saturday, 25 December 2010

Bowel cancer test could save many lives

reposted from: http://news.bbc.co.uk/1/hi/health/8647103.stm

By Clare Murphy
Health reporter, BBC News

Not all polyps will turn into cancer

A brief one-off screening test could prevent thousands of people dying from bowel cancer every year, a study published in the Lancet suggests.

There are now calls for the test to be rolled out across the UK after results from 200,000 people aged 55-64 found it cut deaths by 43% over 10 years.

Cancer Research UK described the results from the Imperial College, London, study as a "rare breakthrough".

Independent advisers will consider the test, the Department of Health says.

The independent bowel cancer screening committee will discuss whether it would be cost-effective to incorporate the procedure - known as sigmoidoscopy - into the UK's screening programmes.

Scientists from Imperial College, London, who carried out the research, argue the costs would be outweighed by the savings generated through reducing the incidence of the disease, the UK's second biggest cancer killer.

Simple test

Click to play

Chief Executive of Cancer Research UK Harpal Kumar explains how the test works

The current screening method for bowel cancer looks for traces of blood in the stools, one of the key symptoms of colorectal cancer. If this is found, the patient is referred for further investigation.

This test - using a flexible scope little wider than a pen to find and remove polyps, the precursors to cancer - is believed to reduce the death rates from the disease by 25% for those who use it.

But by finding and removing polyps - the mainly symptomless growths which can become cancerous - a sigmoidoscopy could stop the disease developing in the first place in the lower bowel.

Two thirds of colorectal cancers occur here.

Easier to conduct than a colonoscopy, which is not suitable for the general population because it requires sedation and can be a lengthy process because the entire bowel must be examined, a sigmoidoscopy can be carried out by a nurse and does not require any pain relief. Laxatives are taken in advance to clear the bowel.

A one-off examination of over 40,000 men and women aged between 55 and 64 in which any polyps were detected and removed reduced the number of cases of the disease by one third, and deaths by 43%, when compared with a group who received no intervention.

It seems likely to reduce colon cancer mortality considerably if it is made widely available

Professor Jon Rhodes
British Society of Gastroenterology

They were followed for an average of 11 years, and lead researcher Professor Wendy Atkin said the results showed people would only need one test in a lifetime.

Combined with the existing blood test to detect any cancers developing further up the colon, "thousands of lives could be saved", she said.

Some 16,000 people die from bowel cancer every year. If the results of this study were extrapolated, about 3,000 would be saved.

Researchers calculate that one life would be saved for every 400 people screened, which compares favourably with breast cancer screening - where the figures are 500 mammograms for every life saved. The main cost would be recruiting the specialist nurses needed to carry out the examination.

"We don't often use the word breakthrough, but there is a tremendous opportunity to use this procedure to push bowel cancer back down the league table of cancer cases in the UK," said Harpal Kumar, head of Cancer Research UK, which helped fund the research.

"Cancer Research UK is calling on the next government to add the test to the existing national bowel screening programme as one of its first priorities.

"Such a programme, backed by all UK governments, would save thousands of lives, whilst also saving the NHS money."

Bowel Cancer UK has also called for the test to be added to the existing screening programme.

And Professor Jon Rhodes, of the British Society of Gastroenterology, described the results as "very exciting".

The British Society of Gastroenterology would welcome the establishment of early pilot centres to establish further data on service delivery and uptake in routine NHS practice," he said.

Thursday, 16 December 2010

UK National Screening Committee (UK NSC) statement on flexible sigmoidoscopy

reposted from: http://www.screening.nhs.uk/cms.php?folder=3014

Flexible sigmoidoscopy

For immediate release (29 October 2010)

Dr Anne Mackie, UK NSC Director of Programmes, said:

“We welcome the Government’s commitment to invest in new, effective screening methods. Initial indications suggest that flexible sigmoidoscopy could be a valuable technology and it is important that we research its effectiveness in a timely way.

“Any new screening methodology needs to be rigorously investigated. Research has been commissioned to model how screening using FS might work in practice as part of the bowel cancer screening programme. The UK National Screening Committee will investigate these issues in full at its next meeting in November, and final recommendations to Ministers will be made in Spring 2011.”

Professor Julietta Patnick CBE, Director of the NHS Cancer Screening Programmes said:

We’re excited by the coalition’s commitment to introduce flexible sigmoidoscopy for bowel cancer screening if it is recommended by the National Screening Committee. The addition of flexible sigmoidoscopy will allow us to build on the great success of the existing bowel cancer screening programme. If recommended, we will be busy over the next few months developing the processes and QA procedures that will be needed in order to deliver this new service safely and effectively.

Ends

Notes to editors

1. The UK National Screening Committee

The UK National Screening Committee is chaired by the Chief Medical Officer for Scotland and advises Ministers and the NHS in all four UK countries about all aspects of screening policy and supports implementation. Using research evidence, pilot programmes and economic evaluation, it assesses the evidence for programmes against a set of internationally recognised criteria. Assessing programmes in this way is intended to ensure that they do more good than harm at a reasonable cost.

2. UK NSC research into flexi sig

At its meeting on 16 June the UK NSC received a verbal update on the FS trial and was informed that the results of the trial were very positive. The Committee welcomed the research, but identified a number of issues that required further investigation. This additional work will allow the UK NSC to make a full assessment of all the available evidence against its criteria, before making a final decision.

The issues requiring further investigation are:

The need for further modelling to assess the impact of introducing a screening programme for bowel cancer using FS (include taking account of all available international evidence)
The age at which the screening would be most effective to screen (the trial participants were between 55 and 64 years)
The acceptability and uptake of the test in the general population (the trial population had all indicated before entering the trial that they would take up a screening invitation)
The clinical management of people identified as requiring long term surveillance, the size of this group, and the resources involved
How it would fit in with the current bowel cancer screening programme.

Modelling work to address these questions is being taken forward by the School for Health and Related Research (ScHARR) at the University of Sheffield, and is due to report in late October, ahead of the next UK NSC meeting in November.

3. The bowel cancer screening programme

The NHS Bowel Cancer Screening Programme started rolling out in July 2006 and achieved nationwide coverage by 2010.

Programme hubs operate a national call and recall system to send out faecal occult blood (FOB) test kits, analyse samples and despatch results. Each hub is responsible for coordinating the programme in their area and works with up to 20 local screening centres.

The screening centres provide endoscopy services and specialist screening nurse clinics for people receiving an abnormal result. Screening centres are also responsible for referring those requiring treatment to their local hospital multidisciplinary team (MDT).

4. The UK NSC review process

A national screening programme is established only if certain conditions are met. These include having an accurate and acceptable screening test, being able to provide treatment and advice for people who are found to have a particular condition, and making sure the screening programme does more good than harm to those who are screened.

October 3rd 2010 - David Cameron announces extra £164M on Flexi-scope bowel cancer screening

reposted from: http://news.bbc.co.uk/1/hi/programmes/andrew_marr_show/9055402.stm
October 3rd 2010. crabsallover highlights. Crabsallover blogs about bowel cancer - Flexi-scope.

DAVID CAMERON:

... the NHS budget is going to grow in real terms every year during the life of this government. And that means we're able to not just leave it as it is; we are going to improve it. I mean take cancer. Today we're announcing that actually we're going to be spending another £164 million on cancer provision and really updating and improving our screening processes, particularly on bowel cancer, which can save 3,000 lives a year. And I think it's very important as we take the country through what are difficult decisions, to say look there are some things that are so important to families - like my family, like the thousands of families watching this programme - and the NHS is one of those things.

ANDREW MARR:

(over) If we were as good at curing cancer as the average European country, about 5,000 to 10,000 people in this country who die would live a year.

DAVID CAMERON:

That's right.

ANDREW MARR:

Can you say that you intend to close that gap?

DAVID CAMERON:

I absolutely want to close that gap. And I think the announcement today is part of that because we're dealing with one of the problems, which is screening people when they get to about our age. We need more screening. We've got to make sure …

ANDREW MARR:

We won't go into the nasty details, thank you.

DAVID CAMERON:

Alright, we won't go … (laughs) The flexi sigmoidoscopy, I think it's called, but I won't go into the details of where the camera goes.

ANDREW MARR:

Thank you.

DAVID CAMERON:

But if we look at that. And also the other thing is the early warning signs. The truth is we're never going to get to the best in Europe levels of cancer unless we recognise the symptoms earlier and treat people earlier. And so it's not just money. This is about how well GPs do the job, and we need to improve that as well.

Digital camera 'Flexi-Scope' could save 3000 deaths in UK from bowel cancer each year

reposted from: Cancer Research UK blog http://scienceblog.cancerresearchuk.org/2010/04/28/new-study-marks-major-advance-in-bowel-cancer-screening/

crabsallover highlights in bold red. I first reported Flexi-scope research in May 2010 when it was announced.

"New study marks major advance in bowel cancer screening" Cancer research UK

A new one-off bowel test could reduce deaths by 40 per cent (click to enlarge)

What if having your bowel investigated with a tiny camera – just once – could greatly reduce the risk of dying from bowel cancer and of developing the disease in the first place? Striking new results from an important study show that this is very real possibility. We don’t often use the word breakthrough – but this is one of those rare occasions.

Thousands of people could be saved from developing bowel cancer because of this test and thousands more could be diagnosed early when treatment is most effective.

As Harpal Kumar, our Chief Executive Officer, said, “This is one of the most important developments in cancer research for years.”

For the past 16 years, Professor Wendy Atkin from Imperial College London has been coordinating a trial of a test called flexible sigmoidoscopy or, more commonly, ‘Flexi-Scope’. It involves a tube called an endoscope, which has a tiny camera and light at the end of it.

Cancer Research UK is proud to have supported much of Professor Atkin’s work, including part-funding this trial. Doctors can use a Flexi-Scope to look for cancers in the bowel – or for early signs of the disease’s development. As with many cancers, early detection is vital for bowel cancer, and over 9 in 10 people will survive their disease for more than five years if it is diagnosed at the earliest stage.

But there’s a lot of potential for preventing the disease too. Most bowel cancers develop from symptomless growths called ‘polyps’ or ‘adenomas’. If doctors can find these, they can remove them before they have a chance to develop into cancer. This is a painless procedure and is usually quick, adding on a matter of minutes to the time needed to do the test itself.

For these reasons, Flexi-Scope could be a great way of screening people for bowel problems, and detecting or preventing cancer. But, as with any screening programme, we needed some hard evidence that it would actually save lives. Professor Atkin’s new results, published in the Lancet, show just that, and they are very promising.

What did the trial show?

Professor Atkin’s team recruited over 170,000 people to the trial, a third of whom were invited for one-off screening using Flexi-Scope. Just over 70 per cent of those invited chose to attend and, all in all, the teams screened 40,674 people.

She found that for people aged between 55 and 64, a one-off Flexi-Scope examination reduced people’s chances of developing bowel cancer by a third, compared to a control group who weren’t screened. It also reduced the death rate from bowel cancer by 43 per cent.

All in all, Prof Atkin showed that for every 1,000 people who are screened, 5.2 cases of bowel cancer can be prevented and two deaths could be avoided. Put another way, you would need to screen 191 people to prevent one case of bowel cancer and 489 people to prevent one death. And these figures can only get better with time.

But the figures are only half the story. We also need to consider the size of the prize. Bowel cancer is the third most common cancer in the UK and more than 100 people are diagnosed every day. Death rates have been falling in the past four decades, but the disease still kills around 16,000 people every year.

The prospect of preventing such a common disease that costs so many lives is extremely exciting. Doing so with a one-off five-minute test, whose benefits last for at least 11 years, is even better.

Based on the data, Prof Atkin conservatively estimates that the one-off screen could prevent at least 5,000 people from being diagnosed with bowel cancer and at least 3,000 people from dying from the disease.

To put that into perspective, official figures from the NHS Breast Screening Programme say that breast screening saves 1,400 lives a year in England. That figure is controversial but even so, adding Flexi-Scope to the existing national bowel screening programme could save twice as many lives.

A different screening programme?

The UK already has a bowel screening programme. It uses a different test called the “faecal occult blood test” or FOBT, which looks for hidden traces of blood in stools. In England and Wales, people are invited for screening between the ages of 60 and 69. They are sent a kit to use in the privacy of their own homes, and results are sent to a lab for testing.

The FOBT is also an effective way of screening for bowel cancer. Trials have found that it can reduce death rates from the disease by around 25 per cent, and countries all over the world have used it as the basis of bowel cancer screening programmes. However, Prof Atkin’s latest results suggest that the Flexi-Scope is even more effective. And, crucially, it can prevent bowel cancer as well as detecting it after it has appeared.

The two tests should complement each other well. The Flexi-Scope can only scan the lower part of the bowel. It won’t be able to detect polyps or cancers in the upper reaches, so the FOBT still has a role in detecting early cancers there.

The Flexi-Scope test is currently available in the UK, but only for people with symptoms or after a referral from a GP or specialist. Based on the new results, this could change in the future.

In fact, Cancer Research UK thinks the findings are so promising that we are calling on the UK governments to incorporate the Flexi-Scope as part of the national screening programme for bowel cancer alongside the FOBT test.

We think the Flexi-Scope test should probably be offered to people from their late 50s. This is because most polyps appear in the lower bowel before the age of 60 and slowly develop into cancer over the next few decades.

Will it be acceptable?

A key question is whether people will accept the new test. The signs suggest they will. In an earlier study of 4,400 people who went through Flexi-Scope screening, Prof Atkin showed that virtually all of them were glad they had the test and were satisfied with the procedure. Meanwhile, 91 per cent reported mild or no pain, and 97 per cent said they felt little or no embarrassment.

The risks of the test appear to be small. Removing a polyp can cause a small amount of bleeding and there is around a 1 in 50,000 chance that the tube can tear the bowel. There isn’t really a risk of a false-positive, because doctors can only detect and remove polyps if they are there.

And to top off the good news, the Flexi-Scope test could be very cost-effective, especially since it only needs to be done once in an 11 year span. The test’s costs would probably be outweighed by the fact that fewer people need to be treated, and treatments are cheaper for early-stage cancers. In 2006, a study commissioned by the UK Department of Health suggested that a Flexi-Scope screening programme would actually save £28 for every person who was screened.

Of course, Prof Atkin says that there are many practical choices that would affect these calculations, and they would need to be repeated using data from the actual trials. There’s also the pressing need to train people with the endoscopes if Flexi-Scope becomes more widely used.

The new results have closed the door on 16 years of research and opened new and exciting ones. The big question now is whether the country will step through them.

More from Cancer Research UK:

Reference:

Atkin W et al (2010). Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial The Lancet :10.1016/S0140-6736(10)60551-X

Saturday, 11 December 2010

Flexi-Scope bowel cancer screening programme 'breakthrough' for 55-64 year olds

reposted from: Union for International Cancer Control

Why this cancer test really is a breakthrough

If there’s a word used frequently in cancer research that makes my heart sink it is “breakthrough".

Not because I don’t want to see breakthroughs happen frequently – after all, that’s what our scientists and doctors strive for - but because so often early and encouraging results are hyped up to sound definitive. This raises undue hope and expectation amongst patients and their families, which are so often dashed later.

Flexi-Scope (sigmoidoscopy) is the exception that proves the rule. The 16 year trial that has given us remarkable results showing that thousands of lives can be saved by a simple procedure is not just promising. It is truly a breakthrough in bowel cancer prevention. And it is one of the most exciting developments in cancer research that we have seen for many years.

That is why I warmly welcome the government’s decision to make this test available as part of the existing National Health Service’s bowel cancer screening programme. I urge the Department of Health to roll it out throughout the country as soon as possible and I hope very much that Wales, Scotland and Northern Ireland will very quickly follow suit.

There is a good reason for avoiding any kind of delay. Every year, more than 30,000 British men and women are diagnosed with bowel cancer and more than half of them (16,000) will die from the disease, making it the second biggest cancer killer in the UK.

With every week that passes without access to this test, scores of lives are being put at risk. With this test, 10,000 people every year will avoid bowel cancer altogether and deaths from it will drop by almost half among those who attend (43 per cent).

It is extremely rare to see the results of a clinical trial – which Cancer Research UK funded along with the Medical Research Council and National Institute for Health Research - which are quite as compelling as this one and which has quite the huge impact in terms of the potential for improving cancer outcomes.

We have a tremendous opportunity now to use this procedure to push bowel cancer cases back down the league of cancer cases in the UK. That’s why I don’t hesitate to call Flexi-Scope a genuine breakthrough.

So what is it and who should have it? Flexi-Scope is a simple procedure called sigmoidoscopy. A tiny camera mounted on a thin, flexible tube is inserted about a third of the way into the bowel and can detect polyps or symptomless growths in the colon. The camera’s findings are displayed on a screen and any polyps found can be snipped off in a safe and painless procedure before they get a chance to develop into bowel cancer. And as we all acknowledge: prevention is so much better than cure.

Flexi-Scope takes five minutes, is a one off test and experts recommend it should be given to men and women between the ages of 55 and 64. I won’t hesitate to take up my invitation when I reach that age.

Flexi-Scope will supplement rather than replace the existing bowel screening programme which is already saving lives. The existing programme is a do-it-yourself test posted to people, between the ages of 60 and 70, and is designed to detect invisible traces of blood in stool samples. If blood is detected then follow-up usually involves a colonoscopy.

Because, the new test will prevent polyps turning in to cancers, adding Flexi-Scope to the bowel screening programme will spare tens of thousands of families the anxiety and suffering associated with a cancer diagnosis. And, vitally, it will save the National Health Service money that would otherwise be spent on giving bowel cancer patients surgery and expensive follow-up treatment.

The trial - which involved 170,000 people who were followed up for 11 years -reported that most people thought the whole examination procedure was a positive experience. They were fascinated by what they could see on the screen and the long-term follow-up meant they felt reassured about their future health. So will the public turn up for a test like this? We are very hopeful that they will. It could save their lives.

Source:

By Harpal Kumar, Chief Executive, Cancer Research UK, Telegraph UK, October 3, 2010.

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Wednesday, 12 January 2011

Early testing at heart of survival cancer drive

“Start Quote