The issue                                   

Around 1 in 20 people in the UK will develop bowel cancer during their lifetime. The disease kills around 16,000 people each year in the UK, and around 608,000 worldwide – mainly because it has non-specific symptoms and so presents at a late stage.

The research

Professor Jack Hardcastle designed and ran the Nottingham Bowel Cancer Screening Trial until his retirement in 1996, when Professor John Scholefield took over. The trial pioneered the use of Faecal Occult Blood (FOB) testing, which can detect early-stage bowel cancers, and also polyps on the lining of the bowel which may develop into cancer.

The trial randomised over 150,000 individuals aged over 60 in the Nottingham area to receive either biennial FOB tests or no intervention. It showed a 16% reduction in bowel cancer mortality which was maintained in follow up to 2009. The proportion of early-stage cancers detected in the screened groups was 26%, compared with 13% in the control population.

The impact

As a consequence of this trial, the Department of Health launched two screening pilots and introduced a National Bowel Cancer Screening Programme (NBCSP), achieving national coverage in 2010. Since 2008, this has sent out almost 18 million invitations and detected 16,000 bowel cancers, of which 21.6% were early cancers with a 95% chance of cure. It is estimated that the NBCSP saves around 3500 lives each year in the UK. International screening programmes modelled on the UK system will save many more.