Colorectal Cancer Screening in Scotland

In the United Kingdom the National Screening Committee advised the Health Departments to carry out a demonstration pilot of colorectal cancer screening based on the results of the previous randomised trials. These trials all employed the guaiac based faecal occult blood test and a meta analysis indicated that this approach could produce an overall reduction in colorectal cancer mortality of around 16 % [1]. The largest of these trials was the Nottingham study [2] and as this had been carried out in a United Kingdom context it was used as the bench mark for the demonstration pilot. The pilot sites were chosen on the basis of competitive bids and one was located in Grampian, Tayside and Fife in Scotland and one in Coventry and Warwickshire in England. It was agreed that the pilot sites should invite all men and women aged between 50 and 69 to perform a guaiac faecal occult blood test. The tests were mailed out to the potential participants along with an invitation letter, information about screening and instructions as to how to complete the test. The test was then sent back in the mail to the Central Laboratories where they were analysed. Each test involved supplying two samples from each of three separate stools on to six ovals. If five or six ovals were positive the invitee was contacted by a specialist nurse who organised colonoscopy. If one to four ovals were positive then a repeat test with dietary restriction was offered. If any oval was positive in this repeat test colonoscopy was organised and if all ovals were negative a further repeat test was offered. Again colonoscopy was only offered if any of the ovals on the second repeat test were positive.

The demonstration pilot commenced in March 2000 and the results of the first biennial round [3] were analysed by an independent evaluation group. As a result of this evaluation a decision was made by the Departments of Health both in England and in Scotland to roll out a National Screening Programme within the United Kingdom National Health Service. As the Health Departments within the United Kingdom are autonomous the organisation of the Screening Programmes in England and Wales are slightly different and the rest of this article will refer to the situation in Scotland only.

References

• 1 Towler B. et al . A systematic review of the effects of screening for colorectal cancer using the faecal occult blood test.  Hemoccult BMJ. 1998;  317 559-565
• 2 Hardcastle J D. et al . Randomised controlled trial of faecal occult blood screening for colorectal cancer.  Lancet. 1996;  348 1472-1477
• 3 Steele R JC. et al . A demonstration pilot for colorectal cancer screening in the United Kingdom: a new concept in the introduction of health care strategies.  J Med Screen. 2001;  8 197-202
• 4 Fraser C G. et al . Immunological testing of guaiac faecal occult blood test positive individuals in a colorectal cancer screening programme facilitates clinical risk stratification.  Lancet Oncology. 2006;  7 1-6