B144: How many lives will bowel cancer screening save if we improve participation in Merseyside? 

Matthew Saunders1,Daniel Seddon2

1Public Health England, Cjesjire&Merseyside, UK,2NHS England North, London, UK

Presenting date: Tuesday 3 November





Bowel cancer is the second most common cause of cancer death in England, accounting for approximately 14,000 deaths per year (ONS, 2012; Cancer Research UK, 2014). Bowel cancer screening (stool faecal occult blood testing (FOBT)) reduces the risk of bowel cancer death by approximately 16% (Hewitson, et al., 2007). Screening uptake in Merseyside is about 53%, against a national target of 60%. We wanted to know the likely impact of improving uptake to reach that target. How many lives could be saved, and how many more cancers detected?

Data outputs (i.e. projected age-stratified mortality rates) from a 2008 modelling study of the UK bowel cancer screening pilots were applied to Merseyside mid-year population estimates  to predict the number of lives saved through bowel cancer screening in Merseyside and the predicted number of additional lives saved by improving screening uptake to target. We also took regional key performance indicators and applied data from these to the Merseyside population to obtain data on process outcomes (i.e. number of additional positive test results, colonoscopies, cancers detected, and adenomas detected).

According to our estimates, bowel cancer screening currently prevents around 21 deaths per year in Merseyside. The number of deaths prevented increases over time as the effect of adenoma excision plays out . Cumulatively, the programme has prevented a total 79 deaths since screening was introduced in 2007. We found that improving screening uptake to 60% (from 52.1%) might result in 20 additional deaths prevented over the next 10 years. We also found that for every 10% increase in uptake, there would likely be an additional 144 positive results, 123 colonoscopies, and nine cancers and 63 adenomas detected.

All modelling studies, including this one, are subject to uncertainties. Actual bowel cancer death rates from 2008 to 2014 where higher than the original study had predicted, and bowel cancer is more common in Merseyside than England as a whole. This may mean that more people will benefit from bowel cancer screening in Merseyside than predicted here. Also, the predictions here assume a mix of people attending for screening. In practice, those most likely to benefit from screening are least likely to attend. For example, people living in more socioeconomically deprived areas are less likely to take part in screening, yet more likely to benefit. We speculate, therefore, that efforts focussed on improving bowel screening uptake in more socioeconomically deprived areas, if successful, are likely to be even more fruitful in preventing death than predicted here.