People under 50 with bowel cancer often face lengthy delays being diagnosed, significantly reducing their chances of survival. Now, a new risk assessment tool aims to help GPs determine which patients need further tests by predicting their risk of bowel cancer based on their symptoms.
One in 12 people who visit their GP will do so with bowel-related symptoms. Most of these symptoms are not caused by cancer and it can be difficult for GPs to decide which of their patients to refer to for further tests.
People below the age of 50 are not covered by national bowel cancer screening programmes. Yet, the number of under-50s diagnosed with bowel cancer has seen a 45% increase since 2004. The number of people diagnosed with inflammatory bowel disease is also rising and many of these are also below the age of 50.
A delay in diagnosis of bowel cancer can have serious consequences. Around 98% of people diagnosed with bowel cancer in the early stages will survive for five years or more. However, bowel cancer diagnosed at stage four will see fewer than one in 10 people survive for this length of time.
For the under 50s, a disproportionately high number – three out of every five people – is diagnosed at stages three or four.
More than a third (34%) are diagnosed in an emergency situation, for example in A&E. This means that the younger you are (i.e. below the age of 50), the lower your chances of surviving bowel cancer.
The bowel cancer and inflammatory bowel disease risk assessment tool was published in the British Journal of General Practice. It was developed with funding from the Department of Health to give GPs guidance on which patients to refer for further tests based on their symptoms, a blood test and a physical examination.
The tool uses this information to calculate the person’s risk of bowel cancer or IBD and suggests the most appropriate next steps for GPs.
- If the patient is predicted to have a 3% risk or greater, GPs are advised to refer them for an urgent colonoscopy or specialist assessment.
- If the risk is predicted to be between 1 and 3%, GPs should request a faecal calprotectin test which shows up inflammation in the bowel. This can rule out a less serious condition such as irritable bowel syndrome.
- If the risk is below 1%, GPs are advised to monitor the patient’s progress but not to request further tests at this point.
Clinicians are keen to stress that the tool is not designed to replace a GP’s clinical judgement but rather to support them to make referral decisions based on sound evidence.
Bowel Cancer UK launched a campaign in 2013 called Never Too Young. Its aim is to improve the diagnosis of young people with bowel cancer and IBD. The charity found that one in five younger patients have to visit their GP five times or more before receiving a definitive diagnosis which it describes as “simply not acceptable”.
If you are outside the standard screening age, you may prefer to go for private bowel cancer screening.
The benefit of private screening is that it is carried out using a colonoscopy, which is the most in-depth and accurate way to screen for bowel cancer. A colonoscopy can not only detect early signs of cancer but during the procedure, little biopsies can be made to remove any bowel polyps that could turn into cancer in the future.