Investigating a programme modification to the NHS Bowel Cancer Screening Programme (NHS BCSP) to incorporate blood-based liquid biopsy triage tests for patients who screen positive on a faecal immunochemical test (FIT)

Exploring the use of a blood test when people need further action after a bowel cancer screening test 1.1 How does the NHS screen for bowel cancer in the UK? Bowel cancer is common in the UK. Older people are more likely to get bowel cancer and have lower chances of successful treatment, especially if the cancer is detected at an advanced stage. The UK National Screening Committee (UK NSC) recommends that everyone aged 50 to 74 is offered screening for bowel cancer every two years. People in this age group are sent a home testing kit in the post. They send a small amount of poo to a testing lab. The lab tests the poo for traces of blood, which can be a sign of bowel cancer. Most people hear that their test result is normal, and no further action is needed. Some people are told that their poo had some traces of blood in it. They will be offered a further test called a colonoscopy to find out what is causing the blood. A specialist uses a thin, flexible tube with a camera to look inside the bowel. Colonoscopy is very effective at diagnosing bowel problems. But there are some downsides: some people find it embarrassing or uncomfortable, and the preparation – drinking a special solution the day before to completely empty the bowel – can be unpleasant and disruptive. Complications can also occasionally occur. Colonoscopy is also expensive to the NHS because it needs a specialist team. 1.2 What are we trying to find out? The UK NSC wants to explore if they could improve the screening programme. They want to know if people who need further action after the poo test should have a special blood test done to look for signs of cancer. Only the people whose blood test also shows these signs of cancer would then be invited to have a colonoscopy. Avoiding an unnecessary colonoscopy could be better for patients and reduce the workload and costs for the NHS. But this would only be worthwhile if the blood test results are reliable and the benefits outweigh any potential harms. The UK NSC wants to check if there is enough evidence for it to be worth exploring this idea in more depth. We’ll search for how many studies and what types of studies have looked at: • How accurate these blood tests are in the relevant people (those who needed further action after the poo test). • Whether people think it’s acceptable to have one of these special blood tests when further action is needed after the poo test, and to use the results to decide if someone should have a colonoscopy. • What the overall effect on people’s health would be of using these special blood tests to decide who should have a colonoscopy, and the overall value for money for the NHS.