In recent news, it was revealed that England’s bowel cancer screening program for individuals aged 60 to 74 has successfully prevented 20,000 cases of bowel cancer over the past decade. This is part of England’s ongoing efforts to expand screening to include individuals aged 50 to 59. Additionally, there has been excitement surrounding a new blood test being trialed in the UK that can detect 50 types of cancer.
The benefits of increased cancer screening are clear: early detection leads to higher chances of successful treatment. However, it is important to recognize the potential harms that come with screening. Not only can it cause anxiety and stress for those receiving ambiguous or false positive results, but it also places a strain on the NHS.
The majority of individuals who undergo screening do not have cancer, yet some may still receive misleading results that lead to unnecessary further testing. This can cause heightened anxiety for weeks or even months until cancer is ruled out. It is crucial for researchers to continue refining screening tests to minimize false positives, and for the NHS to make informed decisions about who should be screened and when.
Furthermore, screening is not a one-time event but rather a recurring process. Over time, the chances of being wrongly flagged for testing or treatment increase. For example, a recent study estimated that a 50-year-old beginning bowel cancer screening today has a 15% chance of being wrongly flagged for a colonoscopy by the age of 74. Breast cancer screening also carries the risk of overdiagnosis.
From an NHS perspective, screening requires significant resources. False positives result in further, more intensive tests that consume hospital resources. If the NHS plans to expand screening programs, it must allocate adequate funding and capacity to deliver both screening and subsequent testing and treatments. However, the NHS is currently struggling to meet cancer diagnosis and treatment targets, with over a million breaches since October 2022. Diagnostic equipment and staff are already stretched thin, resulting in long wait times.
Bowel cancer screening, which involves sending a stool sample for testing, is relatively harmless compared to other forms of screening. The main potential harm lies in unnecessary colonoscopies. However, there is also a considerable benefit in identifying pre-cancerous growths and detecting cancer early.
Expanding bowel cancer screening to individuals in their 50s would significantly increase the number of screenings performed each year in England. While fiftysomethings are less likely to develop bowel cancer or adenomas compared to those in their 60s, the increase still means that many more individuals without cancer or pre-cancerous growths would undergo screening. This could lead to thousands of people being referred for unnecessary colonoscopies, further straining already overwhelmed services.
Similar issues arise with the new blood test for potential cancers. While the test is intended for diagnosing individuals with non-specific symptoms that could indicate cancer, the NHS is trialing it on 140,000 people without any symptoms. If successful, the test could be extended to a million more people in the coming years. However, a recent UK study found a false positive rate of about 1.5% among participants with non-specific symptoms. This means that thousands of individuals without cancer could be wrongly flagged for further testing.
For the NHS, this means an influx of tens of thousands more people into the cancer diagnostic pathway, increasing wait times and straining resources. It is essential to transparently communicate the benefits, harms, and costs of screening to the public. While expanding screening may seem like a clear victory, we must engage in deeper discussions about the optimal use of limited resources to truly enhance cancer treatment in the UK.
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