The incidence of missed cancers in the NHS Bowel Cancer Screening Project: a comparison with screen-detected cancers from a single centre: LTP29

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Aim:We compared the characteristics of screen detected colorectal cancers (SDC) and non-screen detected cancers (NSDC) in the first 30 months of the national Bowel Cancer Screening Project (BCSP) in our region.Method:Monitoring of outcomes is carried out by a specialistpractitioner using aprospectively maintained database and information from regional colorectal cancer audit supplemented by individual chart review.Results:One hundred and fifteen thousand three hundred and fifty-three faecal occult blood (FOB) kits have been distributed, with 66 956 (58%) returned. These generated 762 screening colonoscopies, detecting 79 cancers and 351premalignant lesions. To date, 26 NSDC havepresented in patients returning negative FOB kits, with no undetected cancers in the population undergoing screening colonoscopies. Eight percent of NSDC were asymptomatic with iron deficiency anaemia detected on routine testing. The remainderpresented with altered bowel habit 62%, bleeding 31%, abdominal pain 42% and unexplained weight loss in 42%.Conclusion:Our early experience of BSCP demonstrates the expected cancer and polyp detection rates (˜ 50% of those directed to colonoscopy). The incidence of missed/interval cancers at our centre is 1 per 2500 patients returning negative FOB kits. Of note, thesepresent relatively less frequently with overt bleeding, and more commonly with unexplained weight loss when compared with SDC.

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