Beth Dillon explores the importance of funding for improving and developing cancer screening.
The University of Glasgow has been awarded a £3.37m research grant through the INSPIRE (INtegrated TeChnologies for Improved Polyp SurveillancE) project to improve the bowel cancer screening process.
The project uses artificial intelligence to identify patients who are more likely to have bowel cancer or to develop future tumours. High-risk patients will then be invited for further tests. Currently, those aged 50-74 are invited to send a stool sample away every two years which is analysed for traces of blood. Guidelines are then used to decide who needs a colonoscopy, which then examines the bowel.
However, there are numerous reasons for blood in stool, ranging from medication side effects to inflammatory bowel disease, yet current screening methods cannot identify the differences. The current screening programme hence works upon a “population-centred” approach which relies on testing a vast number of people, with only a few cases of cancer being diagnosed. By comparison, it is hoped that this research will yield a “patient-centred” method that will enhance accuracy in identifying patients needing further tests and will improve access to colonoscopies. This aims to reduce the time till diagnosis and the treatment starts.
Screening programmes are vital for catching conditions earlier than they would have been detected otherwise. This is highlighted by the fact that the screening programme is responsible for the detection of the majority of early-stage bowel cancer cases.
But why is it important to diagnose cancer early?
When diagnosed at its earliest stage, 98% of people with bowel cancer survive for one year or more, compared with 44% of people when the disease is diagnosed at a later stage. An early-stage cancer is less likely to have spread to other areas, greatly increasing the range of treatments that can be offered. For many diagnosed in the late stages, the focus shifts from a curative approach to palliative care, with a priority on preserving comfort and quality of life.
Screening forms a crucial part in bowel cancer management. Bowel cancer is a good candidate for a screening programme as there are several treatments upon diagnosis, the main option being surgery. Chemotherapy and or radiotherapy are also used in conjunction with surgery. As reflected across oncology, bowel cancer has also been affected by the development of targeted drugs. These drugs don’t affect the whole body as a lot of traditional chemotherapies do; they only act upon a specific target, reducing side effects and improving effectiveness. In bowel cancer treatment the most prominent is Cetuximab, an epidermal growth factor receptor inhibitor (EGFR). An Epidermal growth factor (EGF) is a protein that stimulates cell growth by binding to a receptor and making the cell divide. In cancer, this process is uncontrolled, causing increased cellular growth. Cetuximab works by blocking the receptor and preventing EGF binding, inhibiting the signal, causing the cells to stop dividing. However, these treatments are far more effective with early-stage cancer, which is why screening is needed.
Screening programmes are not without their problems – and this is where the new funding comes in. A big issue is specific diagnosis. Currently, for every 100 people screened for bowel cancer, only two will test positive. The number of people who are referred for a colonoscopy is far greater than the number who eventually get diagnosed with bowel cancer (only about 12% of those invited receive a diagnosis). This creates huge amounts of physical and emotional stress for the patient. Therefore, any research which can accurately reduce the number of people who need to go through undue procedures is extremely beneficial.
Other screening programmes exist across the NHS, with the first participation in screening programmes occurring in the foetal period, all the way up to those aged 74. Most applicable to the student population is the cervical smear test, which begins at age 25. As with bowel cancer above, catching cervical cancer early greatly improves survival rates and treatment options. People with a uterus, aged 25-64, registered with a GP in Scotland automatically get sent an invitation to attend cervical screening appointments every five years.
The importance of effective screening programmes cannot be overstated and hopefully, this funding will go some way to improve both the screening process itself and outcomes for those with bowel cancer.