Colorectal cancer screening and COVID: getting tested during the pandemic

The NHS Bowel Cancer Screening Service and colorectal cancer screening within the private sector were greatly impacted by the COVID-19 pandemic. Dr John Martin, an expert in colorectal cancer screening, explains how the coronavirus has affected your ability to receive a colorectal cancer screening test.

How has the coronavirus has impacted colorectal cancer screening in England?

In the public sector

Colorectal cancer screening on the NHS has two components.

• FIT Testing: Every 2 years, faecal immunochemical tests (FIT) are sent to all people between the ages of 60 -74 years who are registered with a GP. Once returned, the kit is analysed for the presence of blood and, if present at a sufficient level, the individual is offered a colonoscopy
• Bowel Scope Screening: This is a limited endoscopic examination of the left side of the colon, offered as a one-off test to all people registered with a GP in their 56^th year.
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During the coronavirus COVID-19 pandemic, the NHS colorectal cancer  screening programme paused the sending of stool FIT kits. In addition, most endoscopy units were closed, meaning that those individuals with a FIT kit result requiring colonoscopy were unable to have this examination. The Bowel Scope programme was also ceased.

In the private sector

There is no formal screening programme within the private sector, but colonoscopy is often performed for appropriate patients, at their request, following a discussion of the risks and benefits.

Most private endoscopy services were closed during the pandemic, so this service was not available.

Has colorectal cancer screening resumed?

In the public sector

Since the pandemic, FIT testing has resumed and kits are being sent to individuals. Most screening centres have reopened and are performing colonoscopy for those that require this, but the service has a significant backlog as a result of COVID-19. There are patients who returned kits before the service stopped and require colonoscopy, and there are also a large number of people who should have received a testing kit but did not, as the service was not active.

As of the beginning of September 2020, most of the patients requiring colonoscopy prior to the shutdown have had their procedure and the rate of invitations has been increased in order to catch up on the backlog of individuals who have had their kit delayed. The rate of recovery, however, may vary in different parts of the country, as the capacity to provide colonoscopy is not consistent between different areas.

Bowel Scope has not restarted and is currently the subject of a government consultation to consider withdrawing this service.

In the private sector

Most private hospitals are now open, although some are helping the NHS by offering the capacity to perform procedures for NHS patients within their endoscopy units. This limits the availability to perform private cases in some hospitals, but this effect is variable and depends on the institution.

What are the consequences of the break in colorectal cancer screening?

Inevitably, some patients will have a delayed colonoscopy that will lead to a delay in the diagnosis of some cancers, but the service is working extremely hard to minimise any interruption to individuals along the screening pathway. Reassuringly, most cancers discovered within screening are at an early stage, so a short delay in diagnosis is unlikely to result in any harm to the patient. However, it is important that people return their kits and attend colonoscopy appointments, so any delay is kept to a minimum.

What measures are being taken to ensure patient safety from the virus?

Protective measures will be in place in all endoscopy units. Although practices will vary, the principle measure may include:

• Screening of patients to ensure they have no COVID symptoms and have not been in contact with potentially infected patients
• Clinic staff wearing appropriate PPE (personal protective equipment)
• COVID testing of clinical staff to ensure they are virus-free
• COVID testing of patients prior to attending for the examination
• Self-isolation of patients prior to attending for the examination
• Socially distancing within the unit

These measures will reduce capacity within the unit so fewer patients can be seen, but patient safety is the priority.

What is your advice for patients who are worried about contracting the virus?

The risk of catching COVID in hospital is very low. If you have tested positive on a FIT screening test, or are avoiding your screening test, your risk of coming to harm from a delayed diagnosis is much higher than attending for your investigations .

In addition, if you have symptoms, you should get checked. It’s that simple.

You can receive Dr Martin’s first-class patient care and specialist expertise for your gastroenterology needs, including colonoscopy – learn more and arrange an online or face-to-face consultation.