Patient Experience
4 April, 2022
Bowel cancer is one of the top three cancers diagnosed in Ireland each year, for men (2nd most common) and women (3rd most common). Every year around 2,800 people are diagnosed with this cancer in Ireland (NSS 2022).
In 2012 the Government announced the implementation of the National Colorectal Cancer Screening Programme to tackle the increasing incidence of colorectal cancer in Ireland. This was to be achieved through early detection and better chance of recovery. The Colorectal Cancer Screening programme was branded as BowelScreen and rolled out nationally.
Within St James’s Hospital, with the backing of all key stakeholders the BowelScreen service was established. An amazing team including the endoscopy staff from reception to discharge lounge, Consultant Gastroenterologists Dr Hartery, Dr Holleran, Dr MacCarthy and Consultant Colorectal Surgeons Prof McCormick, Mr Larkin, Prof Mehigan, to the Histopathology Consultants Dr Muldoon, Dr Ryan and of course an equally amazing cohort of patients, have all ensured that the service has been hugely successful to date since its implementation in 2013.
What is Bowel Screening?
Bowel Screening is the early detection of cancer or cancer pre cursers such as adenomas within the bowel, before the presence of symptoms. The target profile is those most at risk of developing the disease, men and women age 60 t0 69. This is the first cancer screening programme to include both men and women, and the plan is to increase the age cohort eventually to 55 to 75 years.
What is involved?
Those within the age 60 to 69 are invited to take part in the programme. They are offered a free home screening test called a FIT kit. FIT stands for Faecal Immunochemistry Test and it is the screening tool used to detect the presence of blood within the stool sample of the client taking part.
How is the test done?
The benefit of the FIT kit is that it is done in the privacy of the clients’ home. The easy to use home test kit includes step by step instructions, packaging that is user friendly, has easy to follow diagrams and instructions on how to obtain the stool sample and how to return the sample to the lab.
Results:
Within 4 weeks the client and their GP will receive their FIT test results. 95% of participants will receive a “normal” result indicating that no blood was detected or levels that do not signify the requirement for further testing. This cohort will be sent out another home test kit in 2 years once they remain under the age profile of 69.
The remaining 5 % their details are transferred to one of the designated BowelScreen units with the aim of proceeding for a colonoscopy. Colonoscopy is the gold standard investigation for examining the lining of the large bowel for any abnormalities. It involves the insertion of a flexible tube with a camera in to a bowel empty of contents to closely assess the lining of the bowel.
BowelScreen in St James’s Hospital:
Aisling Carolan and Lynda Foy are the Clinical Nurse Managers that manage the Bowelscreen programme in St James’s Hospital. The role involves liaising with the client from the very first step of their BowelScreen pathway, following the abnormal FIT to referral to colonoscopy or appropriate services, managing surveillance programme, informing the client of their results and discharging from the programme. Our role is just one of the multidisciplinary team effort.
Pathway following results:
On receipt of the abnormal result, many clients are anxious and fearful of the “what if’s”. The initial phone call to the client is so important. It is key in gaining their trust, assessing the level of information suited to the client, educating and counselling the patient, all while obtaining a detailed history and assessment of the physical, psycho social and overall holistic well-being of the patient. Following this initial phone call, the majority of patient’s report feeling relieved, less anxious, well informed and prepared for their next stage of the pathway, colonoscopy.
Colonoscopy:
Those deemed suitable are brought forward within 20 working days for their colonoscopy. The colonoscopy is performed by one of the team of BowelScreen Consultants.
Approximately 50% of BowelScreen colonoscopies have a result that does not require further treatment. Their FIT may have been positive secondary to the presence of haemorrhoids or diverticulum and they will receive a FIT kit again in 2 years.
Polyps or pre-cancerous adenomas are detected in 45% of BowelScreen colonoscopies. These polyps are examined in the histopathology lab and the results discussed between the performing Consultant and BowelScreen CNS or discussed at the weekly histology Multidisciplinary team meeting. Clients may require surveillance at 1 year or 3 year intervals following their colonoscopy, others with polyps may not need any further surveillance and will obtain a FIT kit in 2 years.
Colorectal cancer is found in 5% of BowelScreen colonoscopies. These participants are referred to the Colorectal Cancer Nurses Delia and Katrina for further management and treatment. The BowelScreen CNS continues to follow the client on this pathway to document their treatment, results and journey on the Colorectal Cancer Screening database.
Why is it important to get the BowelScreen test done?
Prevention is better than cure. Colorectal cancer is preventable through early detection via screening. The presence of blood on the home FIT Kit could identify a large bleeding polyp that has not yet developed in to a cancer. This polyp or adenoma will be removed during colonoscopy and will never get the opportunity to develop in to a cancer.
When we phone clients with the result of their colonoscopy, for that 95% cohort, in contrast to their initial fears and embarrassments on the first phone call, this is replaced with relief and gratitude, and asking how they can spread the word on how great the service is.
For the 5% that receive a cancer diagnosis, they are supported and assisted through this stage of their pathway by a wonderful Colorectal Cancer team. They have reassurance that they are engaged in a Cancer Centre of Excellence, and for many, their cancer was detected before they had symptoms.
How to contact us:
BowelScreen St James’s Hospital: 01 410 3802 email BowelScreen@stjames.ie
National Screening Services: 1800 454555
www.hse.ie/bowel/screening