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22 June 2017 | Comment | Article by Ruth Powell

New tool to reduce bowel cancer misdiagnosis in younger patients

Over 41,000 people are diagnosed with bowel cancer every year in the UK, an average of 110 per day according to figures published by Cancer Research UK. It is the UK’s second biggest cause of cancer deaths.

There are many factors involved in the risk of developing bowel cancer, including age, genetics and lifestyle factors (such as the amount of red and processed meat consumed, being overweight, alcohol intake and smoking). It is recognised that fibre intake and physical activities can help protect against the development of bowel cancer.

Bowel cancer is very treatable and the earlier a diagnosis is made, the easier it is to treat. Survival rates in the UK have continued to increase due to a combination of earlier diagnosis and better medical treatment. In fact, the survival rate in the UK has doubled in the past 40 years. Where bowel cancer is diagnosed in its earliest stage, around 98% of patients survive for a period of 5 years or more.

In the UK, 95% of people diagnosed with bowel cancer are over the age of 50, but there are over 2,500 people under the age of 50 diagnosed each year. Of these people under 50, only 20% will be diagnosed when their cancer is at an early stage and around 60% are likely to be diagnosed with later stage bowel cancer (stage 3 or 4), which is associated with lower survival rates.

In the UK, bowel cancer screening programmes have been in place for around 10 years now. People over 60 (over 50 in Scotland) are invited to take part in screening, which involves participants receiving and returning a home testing kit. Screening continues every two years up to the age of 75. The aim of screening is to look for hidden traces of blood within stool samples, which can lead to an early diagnosis of bowel cancer being made.

According to Bowel Cancer UK, the symptoms of bowel cancer can include:-

  • Bleeding from the rectum and/or in stools
  • A change in bowel habits lasting 3 weeks or more
  • Unexplained weight loss
  • Extreme tiredness for no obvious reason
  • Abdominal pain or lump

It should be noted that most people with the above symptoms do not have bowel cancer and they can be due to another health problem. If you are suffering with any such symptoms, you should go and see your GP to discuss your symptoms further.

The National Institute for Care and Health Excellence (NICE) Guidelines set out that the following patients should be referred to Hospital for investigations under the 2 week referral scheme:-

  • People aged under 40 with unexplained weight loss and abdominal pain; or
  • People aged 50 and over with unexplained rectal bleeding; or
  • People aged 60 and over with iron deficiency anaemia or changes in bowel habits; or
  • Any patient whose blood test results show blood in their stools

According to the NICE Guidelines, a referral under the 2 week scheme should be considered in a patient aged under 50 with rectal bleeding and any of the following unexplained symptoms or findings:-

  • Abdominal pain
  • A change in bowel habits
  • Weight loss
  • Iron deficiency anaemia

Despite the NICE Guidelines, it is clear that a significant number of people under 50 who are diagnosed with bowel cancer, are not diagnosed at an early stage, when treatment is easier and the survival rates are much higher. This is partly due to people under 50 not acting quickly when they develop possible symptoms – around 25% of people under 50 will wait an average of 3 months before going to see their GP – and around 20% will have to visit their GP 5 times before a referral to a specialist is made.

It was recently announced that following research by the University of Exeter, Durham University and the North Tees and Hartlepool NHS Foundation Trust, a new risk assessment tool has been made available to GP’s to calculate a patients’ percentage risk of having a serious bowel condition, including bowel cancer. This can be used in all patients, including those under the age of 50.

The tool is used based upon a person’s symptoms, a physical examination and blood test results.

If a patient is deemed to have a risk of 3% or over for bowel cancer, they should be referred for an urgent colonoscopy. A patient with a risk between 1-3% should be recommended to have a faecal calprotectin test. A patient with a risk below 1% does not need any further tests.

Use of this tool is aimed to speed up the time between a patient’s initial attendance at their GP to a diagnosis being made. This may lead to more patients with bowel cancer being diagnosed at an earlier stage and result in higher survival rates amongst this group of patients.

Sadly, as the figures above show, a high proportion of patients under the age of 50 will be diagnosed with bowel cancer when the disease is in its later stages, resulting in a poorer prognosis. We are often approached by patients who have experienced delays in being referred to a specialist for investigations into their bowel symptoms, and who have encountered delays in diagnosis and treatment of bowel cancer.

If you or a family member has suffered as a result of any of the issues noted above, we have a dedicated and approachable team who can assist.

The Medical Negligence department at Hugh James is ranked in the top tier for their expert clinical negligence advice by both major legal guides – Legal 500 and Chambers and Partners. For more information, visit our Medical Negligence page or get in touch to find out if you are eligible to claim.

Author bio

Ruth Powell


Ruth is a Partner and Head of our Clinical Negligence Department. She has exclusively practised in clinical negligence since qualifying in 1995 and has a wealth of experience in complex and high value clinical negligence claims.

Disclaimer: The information on the Hugh James website is for general information only and reflects the position at the date of publication. It does not constitute legal advice and should not be treated as such. If you would like to ensure the commentary reflects current legislation, case law or best practice, please contact the blog author.


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