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Wilson and Jungner Criteria for
Screening 1968
 Knowledge of disease:
 The condition should be important.
 There must be a recognisable latent or early symptomatic stage.
 Natural course of condition, including development from latent to declared
disease, should be adequately understood.
 Knowledge of test:
 Suitable test or examination.
 Test acceptable to population.
 Case finding should be continuous (not just a "once and for all" project).
 Treatment for disease:
 Accepted treatment for patients with recognised disease.
 Facilities for diagnosis and treatment available.
 Agreed policy concerning whom to treat as patients.
 Cost considerations:
 Costs of case finding (including diagnosis and treatment of patients diagnosed)
economically balanced in relation to possible expenditures on medical care as a
Bowel Cancer Screening
By Alex Pearce-Smith
Why Screen for Bowel Cancer?
 1 in 20 of UK population will develop bowel
 3rd most common cancer.
 2nd biggest cancer mortality – 16,000 deaths
from bowel cancer per yr in UK.
 Screening has been shown to decrease
mortality by 16%.
What is the purpose of screening?
 Early (pre-symptom) detection at time when
more likely to be curable.
 Polyp detection and excision can reduce
incidence of future cancers.
How is the screening organised?
 Nationwide coverage since 2010.
 All 60-69yr olds every 2 yrs – over 70s can request test.
 Program hubs organise call and recall and co-ordinate with
local screening centres.
 Piloted in North Warwickshire (2006-7).
Approx ½ Million residence with 57% uptake
Approx 2% postive and 1.6/1000 dx Bowel Ca
Higher rates in men and in Scotland.
552 cancers detected.
 92 (16.6%) Polyps.
 48% Dukes A
 1% Metastasised
 Cost £76.2 Million per yr.
The Test
 Bowel Cancer – the facts
leaftlet sent out.
 Kits opposite sent out a
week later.
 Sample smeared from
paper on to 6 test areas.
 Positive: 5-6 samples
 Unclear: 1-4 samples
 Negative: All samples
What Happens?
 Majority of people approx 98% have normal
result and will be invited back in 2 yrs.
 Approx 2% will have a positive result and
will be called for discussion re colonoscopy.
 Approx 4% will have equivocal result and
have further test sent – most of these will be
 5 of 10 will have a normal colonoscopy.
 4 of 10 will have a polyp – which if removed
will reduce the risk of cancer.
 1 of 10 will have bowel cancer.
 Risks: 1 in 150 heavy bleeding.
 1 in 1,500 perforation.
 1 in 10,000 – death.
Predicted Outcomes and The
Screening Pathway