Dear Editor,

I RECEIVED my NHS bowel cancer screening invitation letter today and was surprised by a startling revelation in their information leaflet.

The NHS invite those aged 60 to 74 to use a testing kit in their home to identify blood in their faeces (poo), with the kit being sent to a laboratory for a result. The minimum age is being gradually lowered to people in their fifties.

The accompanying information letter published by Public Health England (PHE) in 2018 states that most tests will not require further action, but they do not guarantee that you do not have bowel cancer.

Unfortunately, around 2 in 100 people will require further tests, usually a colonoscopy, which is a camera on a tube slid up the rectum. During this camera inspection any suspicious polyps or other tissue can be removed with a wire loop passed down the tube.

However, the leaflet states that a colonoscopy is not without risk of complications. Around 1 in 1700 people will receive a bowel perforation from the camera (colonoscope) and 1 in 2400 people will bleed heavily requiring a transfusion.

From my perspective the chances of receiving an injury are quite high. Even more worrying is that in rare cases a death may occur. The leaflet states that an audit was conducted in 2011 that showed that no deaths occurred. This audit examined colonoscopies taken from adults in 302 National Health Service hospitals between 28 February 2011 and 11 March 2011. This sample was 94 percent of all adult colonoscopies taken nationally.

My real concern is the accuracy of the risks stated by PHE from the 2011 audit, which was the research of Gavin, DR and others. Upon examination of the research extract on the British Medical Journal website, I discovered that the total number of colonoscopies examined in 2011 was 20,085, one less than quoted. Being intrigued I delved further and was astonished by the following statement:

“A total of eight perforations and 52 significant haemorrhages were reported. Eight patients underwent surgery as a consequence of a complication.”

If my maths are correct, and I’m happy to be corrected, those figures return a risk of significant haemorrhage of 1 in 386, plus a lesser risk of perforation of 1 in 2510. This discrepancy certainly needs an answer, something that YourHarlow may be able to extract from the UK Health Security Agency, the agency that replaced PHE.

Also, it is quite worrying that the last audit was 10 years ago, which I believe does not show due diligence, especially as that audit stated the previous audit was seven years earlier. One would expect that technology has moved on in those ten years and colonoscopy procedures improved. Another concerning statistic from the 2011 audit is that the “polyp detection rate for larger polyps (≥10mm diameter) was 11.7%.” Of further concern to me is that the overall detection rate was stated as 32.1%, but why an even lower rate for larger polyps?

Further, I believe that the odds of injury require better training and supervision to significantly reduce those odds. Perhaps, better equipment may be required? I wonder if statistics are collated and published so that patients may assess which hospitals are below par? I wonder how Princess Alexandra compares to the national average? YourHarlow might like to ask PAH what their colonoscopy complications ratio is so that Harlow citizens may make an informed decision. The added difficulty is that the private Rivers Hospital performs a lot of NHS colonoscopies and their success rate would be interesting to know if available.

Regards,
David Forman
Holmes Meadow
Harlow