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Journal of Public Health Advance Access originally published online on May 3, 2005
Journal of Public Health 2005 27(3):246-253; doi:10.1093/pubmed/fdi030
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© The Author 2005, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved.

Impact of UK Colorectal Cancer Screening Pilot on hospital diagnostic services



Jacqueline Price

Christine Campbell

Joanne Sells

David Weller

Harry Campbell
Jacqueline Price, Clinical Lecturer, Christine Campbell, Research Fellow, Joanne Sells, Medical Student, David Weller, Professor of General Practice, Harry Campbell, Professor of Genetic Epidemiology, Department of Community Health Sciences, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK.


Margaret Kenicer
Margaret Kenicer, Consultant in Public Health Medicine, Tayside Health Board, King’s Cross Hospital, Clepington Road, Dundee DD3 8EA, UK.


Malcolm Dunlop
Malcolm Dunlop, Professor of Coloproctology, Academic Unit of Coloproctology, Department of Oncology, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK.

Address correspondence to Dr J. Price. E-mail: Jackie.Price{at}ed.ac.uk

Objective To determine the impact of the UK Colorectal Cancer Screening Pilot on hospital services involved in the diagnosis of colorectal cancer (predominantly colonoscopy, double contrast barium enema and pathology).

Methods Routine data from seven hospitals at two sites within Scotland and England participating in the Pilot were collected on activity levels and waiting times for key hospital services (GI medicine, surgery and radiology), plus questionnaire survey data from hospital consultants.

Results Hospital colonoscopy activity increased by 31 per cent in Scotland and 21 per cent in England due to the investigation of faecal occult blood testing (FOBt) positive subjects. The demand for symptomatic (non-screening) colonoscopy also increased. Pilot-generated activity was less than predicted for barium enema services (maximum 3 per cent increase in service volume) but greater than expected for pathology, with approximately 200 specimens/month generated. Out-patient review of Pilot colonoscopy patients and associated administrative duties added substantially to overall GI service workload, but quantification was limited by the quality of routinely available data. There was a wide discrepancy in colonoscopy waiting times between screened and symptomatic patients, with predominantly longer waits for symptomatic patients: otherwise the quality of colonoscopy services appeared to improve. In any future national screening programme, follow-up of patients with adenomas will result in a further increase of 28 per cent in the number of colonoscopies generated (over and above colonoscopy for FOBt-positive subjects), adding substantially to overall workload.

Conclusions During the planning of any successful national colorectal cancer screening programme, careful consideration must be given to the wider aspects of workload associated with screening, as well as to the implementation of appropriate hospital data collection systems.

Keywords: colorectal cancer, screening, hospital impact


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