What assessment has the Minister made of the impact of the decision to withdraw screening above the recommended age group of 74 and any new evidence which may have subsequently emerged on asymptomatic bowel screening post-74 years of age following that decision?
Asymptomatic bowel screening over the age of 74 has never been offered in Wales as it is the Welsh Government’s policy to follow the independent, expert advice of the UK National Screening Committee (UK NSC) which recommends routine asymptomatic bowel screening for men and women between 50 and 74. This is because there are risks associated with screening as well as benefits. As such, there needs to be a balance between the benefits and potential harms of the screening test being offered. For asymptomatic bowel screening above the recommended age group, the additional risks from false positive results and any follow-up investigations outweigh the potential benefits in an older population. At any age group, anyone with any symptoms of bowel cancer is exhorted to seek prompt advice from their doctor, so that investigation can be offered. This approach offers the appropriate balance of risks, benefits, population equity and efficient use of resources.
The bowel screening programme in Wales currently offers screening to people with no symptoms, aged 55 to 74. Work to reduce the starting age for bowel screening, in line with UK NSC recommendation, commenced in October 2021 with people aged 58 and 59 receiving invitations. People aged 55 to 57 started to receive invitations as of October 2022. The intention is to expand the age range down to those aged 50 and to increase the test sensitivity over the next few years.
The limited capacity of endoscopy services, exacerbated by the pandemic, poses challenges for meeting the UK NSC’s recommendation to offer screening to men and women aged 50 to 74 along with timely follow-on colonoscopy. The expansion of the screening programme is leading to large increases in demand for colonoscopy as more people are being offered screening, the test is more sensitive, and a greater proportion of those eligible are taking part in the programme. Our priority, therefore, is to make asymptomatic population screening available to all those within the recommended age cohort, at the recommended test sensitivity, before considering the evidence for expanding access beyond the recommended age group. This is a very challenging programme, and it is important that those in the recommended age range are the current focus of the screening capacity that is available.
At present, there is insufficient evidence for extending the age range beyond the recommended cohort. However, the UK NSC considers any new evidence on behalf of the four UK countries and keeps all its policy positions under regular review when new papers are published. Should the committee recommend asymptomatic bowel screening outside of the current age range, the Welsh Government will consider how this can be implemented in Wales.