Current UK guidelines for the surveillance of people found to have bowel polyps classify people into those who are at low-, intermediate- or high- risk of developing bowel cancer in the future. The guideline was developed in 2002 by Professor Atkin (head of CSPRG) and Professor Brian Saunders, a consultant gastroenterologist at St Mark’s Hospital in Harrow, the only hospital in the UK focusing on diseases of the bowel. Professor Saunders is a world expert on colonoscopy examination. In 2011 our guideline was adopted by NICE (the National Institute of Clinical Excellence).
This guideline was developed in 2002 and now needs to be re-examined. People with intermediate-risk bowel polyps are currently recommended to have 3-yearly surveillance colonoscopy. This is likely a good option for some people in the intermediate-risk group, but it may not be the best option for others. For example, there might be a group of people for whom the 3-yearly surveillance colonoscopy is unnecessary. For others, the 3-year interval might be too long and a shorter interval could reduce the risk of a missed polyp developing into more serious disease. Perhaps an interval greater than 3 years might be perfectly safe and effective for others in this group? With many questions unanswered, there is a need for ongoing research into this area to provide the evidence to inform the guidelines used by doctors and screening programmes.
The overarching aim of the IA study is to provide robust evidence to underpin the guidelines for how we monitor people in the intermediate-risk group, and make improvements if necessary. We also want to provide insights into the psychological impact of having surveillance on patients and costs to the NHS.
The AA study will provide further evidence to support an update of the guidelines for monitoring people with any type of bowel polyp, and investigate the potential cost implications to the NHS.
We hope that our research will be used to help ensure patients get the best possible care and to enable NHS resources to be used in the most sustainable way.