A Population based Colorectal Cancer Screening Program

We present results of the first year of our Bowel Cancer Screening Program (BCSP), which was initiated and backed by the Right Honourable Minister for Health, Dr John Cortes, in Gibraltar in March 2014.

The Gibraltar Bowel cancer screening Program is offered by immunochemical Faecal Occult Blood testing (iFOBt) to the population between 60 and 74 years every 2 years. All FOB positive and double inconclusive patients are invited for a screening colonoscopy. Any patient with positive findings ranging from anal fissure, to haemorrhoids, colon polyps and colo-rectal cancer are referred to the colo-rectal surgery service for treatment and follow-up. All negative colonoscopy patients are referred back to the BCSP, for repeat iFOBt every 2 years.

Between April 2014, 1980 iFOBt kits were sent out to patients. Compliance was 62% with 1228 kits returned. With a higher sensitivity threshold for the iFOBt, 104 patients tested positive or were double inconclusive (8.46%). All these patients were offered colonoscopy.

56 patients underwent colonoscopy, with a completion rate of 91.1 %( 51 colonoscopy). Completion was established by CT colonography in 5 patients. 21 patients had polyps (37.5%), 6 had cancer (10.7%). All polyps were adenomatous, and 5 cancers were T1 No Mo, with one cancer T2 N1 Mo.

In conclusion, a population based bowel cancer screening program is an excellent pathway for early detection of colorectal cancer and pre-cancerous lesions.


Posted by: Ezzat Tadros, Consultant Surgeon, St Bernard`s Hospital, Gibraltar (11-Jun-2015)