The National Bowel Cancer Audit highlights the need for a continued focus on early diagnosis

The findings from the National Bowel Cancer Audit’s (NBOCA) State of the Nation report have been released. The audit measures and compares the diagnosis, treatment, quality and outcomes of care for nearly 39,000 bowel cancer patients across England and Wales. The report makes recommendations to health bodies to allow them to understand where variations in care exist and where improvements can be made.

The audit includes data on people diagnosed with bowel cancer between 1 April 2022 and 31 March 2023.

Key points from the audit include:

• Only 40% of bowel cancers were diagnosed at Stages 1 and 2, remaining static in comparison to previous years. While there has been an increase in the proportion of cases diagnosed at an early stage, progress is too slow if we’re to meet the targets laid out in the Quality Statement for Cancer in Wales and the NHS Long Term Plan in England, the second of which sets out to achieve 75% of cancers diagnosed at an early stage by 2028.
• The proportion of patients diagnosed through bowel cancer screening is gradually increasing. In 2022/23, 10.8% of patients aged 50-59 received a diagnosis from FIT screening (an at home test which looks for hidden amounts of blood in poo). This is up from 4.6% in 2019/20 when a different test, bowel scope, was offered to only some people aged 55.
• NICE guidance recommends that all bowel cancer patients should be offered testing for Lynch syndrome at the time of diagnosis. The report found that in 2021, 57% of bowel cancer patients in England were tested for Lynch syndrome. This is up from 54% in 2020 reflecting positive improvements in the testing for the condition. Data on Lynch syndrome testing is still not available in Wales.
• Providers are not meeting the target to reverse patient’s ileostomies, with 38% of patients waiting 18 months or longer. Unclosed ileostomies can affect people’s quality of life and can occasionally cause further complications for patients.
• There has been a reduction in 90-day post-operative mortality (any death following major surgery within 90 days of the procedure) from 3.4% in 2018/19 to 2.7% in 2022/23.

Dr Lisa Wilde, Director of Research, Policy and Influencing said: “Whilst this report shows a number of small improvements in bowel cancer care across England and Wales, it's sadly not enough. Too many people are continuing to be diagnosed with bowel cancer at the later stages when the disease is harder to treat. If we're to improve outcomes for patients, more needs to be done to understand why early diagnosis figures have remained static for so long.

“It's positive to see that more bowel cancer patients have access to the right support when they're going through treatment however there is still a long way to go, especially when it comes to the long waits many are facing for ileostomy reversals, which can affect an individual’s quality of life.

“All bowel cancer patients should have access to the best quality care and support and we'll continue to campaign for improvements in waiting times, early diagnoses and patient outcomes. We're calling on the Government to commit to these improvements and make bowel cancer a priority within their upcoming Cancer Plan.”

• Learn more about our policy and campaigning work
• Read our report on the progress of bowel cancer in England against the ambitions of the NHS Long Term Plan
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• Read about our early diagnosis campaign