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Fast track referrals for colorectal cancer: the impact of the faecal occult blood test screening programme

Implementation of the national faecal occult blood test screening programme for colorectal cancer (CRC) in the UK will lead to a 69% increase in the annual number of endoscopy investigations. Current capacity for these investigations will be inadequate and the real costs of implementing the programme will exceed the funding allocated. Since July 2000, hospital specialists have been required to see any patient suspected of having colorectal cancer within 2 weeks of referral [1]. Known as fast-track referral or two-week wait, this system has significantly changed the traditional conduits of referral from primary care to the hospital setting. The use of a proforma helps to identify a group of high-risk symptoms and signs that warrant urgent referral and investigation, usually by colonoscopy [2], although some 15% may be investigated by barium enema [3]. In August 2005, the UK Department of Health (DoH) stated its intent to screen all members of the UK public aged 60–69 years for CRC [4]. The screening test, based on faecal occult blood testing (FOBT) would be performed once every 2 years and, when fully implemented, is estimated to reduce mortality from CRC by 15% [5], at a cost of £37.5 million in its first 2 years. In this article, we look at the number and outcomes of fast track referrals, the likely number of new referrals generated as a result of the FOBT screening programme and the projected costs. We question if there is sufficient capacity in the current system to absorb these new referrals, and whether the funding allocated by the DoH is realistic.