{"entity":{"id":"idea-crc-uk-colonoscopy-capacity-and-fit-threshold","kind":"idea","name":"UK gap: match endoscopy capacity and quality to the faecal immunochemical test thresholds the NHS has already set","aka":[],"tldr":"Every positive stool test in England, from the screening programme and from the symptomatic pathway, ends in a colonoscopy. The thresholds have been lowered faster than the capacity to act on them, and who performs the test decides whether it prevents anything.","summary":"This is a placeholder for the UK-specific analysis written by the UK and NHS file of this deep dive, which owns the programme ages, the symptomatic faecal immunochemical test threshold in NICE NG12, the National Bowel Cancer Audit indicators and the endoscopy workforce figures. The evidence this roadmap can contribute is the general form of the constraint: NordICC showed that a screening programme delivers the effect of its uptake, not of its test, and Kaminski showed a roughly tenfold difference in interval cancer risk between endoscopists with adenoma detection rates below 11 percent and above 20 percent.\n\nThe two levers are therefore capacity, which sets how quickly a positive test reaches a colonoscopy, and quality assurance, which sets whether that colonoscopy finds the adenoma. Neither is a research question in the usual sense, which is why they attract less attention than the trials on the rest of this page.","asOf":"2026-09-24","links":[{"label":"NICE NG12: suspected cancer, recognition and referral","url":"https://www.nice.org.uk/guidance/ng12"},{"label":"National Bowel Cancer Audit (NATCAN)","url":"https://www.natcan.org.uk/audits/bowel/"}],"tags":["colorectal-evidence"],"related":["colorectal-roadmap","early-detection-roadmap"],"cancers":["colorectal"],"sections":["early-detection"],"technologies":["colonoscopy","endoscopy","colorectal-screening","ai-endoscopy-detection"],"targets":[],"drugs":[],"companies":[],"institutions":["nice","cruk"],"pathways":[],"terms":["fit-test"],"trials":[],"people":[],"bottlenecks":["b-workforce","b-early-detection","b-care-fragmentation","b-global-access"],"keyPapers":["paper-kaminski-adenoma-detection-rate-interval-cancer-nejm-2010","paper-bretthauer-nordicc-colonoscopy-screening-nejm-2022","paper-atkin-flexible-sigmoidoscopy-17-year-follow-up-lancet-2017"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Aligning endoscopy capacity and endoscopist-level adenoma detection rate accreditation to the faecal immunochemical test thresholds already in use reduces post-colonoscopy colorectal cancer incidence and shortens the interval from positive test to diagnosis, with a larger population effect than any currently funded change in the test itself.","rationale":"Thresholds have moved faster than capacity, and the quality distribution of colonoscopy is wide enough that the same positive test produces very different outcomes depending on who investigates it.","test":"To be specified by the UK and NHS file of this deep dive against National Bowel Cancer Audit and screening programme data: a service evaluation linking regional endoscopy capacity and adenoma detection rate distributions to time from positive test to diagnosis, stage at diagnosis and post-colonoscopy colorectal cancer rates.","maturity":"being-tested-at-scale","actor":"policy","cost":"large","horizonYears":4},"route":"/ideas/idea-crc-uk-colonoscopy-capacity-and-fit-threshold/","neighbours":{"roadmap":[{"id":"colorectal-roadmap","kind":"roadmap","name":"Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation","route":"/roadmaps/colorectal-roadmap/"},{"id":"early-detection-roadmap","kind":"roadmap","name":"Early detection roadmap: organ screening → blood tests for many cancers","route":"/roadmaps/early-detection-roadmap/"}],"cancer":[{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"}],"section":[{"id":"early-detection","kind":"section","name":"Early Detection & Screening","route":"/fronts/early-detection/"}],"term":[{"id":"colonoscopy","kind":"term","name":"Colonoscopy","route":"/terms/colonoscopy/"},{"id":"endoscopy","kind":"term","name":"Endoscopy (EGD, EUS, ERCP)","route":"/terms/endoscopy/"},{"id":"fit-test","kind":"term","name":"Faecal immunochemical test (FIT)","route":"/terms/fit-test/"}],"technology":[{"id":"ai-endoscopy-detection","kind":"technology","name":"AI polyp detection in colonoscopy","route":"/technologies/ai-endoscopy-detection/"},{"id":"colorectal-screening","kind":"technology","name":"Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood)","route":"/technologies/colorectal-screening/"}],"institution":[{"id":"cruk","kind":"institution","name":"Cancer Research UK","route":"/institutions/cruk/"},{"id":"nice","kind":"institution","name":"National Institute for Health and Care Excellence","route":"/institutions/nice/"}],"bottleneck":[{"id":"b-care-fragmentation","kind":"bottleneck","name":"Fragmented care and guideline gaps","route":"/bottlenecks/b-care-fragmentation/"},{"id":"b-global-access","kind":"bottleneck","name":"Most of the world has almost no cancer care","route":"/bottlenecks/b-global-access/"},{"id":"b-workforce","kind":"bottleneck","name":"Not enough oncologists, nurses, pathologists, physicists","route":"/bottlenecks/b-workforce/"},{"id":"b-early-detection","kind":"bottleneck","name":"The hardest cancers are found late","route":"/bottlenecks/b-early-detection/"}],"paper":[{"id":"paper-bretthauer-nordicc-colonoscopy-screening-nejm-2022","kind":"paper","name":"Effect of colonoscopy screening on risks of colorectal cancer and related death (NordICC)","route":"/key-papers/paper-bretthauer-nordicc-colonoscopy-screening-nejm-2022/"},{"id":"paper-atkin-flexible-sigmoidoscopy-17-year-follow-up-lancet-2017","kind":"paper","name":"Long term effects of once-only flexible sigmoidoscopy screening after 17 years of follow-up","route":"/key-papers/paper-atkin-flexible-sigmoidoscopy-17-year-follow-up-lancet-2017/"},{"id":"paper-kaminski-adenoma-detection-rate-interval-cancer-nejm-2010","kind":"paper","name":"Quality indicators for colonoscopy and the risk of interval cancer","route":"/key-papers/paper-kaminski-adenoma-detection-rate-interval-cancer-nejm-2010/"}]}}