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The fastest rise in bowel cancer is in people two decades younger than any screening programme, who reach diagnosis through symptoms, often after several visits. Screening cannot help them; the referral pathway can.
This is a placeholder for the UK-specific analysis written by the UK and NHS file of this deep dive, which owns the NICE NG12 referral criteria, the symptomatic faecal immunochemical test threshold, the faster diagnosis standard and the National Bowel Cancer Audit's route-to-diagnosis data. The evidence this roadmap contributes is the shape of the problem: incidence in people aged 20 to 29 rose 7.9 percent a year across 20 European countries between 2004 and 2016, the proportion of United States rectal cancers diagnosed under 55 doubled to 29.2 percent, and 60 percent of new cases were advanced at diagnosis in 2019 against 52 percent in the mid-2000s.
Because these patients are below every screening age, the only lever is the symptomatic pathway: how a young adult with rectal bleeding or a change in bowel habit is triaged, whether a faecal immunochemical test is used to rule out rather than to delay, and how many primary care contacts precede referral.
The numbers behind the argument that the screening programme is working for the people it covers and failing everyone below its start age; the stage shift going into reverse is the most uncomfortable figure on this roadmap.
The European counterpart to Siegel 2017, and the evidence a UK screening age extension has to be argued against: the fastest relative rise is in people two decades below any screening programme's start age.
The paper that turned early-onset colorectal cancer from an anecdote into a policy problem, and the direct evidence behind lowering the screening start age from 50 to 45 in the United States.
Shares Colonoscopy, Faecal immunochemical test (FIT), National Institute for Health and Care Excellence, Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood) and the tag colorectal-evidence.
Shares Colorectal cancer incidence patterns in the United States, 1974-2013, Find out what is driving early-onset bowel cancer, starting with colibactin, before extending screening any further, Early-onset colorectal cancer (under 50), The hardest cancers are found late and the tag colorectal-evidence.
Shares Increasing incidence of colorectal cancer in young adults in Europe over the last 25 years, Colorectal cancer incidence patterns in the United States, 1974-2013, Find out what is driving early-onset bowel cancer, starting with colibactin, before extending screening any further, Early-onset colorectal cancer (under 50) and the tag colorectal-evidence.
Shares Colorectal cancer statistics, 2023, Colonoscopy, Faecal immunochemical test (FIT), Early-onset colorectal cancer (under 50) and the tag colorectal-evidence.
Shares National Institute for Health and Care Excellence, Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), Cancer Research UK, The hardest cancers are found late and the tag colorectal-evidence.
Shares Faecal immunochemical test (FIT), Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), The hardest cancers are found late, 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 and the tag colorectal-evidence.
Shares Colonoscopy, Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), Fragmented care and guideline gaps, The hardest cancers are found late and the tag colorectal-evidence.
Shares Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), Cancer Research UK, The hardest cancers are found late, 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 and the tag colorectal-evidence.