Resuming bowel cancer screening post-COVID-19.

One of many challenges that will arise in the wake of the COVID-19 pandemic is how to resume services that were put on hold to reduce strain on the UK's National Health Service during the initial outbreak. One such service is bowel cancer screening, which has largely been halted in the UK since the end of March. Suspension of screening services permitted the reallocation of resources at a crucial time, but this suspension means that more than 1 million people in England have now not been invited to bowel cancer screening, including roughly 675 000 people who would have received a faecal immunochemical test (FIT) by mail, allowing them to be screened at home. Not only is screening being delayed but approximately 8500 people who received a positive FIT test result before lockdown began are awaiting an appointment for a follow-up colonoscopy. Up to 10% of individuals with a positive FIT test could subsequently be diagnosed with bowel cancer, which is treatable with curative surgery if caught early enough. These patients will need to be prioritised once screening resumes, but concerns are now mounting that delays due to COVID-19 will also lead to an overall increase in the number of preventable deaths from this cancer.

Resumption of screening will depend largely on capacity and safety, which are closely linked. Colonoscopies are aerosol-generating procedures that carry a risk of SARS-CoV-2 transmission; risk mitigation strategies mean that the number of colonoscopies that can be done per day will probably be much lower than before the pandemic. The backlog will be considerable and patients who are invited to screening should be reassured that it is safe to attend. Consideration needs to be given to expanding the existing capacity of under-resourced endoscopy units, including investment and exploring more fully the use of FIT to help triage and prioritise patients who need a colonoscopy. Thus far, only Wales has outlined official plans to resume some screening services at the end of June. Serious consideration needs to be given to how these services are not only resumed but optimised to minimise the collateral effects of COVID-19.