A 90-second test for bowel cancer could spare more than half a million people a year from invasive colonoscopies.
Experts believe the test, which can rapidly rule out the disease in 80 per cent of patients with worrying symptoms, could make a significant dent in NHS waiting lists.
The Oricol test, made by the Cambridge-based company Origin Sciences, uses a “triomic” approach that assesses three factors: genetic mutations, the epigenetic chemical tags that switch genes on and off, and the bacteria associated with early cancer development.
A study of 800 patients tested in Shropshire, to be published in the Nature Communications science journal this week, confirmed that this approach accurately separates healthy patients from those with cancer. It also picks up polyps, a sign that cancer could be on the way. Scientists describe the test as a “biological tape recorder”.
Given by a nurse at a community diagnostics centre, it cannot definitively diagnose bowel cancer. Instead those who receive a positive result must have a colonoscopy in hospital. But the study results confirm it is an accurate way of giving the majority of patients the all-clear, meaning they never require the more invasive test.
If a larger study, due to be published next year, confirms the test is an accurate way of ruling out bowel cancer it could be quickly introduced.
NHS officials are watching the technology with interest. Almost 44,000 people a year in Britain are diagnosed with bowel cancer, also known as colorectal cancer, and it kills 17,500 a year.
About 750,000 people in Britain each year are referred for a colonoscopy after displaying the warning signs, which include blood in the stool. A colonoscopy, in which a long flexible tube with a camera is used to examine the inside of the large intestine, is the gold standard for diagnosing bowel cancer. But it is invasive and expensive, costing the NHS between £800 and £1,200 per patient.
Jon Lacy-Colson, a colorectal surgeon at Shrewsbury and Telford Hospital NHS Trust, which has been using the Oricol test, said: “A colonoscopy requires bowel prep, it requires taking two days off work and then 45 minutes having this invasive test. For every 100 patients who have a colonoscopy after reporting symptoms, four of them have got cancer. Sixteen of them have got a significant polyp. The remaining 80 don’t have anything serious.”
He said the Oricol test meant those 80 per cent of patients without problems could be given the all-clear without enduring a colonoscopy. Nationally, that would mean reducing the number of colonoscopies conducted on the NHS by at least 600,000 a year.
And it is far quicker. “Under the old system it took us 14 days just to see people for a colonoscopy,” Lacy-Colson said. “We’re seeing people for this test at day three.”
Oricol, which is expected to cost the NHS less than £300 per test, involves inserting a small syringe into the rectum. A balloon is briefly inserted, deflated then removed. It is then analysed in the lab.
Parminder Dhani, 65, from Telford, was diagnosed with bowel cancer in June after taking part in the Oricol trial. She was referred by her GP after experiencing stomach pain. Getting the new test was “very quick, very easy and quite comfortable”, she said. A colonoscopy confirmed she had bowel cancer and she was referred for surgery. The speed of the process was remarkable, she said. “It all happened really quickly — from the process to actually having it removed.”
COURTESY OF PARMINDER DHANI
Lord Prior of Brampton, a former health minister and former chairman of NHS England, is convinced the test could have a significant impact. “It could be a big thing for the NHS,” said Prior, who chairs the Origin Science advisory committee. “It could make a massive difference both to patient outcomes and to the cost of diagnostics.”
Bowel cancer is frequently picked up too late. Deborah James, the cancer blogger who became famous as “BowelBabe”, died in 2022 aged 40, five and a half years after being diagnosed with stage-three bowel cancer. She went to the GP several times with symptoms but waited so long for a colonoscopy that she paid to have one privately. Bowel cancer referrals in England have risen from 360,000 to a peak of 419,000 a week since James died.
Jo Williams, group chief executive of Shrewsbury and Telford Hospital NHS Trust, where 2,000 patients have had the test, said: “This new test could revolutionise the entire colon cancer diagnostic pathway and have a huge impact on our patients. It will make it a more comfortable experience for patients, particularly for those who find tests and a healthcare setting a stressful experience. If successful, the test could lead to a reduction in the number of patients requiring a colonoscopy and cancer could be diagnosed at an earlier stage.”
Hugo Lywood, chief executive of Origin Sciences, said in future the company’s device could be used to test for several cancers at once. It could also be used to vastly improve the bowel cancer screening programme, in which everyone aged 50 to 74 is offered an at home test every two years assessing blood in the stool. “The screening programme only picks up 10 per cent of all cases of colorectal cancer in the UK,” said Lywood. The remainder are picked up when symptoms arise, typically once the disease has advanced.
Lywood attributed this to the low sensitivity of the faecal screening test sent through the post, which is set low so the NHS is not overwhelmed by demand for colonoscopies. If Oricol were used as an interim test, to confirm the faecal test findings but before colonoscopy, the sensitivity of the initial test could be raised. “We think we could shift that 10 per cent of cases found through screening to 60 per cent,” Lywood said.
And because his test is good at picking up polyps or advanced adenomas, an early sign that cancer could be on the way, it could trigger early treatment. Lywood said: “In that case it becomes a cancer prevention tool.”