Well, my only own experience is that one of my grandmothers died before I had a chance to know her, because she was taken by bowel cancer when I was two months old. 

Bowel cancer is the fourth most common cancer in the UK. Around 16,000 people die from the disease each year—900 in Wales—making it the second biggest cancer killer. The scale is growing, where it is estimated that between now and 2035, around 332,000 additional lives could be lost to the disease across the UK, and this shouldn’t be the case, because the disease is preventable, treatable and even curable. Nine in ten people will survive bowel cancer if diagnosed at the earliest stage.

Screening is the most effective method of detecting bowel cancer early and plays a key role in improving survival rates. Across the UK, bowel cancer screening programmes send everyone aged between 60 and 74 a home testing kit—and I note David Melding's comments earlier, in that context—every two years. In Scotland, they are also sent to people in their 50s. Referral by GP is still the route by which most people are diagnosed. Referral through primary care is a key route to diagnosis for those who experience symptoms that could be bowel cancer, and for those below the age covered by the screening programme. People who experience symptoms should be referred for the most reliable and accurate diagnostic tests for bowel cancer available: a colonoscopy and flexible sigmoidoscopy, which can detect cancer at the earliest stage of the disease. While effective public health awareness programmes can alert people to the symptoms of bowel cancer and encourage them to seek advice from their GP, it's also important that GPs are able to recognise these symptoms and refer appropriately and promptly.

However, as the symptoms of bowel cancer can be hard to diagnose accurately, and can also be symptoms of other less serious and more common bowel conditions, it can be difficult for GPs to know who to refer and when. This can result in delays to patients being able to access diagnostic services and, in some cases, patients having to see their GP more than five times before referral. NICE guidelines for suspected cancer, updated in July 2017, are in place to help GPs to make these decisions. These recommend that the faecal immunochemical test, or FIT, is adopted in primary care to guide referral for suspected bowel cancer in people without rectal bleeding, who have unexplained symptoms but do not meet the criteria for a suspected cancer referral pathway. Using FIT in this way could help GPs to better identify and refer the right patients quickly and detect bowel cancer early. We need to see this adopted in Wales before 2019, alongside England and Scotland, where it has already been piloted and used in some areas.

The annual cancer report recognises that a poor interface between primary and secondary care is a major cause of delays for cancer patients. In response to this, the Welsh Government included recognition and early referral of cancer as part of the Wales GP contract for 2017-18. This requires primary care teams to develop strategies to improve recognition and early diagnosis. These interventions should support earlier diagnosis of people with cancer who present in primary care, and may also potentially lead to a reduction in demand for colonoscopy services.

Jackie Hill from Wrexham was diagnosed with bowel cancer after repeated trips to see her GP. She said:

'my GP examined me but could not detect a lump. I was given laxative and told to go back in the New Year. I went back and told my GP that I was bleeding even more and felt very tired. My blood test came back normal. I went back again three months later as the bleeding was very heavy, but I was told there was nothing wrong. Eight months after my first visit, I returned and was referred for the camera to allay my fears, but never once was cancer considered as the blood tests had come back normal and I was told I was too young for cancer. At one time my GP even said to me: "And what do you want on this urgent appointment?" I was finally diagnosed with stage 2 cancer. I thought, very naively, when I was diagnosed that I would have the tumour removed and then back to normal. Because of the consequences of my treatment, I am constantly worried about going out of the house and many times when I am ready to leave the house I have to go to the toilet. My first thought when I go anywhere is where the toilets are and will they be clean.'

Wales must therefore optimise bowel cancer screening by using FIT at the optimal sensitivity threshold, expanding the age range and increasing uptake. Thank you.