Feasibility and likely outcomes of dynamic individualised bowel cancer screening

Applications are invited from graduates with a BSc (First or Upper Second) or MSc (Distinction), or equivalent, to work within the Centre for Cancer Prevention. This 3 year studentship will commence in Autumn 2017 and will be based at the Charterhouse Square Campus. This is an exciting opportunity for a graduate from disciplines related to epidemiology, statistics, and behavioural sciences.

The change from guaiac faecal occult blood testing (gFOBt) to faecal immunochemical testing (FIT) provides an opportunity to improve the efficiency of the bowel screening programme at a time of scarce resources. gFOBt results in a positive or negative result, whereas FIT yields a continuous quantity. At the moment, the programme is considering the relevant threshold, and the likely relative effects on outcome and resources of low threshold combined with long interval compared to high threshold and short interval. However, the continuous FIT test may afford the possibility of changing the individual interval depending on serial results so far.

The proposed project will first review the literature for effects of different intervals and FIT thresholds, not only on numbers referred to endoscopy and abnormalities detected, but on longer term risk of colorectal cancer. It is anticipated that published data on the latter will be sparse. The second part of the project will involve analysis of follow-up on cohorts already recruited (e.g the UK FIT pilot, and the FIT for Follow-Up study) to augment this. This dual strategy is expected to yield identification of a low risk group who could safely have an extended interval until their next screen. This would be of considerable value given the strain on endoscopy resources as a result of the programme at the moment.