1 February 2023

Simple urine test could halve the number of surveillance colonoscopies for bowel cancer.

A multi-centre study coordinated by University Hospitals Coventry and Warwickshire (UHCW) NHS Trust has discovered a simple urine test could potentially halve the number of colonoscopies needed to perform surveillance in those of high risk of developing colorectal cancer from polyps.

Polyps are small growths on the inner lining of the colon or rectum and are present in one in four people over 50. Most are harmless but a type of polyp called an adenoma can lead, if not removed, to colorectal cancer which results in 16,800 UK deaths a year.

The study findings, funded by national bowel health charity Bowel Research UK, were recently published in Cancers Journal (https://www.mdpi.com/2072-6694/14/19/4951/htm).

The aim of the study, which involved 360 patients and was run from university teaching hospitals in Coventry, Leicester, York, and Plymouth, was to find out whether a particular ‘signature’ of urinary volatile organic compounds (VOCs) reliably predicts the presence of polyps which have an elevated risk of becoming cancerous, or that had already become so.

Results showed that when combined with a Faecal Immunochemical Testing (FIT), a sensitivity score was achieved for detecting high-risk polyps of 0.94, which means the combination of the two tests will identify people with these (pre)cancerous polyps 94 per cent of the time.

UHCW NHS Trust Consultant Gastroenterologist Professor Ramesh Arasaradnam, who co-ordinated the study, says: “This is very good news for the NHS.

“We found that a simple urine test could potentially halve the number of surveillance colonoscopies needed each year.  A urine test, when combined with a stool test, was able to detect with a very high degree of certainty the presence of polyps at risk of turning into cancer.

“By replacing colonoscopies with routine urine tests for ‘at risk’ patients, we would take pressure off endoscopy services and offer substantial cost savings to the NHS.”

According to NHS statistics, more than 100,000 of the 685,000 annual colonoscopies take place for polyp surveillance, each at a cost of £550.

In England, people aged 60+ are invited to complete a Faecal Immunochemical Test during national bowel cancer screening.

Lynn Dunne, Interim Chief Executive Officer of Bowel Research UK, added:

“The benefits of urine tests are that they are quick and simple to do and would be preferable to most patients over regular colonoscopies. Colonoscopies are both expensive to conduct and uncomfortable for patients, requiring unpleasant bowel preparation and fasting beforehand. They also carry a small risk of serious complications.

“The possibility that a simple urine test that could be done at home and, added to the home FIT test as part of the national screening programme to improve accuracy of diagnostic testing and reduce the need for follow-up colonoscopy, is an incredibly positive finding and a win/win for patients and the NHS. We are delighted our funding has led to such promising results.”

Additional research is now set to be undertaken to further validate the findings and outline possible recommendations about how this could be embedded across the health service.