Publication - Strategy/plan

Bowel Cancer Framework for Scotland

Published: 20 Apr 2004
Part of:
Health and social care

Bowel cancer is an improtant health issue worldwide and, in Scotland, it represents a major problem. In this framework the key components of a national bowel cancer service programme are outlined.

29 page PDF

362.8 kB

29 page PDF

362.8 kB

Bowel Cancer Framework for Scotland
Page 2

29 page PDF

362.8 kB



The Scottish Executive's policies to support improvements in the health of Scottish people are set out in a variety of published documents ( see reference list at end).

Of these, perhaps improving diet and exercise can have the most impact on incidence of, and mortality from, bowel cancer in Scotland.

It is not intended to provide a comprehensive status report on these various initiatives here, however, a summary is provided that clearly demonstrates a wide range of actions being taken by the Scottish Executive and NHSScotland who are continuing to work in partnership to help achieve, among others, the overall cancer mortality target of a 20% reduction in deaths from cancer in the under 75s by 2010 (1995 baseline). In 2002 there were 22.8 deaths from cancer per 100,000 of population, which is a fall of 16% compared to the 1995 baseline.

ISD statistics show that in 2000 bowel cancer was the third most frequently diagnosed cancer in both sexes. Incidence was higher in males with a statistically significant increase of 12% over the period 1991 to 2000. However, the 2.1% increase in females was not statistically significant. Mortality fell for males (-12.4%) and females (-23.8%) over the period from 1993 to 2002.

The effects of unhealthy lifestyles and deprivation have long been recognised, although more work is needed to better understand the complex biological interactions that may influence individual and population health.

The government is committed to closing inequality gaps and, in the health area, is setting up a Centre for Population Health Studies in Glasgow, as set out in A Partnership for a Better Scotland: Partnership Agreement (2003).


Basic Elements

  • Lifestyle Intervention

  • Chemoprevention

  • Population Screening and Surveillance of High Risk Groups

What is required?

What is already happening?

Next steps

Service Implications

Lifestyle Intervention

  • Health/lifestyle education

  • Scottish Executive Improving Health in Scotland - The Challenge provides a strategic framework to deliver health improvement

  • Creation of NHS Health Scotland to provide a national focus for improving health

Smoking cessation

  • A tobacco control action plan "A Breath of Fresh Air for Scotland" was launched in January 2004. The Action plan offers a broad-based programme of action aimed at:
    - accelerating reductions in smoking and smoking prevalence;
    - further extend smoking cessation services:
    - an additional 1m this year and 5m in 2005/06 allocated for smoking cessation services
    - Zyban/Nicotine Replacement Therapy available on prescription and free to those least able to afford it
    - 900k for 11 new initiatives designed to support smokers to give up
    - Tobacco Advertising and Promotion Act bans tobacco advertising
    - Reducing through legislative and other action, the availability and attractiveness of cigarettes particularly to children and young people; and
    - Sponsoring a public debate on action to minimise the impact of second-hand smoke

  • South Ayrshire Schools Tobacco Awareness Project (NOF funded)

  • Smoking cessation in South Glasgow (NOF funded)

  • Towards a smoke-free Highland (NOF funded)

  • Pharmacy smoking cessation services in North
    of Scotland (NOF funded)

  • Smoking and Young people in Tayside (NOF funded)

  • Tobacco policy programme in Dumfries & Galloway (NOF funded)

  • Establishment of Centre for Population Health Studies in Glasgow

  • New smoking cessation targets will be set for each NHS Board this year

  • A new Ministerial Working Group will guide the implementation of the action plan and help to shape the future direction of national tobacco control policy in Scotland


  • Nutritional standards for school meals ( Hungry for Success) were introduced, backed by a major investment (63.5m) and detailed monitoring and inspection programme. Implementation underway across Scotland

  • Free fruit for all primary 1 and 2 pupils introduced

  • Food industry moving to support policy changes in Scotland. In response to Hungry for Success, Coca-Cola removed branded vending machines from all Scottish schools and agreed to provide water and healthier choices

  • Product specifications, developed by Food Standards Agency Scotland, set levels for fat, salt and sugar in processed food for Scottish school menus. In response, suppliers and manufacturers, including Brakes, developed new healthier ranges

  • The healthyliving campaign has kept awareness of healthy eating messages high. Campaign has made its presence felt in a big way supporting the work of health boards and communities in both local and national press

  • Great deal of activity at local level driven by local authorities and health boards. Increased investment is driving the development and implementation of local nutrition action plans throughout Scotland stimulated by the Health Improvement Challenge

  • Eating more fruit and vegetables project in Ayrshire & Arran (NOF funded)

  • Dietary prevention of bowel cancer a patient-focused education programme
    - University of Edinburgh (NOF funded)

  • Community Action on Food in Clydebank (NOF funded)

  • Pollock Fresh Fruit and veg "community kitchen" (NOF funded)

  • Community Food initiatives in North of Scotland (NOF funded)

  • Healthy eating in Orkney (NOF funded)

  • Fruit for early years in Shetland (NOF funded)

  • Pre-5 healthy eating initiative in Edinburgh (NOF funded)

  • The European Prospective Investigation into Cancer and Nutrition (EPIC) is a study, coordinated by the International Agency for Research on Cancer (IARC), designed to investigate the relationships between nutritional status, lifestyle and environmental factors and incidence of cancer and other chronic diseases. To focus research efforts several working groups have been established including one on bowel cancer looking at meat, fruit and vegetable consumption and iron and fibre intake


  • In January 2002 the Scottish Executive published a national Plan for Action on Alcohol Problems. The two key priorities of the Plan are to reduce binge drinking and to reduce harmful drinking by children and young people. The plan seeks to kick-start a cultural change in current harmful drinking patterns

  • The Executive has also launched a national communications strategy, published the Alcohol Problems Support and Treatment Services Framework, and set up the National Alcohol Information Resource

  • Local Alcohol Action Teams have been strengthened and have produced three-year plans for local delivery of the national Plan and the Executive has announced an injection of specific funding to 8m between 2004-05 and 2005-06 to support this local action

  • The responses to the Nicholson Committee's Report on the Review of Liquor Licensing Law in Scotland have been independently analysed and are being considered by Ministers. The Scottish Executive will publish a White Paper in due course and this is expected to lead to new liquor licensing legislation for Scotland

Service Implications

  • A sub-group of the Scottish Ministerial Advisory Committee on Alcohol misuse has been set up to lead a review on the progress in delivering the Plan for Action on Alcohol Problems and in determining future priorities. Action flowing from the Nicholson review, the consultation on anti-social behaviour proposals and the English Alcohol Harm Reduction Strategy will have a significant bearing on how we take future action forward

Physical activity

  • Publication of national strategy Let's Make Scotland More Active

  • Appointment of National Physical Activity Coordinator

  • Physical activity advice included in second phase of healthyliving campaign

  • Investment in local infrastructure to support the establishment of local Paths to Health walking groups

  • 24m investment to develop and expand the Active Schools programme

  • National Walking initiative being developed

  • Funding the development and delivery of training for physical activity specialists/deliverers

  • Helping to build capacity among community planning partners for developing active travel as an integral part of their physical activity plans

  • Widening opportunities for employers to provide physical activity opportunities for their staff in partnership with Scotland's Health at Work (SHAW) and Jogscotland

Voluntary sector

  • Colon Cancer Concern aim to raise awareness and reduce deaths from bowel cancer through the provision of information, support and advice, education programmes for healthcare professionals and research into long-term solutions


  • Chemoprevention seminar in October 2002 looking at the current position and issues

  • Bowel cancer and folic acid trials

  • NSAID use and bowel polyp/adenoma incidence

  • Maintain a watching brief on developments and review in 2004-05

Population Screening and Surveillance of High Risk Groups

  • See section on early detection

Research Implications

Lifestyle Intervention

  • Development of effective lifestyle modification techniques

  • Evidence about what works in this area is patchy

  • Requires innovative thinking and evaluation through the Health Improvement demonstration projects such as the Cancer Challenge (Bowel Cancer screening)

  • Continued research and evaluation of projects

  • A cancer portfolio steering group has been set up to identify priorities for any additional expenditure within the Chief Scientist Office (CSO) cancer budget that would impact on cancer research in Scotland and add value to existing funding streams


  • Development of effective chemoprevention

  • Performance of chemoprevention trials

  • Identification of populations that would benefit

  • CSO is spending ~0.5million per year in support of project grants related primarily to the genetic determinants of colorectal cancer, ways of improving the FOB test, chemoprotective effects of NSAIDs, surgical reliability and immunotherapy

  • CSO is spending 0.5m per year in support of translational cancer research carried out by the Edinburgh and Glasgow/Dundee National Translational Research Centres (NTRAC). Both workplans build on existing strengths in colorectal cancer research and aim to apply advances from laboratory research to clinical care

  • Support Scotland to participate in national and international trials (Scottish Cancer Research Network)

  • Two Scottish Translational Cancer Research Centres (Glasgow/Dundee combined and Edinburgh)

Population Screening and Surveillance of High Risk Groups

  • See section on earlier detection