Establishing the added benefit of measuring MMP9 in FOB positive patients as a part of the Wolverhampton colorectal cancer screening programme

FOBt positive people aged 60–69 years attending the Wolverhampton NHS Bowel Cancer Screening Unit and providing consent for colonoscopy will be recruited. Participants will provide a blood sample prior to colonoscopy and permission for collection of the clinical outcome from screening unit records. Multivariate logistic regression analyses will determine the independent factors (patient and disease related, MMP9) associated with the prediction of neoplasia.Colorectal cancer is a major cause of morbidity and mortality. Pilot studies have confirmed the feasibility of the national cancer screening programme that is based on FOBt. However, the test has high false positive rates. MMP9 has significant potential as a marker for both adenomas and cancers. This study is to examine whether using MMP9 as an adjunct to FOBt improves the accuracy of screening and reduces the number of false positive tests that cause anxiety and require invasive and potentially harmful investigation.About one in 20 people in the UK will develop colorectal cancer during their lifetime [1]. It is the third most common cancer in the UK, and the second leading cause of cancer death, with over 15,000 people dying from colorectal cancer each year [2]. Colorectal cancer incurs an annual expenditure of more than ￡300 million in surgical, adjuvant, and palliative treatment [3]. As the population ages these costs are set to increase. Reduced costs of treatment could be achieved by earlier diagnosis. However, most cases are diagnosed at a late stage which is strongly associated with poorer survival; the five year overall survival rate of colorectal cancer is only 48% [4]. Benefits, in terms of improved survival, improved quality of life and reduced treatment costs, could be accrued by earlier diagnosis.FOBt screening can detect colorectal cancer at an early stage when treatment is more likely to be effective. It also provides an opportunity to identify precursors to invasive disease, polyps, which can be re