Colorectal cancer in the Royal Navy--an opportunity to intervene?

Colorectal cancer is uncommon in Royal Naval personnel; an average of two cases are diagnosed annually, often with disease advanced at presentation. During the next five years, 10 serving individuals are likely to present with colorectal cancer and many, if not all of these, already harbour premalignant adenomas or asymptomatic colonic malignancy. Currently over 2,000 servicemen are estimated to carry undiagnosed colorectal adenomas. Requests for hospital appointments for those reporting a family history of colorectal cancer and who request screening are increasing in frequency. An understanding of the personal implications of a family history of colorectal cancer and a basis for the management of these individuals will be provided. This paper considers ways in which the impact of colorectal cancer on the Royal Navy and its pensioners could be altered. Evidence derived from population based and family history based colorectal cancer screening studies are organised into a protocol by which the Royal Navy might be examined. The effect of a family history of colorectal cancer on disease incidence and the percentage of positives resulting from faecal occult blood testing are applied to the age profile of the Royal Navy. These show that a maximum of 56 flexible sigmoidoscopies and 90 colonoscopies would be needed in the first year of a programme to attempt the early detection of colorectal neoplasia. This paper is aimed at gaining feedback from primary and secondary care practitioners so that the possibility of introducing a programme for the early detection of colorectal cancer in the Royal Navy can be considered.