Bowel Screening
The NHS bowel cancer screening programme (NHS BCSP)
Bowel cancer is a general term for a type of cancer that begins in the large bowel. Depending on where the cancer starts, bowel cancer is sometimes called colon cancer, rectal cancer, or colorectal cancer (see also our section on bowel (colorectal) cancer).
What is bowel cancer screening?
Bowel cancer screening aims to detect bowel cancer at an early stage in people with no symptoms, as treatment is most likely to be effective at this stage.
Bowel cancer screening can also detect polyps in the bowel. These are not cancers but may develop into cancers over time. Polyps can be easily removed to reduce a person's future risk of bowel cancer.
Screening for bowel cancer in the UK involves 3 stages: first, identifying people in the population who are most at risk of developing bowel cancer; second, offering people in that group a screening test; and third, offering a diagnostic test (such as a colonoscopy) to those who have had an abnormal test result (see also ‘'unclear', 'abnormal', or 'further testing needed' result’).
Polyps and bowel cancers sometimes bleed, which is why screening can involve looking for blood in bowel motions (in stools or faeces).
Understanding and views of the bowel screening test
A man we talked to about screening pointed out that blood in a motion (a bowel movement) 'may be due to something else, such as piles, but an abnormal bowel test result needs further investigation'.
The Faecal Occult Blood test detects hidden blood in a person's motion. Blood in the motion indicates that another test is needed, such as a colonoscopy.
The Faecal Occult Blood test detects hidden blood in a person's motion. Blood in the motion indicates that another test is needed, such as a colonoscopy.
What do you think is meant by screening, when we say screening for bowel cancer?
Basically it's to detect blood in your stool, that's the indicator which says to them it needs further investigation. If there's blood in your stool it shouldn't be there and if the reason, I mean it could be a simple reason, people have piles, it could be any reason, but if it is to do with a malignant bowel cancer then the earlier it's treated, and I believe it can be treated successfully and obviously it's to the good and you must have it done. It won't go away, it's no good burying your head in the sand, it needs to be investigated and treated and then your chances of coming out successfully obviously have got to be much better.
Many women we spoke with said they understood what is meant by the term 'screening' because they have mammography as part of screening for breast cancer and cervical screening as part of screening for cervical cancer (see ‘Breast Screening’ and ‘Cervical Screening’ for more information).
She describes screening as a form of 'sifting' to find people who may need treatment.
She describes screening as a form of 'sifting' to find people who may need treatment.
Do you think people understand what is meant by screening?
Well I think that they have, women especially, realise with the mammography, with the breast screening and also the smear test is another screening isn't it, so yes I think, I think we know what screening means, that they go through everyone to find, a sifting really of finding the good, you know the bad ones that need treatment.
So when you say they go through everyone, can you say a little bit more about that for those people who might not understand?
Well they do a test on everyone who presents themselves for testing to find any problems that may crop up, any problems even in the early stages of the problems so that they can be caught early and the operation is not as, not such a big operation is needed to clear things up.
So anybody, even people who are perfectly healthy would be invited to be screened?
I'm perfectly healthy and I, I was, yes I am perfectly healthy now, but I did have my doubts.
Some people we spoke with understood that the purpose of screening was 'to catch an illness at an early stage before there were symptoms', but the idea of or use of the term 'screening' was not familiar to everyone.
One woman we spoke with said that when she first heard about the bowel screening programme she thought of 'the Big Screen' and wondered if she would be filmed. Another person we spoke with thought that 'the word screeing sounded a bit technical' and preferred to call it 'a check-up'.
He prefers the term check-up.
He prefers the term check-up.
When people are invited for screening for bowel cancer what do you think they think is meant by that?
I think people think there is a, there is, possibly that there is already cancer there or you know I think screening is a very, very technical term and I would think easier is to say having a check up to ensure that there isn't any problems and you know, sooner than screening, putting it in normal term, terminology, that screening perhaps is a bit too disastrous really. I think it would better if it just said check-up to ensure there isn't any bowel problems.
At first she thought that screening might involve a film.
At first she thought that screening might involve a film.
Very interesting.
Mm they might, mightn't they?
A really interesting point. And now what's your understanding of screening?
Well my understanding of it now is you just get your kit and away you go.
Why participate in bowel screening?
It is known that taking part in regular bowel cancer screening reduces the chance of dying from bowel cancer, but it is important to consider the disadvantages as well as the advantages of screening.
Sir Muir Gray, the former Programme Director of the UK National Screening Committee, spoke with us about bowel screening..
Sir Muir Gray discusses some of the advantages and disadvantages of screening.
Sir Muir Gray discusses some of the advantages and disadvantages of screening.
All screening programmes do harm - we are very conscious of that. In fact all medical care does harm. But when you've got something wrong with you, you go and see the doctor, you accept that there's a risk of side effects. But when we send you a letter, to a healthy person like yourself, aged 65 or 62 or whatever, and we invite you as a healthy person to come and be screened, then we've got to be doubly careful about the risks. So the disadvantage of screening, that people have reported to us, firstly there is anxiety, some people don't like the thought of it, some don't like to do the test for bowel cancer screening. So there are psychological issues. These almost always go away very quickly, but we know that people get anxious. The thing that really worried us about bowel cancer screening was the fact that in the tests, the colonoscopy, it is like any intervention in medicine, it carries a risk, and for this reason, we've designed a bowel cancer screening programme like a Japanese car industry. We've paid attention to quality and safety at every stage in the process. So there are disadvantages. It's not perfect. Some people with bowel cancer will not be detected as a result of the screening programme. Some of the people we've found with bowel cancer, even if they are having treatment, it may not help them have a better outcome. The advantages of bowel cancer screening are that if you are of the age which we invite you to come for a screening, it is the single best means of reducing your risk of dying of bowel cancer. So, we are very careful to say to people, 'We are making an invitation to you, we are offering you the opportunity to be involved. There are disadvantages, we have taken great care to try to minimise those disadvantages, and maximise the advantages, but it is really up to you to decide what you want to do.'
Who is elligible for bowel screening?
The NHS Bowel Cancer Screening Programme (NHS BCSP) offers screening to everyone eligible to take part within a specified age group.
Bowel screening invitations and screening kits are sent every 2 years starting from the age of eligibility up to the age of 74. The starting age for bowel screening is dependent on location and ranges from starting between age 50 and 60.
In England, people aged 54-74 are invited to take part every two years, and the programme is set to gradually expand to start inviting people starting from age 50.
In Wales and Scotland, screening is offered every 2 years to people aged between 50-74.
In Northern Ireland, screening is offered every 2 years to people aged between 60-74.
For more information about bowel screening see Cancer Research UK and the NHS in your local region (‘Resources and Information’).
Understanding selection criteria for bowel screening testing
People we spole with did not always understand that everyone in a specified age group is invited to take part in bowel screening.
Some thought their name had been 'drawn at random' or that they were chosen according to 'some other purpose' (see 'The invitation for bowel cancer screening').
Some people also wondered why screening is offered only to people in that age group.
Sir Muir Gray explains why people aged between 60 and 69 are offered screening for bowel cancer.
Sir Muir Gray explains why people aged between 60 and 69 are offered screening for bowel cancer.
Well somebody said to me once that the first screening test is looking at your birth date. And when we take a screening programme we look at a subset of the whole population so we don't see any point in offering people of 30, bowel cancer screening. Some people do get bowel cancer at age of 30, but it is very, very uncommon. So what we try to do is identify the population in which the benefits are greatest because then the balance of benefits to risks is most favourable. So we did modelling, we looked at different options for screening and came to the conclusion that people in their 60's were those who stood most to benefit, and for this reason the first screening test we do is to identify people through your medical records to make you the offer of attending for screening.
Flexible sigmoidoscopy (flexi-sig) screening pilot
Flexible sigmoidoscopy is a way of looking at the inside of the bowel using an endoscope (a thin flexible tube) that is put into the rectum/back passage and guided around the lower part of the bowel to detect bowel polyps and cancers early before any symptoms develop.
The NHS introduced bowel scope screening with flexible sigmoidoscopy (flexi-sig) as part of a pilot programme that ran until 2021. The pilot programme began in March 2013 with people in 6 pilot groups/areas invited for 'bowel scope screening' around the time of their 55th birthday.
The programme ended in 2021 in order to focus on bowel screening using the faecal immunochemical test (FIT test) and to increase capacity with scope (endoscopy) services as part of follow up testing.
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