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About bowel cancer screening

Men and women discussing bowel cancer

This page tells you about screening for bowel cancer. You can find the following information

 

A quick guide to what's on this page

About bowel cancer screening

Bowel cancer screening aims to detect bowel cancer at an early stage in people with no symptoms. Early treatment is more likely to work. Bowel cancer screening can also find polyps. Polyps are not cancers, but may develop into cancers over time. They can easily be removed, reducing the risk of bowel cancer developing. If you have symptoms, see your doctor. Don't wait for a screening appointment.

Screening in the UK

In England, men and women aged between 60 and 69 years old are invited for bowel screening every 2 years. This is being extended to include people up to the age of 75. In Northern Ireland men and women aged between 60 and 71 are offered screening. They hope to extend the programme to include people up to the age of 74 from 2014. The national bowel screening programme in Scotland screens men and women aged between 50 and 74. In Wales, the screening programme invites people aged between 60 and 74 for screening. They aim to start screening from the age of 50 over the next few years.

When you are offered screening you get a testing kit through the post. This test checks for hidden (occult) blood in your stool (faeces). It is called an FOB test (faecal occult blood test). You can do the test yourself at home. You smear a small sample of stool onto a piece of treated card. Then you send the card back in a hygienically sealed, prepaid envelope. Your results come by post too.

Only 2 out of every 100 people tested (2%) are likely to have a positive result, showing that there is blood in their stool. A positive FOB test does not mean you have cancer. But it does mean you need further tests. Usually you have a colonoscopy so that a specialist can see inside your bowel and find out what is causing the bleeding.

In England, a test to examine the inside of the rectum and lower bowel, called flexible sigmoidoscopy or bowel scope, is being introduced as part of the NHS bowel cancer screening programme. This is to be gradually rolled out across the country over the next few years. Bowel scope screening will be a one off test for everyone aged 55. The FOB test will continue from age 60 as before.
 

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What we mean by screening

Screening means looking for early signs of a disease in healthy people who do not have symptoms. Bowel cancer screening aims to detect bowel cancer at an early stage when treatment is more likely to work. If you already have symptoms, you need to see your doctor straight away. Don't wait for a screening appointment. 

Research has looked at 2 main ways of screening for bowel cancer

There is information about these tests further down this page.

 

UK bowel cancer screening

UK bowel cancer screening programmes aim to detect bowel cancer at an early stage. Regular bowel screening has been shown to reduce the risk of dying from bowel cancer by 16%.

As well as finding cancer at an early stage, bowel cancer screening can find polyps on the inner lining of the bowel. Polyps develop when cells grow too quickly and form a clump known as a bowel polyp or an adenoma. These are usually benign (non cancerous) but some may contain cancer cells. They may develop into a cancer over a number of years. Polyps can easily be removed, which reduces the risk of bowel cancer developing.

There are separate bowel screening programmes in England, Wales, Scotland and Northern Ireland. In England, men and women aged between 60 and 69 years old are sent a stool testing kit (faecal occult blood test) every 2 years. This is being extended to include people up to the age of 75. Currently, people aged 70 and over can request a kit by contacting the bowel cancer screening helpline on 0800 707 6060. The programme is also starting to invite people aged 55 for a test to look at the inside of the lower bowel and rectum. This is called bowel scope screening.

In Northern Ireland, men and women aged between 60 and 71 are invited for bowel screening using the stool testing kits. They hope to extend the programme to invite people up to the age of 74 from 2014.

The national bowel screening programme in Scotland screens men and women aged between 50 and 74 years. In Wales, the screening programme is sending testing kits to people aged between 60 and 74. They aim to start screening people from the age of 50 over the next few years.

 

Stool testing

Stool testing means looking for hidden (occult) blood in your stool (faeces). It is also called faecal occult blood testing, or FOB, for short.

If you are within the age range of the bowel cancer screening programme, you will get a testing kit through the post every 2 years. This is a simple way for you to collect small samples of your bowel motions. You do this in your own home. You wipe the sample on a special card, which you then send to a laboratory for testing in a hygienically sealed, prepaid envelope. There are detailed instructions with each kit. You may think that the test sounds a bit embarrassing or unpleasant, but collecting the samples only takes a minute. You will be sent the results of your test by post within 2 weeks.

Only around 2 out of every 100 people tested (2%) are likely to have blood in their stool sample (an abnormal result). Other medical conditions or some things in your diet can cause an abnormal FOB result so this does not necessarily mean you have cancer. If you have an abnormal result, you will be offered an appointment with a specialist nurse at a bowel screening centre. You will have a more detailed examination, and may be offered a colonoscopy to see whether there is a problem that needs treatment.

In England, for every 1,000 people who have the FOB test, around 20 will have an abnormal result and may be asked to do the test again. Around 16 of those people will have a colonoscopy. Of those 16

  • About 8 people will have nothing abnormal found at colonoscopy
  • About 6 will have polyps
  • About 2 will have cancer

Some people have an unclear result, which means there was a slight suggestion of blood in your FOB test sample. If you have an unclear result, you will be sent another FOB test kit and asked to do the test again. This is because the result could have been caused by medical conditions such as haemorrhoids (piles) or stomach ulcers. 

An abnormal result can happen if you eat a lot of red meat, turnips, or horseradish in the 3 days before the test. You can also have an abnormal result if you have had recent dental work that caused bleeding.

A normal test result doesn't completely rule out cancer. So, it is important to be aware of the symptoms of bowel cancer and see your GP if you are worried.

 

Examining the bowel

People who have an abnormal stool test (faecal occult blood test) as part of the NHS bowel cancer screening programme are offered a test called a colonoscopy. Colonoscopy involves a doctor or specialist nurse examining the whole of the inside of your bowel with a long flexible tube. You can read detailed information on the colonoscopy page

A large UK clinical trial looked into a new bowel screening test. The trial followed more than 170,000 people over 11 years to see who developed bowel cancer. More than 40,000 of those people between the ages of 55 to 64 had a test called flexible sigmoidoscopy. This test may also be called Flexi-Scope, flexi-sig or bowel scope. It involves having a thin, bendy tube put a short way into the rectum and lower bowel. The tube has a tiny camera and light on the end, allowing the doctor to look at the inside wall of the bowel and remove any small growths or polyps. It is a quicker test than having a colonoscopy and you do not usually need medicine to make you sleepy (sedation).

The researchers found that the people who had screening with Flexi-Scope reduced their risk of bowel cancer by a third because any polyps were removed at an early stage. In England, the Flexi-Scope test is now being introduced into the NHS bowel cancer screening programme. This is called bowel scope screening. This will be a one off test for all men and women aged 55. The FOB test will continue from age 60 as before. Bowel scope screening will be slowly rolled out across the country over the next few years.

 

Screening for people at higher risk

Some people are offered regular screening if they are thought to be at higher than average risk of bowel cancer. You can read more about this on the screening people at high risk of bowel cancer page.

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Updated: 6 August 2013