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Bowel cancer screening

Bowel cancer screening aims to check for bowel cancer or abnormalities that could lead to bowel cancer. The screening tests include:

  • testing for blood in your poo (stools)
  • looking inside your bowel using a scope (bowel scope)

What is screening?

Screening means testing people for early stages of a disease before they have any symptoms. For screening to be useful the tests:

  • need to be reliable at picking up cancers or abnormalities that could lead to cancer
  • overall must do more good than harm to people taking part
  • must be something that people are willing to do

Screening tests are not perfect and have some risks. The screening programme should also be good value for money for the NHS.

Who can have bowel screening

The screening programmes send a bowel cancer testing kit every 2 years to people eligible to take part. You need to be registered with a GP to receive your screening invitations. 

There are separate bowel screening programmes for the different countries in the UK. 

In England, people between the ages of 60 and 74 years take part. 

The bowel cancer screening programme in England uses a test called faecal immunochemical test (FIT). 

In some areas, the screening programme also invites people for a bowel scope test to look at the inside of the lower bowel and back passage (rectum). You have this test once, at age 55. 

People aged over 74, can request a screening kit every 2 years by contacting the bowel cancer screening programme on 0800 707 6060. 

In Wales, the bowel cancer screening programme covers people between the ages of 60 to 74 years old. 

The bowel cancer screening programme in Wales mainly uses the faecal occult blood (FOB) test. But this will be gradually replaced by the faecal immunochemical test (FIT) in 2019. 

You can watch a video in Welsh about how to do the FIT in Wales. The video is about 1 minute long. 

For more information and help completing the kit, you can contact the Bowel screening Wales helpline on 0800 294 3370.

The bowel cancer screening programme in Scotland, uses the faecal immunochemical test (FIT). It covers people aged between 50 and 74 years old.

People aged over 74, can request a screening kit by contacting the bowel cancer screening programme on 0800 012 1833. 

In Northern Ireland, the bowel cancer screening programme uses the faecal occult blood (FOB) test. It covers people aged between 60 and 74 years old. 

You can watch a video about how to do the FOB test.

For more information about the bowel cancer screening programme in Northern Ireland contact the helpline on 0800 015 2514.

The bowel cancer screening tests

There are 3 bowel cancer screening tests:

  • faecal immunochemical test (FIT)
  • faecal occult blood (FOB) test
  • looking inside the bowel (bowel scope)

The faecal immunochemical test (FIT)

The FIT looks for tiny traces of blood in the sample of poo which can be a sign of bowel cancer. It is easier to use than the FOB test because you only need to collect one poo sample.

FIT is used in England and Scotland. Wales is currently replacing the FOB test with FIT.

How to do the FIT?

You don’t need to respond to your screening invitation to take part. You will automatically be sent a testing kit (about 2 weeks later). You do the test in your own home. The test is clean and simple. You only need to collect one sample of poo.

In the envelope you receive, there is:

  • a detailed leaflet with instructions on how to do the test
  • a tube with a stick in it to collect your sample
  • prepaid specially designed (hygienic) envelope for you to send it back

The easiest way to collect the sample is to use an old plastic container, line it with toilet paper and pop it in the toilet. And then have a poo.

Once you have collected your poo:

  • dip the stick from the testing kit in the poo
  • make sure the end is covered with poo
  • put the stick back in the tube and twist it shut
  • write the date on the side of the tube
  • you may need to put a sticker from the letter on the side of the tube marked with + (this is only for people in Scotland)
  • put the tube into the prepaid envelope and post it

The faecal occult blood (FOB) test

The FOB test also looks for tiny traces of blood that you might not be able to see which could be a sign of cancer.

Your GP practice will post the test to you, to do in your own home.

You wipe the poo sample on a special card, which you then send for testing in a hygienically, sealed, prepaid envelope. There are detailed instructions with the kit. 

You may think that the test sounds unpleasant, but it doesn't take long.

Looking inside your bowel (bowel scope)

Bowel scope screening uses a thin flexible tube with a tiny camera on the end to look at the inside of your large bowel. It is also called flexi scope or flexible sigmoidoscopy (flexi-sig). 

The test looks for polyps. They are most likely to grow in the lower bowel. The polyps might develop into cancer.

It can also pick up cancers at an early stage.

A specially trained health care professional (endoscopist) puts the tube into your back passage and looks at the lower part of your large bowel. They gently pump some gas into your bowel to open it up so they can see more clearly. They usually remove the polyps they find straight away, using a thin wire loop passed through the scoping tube.

Getting your results

About 2 weeks after your test, you will get a letter with your results. 

There are different results you can get after the FIT. It depends on the UK country you live in.

Most people have normal results. If you live in England and Scotland, instead of saying normal your letter will say ‘no further tests needed at this time’. This doesn’t completely rule out cancer. So it’s important to know your body and what is normal for you. See your GP if you have changes that don’t go away.

A small number of people have abnormal results. If you live in England and Scotland, instead of saying abnormal your letter will say ‘further tests needed’. This means that blood was found in your sample. This can be caused by cancer or by other medical conditions. Most people with abnormal results do not have cancer.

The screening programme may ask you to do the test again if your letter says ‘further tests needed’ or you have abnormal results. Or you'll have an appointment to see a specialist nurse at a bowel cancer screening centre. The nurse will talk to you about having a test to look at the inside of your large bowel. This is called a colonoscopy. 

There are different results you can get after the FOBt. It can be:

  • normal results
  • unclear results
  • abnormal results

Most people have normal results. It’s important to know that this doesn’t completely rule out cancer. Talk to your GP if you have changes in your normal bowel habit that don’t go away.

An unclear result means that there was a slight suggestion of blood in the sample. If this happens, the programme will send you another testing kit.

An abnormal result means that there was blood in your sample. Most people with an abnormal result do not have cancer. Blood in the poo can be caused by other medical conditions or recent dental work. You might need to do the test again. Or you’ll have an appointment to see a specialist nurse at a screening centre. They might talk to you about having a colonoscopy.    

About 95 out of every 100 people (95%) have a normal result. In some people, the endoscopist finds polyps during the test. They will tell you straight away if this is the case.

If you have polyps, the endoscopist usually removes them. They send them to a laboratory to be checked. You might have a test called colonoscopy afterwards to check the rest of your large bowel. 

Possible benefits and risks of bowel cancer screening

Possible benefits

Bowel cancer screening saves lives. It aims to prevent and detect cancer at an early stage when treatment is more likely to work.

Risks

False positive result

This means that the test picks up something even though the person doesn't have cancer. This can cause anxiety and lead to further tests. 

False negative result

Rarely, screening tests miss a cancer. It is important to know the symptoms of bowel cancer and see your GP if you have any symptoms. 

Overdiagnosis

There is a small chance that some people may be diagnosed and treated for bowel growths that would not have caused any harm. 

Damage to the bowel wall

Bowel scope screening is usually very safe, but in rare cases it can damage the bowel wall. Around 1 in 3,000 people have serious bleeding. Or the bowel wall may be torn, but this is even rarer. If this happens, you need surgery straight away to repair the bowel. 

Screening for people at higher risk

Bowel screening works well at reducing deaths from bowel cancer in people in their 50s, 60s and early 70s. As bowel cancer is rare in younger people, screening them is not useful. 

Some people can have regular screening at an earlier age, if they have certain conditions that increase their risk of bowel cancer.

Be Clear On Cancer

Be Clear On Cancer bowel screening campaign aims to encourage people to do the bowel screening test.

Information and help

Dangoor sponsorship

About Cancer generously supported by Dangoor Education since 2010.