Bowel cancer screening

Bowel cancer screening aims to detect bowel cancer at an early stage before symptoms have a chance to develop. It reduces death from bowel cancer [1] and may also help to prevent bowel cancer through the identification and removal of pre-cancerous polyps or adenomas [2].

There are around 44,100 new bowel cancer cases in the UK every year (2017-2019). When diagnosed at its earliest stage, survival is much higher than when the disease is diagnosed at a late stage (stages 3 & 4).

There are separate bowel screening programmes for the different UK nations, which invite eligible people to take part in bowel cancer screening every two years. Bowel cancer screening is available to the following groups in each nation: 

  • England: people aged 56 to 74 years who are registered with a GP. The NHS in England is lowering the age that people can get a screening home testing kit to 50 over the coming years. As part of that, the NHS is currently in the process of expanding bowel cancer screening to 54-year-olds.
  • Northern Ireland: people aged 60 to 74 years who are registered with a GP. 
  • Scotland: people aged 50 to 74 years with a CHI (Community Health Index) number. 
  • Wales: everyone aged 51 to 74 years who is registered with a GP and living in Wales. People aged 51-54 will start to be invited from October 2023 to September 2024. The programme is expected to expand to people aged 50-74 at a future date.   

Download our ‘Bowel cancer screening programme at a glance’ infographic to see how bowel cancer screening criteria varies across the UK.

Bowel cancer screening programme infographic

 

References:

  1. Scholefield JH, Moss SM, Mangham CM, et al Nottingham trial of faecal occult blood testing for colorectal cancer: a 20-year follow-up Gut 2012;61:1036-1040.
  2. Granger, SP, Preece, RAD, Thomas, MG, Dixon, SW, Chambers, AC, Messenger, DE. Colorectal cancer incidence trends by tumour location among adults of screening-age in England: a population-based study. Colorectal Dis. 2023; 00: 1–12. https://doi.org/10.1111/codi.16666

A bitesize guide to bowel cancer

Read our two-page bowel cancer guide on the recognition, referral and management of suspected bowel cancer. It contains tools and resources to help GPs manage suspected bowel cancer cases and answer questions around bowel cancer screening.

Two-page bowel cancer resource

Overview of bowel cancer screening programmes and pathways

Bowel cancer screening reduces bowel cancer mortality. Across the UK the national bowel cancer screening programmes use the Faecal Immunochemical Test (FIT).

FIT uses antibodies that specifically recognise human haemoglobin (Hb). It means that a FIT result is not influenced by the presence of other blood in stools, such as that ingested through diet, therefore reducing the chance of false positive results.

FIT is used to detect and can quantify the amount of human blood in a single stool sample. A positive FIT result suggests that there may be bleeding within the gastrointestinal tract that requires further investigation. Those with a positive result are invited for further testing, normally colonoscopy.

Bowel cancer screening uptake has been increasing across the UK since the introduction of FIT. The most recent data shows that yearly uptake was 69.6% in England [1], 62.1% in Northern Ireland [2] for 2021/22, 66.7% in Scotland for 2020-2022 [3], and 67.1% in Wales for 2020/21 [4].

While FIT is helping to improve bowel cancer screening uptake, uptake is still lower than other cancer screening programmes and inequalities in uptake may still exist.

References:

  1. Office of Health Improvement and Disparities. Bowel cancer screening uptake: aged 60 to 74 years old. Accessed August 2023.
  2. Public Health Agency. Director of Public Health Core Tables 2021 - Supporting the Director of Public Health Annual Report 2022 . Accessed August 2023
  3. Public Health Scotland (2023). Scottish bowel screening programme statistics. Accessed August 2023.
  4. Public Health Wales (2022). Screening Division Inequities Report 2020-21. Accessed August 2023.

While FIT is making a positive contribution to bowel cancer screening uptake, we’re still seeing a short fall in uptake compared to uptake in other cancer screening programmes, and inequalities persist.  

Some people may experience barriers to bowel cancer screening participation, which their GP and wider practice team could help them overcome.

Understanding the barriers to participation and what can be done to address them is key to improving earlier diagnosis of bowel cancers and reducing inequalities in who benefits from bowel cancer screening.

Bowel cancer screening has harms as well as benefits, which is why it is also important to assist people to make an informed decision about whether to take part. Some harms people should be aware of include false positives and negatives, over-reassurance following a normal result, and the risks associated with follow-up colonoscopy.  You can find our public-facing information on  bowel cancer screening here.

Primary care health professionals will be notified as to whether a person has participated in the bowel cancer screening programme and if so, whether they had a positive or negative result.

Safety netting patients:

  • Even in patients with a negative FIT screening result, it is important that GPs continue to be alert to the possibility of bowel cancer. GPs should offer eligible patients who display suspected bowel cancer systems a symptomatic FIT test, which has a much lower threshold for referral than a FIT used for screening.
  • GPs should also remind people to be aware of key signs and symptoms of bowel cancer, and to seek medical advice if they notice anything new or unusual, even if they’ve recently taken part in bowel cancer screening and had a negative result.

The use of FIT in screening vs symptomatic:

There are important key differences in the use of FIT for screening asymptomatic people through the bowel cancer screening programme and for symptomatic patients.

One of the main differences is that the FIT threshold for referral into diagnostic testing is much higher in bowel cancer screening than when testing symptomatic patients. Therefore, it is important to assess patients who present with potential colorectal cancer symptoms, even if they recently received a negative FIT result for screening.

For further information, see our ‘Screening vs Symptomatic FIT infographics

Lynch syndrome is a hereditary condition that increases a person’s risk of bowel and other cancers due to inherited faults in specific genes (MLH1, MSH2, MSH6 and PMS2). It is estimated that approximately 1 in 400 people in England have Lynch Syndrome [1], although only 5% of all Lynch syndrome carriers have been diagnosed [2].

According to UK-wide guidance from the British Society of Gastroenterology (BSG), Lynch syndrome carriers should be offered surveillance colonoscopies every two years.

  • People with Lynch syndrome who carry a mutation in the MLH1, MLH2 or EPCAM gene should be invited between the ages of 25 to 75. 
  • People with Lynch syndrome who carry a mutation in the MSH6 or PMS2 gene should be invited between the age of 35 and 75. 

In England, the NHS Bowel Cancer Screening Programme (BCSP) now oversees the Lynch syndrome surveillance programme to ensure equal and timely access to high quality colonoscopy services for Lynch syndrome carriers. In line with BSG guidance, the BSCP in England will invite people with Lynch syndrome to a Specialist Screening Practitioner consultation followed by a colonoscopy every two years to help reduce their lifetime risk of bowel cancer. Lynch syndrome carriers will not be invited to complete a FIT first as they are on a surveillance pathway.

Previously in England, genetic teams referred people with Lynch syndrome for a surveillance colonoscopy. Lynch syndrome carriers will continue to be managed this way in Wales, Scotland, and Northern Ireland.

Surveillance colonoscopies in England for Lynch syndrome carriers will now take place at a NHS Bowel Cancer Screening Centre. Patients will remain under the care of a genetics team, who will manage other patient needs and risks associated with the genetic condition.

NHS England is advising people with Lynch syndrome to contact their GP practice if they experience any concerning symptoms before their next colonoscopy appointment, or if they are unsure where their local genetics team is based. We encourage primary care health professionals to assess a patient’s individual risk of cancer and consider a referral for urgent suspected cancer if there is clinical concern. For more patient-facing information on Lynch syndrome, please see the ‘Bowel cancer screening resources’ drop-down bar below.

References:

  1. Snowsill T, Coelho H, Huxley N, Jones-Hughes T, Briscoe S, Frayling IM, Hyde C. Molecular testing for Lynch syndrome in people with colorectal cancer: systematic reviews and economic evaluation. Health Technol Assess. 2017 Sep;21(51):1-238. doi: 10.3310/hta21510
  2. NHS England. ‘Life-saving NHS test helping to diagnose thousands with cancer-causing syndrome’. Accessed July 2023.
 

The latest evidence, barriers, and resources to support informed participation of bowel cancer screening

Bowel cancer screening uptake is lower than other national cancer screening programmes, and there are inequalities between areas and across different demographic groups.

In the UK, although gaps in data availability persist, there is evidence that the following groups may be less likely to participate in bowel cancer screening:

  • People with lower socioeconomic status [1, 2]
  • Men [2, 3]
  • People from non-white ethnic communities [4-6]
  • People who do not read or write English or where English isn’t there first language [4]
  • People with learning disabilities [4, 5]
  • People with physical disabilities [5]
  • People with sensory impairment [5]
  • People with severe mental illness [5, 7, 8]
  • People invited for the first time [2]

Taking part in screening is an individual choice, but it must be a choice that is equally available to all. 

We believe it is crucial to reduce inequalities in cancer screening uptake and as a minimum ensure that interventions do not exacerbate inequalities. CRUK has developed a guide offers practical tips to help reduce inequalities, as well as signposting to further resources and information. 

References:

  1. Cancer Research UK (2020). Cancer in the UK 2020: Socio-economic deprivation. Accessed August 2023
  2. Public Health Wales (2022). Screening Division Inequities Report 2020-21. Accessed August 2023
  3. White, A., Ironmonger, L., Steele, R.J.C. et al. A review of sex-related differences in colorectal cancer incidence, screening uptake, routes to diagnosis, cancer stage and survival in the UK. BMC Cancer 18, 906 (2018). https://doi.org/10.1186/s12885-018-4786-7
  4. Young, B. and K. A. Robb (2021). Understanding patient factors to increase uptake of cancer screening: a review. Future Oncology 17(28): 3757- 3775.
  5. Floud S, Barnes I, Verfürden M, Kuper H, Gathani T, Blanks RG, Alison R, Patnick J, Beral V, Green J, Reeves GK. Disability and participation in breast and bowel cancer screening in England: a large prospective study. Br J Cancer. 2017 Nov 21;117(11):1711-1714. doi: 10.1038/bjc.2017.331.
  6. Campbell C, Douglas A, Williams L, Cezard G, Brewster DH, Buchanan D, Robb K, Stanners G, Weller D, Steele RJ, Steiner M, Bhopal R. Are there ethnic and religious variations in uptake of bowel cancer screening? A retrospective cohort study among 1.7 million people in Scotland. BMJ Open. 2020 Oct 7;10(10):e037011. doi: 10.1136/bmjopen-2020-037011
  7. Palmer, C.K., Thomas, M.C., McGregor, L.M. et al. Understanding low colorectal cancer screening uptake in South Asian faith communities in England – a qualitative study. BMC Public Health 15, 998 (2015). https://doi.org/10.1186/s12889-015-2334-9
  8. Kerrison, R.S., Jones, A., Peng, J. et al. Inequalities in cancer screening participation between adults with and without severe mental illness: results from a cross-sectional analysis of primary care data on English Screening Programmes. Br J Cancer 129, 81–93 (2023). https://doi.org/10.1038/s41416-023-02249-3

 

Considerable research has taken place to try and understand the barriers that may prevent those eligible from engaging with the bowel cancer screening programme.

Understanding who is not attending screening and the barriers preventing them from participating is important when looking at ways to support engagement with the programme. The reasons for non-attendance may be complex and several factors may be at place. 

Some of these barriers may include:

  • Fear and denial around the test outcome [1-4]
  • A misconception that the test is not applicable if you don’t have any apparent symptoms of bowel cancer [1,2,5,6]
  • Concerns around the practicalities and cleanliness of the test [3,5-8]
  • Individual perceived risk being low or consideration of future consequences of bowel cancer [2,3,6,7]
  • The fact that it takes place away from the usual health care settings [1,3]
  • Low health literacy and numeracy [9,10]

Some people face barriers further on in the screening pathway after receiving a positive FIT result and may decide not to attend further tests such as a follow-up investigative colonoscopy.

Health professionals plan an important role in providing information to support people to make an informed decision about attending any further tests. Barriers have been researched [11]:

  • Concerns about the procedure (concerns about doing the bowel preparation and fear about pain and discomfort)
  • Anxiety and denial about what might be found
  • Cognitive abilities and ability to make an informed decision
  • Perceived risk and perceived mortality

There is evidence to suggest that inequalities in screening colonoscopy attendance exist, with some groups experiencing more barriers to attending, including those from a non-white ethnic minority, and/or from areas of higher deprivation [12, 13]. To help overcome these barriers and improve uptake, primary care health professionals and the wider practice team should be available to have conversations with patients about what a colonoscopy is and what it involves. They should be able to discuss what a person might expect before, during and after their appointment, and able to talk through any concerns a patient may have around attending a colonoscopy. To support you with these conversations, access CRUK’s patient-facing information on colonoscopies.

References:

  1. Palmer CK, Thomas MC, von Wagner C et al. Reasons for non-uptake? and subsequent participation in the NHS Bowel Cancer Screening Programme: a qualitative study. Br J Cancer. 2014;110(7):1705-11.
  2. Ekberg M, Callender M, Hamer H et al. Exploring the decision to participate in the National Health Service Bowel Cancer Screening Programme. Eur J Cancer Prev. 2014;23(5):391-7.
  3. Miles A, Rainbow S, von Wagner C. Cancer fatalism and poor self-rated health mediate the association between socioeconomic status and uptake of colorectal cancer screening in England. Cancer Epidemiol Biomarkers Prev. 2011;20(10):2132-40.
  4. Hall NJ, Rubin GP, Dobson C et al. Attitudes and beliefs of non-participants in a population-based screening programme for colorectal cancer. Health Expect. 2015;18(5):1645-1657.
  5. von Wagner C, Good A, Smith SG, et al. Responses to procedural information about colorectal cancer screening using faecal occult blood testing: the role of consideration of future consequences. Health Expect. 2012;15(2):176-86.
  6. Bennett K., von Wagner C, Robb, K. Supplementing factual information with patient narratives in the cancer screening context: a qualitative study of acceptability and preferences. Health Expect. 2015;18(6):2032-2041.
  7. Kobayashi LC, Wardle J, von Wagner C. Limited health literacy is a barrier to colorectal cancer screening in England: evidence from the English Longitudinal Study of Ageing. Prev Med. 2014;61:100-5.
  8. Gale CR, Deary IJ, Wardle J et al. Cognitive ability and personality as predictors of participation in a national colorectal cancer screening programme: the English Longitudinal Study of Ageing. J Epidemiol Community Health. 2015;69(6):530-5.
  9. Kobayashi LC, Wardle J, von Wagner C. Limited health literacy is a barrier to colorectal cancer screening in England: evidence from the English Longitudinal Study of Ageing. Prev Med. 2014;61:100-5.
  10. Gale CR, Deary IJ, Wardle J et al. Cognitive ability and personality as predictors of participation in a national colorectal cancer screening programme: the English Longitudinal Study of Ageing. J Epidemiol Community Health. 2015;69(6):530-5.
  11. Kerrison RS, Travis E, Dobson C, Whitaker KL, Rees CJ, Duffy SW, von Wagner C. Barriers and facilitators to colonoscopy following fecal immunochemical test screening for colorectal cancer: A key informant interview study. Patient Educ Couns. 2021 Sep 17:S0738-3991(21)00631-5. doi: 10.1016/j.pec.2021.09.022.
  12. Kerrison, RS, Gil, N, Travis, E, et al. Barriers to colonoscopy in UK colorectal cancer screening programmes: qualitative interviews with ethnic minority groups. Psychooncology. 2023; 32( 5): 779- 792. https://doi.org/10.1002/pon.6123  
  13. Kerrison, Robert S., Dahir Sheik-Mohamud, Emily McBride, Katriina L. Whitaker, Colin Rees, Stephen Duffy, and Christian von Wagner. "Patient Barriers and Facilitators of Colonoscopy Use: A Rapid Systematic Review and Thematic Synthesis of the Qualitative Literature." Preventive Medicine 145 (2021/04/01/ 2021): 106413 

Evidence suggests that there are interventions that can support an increase in participation of bowel cancer screening, while promoting informed consent.  Research shows that primary care involvement can significantly increase participation in bowel cancer screening [1-4]. 

CRUK’s Primary Care Good Practice Guide offers practical advice, which primary care professionals across the 4 nations can use to support people to make an informed decision about participating in bowel cancer screening. The guide also contains a sample telephone script, a GP-endorsed letter template, and a template text message reminder, which you can use to engage with your eligible patients.

GP endorsement letter

A GP-endorsed letter, or enhanced patient leaflet alongside the screening kit appear to have the largest effect on bowel cancer screening uptake. When combined, these interventions increase uptake by up to 12% [1].

A study by Raine et al. provides further evidence for the effectiveness of GP endorsement in increasing bowel cancer screening uptake. This large-scale study included 80% of GP practices in England, added a simple GP endorsement banner to the standard screening invitation letter. Overall uptake increased by 0.7%, which although appears to be a small increase, could mean up to 40,000 extra people screened if rolled out nationally [2].

Enhanced patient leaflet

The Practice Endorsed Additional Reminder Letter (PEARL) project similarly assessed the impact of GP-endorsement on bowel screening uptake, this time in the context of a reminder letter. Overall, bowel screening uptake was 3% higher in practices which used the intervention, compared to other practices which did not [3].

Telephone advice* and face to face health promotion*

Shown to increase uptake by around 8% and 5% respectively, when used in combination with a GP endorsement letter which was sent 2 weeks after their screening due date [4]. The project that incorporated these activities took place in areas of low socio-economic status and high ethnic diversity, suggesting potential to address inequalities in screening uptake. 

Enhanced reminder letters

Enhanced reminder letters with a banner have not only shown to increase uptake, but also reduce the socio-economic gradient in bowel screening uptake [5]. The enhanced version of the leaflet directly addresses perceived barriers to completing the test and provides practical tips. This strategy is supported by previous research showing that providing detailed instructions on the collection, storage and return of screening kits can increase the proportion of people taking part [6,7]. The content was developed with advice from an expert steering group and was extensively piloted. Download this data on increasing bowel cancer uptake.

Text reminders

Evidence has suggested that text reminders increase uptake in first time invitees, although it does not appear to improve overall uptake. The use of text reminders is increasing, and further evaluation will enable us to understand their role in supporting bowel screening uptake [8]. For example, iPlato have been funded by the NHS and Small Business Research Institute (SBRI) to address uptake inequalities and improve bowel cancer screening uptake in South East London, in partnership with the South East London Cancer Alliance (SELCA). We hope this research will build our understanding of the role of text messages in bowel cancer screening uptake. 

Text reminders have also been shown to be effective in other cancer screening programmes. 

*Only tested in combination with other elements

References:

  1. Hewitson P, Ward A, Heneghan C, et al. Primary care endorsement letter and a patient leaflet to improve participation in colorectal cancer screening: results of a factorial randomised trial. Brit J Cancer         2011;9;105(4):475-80.
  2. Raine R, Duffy SW, Wardle J et al Impact of general practice endorsement on the social gradient in uptake in bowel cancer screening. Br J Cancer. 2016 Feb 2;114(3):321-63.
  3. Benton SC, Butler P, Allen K, et al. GP participation in increasing uptake in a national bowel cancer screening programme: the PEARL project. Br J Cancer. 2017;116(12):1551–1557. doi:10.1038/bjc.2017.129
  4. Shankleman J, Massat N, Khagram L et al. Evaluation of a service intervention to improve awareness and uptake of bowel cancer screening in ethnically-diverse areas Brit J Cancer 2014;23;111(7):1440-7.
  5. Wardle J, von Wagner C, Kralj-Hans I et al Effects of evidence-based strategies to reduce the socioeconomic gradient of uptake in the English NHS Bowel Cancer Screening Programme (ASCEND): four cluster-randomised controlled trials. Lancet. 2016 Feb 20; 387(10020): 751–759.
  6. Stokamer CL, Tenner CT, Chaudhuri J, et al. Randomised controlled trial of the impact of intensive patient education on compliance with feacal occult blood testing. J Gen Intern Med. 2005;20(3):278-82.
  7. Miller DP Jr, Kimberly JR Jr, Case LD et al. Using a computer to teach patients about feacal occult blood screening. A randomised trial.  J Gen Intern Med. 2005;20(11):984-8.
  8. Hirst Y. Skrobanski H. Kerrison RS. Kobayashi LC. Counsell N. Djedovic N. et al. Text-message reminders in colorectal cancer screening (TRICCS): a randomised controlled trial. British Journal of Cancer 2017, 116(11): 1408-14

In this section you will find resources and examples of good practice that can enable you to support informed participation in bowel cancer screening.  

Primary Care Good Practice Guide

Cancer Research UK’s Primary Care Good Practice Guide provides health professionals in primary care with practical tools and information to support their practice population to participate in bowel cancer screening through informed choice.

Download the CRUK Bowel Cancer Screening Good Practice Guide - UK wide

Bowel cancer information at a glance

For a more concise overview of bowel cancer detection and diagnosis, you can download CRUK’s ‘Bowel cancer screening at a glance’ resource and our two-page bowel guide to the recognition, referral and management of suspected bowel cancer.

Tackling inequalities

For additional information and support addressing inequalities, download CRUK’s resource ‘Reducing inequalities in cancer screening' and NHS England guidance ‘NHS bowel cancer screening: identifying and reducing inequalities’ on GOV.UK.

FIT screening and symptomatic pathway resources

There are some key differences in the use of Faecal Immunochemical Test (FIT) for screening asymptomatic people through the bowel screening programme, compared to it being used to investigate symptomatic patients.

Cancer Research UK have developed infographics to highlight the different uses of FIT.

 

Visit our FIT Symptomatic webpage for more information.

Talk Cancer: Cancer Awareness Training

Our Talk Cancer training workshops for community-based health workers and volunteers, help trainees feel more confident in talking to the public about cancer.

Find out more or commission a Talk Cancer workshop

Cancer Awareness Roadshow

Our Roadshow nurses visit local communities, raising awareness of cancer risk factors, screening and early detection. We work closely with health partners in each area we visit and help signpost people to local services.

Find out more and work with the Cancer Awareness Roadshow in your area

You can share the following resources with your patients to help increase awareness, understanding of and participation in the bowel cancer screening programme. 

Animated videos to support completing the bowel cancer screening test 

An animated video which explains how to complete the bowel cancer screening test kit. There is a subtitled version too. 

 

NHS screening animations 

You can also find short animations produced by NHSE Screening which explain how to use your bowel cancer screening kit here. Subtitles are available in English, as well as Arabic, Bengali, Chinese (simplified and traditional), Farsi, Gujarati, Polish, Portuguese, Punjabi and Urdu. A British Sign Language version is also available. 

Infographic – how to do bowel cancer screening 

A step-by-step infographic on how to complete the bowel cancer screening test kit and practical tips how to collect the poo sample. 

 

Bowel Cancer Screening Programme (BCSP) information 

Bowel cancer screening programmes send leaflets with invitations to bowel cancer screening. They include information to support informed choice with respect to bowel screening participation, and information about benefits and harms. You can find key patient leaflets and information below to support patient participation in bowel cancer screening.

Lynch syndrome resources 

There are several patient resources to support informed participation in Lynch syndrome surveillance: 

Improving Uptake Project

In Phase 1 of the Improving Bowel Cancer Screening Project, all GP practices in Pennine Lancashire were asked to contact 5+ patients who had not responded to their screening invitation. They chose to either telephone or send a letter, or discuss opportunistically face to face during a consultation. The practices were asked to review these patients 3-4 months later to see if they had subsequently attended, and review the result. GPs were also provided with an information pack and training.

Key findings:

  • Practices were incentivised to take part. Any that demonstrated innovative methods of increasing patient participation were eligible to apply for additional payment
  • Approximately 76 practices returned figures which were then collated and summarised
  • 1,009 patients who had not initially participated in bowel screening were contacted
  • 15.9% of patients subsequently requested replacement bowel screening kits and returned them to the screening hub
  • Subsequent participation was more likely if there had been face to face discussion (35%) than telephone advice (20%), letter (11%) or unknown method of contact (8%)

Location: Pennine Lancashire, Blackburn with Darwen and East Lancashire CCGs

Date: 2014/15

Contact: Dr Neil Smith, Cancer Clinical Lead, neil.smith2@nhs.net

Download report Download presentation

 

Automatic Email Request

In Phase 2 of the project in Lancashire, more links were established between the Bowel Cancer Screening Programme hub (for the North West & Midlands) and each GP Practice via the EMIS web record system. This enabled the direct electronic transfer of registered patients’ bowel screening results from the hub to each practice and also the option for practices to order a replacement test kit on behalf of a previous non-responder via email. Practices were similarly incentivised to take part in Phase 2 of the project.

Key findings:

  • Preliminary data (as at February 2017) shows that 729 requests were made for replacement kits and 317 patients (44%) completed them, 7 abnormal results were recorded from 38 practices
  • The project demonstrates that a large regional screening hub based in an acute hospital setting can work collaboratively with primary care professionals at a local level to achieve health improvement and a good outcome
  • Phase 3 of the project will build on the work already achieved, sharing evidential learning with others and expanding as appropriate

Location: Pennine Lancashire – Blackburn with Darwen and East Lancashire CCGs

Date: 2016/17

Contact: Dr Neil Smith, Cancer Clinical Lead, neil.smith2@nhs.net

Download report

 

Call for a Kit Clinic

The ‘Call for a Kit’ intervention was set up in Lancashire to address previous non-responders. Those who have not completed the kit are invited to an appointment at their GP practice with the BCSP health promotion team. They are shown the kit and a DVD on how to complete it. Questions and anxieties are addressed, and if they agree to complete the test and require a replacement kit, the team phone the screening hub and order a kit on their behalf.

Key findings:

  • 84% of people invited to the clinic actually attend in person; 91% of people attending the clinic have a kit ordered; 58% of people who attended subsequently completed the kit
  • Gender specific clinics were also offered to patients, this worked well and helped subjects overcome issues around cultural dignity, discussing sensitive body parts and aided discussions on how to collect poo
  • The clinic offered 5 different languages to engage with patients who actually attended
  • Next steps include running the Call for a Kit clinics in next cohort of lowest uptake GP practices in each CCG

Location: Lancashire

Date: 2015/16

Contact: Shahida Hanif, BCSP Health Promotion Specialist, Shahida.Hanif@bfwhospitals.nhs.uk

Download report Download evaluation

 

Community Awareness Activities

Early Presentation Symptoms

A community-led engagement campaign (the Cancer Collaborative) was set up in North East Lincolnshire to work with healthcare professionals and to raise awareness of the signs and symptoms of cancer. When the bowel screening programme started, the activity was extended to include messages around screening. It draws upon the local experiences and knowledge of communities and practitioners to identify a wide range of solutions that will work locally.

Key findings:

  • Marketing and community involvement materials were developed following audience testing
  • Badges and stickers which could be worn by health professionals were developed and used as a prompt for conversation with patients
  • Bowel screening uptake in North East Lincolnshire increased from 55.2% in 2008 to 59.9% in 2013
  • Consistent ‘reminding’ of the key messages to the local target population has been seen to increase uptake in bowel screening
  • In planning for the future, the team continue to monitor activity and work with primary care to focus on low uptake areas.

Location: North East Lancashire

Date: 2015

Contact: Julie Grimmer, Collaborative Programme Manager, julie.grimmer@nhs.net

Download report

Till Receipt Awareness Campaign

Four 99p Stores in Merseyside were chosen to run a bowel screening awareness campaign based on their central locations, and due to their diverse population customer group. The campaign included awareness messages printed on the reverse side of till receipts, which were used at the main till banks. The till receipt included messaging such as: ‘Over 60? Do your bit – return your screening kit. Bowel screening saves lives.’

Key findings:

  • Till receipt campaigns can be a low cost option to marketing awareness messages 
  • There were a number of limitations with the project, which included: difficulties with evaluation e.g. linking increases in participation directly with the campaign, other campaigns running at the same time
  • It is recommended that healthcare partners pay close attention to contracting, ensuring all parties are clear on their commitments and expectations from the start.

Location: Merseyside

Date: 2014

Contact: Marie Coughlin, Screening and Immunisation Manager, marie.coughlin@nhs.net

Download report

Barbers Pilot Project

The barber’s project in Blackburn with Darwen was developed, facilitated and delivered by Sadiq Patel who is a BCSP Community Engagement Officer. Ten barbers were recruited to take part in the pilot within two low uptake, high ethnic minority areas. The barbers were supported to plan one week’s bowel cancer screening campaign within their salons and record data on the numbers engaged. They also recorded the key issues raised by local communities.

Key findings:

  • The project was incentivised and barbers received an award once the project was completed
  • Trained volunteers were involved in raising awareness at the barber shops during peak times, including holding weekly information stands in each shop
  • Over 1,600 men were engaged within the salons by the ten barbers (1,099 of these men were below 60, and 671 were between 60-75)
  • The project allowed for 1,770 bowel screening materials to be distributed
  • Utilising barbers in engaging with specific communities was seen to be worthwhile.

Location: Lancashire, Blackburn and Darwen CCG

Date: 2014

Contact: Sadiq Patel, BCSP Community Engagement Officer, Sadiq.Patel@bwdcvs.org.uk

Download report

Quality improvements and future optimisation of bowel cancer screening

Primary Care Network (PCN) GP Contract

In England, the Primary Care Network (PCN) GP Contract for Early Diagnosis requires PCNs to: Contribute to improving local uptake of National Cancer Screening Programmes by working with local system partners to agree the PCN contribution to local efforts to improve uptake in bowel cancer screening and follow up on non-responders to invitations.

This must build on any existing actions across the PCN’s Core Network Practices and include at least one specific action to engage a group with low participation locally. Visit CRUK’s GP Contract Hub for more information

Integrated Care Board (ICB) commitments 

NHS England has published guidance to support Integrated Care Boards (ICBs) and their partner NHS trusts to develop their first 5-year joint forward plans (JFPs) with system partners. The guidance requirements may be applied and relevant to improving cancer screening services. For example, ICBs are required to improve quality services and reduce inequalities - which we know exist in bowel cancer screening. Guidance also states that ICBs and partner trust may wish to seek the views of underserved groups (such as inclusion health and vulnerable populations) as part of the duty to reduce inequalities.

The 2023/24 operational planning guidance also states that ICBs should commission key services to underpin progress on early diagnosis. This includes working with regional public health commissioners to increase colonoscopy capacity to support the extension of the NHS bowel cancer screening programme to 54-year-olds and patients with Lynch syndrome.

The Scottish Equity in Screening Strategy

The Scottish Equity in Screening Strategy 2023-2026 also provides an overview of current national projects to support the reduction of screening inequalities, which may be of interest to health professionals in Scotland.

The UK National Screening Committee (NSC) has recommended that screening for bowel cancer should be offered, using the Faecal Immunochemical Test for people aged between 50 and 74, every two years, with a threshold of 20 μg/g. Download CRUK’s ‘Bowel cancer screening at a glance’ resource to see the different screening thresholds that are used across the UK bowel cancer screening programmes. 

FIT sensitivity threshold 

FIT measures micrograms of human haemoglobin per gram of faeces. The definition of a positive or negative result can be changed by altering the numerical FIT threshold. As a general statement, the lower the threshold, the more sensitive the test will be and the more cases of cancer and adenoma that will be detected and ultimately deaths from bowel cancer averted. 

The FIT screening threshold is 80 µg/g in Scotland and 120 µg/g in England, Wales and Northern Ireland. 

There are plans across the UK to reduce the FIT screening threshold in order to detect more bowel cancers early. 

FIT age extension 

In Scotland, people aged 50-74 are already invited for bowel cancer screening.  

England and Wales are extending the bowel cancer screening programme to people aged 50-74 (from 60-74) using a phased approach. People aged 54 in England will start to be invited from December 2023. Wales is starting to invite people aged 51-54 from October 2023.  

The rate of progress implementing the extension varies regionally, and GPs can check with their local bowel cancer screening hub or centre to know which age groups are now being invited to participate.  

In Northern Ireland, people aged 60-74 are invited for bowel cancer screening. 

Please note that people aged over 74 years in England and Scotland can request a bowel cancer screening kit.