NHS Bowel Cancer Screening Programme

If you have been invited for bowel cancer screening, and have any questions about the kit, you should call the freephone number shown on the information leaflet. If you are worried about a specific problem or symptom, or otherwise worried about the risks of bowel cancer, then you should talk to your GP.

The NHS Bowel Cancer Screening Programme is now being rolled out across the country. Update on the roll out of the NHS Bowel Cancer Screening Programme.

Why screen for bowel cancer?

About one in 20 people in the UK will develop bowel cancer during their lifetime. It is the third most common cancer in the UK, and the second leading cause of cancer deaths, with over 16,000 people dying from it each year.¹

Regular bowel cancer screening has been shown to reduce the risk of dying from bowel cancer by 16 per cent².

What is the purpose of bowel cancer screening?

Bowel cancer screening aims to detect bowel cancer at an early stage (in people with no symptoms), when treatment is more likely to be effective.

Bowel cancer screening can also detect polyps. These are not cancers, but may develop into cancers over time. They can easily be removed, reducing the risk of bowel cancer developing.

How is the NHS Bowel Cancer Screening Programme organised?

The NHS Bowel Cancer Screening Programme is now being rolled out nationally and will achieve nation wide coverage by 2009.

Programme hubs operate a national call and recall system to send out faecal occult blood (FOB) test kits, analyse samples and despatch results. Each hub is responsible for coordinating the programme in their area and works with up to 20 local screening centres.

The screening centres provide endoscopy services and specialist screening nurse clinics for people receiving an abnormal result. Screening centres are also responsible for referring those requiring treatment to their local hospital multidisciplinary team (MDT).

As the programme is rolled out, details of implementation will be sent to local GPs and announced in the local press.

The English Bowel Cancer Screening Pilot, based in Coventry and North Warwickshire, invited men and women for screening until the pilot finished in March 2007.

The objective of the English Colorectal (Bowel) Screening Pilot was to assess the feasibility of introducing into the NHS a national screening programme for colorectal (bowel) cancer based on faecal occult blood testing. The pilot took place in two English health authorities and three Scottish health boards. The participants were men and women aged 50-69 years.

Results
478 250 residents of the pilot areas were invited to take part in the screening programme. Uptake (the proportion in whom a final faecal occult blood test result was available) was 56.8% (n = 271 646). The overall rate of a positive test result was 1.9% and the rate for detecting cancer was 1.62 per 1000 people screened. Both these values were higher in Scotland than in England, higher in men than in women, and increased with age. The positive predictive value was 10.9% for cancer and 35.0% for adenoma. 552 cancers were detected by screening; 92 (16.6%) were polyp cancers. 48% of all screen detected cancers were Dukes's stage A, and 1% had metastasised at the time of diagnosis.

Following the pilot, the NHS Bowel Cancer Screening Programme was introduced in England in July 2006.

Who is eligible for bowel cancer screening?

The NHS Bowel Cancer Screening Programme offers screening every two years to all men and women aged 60 to 69. People over 70 can request a screening kit by calling a freephone helpline when the programme reaches their area.

Will GPs be involved?

GPs are not directly involved in the delivery of the NHS Bowel Cancer Screening Programme but they will be notified when invitations for bowel cancer screening are being sent out in their area. They will also receive a copy of the results letters sent to their patients.

How much does bowel screening cost?

In 2006- 2007 the cost of the bowel screening programme was £10,000,000.
In 2007-2008 it is £27, 500,000.
In 2008-2009 it will be £55, 000,000

How will the screening process work?

Men and women eligible for screening will receive an invitation letter explaining the programme and an information leaflet entitled Bowel Cancer Screening - The Facts. About a week later, an FOB test kit will be sent out along with step-by-step instructions for completing the test at home and sending the samples to the hub laboratory. The test will then be processed and the results sent within two weeks.

What happens next?

Around 98 in 100 people will receive a normal result and will be returned to routine screening. They will be invited for bowel cancer screening every two years if still within the eligible age range.

Around 2 in 100 people will receive an abnormal result. They will be referred for further investigation and usually offered a colonoscopy.

Around 4 in 100 people may initially receive an unclear result which means that there was a slight suggestion of blood in the test sample. This could be caused by conditions other than cancer such as haemorrhoids (piles). An unclear result does not mean that cancer is present, but that the FOB test will need to be repeated. Most people who repeat the test will then go on to receive a normal result.

Chart showing the predicted outcomes of bowel cancer screening	Flowchart of the bowel cancer screening pathway
Click to download PDF (32Kb)	Click to download PDF (25Kb)

How does the FOB test work?

Polyps and bowel cancers sometimes bleed, and the faecal occult blood (FOB) test works by detecting tiny amounts of blood which cannot normally be seen in bowel motions. 'Occult' means hidden. The FOB test does not diagnose bowel cancer, but the results will indicate whether further investigation (usually a colonoscopy) is needed.

People who receive an abnormal result will be offered an appointment with a specialist nurse. The nurse will explain what a colonoscopy involves, assess the patient's fitness for the procedure, and answer any questions.

What is a colonoscopy?

A colonoscopy is an investigation that involves looking directly at the lining of the large bowel. A sedative is given and then a thin, flexible tube with a tiny camera attached (a colonoscope) is passed into the back passage and guided around the bowel. If polyps are found, most can be removed painlessly, using a wire loop passed down the colonoscope tube. These tissue samples are then checked for any abnormal cells that might be cancerous.

What are the risks of colonoscopy?

A colonoscopy is the most effective way to diagnose bowel cancer and for most people it is a straightforward procedure. However, as with most medical procedures, there is the possibility of complications. These can include heavy bleeding (about a one in 150 chance) which will need further investigation or medical advice. There is approximately a one in 1,500 chance that the colonoscope could cause a hole (perforation) in the wall of the bowel. In extremely rare cases , colonoscopy may result in death. Current evidence suggests that this may only happen in around one in 10,000 cases.

¹CancerResearch UK, 2005. Cancerstats
²Cochrane Database of Systematic Reviews, 2006. Screening for colorectal cancer using the faecal occult blood test: an update.