If bowel cancer is detected at an early stage, before symptoms appear, it’s easier to treat and there’s a better chance of surviving it. Taking part in the NHS bowel cancer screening programme reduces your chances of dying from bowel cancer, and removing polyps in bowel scope screening can prevent cancer. Sadly, less than 60% of people participate in screening in England and the figure is lower in some regions of the UK.
The method used by the NHS Screening Bowel Screening Programme all over the UK to screen for bowel cancer is a simple FOB (faecal occult blood) test which detects blood hidden in small samples of stool (poo).
You complete the test over the course of a few days, in the privacy of your own home. Once complete, you simply return it in the post to a central laboratory for testing.
A FOB test does not diagnose bowel cancer, but will identify blood in the faeces (poo). If your test is positive you will be invited to attend your local screening centre for a further test to find out what is causing the bleeding.
The bowel screening programme now covers the whole of the UK. It aims to detect polyps and other changes in the bowel that might develop into bowel cancer in the future. It can detect bowel cancer at a much earlier stage, before people are experiencing any obvious symptoms. This is very important, because bowel cancer is usually a very slow growing disease, and can be cured with a straightforward operation if it is detected before it has started to spread. Benign (harmless) polyps can also be removed quickly and easily in a simple procedure that will significantly reduce the risk of bowel cancer developing later.
The Department of Health in England launched a new, additional, one-off bowel screening test for 55 year olds in March 2013, known as the bowel scope. Roll out of this test has been slower than expected and it is not yet available across England.
New Faecal Immunochemical Test (FIT)
The current screening test (FOB test) is set to be replaced by FIT test all over the UK This new test should have several advantages:
- it can be measured more reliably by machine than by the human eye
- it is less likely to result in a false positive result, which can happen with the FOB test if you have eaten certain foods or taken certain medicines
- it is sensitive to a much smaller amount of blood and can detect cancers more reliably and at an earlier stage
- it needs just one tiny sample from a single bowel motion compared to 2 samples from 3 different motions for the FOB test
- it is a more acceptable way for people to collect a sample, so it is likely that an extra 7% of people sent a kit will complete and return it.
The FIT test will be introduced all over England on the same date, expected to be in Spring 2018 and in Wales in 2018/19. We do not have any date for Northern Ireland yet. It was introduced in Scotland in November 2017.
Around one in 17 people in the UK will develop bowel cancer – men and women of all ages, cultures and backgrounds. It is the third most common cancer and the second biggest cause of cancer deaths. Bowel cancer screening has been shown to reduce the risk of dying from bowel cancer by 16 per cent.
Bowel screening can detect bowel cancer in people that have no symptoms. When diagnosis is made early, before it has had a chance to spread, bowel cancer can be cured in over 90% of cases. The later a diagnosis is made, the more difficult bowel cancer is to treat.
Points to bear in mind
- Like all screening tests, the FOB test is not 100% reliable.
- There is a chance that the cancer can be missed if it was not bleeding when you did the test.
- Bowel cancer may start to develop in the two years between screening tests, so be aware of the symptoms and see your GP if concerned.
If you are in the target age group, an invitation letter will be sent to you, followed 2 weeks later by a screening test kit. Your screening programme will start within a few weeks of your 60th birthday (50 in Scotland), and be repeated automatically, every two years until your 75th birthday. The pack comes with full instructions on how to complete the test in the privacy of your own home. Over a period of several days, you will need to collect very small samples of your faeces (poo) on a special test card, after you use the toilet. This card is then posted back to a laboratory, where a chemical is added to the samples on the card to check for blood.
Around 98 in 100 people will receive a ‘normal’ result and will be asked to undertake a further test in 2 years if they are still within the eligible age range.
In around 4 in 100 people – the test may initially be ‘unclear’ which means you will be asked to repeat the test up to two more times. Most people who repeat the test receive a ‘normal’ result.
Around 2 in 100 people will have an ‘abnormal result’ and will be offered an appointment with a specialist screening practitioner at a local bowel screening centre to discuss having a colonoscopy, a more detailed examination of your bowel. Please see an explanation of the colonoscopy procedure.
England, Wales, Scotland and Ireland each have a slightly different strategy for bowel cancer screening:
The NHS Bowel Cancer Screening Programme is offered every two years to everyone (registered with a GP) in England aged 60 to 74. People 75 and over may request a screening kit by calling the freephone helpline below.
The programme should start within a few days of your 60th birthday and continue automatically, provided you are registered with a GP practice and they have an accurate record of your home address. If you are within the screening age range and have not yet received your first test kit, please contact the national helpline to request one.
More information is available from www.cancerscreening.nhs.uk or call 0800 707 60 60.
The Bowel Screening Wales programme is offered every two years to everyone (registered with a GP) in Wales aged 60 to 74. You cannot request a kit if you are 75 and over.
The organisation of sending out testing kits works in exactly the same way as the programme for England. More information is available from: www.wales.nhs.uk/bsw or call 0800 294 3370.
The Scottish Bowel Screening Programme is offered every two years to everyone (registered with a GP) in Scotland between the ages of 50 to 74. People 75 and over may request a kit.
The organisation for sending out of testing kits works in exactly the same way as the programme for England.
More information is available from www.nhsinform.co.uk or call 0800 0121 833.
The Northern Ireland Bowel Cancer Screening Programme offers screening every two years to all men and women aged 60 to 74. After your first screening test you will be sent another invitation and screening kit every two years for as long as you remain within the screening age group. If you are 75 and over you cannot request a screening kit.
Full information on the programme is available at www.cancerscreening.hscni.net or call 0800 015 2514.
The BowelScreen programme has now started in Ireland, on a phased basis starting with men and women aged 60-69. Over time the programme will be extended on a phased basis until the full 55-74 age group is reached.
More information is available from www.cancerscreening.ie or call Freephone 1800 45 45 55.
Screening ages are set to reflect the fact that bowel cancer occurs most commonly in people over the age of 60, and it is usually a slow growing disease. If you are concerned about bowel cancer but not experiencing symptoms and don’t qualify for the screening programme, you could order a screening kit (FOB or FIT) online from a private laboratory. However, if the private test gave a positive or unclear result, you would then have to consult your GP.
Please remember that no screening test is 100% reliable. If you have symptoms of bowel cancer at any age, you should not wait for a screening invitation, but make an appointment with your GP.
Please see our ‘Detect & Diagnose’ booklet for more information on the symptoms of bowel cancer and other bowel diseases and for a list of questions that your GP might ask you.