Bowel cancer screening – it’s time to raise the bar

Bowel screening services in Yorkshire are over-performing when it comes to the number of people checked for early signs of cancer. But the standards that need to be met are set far below those of other cancer screening programmes. In this blog, we look at why this is a problem, and how many lives could be saved by raising the bar.

Bowel screening was introduced to save lives by helping to find more cancers at an early stage. Every year 3,500 people in the region are diagnosed with bowel cancer. Just under half of these people are diagnosed at an early stage, when treatment is more likely to be successful. But that means that more than half of bowel cancers are found at a late stage when the likelihood of survival is lower.

To help find more bowel cancers early, people between 60 and 74 years old are invited to take part in the bowel screening programme every two years. The programme is also being gradually rolled out to everyone aged 50 to 59. Thanks to bowel screening, an estimated 220 lives are saved every year in Yorkshire.

The UK National Screening Committee sets two different targets for bowel screening ‘uptake’, which is the percentage of people who are screened within six months of being invited.

One is the ‘acceptable’ target – the minimum standard which all areas should be meeting. For bowel screening, this target is set at 52% – so the aim is for just over half of people to do a test within six months of being invited.

The other is the ‘achievable’ target – a higher, more ambitious target that areas should be striving to reach and maintain. For bowel screening, this is currently 60%.

Overall, many areas of Yorkshire have been meeting both these targets for many years, although uptake varies within the region and there are a small number of areas that struggle to reach the standard. There has also been an additional boost in screening uptake in recent years thanks in part to an easier and more effective new home-testing method called the Faecal Immunochemical Test (FIT), which was introduced from 2019.

While it is good news that Yorkshire is meeting the targets for bowel screening, these targets are far below those set for other cancer screening programmes. Breast screening has acceptable and achievable targets of 70% and 80%, respectively. Cervical screening has a minimum acceptable target of 80%.

If the targets for bowel screening remain relatively low, then there is less incentive for GP practices and Primary Care Networks to strive to increase the number of people taking part as many are already meeting the required standard.

More than half of bowel cancers are detected at a late stage when the likelihood of survival is reduced. However, in some parts of Yorkshire, people are significantly more likely to be diagnosed with and die from bowel cancer than in England as a whole.

Yorkshire Cancer Research is calling on the UK National Screening Committee to review the targets for bowel screening and consider raising the bar to bring them in line with breast and cervical screening.

We propose that the minimum ‘acceptable’ target for bowel screening uptake should be raised from 52% to 70% – in line with breast screening. Although a small number of GP practices are failing to meet the current 52% standard, overall, our region is already meeting the proposed target of 70%.

We also propose that the higher ‘achievable’ target should be raised from 60% to 80% – again, in line with breast screening. This more ambitious target provides much more scope for improvements, as only 4% of GP practices in our region would currently meet this 80% threshold.

Raising bowel screening targets will encourage GP practices and Primary Care Networks to get more people to complete their bowel screening when invited.

This would have a positive impact on the early diagnosis of bowel cancer in Yorkshire, and the proportion of people who survive. If the ‘achievable’ uptake target was raised to 80% and all areas in Yorkshire met this, we estimate an additional 43,681 people would be screened within six months of being invited. As well as finding more cancers early, in Yorkshire alone this could identify nearly 300 more people at high risk of bowel cancer, who can then take steps to reduce their risk such as having pre-cancerous growths in their bowel removed. Across England, hundreds of lives could be saved with action driven by updated targets.

It’s time to raise the bar for bowel screening to meet the high standards in other cancer screening programmes.