Changes to bowel cancer screening: what you need to know content
NHS England has recently stopped offering people a bowel scope test as part of the bowel cancer screening programme. Find out more about the changes to bowel cancer screening and what they mean.
What is the bowel cancer screening programme?
Bowel cancer screening is designed to help spot the early signs of bowel cancer. Until recently in England, the screening programme was made up of two parts: home-testing kits, which people use to collect a sample of poo to send to a lab, and a one-off test called bowel scope screening.
What is bowel scope screening, and what is happening?
Bowel scope screening – also known as flexible sigmoidoscopy – is a test where a flexible tube with a camera is inserted into the lower part of the bowel to find any early signs of cancer, such as growths like ‘polyps’ or ‘adenomas’, and bowel cancers that aren’t yet causing symptoms. Polyps can often be removed during the test, preventing cancer from ever developing.
A sigmoidoscopy is similar to a colonoscopy, except during a colonoscopy the whole bowel is examined, whereas a sigmoidoscopy just looks at the lowest part of the bowel most often affected by bowel cancer and polyps.
In 2013, bowel scope screening began to be offered as a one-off test to people aged 55 in England, as part of the Bowel Cancer Screening Programme. However, since then, bowel scope screening has only been rolled out to about 60% of GP practices in England. This created a postcode lottery for those eligible. NHS England has now decided to stop offering bowel scope screening in England altogether.
This does not affect home-testing kits which form the other part of the bowel cancer screening programme, which continue as normal.
Why is bowel scope screening being stopped?
NHS England has decided to stop offering bowel scope screening based on the following reasons:
Introduction of the FIT test
In 2019 a new version of the home-testing kit was introduced, called faecal immunochemical test (FIT). The national screening committee recommended that if FIT is used according to the recommendations, the bowel scope test isn’t needed anymore.
Stopping bowel scope services will allow NHS England to expand the bowel screening programme by providing home-testing kits for people aged 50-59 (in addition to those aged 60-74 who already receive it). The kits will start being sent to those aged 56-59 from April 2021 before being rolled out to further age groups.
Lack of resources
There were limited staff to carry out the bowel scope screening, despite efforts to recruit and train more clinical endoscopists.
Low participation
There was a lack of resource even though participation in the programme was lower than expected. Just 4 in 10 people took up the offer of bowel scope screening when invited, limiting its potential to reduce bowel incidence and death rates. Targeted strategies and interventions would have been required to improve participation and ensure the programme's success once rolled out to the whole of England.
Low detection rate
The bowel scope programme did not pick up as many abnormal growths as expected. The ‘adenoma detection rate’ (ADR), which is used to measure the quality of screening, did not reach that achieved in research trials.
COVID-19 pandemic
The COVID-19 pandemic disrupted endoscopy services. Bowel scope screening was not seen as a priority to restart after the first wave of the pandemic. NHS England stopped the one-off bowel scope test to help the endoscopy service tackle backlogs after the COVID-19 pandemic.
What does Yorkshire Cancer Research think about these changes?
While we understand the reasons why bowel scope screening had to be stopped, it is still a disappointing decision. Bowel scope screening had the potential to not only spot bowel cancer earlier, but help prevent people from developing it all together, as any cancerous changes can often be removed during the procedure.
Some estimates have suggested that bowel scope screening could have reduced a person’s risk of bowel cancer by a third (35%), and the risk of dying from bowel cancer by more than 40%. This is because bowel cancers picked up through the bowel scope screening are often found early when they are easier to treat, and the detection and removal of polyps stops cancer from starting in the first place.
However, bowel scope screening is an expensive and resource-intensive procedure. Given the delayed roll-out, it is understandable that NHS England decided that it was better to focus on providing more people with home-testing kits to expand the Bowel Cancer Screening Programme. But this was based on advice by the UK National Screening Committee which recommended that the FIT test be made even more sensitive to refer more people for colonoscopies, to make up for the stopping of bowel scope screening.
Given bowel scope is being cancelled, we want to see this being implemented as soon as possible, but it can’t happen without an increase in capacity among the endoscopy workforce.
This may not be the end for bowel scope, with experts continuing to consider a future role for the test in other parts of the bowel cancer diagnosis pathway.
But for us at Yorkshire Cancer Research, the end of its use as a screening tool exposes the need for more investment from the Government in cancer diagnosis services – to both provide the equipment and train the skilled workforce needed. This investment is something that we have been calling for from the Government long before COVID-19, alongside other cancer charities through the One Cancer Voice group.
What if I have been invited for a bowel scope test? Should I still go to my appointment?
If you were invited for a bowel scope appointment but have had this delayed due to the COVID-19 pandemic, your appointment will be cancelled, and you will instead be sent a home-test kit from April 2021.
What bowel cancer screening will I get instead?
People aged 60-74 will still be sent the home-testing kit in the post every two years as normal. You use the kit to collect a small sample of your poo and send it off to a laboratory. The sample is then tested for the presence of blood in your poo (a potential symptom of bowel cancer). If blood is found in your poo, you could be referred for further tests, including a colonoscopy.
From April 2021 the NHS is rolling out the bowel cancer screening programme to include everyone aged 50 to 59. This is happening gradually over 4 years and currently includes 56 and 58-year-olds, so you may get a test before you're 60.
What has been the impact of COVID-19 on bowel cancer diagnosis?
During the first wave of the pandemic, fewer people were being referred for diagnostic tests and treatment, leading to 550 fewer people in Yorkshire receiving a diagnosis of bowel cancer than expected. Stuart Griffiths, our Director of Research & Services, has recently written a blog about the impact of the COVID-19 pandemic on bowel cancer services in Yorkshire.
What is Yorkshire Cancer Research doing to improve bowel cancer diagnosis and care?
Yorkshire Cancer Research funds the Bowel Cancer Improvement Programme, which aims to reduce the ‘postcode lottery’ that exists across Yorkshire in bowel cancer diagnosis and treatment. Reducing the variations in care for bowel cancer could save up to 300 lives each year in the region.
We’ve also been working with local health leaders in Bradford to help improve bowel cancer screening rates in Bradford and Airedale. Bradford has the lowest bowel cancer screening rate in England. It is a multicultural city and so a tailored approach is needed to encourage more people to take part in screening.
Finally, we also fund a whole range of research into bowel cancer screening, awareness, diagnosis, and treatment. Read more about the research projects funded by Yorkshire Cancer Research.
If you receive a home-testing kit in the post, please complete and return it as soon as you can. Finding cancer early means it can often be treated more successfully.
In the meantime, if you have any symptoms of bowel cancer, we encourage you to contact your GP as soon as possible. These symptoms can include:
- bleeding from your bottom,
- blood in your poo,
- a persistent and unexplained change in your bowel habits,
- unexplained weight loss,
- extreme tiredness,
- pain or lump in your stomach.
References
Von Vagner C, Bonello B, Stoffel S, et al. (2018) “Barriers to bowel scope (flexible sigmoidoscopy) screening: a comparison of non-responders, active decliners and non-attenders.”, BMC Public Health, 18(1):p1161. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6173878/
Atkin WS, Edwards R, Kralj-Hans I, et al. (2010) “Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial.” The Lancet, 375(9726):p1624-1633. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60551-X/fulltext
NHS (2021). Bowel cancer screening. Available from: https://www.nhs.uk/conditions/bowel-cancer-screening/ [Last accessed January 2021].
Public Health England (2021). Bowel cancer screening: programme overview. Available from: https://www.gov.uk/guidance/bowel-cancer-screening-programme-overview [Last accessed January 2021].
Public Health England (2019). Bowel Scope Screening. Available from: https://www.gov.uk/government/publications/bowel-scope-screening-test-what-it-is [Last accessed January 2021].
UK National Screening Committee (2020). Consultation on the permanent discontinuation of Bowelscope in the English Bowel Screening Programme. Available from: https://legacyscreening.phe.org.uk/policydb_download.php?doc=1312 [Last accessed January 2021].