Overview of UK bowel cancer screening programmes

Screening test

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.

Screening uptake statistics

Bowel cancer screening uptake has been increasing across the UK since the introduction of FIT. The most recent data shows that yearly uptake was 70% in England for 2022-23  ¹

, 58% in Northern Ireland for 2022-23 ²  66% in Scotland for 2021-23 ³, and 67% in Wales for 2021-22 ⁴.

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

Promoting informed choice

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. Read more on encouraging informed participation in 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 direct your patients to our public-facing information on bowel cancer screening to support them to make an informed choice.

Safety netting advice

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, 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.

For further information, see our safety netting best practice page.

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 FIT symptomatic page.

Bowel cancer surveillance and Lynch syndrome

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 Syndrome⁵

, although only 5% of all Lynch syndrome carriers have been diagnosed⁶.

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, see the ‘Bowel cancer screening resources’ section on this page.

Read more

• Bowel cancer screening home

• Encouraging informed participation

• Quality improvements and future optimisation