Bowel Screening

Why some were reluctant or did not take part

Many factors affect a person's decision whether or not to take part in screening for bowel cancer (also see Why people decided to take part in screening). In most countries, such as the USA, screening is not free, so cost probably deters many people. In the UK screening for bowel cancer is free.

People may be reluctant to take part in screening because they believe they are at low risk of developing the disease. One man we interviewed, for example, said he only took part in screening for bowel cancer because his wife insisted.

Lack of time may also deter some people from taking part. In some countries people have to collect the test kit from their General Practitioner (GP) or from a local hospital. In the UK people receive their test kits by post, so lack of time is less likely to affect the initial decision to take part. However, the man mentioned above was reluctant to repeat the test, partly because he led a busy life.

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People had other reasons for being reluctant to take part in screening. Many said they found the idea of Faecal Occult Blood test procedure very unpleasant and this had at times put some people off doing the test, at least temporarily. Some finally rationalised that it was no worse than dealing with babies' nappies (Note that many people found the test easy - see 'Doing the Faecal Occult Blood test at home').

One woman had first decided not to take part because she found the idea of doing the test “pretty disgusting” (see 'Initial reaction to the invitation for screening'). A woman with arthritis was concerned about how she would manage to do the test. 

Even once they had decided to be screened some delayed doing the Faecal Occult Blood test for various reasons. One woman worried that the doctors might find a problem and did not like the idea of a colonoscopy. She also worried about putting her stool samples in the post, saying she would feel “devastated” if the postman opened the sample card. A man questioned how hygienic it was to send samples in the post.

Others delayed because they felt well when they received the invitation for screening and at first felt they did not want to know if anything was wrong. One woman said that even when she was invited for breast or cervical screening she argued the pros and cons with herself before attending.

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Some people had been invited to be screened but had declined. They explained that they were not put off by the idea of handing the samples - indeed one woman had worked as a carer and another as a nurse. One said that she liked the information leaflet that arrived with the initial invitation for screening and at first had intended to take part, but she had found the instructions that came with the Faecal Occult Blood test kit unclear. She did not realise that she had 14 days to produce the 3 samples and said that if she had been asked for a one-off sample she would have done it 'straight away.' 

A retired nurse had also decided against screening. She thought she should take part and even had a friend who had survived bowel cancer after finally attending screening after three invitations. In the past she had delayed having cervical smears, and had developed cervical cancer, so understood the advantages of an early diagnosis. Her main reason was that she had once had an endoscopy for gastric problems, which she described as “the worst experience”, so she was afraid of other investigations, such as colonoscopy. She knew that it was possible to have an anaesthetic or a sedative during a colonoscopy but said she reacted badly to both sedation and anaesthetic.

A man who had decided not to participate said that he understood the importance of screening and even wondered if it might help to make it compulsory, with a fine for non-attendees. 

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He decided not to do the test partly because of his past experience of colonoscopy, which he had found embarrassing, undignified, and depressing, and partly because he had seen a friend die of bowel cancer after a series of operations. That experience, and his brother's recent death from cancer, had made him pessimistic about treatment, and he did not want to dwell on cancer (note that most people we talked to found the colonoscopy less uncomfortable than they expected- see 'Having a colonoscopy and treatment during it').

Last reviewed May 2016.
Last updated May 2016.

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