Bowel cancer is a general term for cancer that begins in the large bowel. Depending on where the cancer starts, bowel cancer is sometimes called colon cancer, rectal cancer or colorectal cancer. Bowel cancer screening aims to detect bowel cancer at an early stage, in people with no symptoms. This is when treatment is most likely to be effective. Bowel cancer screening can also detect polyps in the bowel. These are not cancers, but may develop into cancers over time. Polyps can be easily removed, reducing a person’s future risk of bowel cancer.
Screening for bowel cancer in the UK involves 3 stages: firstly identifying the people in the population who are most at risk; secondly offering people in that age group a screening test (the faecal occult blood test (FOBt)); and thirdly, offering a diagnostic test (such as a colonoscopy) to those who have had an abnormal faecal occult blood test result.
Polyps and bowel cancers sometimes bleed which is why we screen for blood in bowel motions (i.e. poo, stools, faeces). A man we talked to about screening pointed out that blood in a motion may be due to something else, such as piles, but that an abnormal faecal occult blood test result needs further investigation.
The Faecal Occult Blood test detects hidden blood in a person’s motion. Blood in the motion…
Many women understand what is meant by ‘screening’ because they have mammography as part of screening for breast cancer and smear tests as part of screening for cervical cancer.
She describes screening as a form of sifting to find people who may need treatment.
Some understood that the purpose of screening was to catch an illness at an early stage, before there were symptoms, but the idea of screening is not familiar to everyone. One woman said that when she first heard about the screening programme she thought of the ‘Big Screen’ and wondered if she would be filmed. A man thought that the word ‘screening’ sounded a bit technical and preferred to call it a ‘check-up’.
He prefers the term check-up.
At first she thought that screening might involve a film.
It is known that taking part in regular bowel cancer screening reduces the chance of dying from bowel cancer by about 16% but it is important to consider the disadvantages as well as the advantages of screening (Cochrane Database of Systematic Reviews 2006). The screening process is not completely safe, and bowel cancer may be missed during a colonoscopy.
Sir Muir Gray discusses some of the advantages and disadvantages of screening.
Sir Muir Gray is the former programme director of the UK National Screening Committee.
In England, Wales and Northern Ireland the NHS Bowel Cancer Screening Programme offers screening every 2 years to all men and women aged 60–74. The national bowel screening programme in Scotland screens men and women aged 50–74 (Scottish Bowel Screening Programme). People did not always understand that everyone in the age group was invited to take part – some thought their name had been drawn at random, or for some other purpose (See Initial reaction to the invitation for screening). Some people wondered why screening is offered only to people in that age group.
Sir Muir Gray explains why people aged between 60 and 69 are offered screening for bowel cancer.
For more information about the NHS Cancer Screening Programme for bowel cancer phone 0800 707 6060 and ask for a leaflet (see resources) or visit their website for a copy.
Flexible sigmoidoscopy (flexi-sig) screening
The NHS has also decided to introduce bowel scope screening (flexible sigmoidoscopy (flexi-sig) screening) for all men and women when they reach the age of 55. The pilot began in March 2013 with men and women in 6 pilot areas being invited for ‘bowel scope screening’ around the time of their 55th birthday. This new test is not yet available everywhere across England. The target is for all screening centres to offer bowel scope screening by December 2016.
Flexible sigmoidoscopy is a way of looking at the inside of the bowel using an endoscope (a thin flexible tube that is put into the rectum/back passage and guided around the lower part of the bowel) to detect bowel polyps and cancers early before any symptoms develop.
Bowel scope screening is an addition to the existing NHS Bowel Cancer Screening Programme. People aged over 55 will be able to request bowel scope screening up to their 60th birthday. At 60, people will be offered the faecal occult blood test (FOBt) as now, whether or not they have had bowel scope screening. For more information see NHS Bowel Screening Programme (see resources).