Bowel Cancer Screening

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Introduction

Introduction

If bowel cancer is detected at an early stage, before symptoms appear, it's easier to treat and there's a better chance of surviving it.

To detect cases of bowel cancer sooner, the NHS offers two types of bowel cancer screening to adults registered with a GP in England:

  • All men and women aged 60-74 are invited to carry out a faecal occult blood (FOB) test. Every two years, they're sent a home test kit, which is used to collect a stool sample. If you're 75 or over, you can ask for this test by calling the freephone helpline on 0800 707 60 60.
  • An additional one-off test called bowel scope screening is gradually being introduced in England. This is offered to men and women at the age of 55. It involves a doctor or nurse using a thin, flexible instrument to look inside the lower part of the bowel. 

Taking part in bowel cancer screening reduces your chances of dying from bowel cancer, and removing polyps in bowel scope screening can prevent cancer. However, all screening involves a balance of potential harms, as well as benefits. It's up to you to decide if you want to have it.

To help you decide, read on to learn about what the two tests involve, what the different possible results mean, and the potential risks for you to weigh up.

What does the FOB screening test involve?

The home testing kit is used to collect tiny stool samples on a special card. The card is then sealed in a hygienic freepost envelope and sent to the screening laboratory.

It will be checked for traces of blood that may not be visible to the naked eye, but could be an early sign of bowel cancer.

For more information, read what the FOB screening test involves.

Your results

You'll receive the results of your FOB test within two weeks of sending in the test kit. There are three types of result:

  • Most people will have a normal result - no further tests are needed and you'll be invited to take part in screening again in two years (if you're still aged 60-74).
  • A few people will have an unclear result - you'll be asked to repeat the FOB test up to twice more.
  • A few people will have an abnormal result - you'll be offered an appointment to discuss colonoscopy at a local screening centre.

Read more about FOB test results.

If you're outside the age range...

People aged 75 and older can still be screened for bowel cancer. They can request an FOB screening kit by calling the freephone helpline on 0800 707 60 60.

People younger than 60 aren't eligible for the FOB screening test, but can have bowel scope screening (see below). If you have symptoms, are worried about a family history of bowel cancer, or worried about your bowel health in any way, speak to your GP.

What does bowel scope screening involve?

Bowel scope screening is done by a specially trained nurse or doctor at an NHS bowel cancer screening centre.

The doctor or nurse will put a thin flexible tube into your bottom to look inside the lower part of your bowel and remove any small growths, called polyps, that could eventually turn into cancer.

Read more about bowel scope screening.

Your results

You'll receive the results of your bowel scope screening test within two weeks of your appointment. 

  • Most people will have a normal result.
  • Some people will have polyps, which may mean having another examination of the bowel (a colonoscopy).
  • Rarely, the test will find cancer.

Read more about bowel scope screening results.

What are the risks?

No screening test is 100% reliable. There's a chance a cancer can be missed if it wasn't bleeding when the screening test was taken. This means you might be falsely reassured.

Bowel scope screening is usually safe, but in rare cases it can cause harm to the bowel. Learn more about the risks of bowel scope screening.

If you get an abnormal result, you'll be offered a colonoscopy. Although rare, there are risks associated with having this investigation. Most people who have a colonoscopy will not have cancer. Learn more about having a colonoscopy (PDF, 270kb).

Bowel screening helpline

Call the bowel screening helpline on 0800 707 60 60:

  • to request a home test kit if you're 75 or over
  • if your home test kit hasn't arrived when you expected it
  • to find out if bowel scope screening is available in your area
  • if you want more information about bowel cancer screening

If you have a question about bowel cancer screening, you can also check to see if it's already been answered in our FAQs.

About the FOB test

About the FOB test

The FOB test is a home test kit offered to all 60-74 year olds in England. It checks for the presence of blood in a stool sample, which could be an early sign of bowel cancer. If you are 75 or over, you can ask for this test by phoning 0800 707 60 60.

FOB stands for "faecal occult blood" ("occult blood" means "hidden blood"). It can detect tiny amounts of blood in your poo that you cannot normally see.

Why does the NHS offer FOB testing?

Regular bowel cancer screening using the FOB test has been shown to reduce the risk of dying from bowel cancer by 16%.

When are you offered the test?

Men and women in England are offered an FOB test every two years from the age of 60 to 74. As long as you're registered with a GP and your GP has your home address, you should automatically be sent the home test kit by post.

People aged 75 and older can still be screened for bowel cancer. They can request an FOB screening kit by calling the freephone helpline on 0800 707 60 60.

What does it involve?

You carry out the FOB test in the privacy of your own home. The screening kit provides a simple way for you to collect small samples of poo, which you wipe onto a special card. You send this card in a hygienically sealed freepost envelope to the screening laboratory for testing. There are detailed instructions with each kit - read the kit instructions here (PDF, 374kb). If you have any questions about how to use the home test kit, you can call the helpline on 0800 707 60 60.

You may think that doing the test sounds a bit embarrassing or unpleasant, but it will only take a few minutes and is a good way of detecting bowel cancer early.

The FOB test does not diagnose bowel cancer, but the results will tell you whether you need an examination of your bowel (a colonoscopy).

FOB test results

You should receive a results letter from the laboratory within two weeks of sending in your sample. There are three types of results you could receive.

Most people will have a normal result

A normal result means that blood was not found in your test sample. Most people (about 98 out of 100) will receive a normal result. A small number of these people will have repeated the test because they had an unclear result previously.

A normal result does not guarantee that you do not have or will never develop bowel cancer in the future, so being aware of the symptoms of bowel cancer is still important.

A few people will have an unclear result

An unclear result means there was a slight suggestion of blood in your FOB test sample.

Receiving an unclear result does not mean you have cancer, just that you need to repeat the FOB test.

If you receive an unclear result, you will be asked to complete the FOB test up to twice more. This is necessary because polyps and cancers do not bleed all the time.

About 4 in 100 people will initially receive an unclear result. Most people who repeat the test will then receive a normal result.

A few people will have an abnormal result

An abnormal result shows that blood may have been found in your FOB test sample - it is not a diagnosis of cancer, but it does mean that you will be offered a colonoscopy. The abnormal result may have been caused by bleeding from bowel polyps, rather than a bowel cancer. It may also have been caused by other conditions, such as piles (haemorrhoids).

About 2 in 100 people doing the test will have an abnormal result. Sometimes, someone will have an abnormal result after their previous result was unclear.

If you receive an abnormal result, you'll be offered an appointment with a specialist screening practitioner at a local screening centre, to discuss having a more detailed examination of your bowel (a colonoscopy), to see whether or not there is a problem that may need treatment.

A colonoscopy uses a longer tube, which can look for polyps further up the bowel. 

What happens during the colonoscopy?

If polyps are found, most can be removed painlessly, using a wire loop passed down the colonoscope tube.

These tissue samples will be checked for any abnormal cells that might be cancerous.

  • About 5 in 10 people who have a colonoscopy will have a normal result (they do not have cancer or polyps).
  • About 4 in 10 will be found to have a polyp, which if removed may prevent cancer developing.
  • About 1 in 10 people will be found to have cancer when they have a colonoscopy.

A colonoscopy is the most effective way to diagnose bowel cancer. For most people, having a colonoscopy is a straightforward procedure.

However, as with most medical procedures, there is the possibility of complications. These can include heavy bleeding (about a 1 in 250 chance) that needs further investigation or medical advice. The colonoscope can cause a hole (perforation) in the wall of the bowel (about a 1 in 1,000 chance). In extremely rare cases, colonoscopy may result in death. Current evidence suggests that this may only happen in about 1 in 10,000 cases.

Remember: most people who complete the FOB test will not need a colonoscopy.

If you want to opt out...

If you don't want to be invited for bowel screening in the future, call the programme helpline on 0800 707 6060 and the staff will guide you through the opting-out process. If you change your mind at a later date, you can simply ask your GP to put you back on the list.

Frequently Asked Questions (FAQs)

Read some FAQs on the FOB test.


About the bowel scope screening test

About the bowel scope screening test

NHS bowel scope screening is a relatively new test to help prevent bowel cancer. It finds and removes any small bowel growths, called polyps, that could eventually turn into cancer.

The NHS bowel scope screening programme is gradually being rolled out to all men and women in England aged 55. This page aims to help you make a choice about whether to have bowel scope screening.

It includes information about why the NHS offers bowel scope screening, what to expect from it, and the possible risks.

To help you decide whether to have the screening test, you can also read the leaflet NHS Bowel Cancer Screening: Bowel scope screening (PDF, 261kb).

Why does the NHS offer bowel scope screening?

NHS bowel scope screening helps to prevent bowel cancer. For every 300 people screened, it stops two from getting bowel cancer and saves one life from bowel cancer.

Some health problems mean that it might not be possible for you to have bowel scope screening. For more information, read Can everybody have bowel scope screening at 55?.

When are you offered the test?

Bowel scope screening is a one-off test offered to men and women at the age of 55. This is a new type of screening that is gradually being rolled out across England depending on where you live, it may not yet be offered in your area.

As of March 2015, about two-thirds of screening centres were beginning to offer this test to 55 year olds.

As long as you're registered with a GP and living in an area where the test is being offered, you should automatically be sent an invitation.

If you decide not to have bowel scope screening when you are first invited, you can still have it at any time up until your 60th birthday. Just call the freephone helpline number 0800 707 60 60 to ask for an appointment.

At around the age of 60, you will be invited to have more bowel cancer screening using a different kind of test that looks for traces of blood in poo. This test is known as the FOB test.

What does bowel scope screening involve?

Bowel scope screening uses a thin, flexible tube with a tiny camera on the end to look at the large bowel. It can find and remove small growths called polyps from the bowel. Polyps don't usually cause symptoms, but some might turn into cancer if they're not removed.

The technical term for bowel scope screening is flexible sigmoidoscopy screening (sometimes called "flexi-sig").

Bowel scope screening is done by a specially trained nurse or doctor at an NHS bowel cancer screening centre. They look at the lower part of your large bowel, because that's where most polyps are found.

When the nurse or doctor puts the tube into your bowel, they gently pump some carbon dioxide gas inside. This opens up the bowel, so they can see any polyps.

If they find any polyps, they usually remove them straight away. This is usually done using a tiny wire loop passed through the tube. Sometimes the nurse or doctor takes a tiny piece of the bowel (a biopsy) to be looked at under a microscope.

What does bowel scope screening feel like?

Most people do not find this test particularly uncomfortable.

If you do feel pain, it will only last for a few moments. It's most often caused by the carbon dioxide used to open up the bowel, which may give you a bloating or cramping feeling in your tummy. If you do feel pain, tell the nurse or doctor and they will change what they are doing to make you feel as comfortable as possible. Having polyps removed from the bowel is not usually painful.

A few people say they find bowel scope screening embarrassing. The nurse or doctor will do their best to help you feel as relaxed as possible.

How do I prepare for it?

Two weeks before your appointment, your NHS bowel cancer screening centre will write to you. The letter will include an enema and instructions for using it. The enema is a liquid used to clear the poo out of your large bowel, so the nurse or doctor can get a good look at your bowel. The enema comes in a small plastic pouch with a nozzle. Most people find it easy to use.

Use the enema about one hour before leaving home for your bowel scope screening appointment. To use the enema, squeeze the liquid from the plastic pouch into your bottom. The enema will make you poo very soon after you have used it. It should keep your bowel clear for several hours.

On the day of your appointment

After you arrive at the NHS bowel cancer screening centre, the nurse or doctor will explain what will happen, answer any questions and listen to your concerns. They may ask you to put on a hospital gown and then you'll be asked to lie down on a bed ready to have bowel scope screening.

During the screening, if you want, you will be able to see the inside of your bowel on a TV screen. The nurse or doctor will tell you straight away if they remove any small growths (polyps).

Having bowel scope screening usually takes a few minutes, but the whole appointment may take around an hour and a half.

Getting ready for your appointment and having bowel scope screening may take up to half a day, depending on how far away you live from the screening centre.

Bowel scope screening results

You will be told if nothing was found or that samples have been taken for analysis. You will then be sent a letter explaining the results of your bowel scope screening in the two weeks after your appointment. Your GP will also get your results.

Most people will have a normal result

Out of 300 people who have bowel scope screening, 285 will have a normal result. This means that no polyps or cancers were found.

Even if you have a normal result, it is important to look out for symptoms of bowel cancer. This is because people can sometimes get bowel cancer even after a normal result.

Some people will have polyps

The nurse or doctor will usually remove any polyps they find. They will tell you straight away if they have done this. Any polyps that are removed are sent to be checked under a microscope.

Learn more about bowel polyps.

Out of 300 people who have bowel scope screening, about 14 will be offered another test because of the type of polyps found. This test is usually a colonoscopy. This uses a longer tube, which can look for polyps further up the bowel. Learn more about having a colonoscopy (PDF, 270kb).

Very occasionally, people may be asked to come back for an operation to remove their polyps. This only happens to about one person out of every 1,000 who have bowel scope screening.

Rarely, the screening will find cancer

Out of 300 people who have bowel scope screening, about one will be found to have bowel cancer already. If the screening does find cancer, the nurse or doctor will arrange for you to see a specialist as soon as possible.

If cancer is found, it is likely to have been found at an early stage. This means you are likely to have a better chance of successful treatment and survival.

Read about the treatment options for bowel cancer.

Does bowel scope screening have risks?

Bowel scope screening is usually safe, but in rare cases it can cause harm to the bowel. About one person in every 3,000 may have serious bleeding caused by bowel scope screening. Sometimes the bowel can be torn during bowel scope screening, but this is even rarer.

In either case, you would be admitted to hospital straight away and you might need surgery. Most people make a full recovery.

When you go home after bowel scope screening, if you have any severe pain, or blood in your poo that does not go away after 24 hours, you should see a doctor straight away.

The carbon dioxide pumped into the bowel is not harmful.

FAQs

Read some FAQs on bowel scope screening.


Frequently asked questions

Frequently asked questions

I'm in my sixties and some of my neighbours have already received their kit. Have I been missed?

I take care of the hygiene needs of a disabled/elderly person. Can I complete the screening kit for them?

I am a carer, looking after someone who lacks the mental capacity to make their own decisions about screening. They have been invited for screening. How should I deal with their invitation?

It's more than two years since I was screened but I still haven't received my next screening invitation?

I have had bowel surgery. Do I need to continue with bowel screening?

How can I tell if I have a functioning colon?

I suffer from piles. Will this interfere with the screening test?

How does the NHS Bowel Cancer Screening Programme know to invite me? Does the invitation system have all my medical details?

Can everybody have bowel scope screening at 55?

Do I have to have a colonoscopy if I have an abnormal FOB result?

Is screening for bowel cancer available privately?

How do I opt out of the FOB screening?

I'm in my sixties and some of my neighbours have already received their kit. Have I been missed?

If you are a few months after your 60th birthday and not heard from us, please ring the helpline (0800 707 60 60) to check we have your correct details.

Don't forget: if you are worried about possible symptoms, don't wait for screening but speak to your GP.

I take care of the hygiene needs of a disabled/elderly person. Can I complete the screening kit for them?

If the person has asked for help, understands the screening process (including the bowel examination), and does not have a medical condition that means they shouldn't be screened, then the answer is yes. If the person doesn't understand the screening process, however, and/or doesn't have the capacity to consent to it, please read the next FAQ for more information and advice.

I am a carer, looking after someone who lacks the mental capacity to make their own decisions about screening. They have been invited for screening. How should I deal with their invitation?

Speak to your GP first of all, as they will have access to the person's medical records and knowledge of their overall medical health. In general, however:

  • Mental capacity changes over time, in which case the decision about screening should be delayed until the person is more able to decide for him or herself.
  • But if the person you care for is unable to make their own decisions about screening, then you should make what is called a "best interests" decision on their behalf. You'll need to weigh up the benefits of screening, the possible harms, and what you think the person would have wanted. Paid carers in particular should get advice from family members or friends about the person's views before coming to a decision.

For more information on making a best interests decision, you can read Making decisions: A guide for family, friends and other unpaid carers (PDF, 547kb).

It's more than two years since I was screened but I still haven't received my next screening invitation?

The two-year gap between screening invitations is calculated from the date on which your previous screening episode was closed. In some cases (for example, if you had further tests), this could be several months after you received your screening invitation. This, in turn, could delay your next invitation by several months.

I have had bowel surgery. Do I need to continue with bowel screening?

Screening is designed to check the health of your colon (large bowel). If you have a functioning colon, you should continue with bowel screening. People with no functioning colon do not need to be screened.

If you're unsure whether you have a functioning colon, the next FAQ offers more information.

How can I tell if I have a functioning colon?

People who do not have a functioning colon cannot store and pass poo out of their body in the normal way. They need to make continuous use of a pouch or colostomy bag.

You may have to use a colostomy bag temporarily - for example, following treatment. If so, you should be screened in the usual way, when invited, once it is removed.

If after reading this you're still unsure whether you have a functioning colon, you should check with your GP before accepting a screening invitation.

I suffer from piles. Will this interfere with the screening test?

If you have piles (haemorrhoids) there's more chance you will get an abnormal result. An abnormal result may be caused by blood from your haemorrhoids or from another bowel condition. Anyone with an abnormal result is offered a colonoscopy to get a diagnosis.

How does the NHS Bowel Cancer Screening Programme know to invite me? Does the invitation system have all my medical details?

No, the invitations are generated by a system which only has the basic registration details held when you register with a GP. Any additional medical history is only accessed with your permission.

Can everybody have bowel scope screening at 55?

Some health problems mean that it might not be possible for you to have bowel scope screening. Please call the freephone helpline number on 0800 707 60 60 if you:

  • have had all of your large bowel removed, or have a stoma bag to collect your poo
  • are currently being treated for ulcerative colitis or Crohn's disease in your large bowel
  • are waiting for heart surgery or have had heart surgery in the last three months
  • cannot walk more than 100 yards without resting because of a lung or heart problem
  • think you may be too unwell to go for your appointment

Do I have to have a colonoscopy if I have an abnormal FOB result?

If you have an abnormal FOB result, you will be offered an appointment with a specialist screening practitioner. They will fully explain the colonoscopy procedure to you and assess your fitness for it. If you want to go ahead with the colonoscopy, the practitioner will book an appointment for you. It's your choice.

Is screening for bowel cancer available privately?

Yes, but private screening is not the same as NHS screening. NHS screening programmes care for you throughout the whole screening process, including further treatment and care if you need it. In the case of private screening, the care and treatment you may need following screening may not be available from the provider.

For more information, read the NHS leaflet Thinking of having a private screening test? (PDF, 1.1Mb).

How do I opt out of FOB screening?

If you don't want to be invited for bowel screening in the future, call the programme helpline on 0800 707 6060 and the staff will guide you through the opting-out process. If you change your mind at a later date, you can simply ask your GP to put you back on the list.