Aims

1. Bowel cancer screening aims to detect bowel cancer at an early stage, before people experience any symptoms, and when treatment is more likely to be effective.

2. Bowel cancer screening can identify polyps. Once identified they can be removed which reduces the risk of bowel cancer developing.

Bowel cancer screening reduces mortality from bowel cancer by at least 25%.

Target population

Bowel Scope at 55y

A one-off flexible sigmoidoscopy or ‘flexisig’ test in England at the age of 55.
A normal result means: no polyps or cancer were found

Asymptomatic screening kit (Faecal immunochemical test FIT Home test) at 60-74y

60-74y; every 2 years, by faecal immunochemical test (FIT)

The threshold of abnormality for asymptomatic screening programme patients is set moderately-low (120ug Hb/g faeces). So if someone has a negative screening test, and doubt remains, they must be encouraged to undergo a symptomatic FIT test kit which uses a very-low (<10ug Hb/g faeces) threshold and may therefore identify a positive faecal occult blood result.

Patient is referred for colonoscopy if screening FIT test is abnormal.

Other Ages

56-60y: self-refer for flexible sigmoidoscopy (call 0800 707 6060).
60-74y: Home testing kit every 2 years.
≥75y: self-refer for home testing kit every 2 years (call 0800 707 60 60).

Indications for 2ww Colorectal referral

>40y: unexplained weight loss AND abdominal pain (especially worrying if >60y)

>50y: unexplained rectal bleeding

>60y: iron‑deficiency anaemia OR changes in their bowel habit

<50y: rectal bleeding and any [change in bowel habit, abdominal pain, weight loss or iron‑deficiency anaemia]

[Age]: rectal or abdominal mass

FIT test is positive

Faecal immunochemical test FIT in low-risk symptomatic population

Offer testing for occult blood in faeces to assess for colorectal cancer in adults without rectal bleeding and have low-risk symptoms suggestive of colorectal cancer, but do not meet the criteria for a suspected cancer pathway.

≥50y + unexplained weight loss OR abdominal pain

<60y + any change in bowel habit or iron-deficiency anaemia

≥60y + anaemia without iron deficiency

Patient is referred for colonoscopy if low-risk symptomatic FIT test kit is abnormal.