Bowel cancer screening

Historically, bowel cancer screening uptake has been significantly lower than the cervical and breast cancer screening programmes, though significant improvement has been made with the introduction of the FIT test. Bowel cancer screening uptake in North Tyneside has closely mimicked the England trend, albeit at 5-10% higher uptake than England.

Despite North Tyneside having higher uptake than the England trend, there is still variation in uptake within North Tyneside, from 66.4 - 78.3% (Tables 1). Similarly, to the rest of England this variation is aligned to social deprivation within the borough.

The priority for North Tyneside is therefore to increase bowel cancer screening uptake by increasing awareness of screening, removing existing barriers to screening and improving the notification process between the national bowel cancer screening programme (NBCSP) and the local system.

Increase awareness of screening programme

• Professional partners - Local healthcare and partners have different ways of reaching and communicating with the communities they serve. For them to endorse and answer any questions about the screening programme as trusted voices in their communities, it is essential they are informed of when and how the national programme operates. This allows them to plan any interventions and raise awareness within their communities through informational and promotional resources.
• General population - The bowel cancer screening programme is not available to everyone, but most people know someone who is eligible. Therefore, raising general population awareness of the programme may impact on uptake as it may enable conversations within families and communities

Remove barriers to screening

Known barriers for bowel cancer screening include:

• Fear and denial around the test outcome
• A misconception that the test is not applicable if you don’t have any apparent symptoms of bowel cancer
• Concerns around the practicalities and cleanliness of the test
• Individual perceived risk being low or consideration of future consequences of bowel cancer
• The fact that it takes place away from the usual health care settings
• Low health literacy and numeracy
• Gender - on the whole, males were less likely to take part in screening
• People from lower socioeconomic group
• People from ethnic minor communities – note disparity varies by ethnic minority group
• People with severe mental illness

While screening should always be a choice, it is likely that the uptake and variation seen across North Tyneside is not a reflection of informed choice given the association seen with communities with more deprivation and less uptake.

Improve the notification processes

The current process for sending, receiving, and testing bowel cancer screening FIT kits, is managed by the North East Bowel Screening Hub which covers the North East, Humber and North Yorkshire, South Yorkshire, West Yorkshire and part of Bassetlaw.

The Bowel Screening Hub process relies on GP records being accurate and complete for contact details and any reasonable adjustments which may be required by individuals.

An individual is an ‘open episode’ within the Hub system for a total of 15 weeks from the initial informational letter being sent. Once the episode is closed, the GP is informed that the individual has not responded to the invitation to screen.