Key Issues
Inequality in Screening Uptake - Nationally, bowel screening uptake is not equal across the eligible population, and this is the case in North Tyneside with uptake ranging from 66.4 – 78.3% between practices where the national acceptable target is > 60%. This has improved vastly in recent years due to the introduction of the FIT test, with 2020-21 average for England of 66.8% and for North Tyneside 71.8%, Tables 1 and 2.
There is variation within bowel cancer screening uptake and some of this variation is associated with deprivation, with lower uptake in communities experiencing more deprivation as well as ethnicity, having a learning disability or severe mental illness. As screening aims to prevent and diagnose bowel cancer at an early stage when prognosis is best, not accessing screening exacerbates inequalities in morbidity and mortality in communities with high deprivation. Having said that, nationally and locally within North Tyneside, bowel screening uptake amongst people with a learning disability is higher, though variable, and almost comparable to the rest of the population, unlike the other screening programmes Table 2.
Adapting the National Screening Programme for Local Implementation - All national screening programmes are overseen by the National Screening Committee and commissioned through NHSE/I to ensure a universal offer to those eligible which is key to equity within the offer. Several interventions which could be locally implemented have been evaluated to increase uptake to national screening programmes. For example, unlike the other screening programmes, invitations for the bowel screening programme do contain a GP endorsement as well as contact details to request assistance or opt out. However, GP practices are still not informed that someone is being invited to screen, instead being informed once they have been classed as a non-responder, 15 weeks after the initial informational letter.
Impact of Pandemic on the Bowel Cancer Screening Programme - Pre-pandemic, invitations to screen would be sent out, with a positivity rate of 2% requiring further investigative tests, usually a colonoscopy. However, if the positivity rate was higher, and so colonoscopy lists were at capacity, there is a window of 17 weeks from the date last test was returned 2 years ago, within which invitations need to be sent out. This allows the Bowel Screening Hub to be responsive to variation in the positivity rate, and so capacity within secondary care.
In response to the pandemic, the bowel cancer screening programme was paused in March 2020. Colonoscopy is an aerosol procedure and so capacity was reduced to 30-40% of pre-pandemic capacity. Consequently, bowel screening recovered more slowly than cervical screening, only inviting those at highest risk over summer 2020, returning to more than pre-pandemic capacity by December 2020. In July 2020, the UK National Screening Committee also permanently discontinued the bowel scope test for screening as it was unclear if it had any additional benefits alongside the FIT test. The bowel scope test is also a lot more intrusive. Discontinuing the bowel scope in July 2020 also enabled the screening programme to recover more quickly from being paused at the beginning of the pandemic.