Bowel cancer screening

Uptake varies considerably in North Tyneside, Table 1, and leaves 21.7 - 33.6 % of the eligible population registered with a GP not screened. Bowel cancer is associated with deprivation, as are modifiable risk factors such as obesity, diets with a reliance on ultra-processed foods, smoking and alcohol use. Given this, it is critical that those not currently opting in to the bowel screening programme are supported to ensure informed decision making and accessibility.

This unmet need is higher for those living with a learning disability, Table 2.

Mechanisms for Unmet Need

The bowel cancer screening programme invitation process, operates on a regional footprint and is not routinely integrated into primary care. Despite this, GP practices are monitored for their eligible patient cohort’s uptake for bowel cancer screening, with data collected for screened in last 30 months (2.5-year coverage %) . Given the separateness of the invitation and notification processes from local healthcare, it is plausible that it does not meet the needs of all those it is intended for. Examples of where there may be unmet needs include:

GP Lists and Reasonable Adjustments - The bowel cancer screening regional hub pulls GP practice lists of who is eligible for bowel cancer screening every 24 hours . This informs the Hub who is eligible and if any reasonable adjustments are necessary. This relies on accurate information being held by GP Practices and the Hub manually checking for anyone needing reasonable adjustments.

Notification Processes - GP Practices are not informed prior to the informational letter or kit being sent to an individual. Instead, they are only informed of a result or if a patient does not return a kit within 14 weeks. This limits how proactive primary care can be in increasing the uptake of screening with individuals.

Screening Population – the incidence rate of bowel cancer almost doubles between the 45-49 age cohort and the 50-55 age cohort. Therefore, the National Screening Committee UK recommended increasing the screening population from 60-74 to 50-74 in 2018. This is being implemented by adding in another age until 2025, Table 3, and consequently those aged 50-55 and 57-59 (approximately more than 10,000 people) are at an increased risk due to their age and are not yet being screened. The age extension over the next 3 years will seek to address this, though it will require increased capacity across the screening pathway.