Impact: Early detection of bowel cancer through screening

The challenge

Bowel cancer is the second deadliest cancer in the UK – killing 16,000 people a year, that’s equivalent to 45 people every day.

Clinicians felt a screening programme to detect disease before any symptoms were evident, would be key to reducing deaths. Early detection could lead to effective treatment for cancer, which would increase survival rates. At the same time non-cancerous polyps, which might otherwise develop into cancer, could be detected and removed.

Small-scale clinical trials showed a regular screening programme could potentially reduce the risk of death from bowel cancer by 16% - but only if enough people took part.

In 2000 the Department of Health embarked on a pilot national screening programme, with Professor Orbell providing expert advice on the psychology of behaviour change that would determine if men and women would take part in this new type of screening and on the psychological and social impacts.

What we did

The bowel screening programme was pioneering in two ways. Unlike screening for breast or cervix cancers, it was the first national screening programme to involve both men and women and was also the first to involve a self-sampling kit, requiring people to take samples of their own stool and post it to a laboratory for testing.

Professor Orbell’s expertise in behaviour change meant her role was to assess whether people would be happy to do this, whether there were any psychological side-effects and whether there were other psychological factors which might deter people from taking part in a screening programme or encourage their participation.

“We found people were broadly willing and able to use the self-sampling kit and we didn’t detect any sustained adverse psychological side effects, either in those with normal or abnormal results.

“However, we found the self-sampling kit and instructions posed a number of challenges to participation. In particular, some people were worried about their ability to carry out the test properly, some doubted their need for screening, as they didn’t have any symptoms, and others felt there may be negative consequences to taking part,” said Professor Orbell.

She found take-up was particularly low among people on low incomes and those from a BAME background. This led to a further study looking at ways to simplify the test and to a new leaflet explaining the process, and the benefits of taking part. This proved successful in increasing uptake, by nearly 10%, among people on low-incomes.

Tailored recruitment campaigns have also been put in place for people from BAME backgrounds as an Essex survey of 1,000 British-Indian, Pakistani and Bangladeshi people found these groups had particular concerns about possible negative impacts on the family and were worried about the practicalities of taking the test.

What we changed

Cancer Research UK believes screening is the best way to detect bowel cancer early and increase the chances of successful treatment. The UK’s NHS was among the first in the world to implement a population-wide early detection programme to tackle this disease.

Following full evaluation of the pilot project by Professor Orbell, including advice on ways to improve uptake of the test, a decision to embark on a national screening programme was made, and men and women began to receive their invitations to take part in  2006.

By 2019 the proportion of people in the UK being regularly screened reached 61%, exceeding the national target for the first time. Cancers are being diagnosed early, leading to better survival rates.

Bowel cancer deaths have already decreased and are projected to fall by 23%, to 25 deaths per 100,000 people, by 2035.