**Please note the following information is directed at Health Professionals. If you require general information about the Northern Ireland Cancer Screening programmes, please click here**
Overview of Northern Ireland Bowel Cancer Screening
The Bowel Cancer Screening Programme was introduced across Northern Ireland in April 2010. The programme aims to detect bowel cancer at an early stage, when treatment is more likely to be effective. It is offered to all individuals aged 60-74 years who are registered with a GP and who do not have symptoms suggestive of bowel cancer.
Information for those invited to participate in the screening programme can be found at Bowel cancer screening | nidirect
Why screen for bowel cancer?
- Bowel cancer is one of the most common types of cancer found in men and women in Northern Ireland
- About 1 in 20 people will develop bowel cancer in their lifetime
- The risk of bowel cancer increases with age
Bowel cancer screening aims to detect bowel cancer at an early stage, in people with no symptoms, when treatment is more likely to be effective.
Who is screening aimed at?
The Northern Ireland Bowel Cancer Screening Programme offers screening every two years to all individuals aged 60 to 74 who are registered with a GP. People in this age group will automatically be sent an invitation and a screening kit so they can do the test at home. Eligible individuals will be sent another invitation and screening kit every two years for as long as they remain within the screening age group.
How does the screening test work?
The programme uses a quantitative Faecal Immunochemical Test (qFIT) to detect small amounts of blood in the bowel motions. This new test was introduced in in January 2021, replacing the previous guaiac Faecal Occult Blood test (gFOBt).
- Unlike gFOBT, qFIT specifically detects human blood in bowel motions and is not affected by dietary factors. This makes it a more sensitive test for identifying people who may require further investigation of possible bowel bleeding.
- The screening programme currently uses a qFIT threshold of 120 µg Hb/g faeces for referral for further investigation. This threshold was reduced from 150 µg Hb/g faeces in April 2023, increasing the sensitivity of the screening programme and supporting the earlier detection of bowel cancer and advanced adenomas.
- Individuals who have recently completed a bowel screening test before the introduction of qFIT do not need to repeat their test. They will continue to be invited to participate in the screening programme every two years while they remain in the eligible age range.
For further information you can read the Bowel cancer screening: the facts leaflet by clicking here or the Bowel screening test kit instructions leaflet by clicking here
How reliable is bowel cancer screening?
A screening test cannot determine if an individual has bowel cancer. It simply categorises people into two groups – those where further investigations are indicated based on the result, and those who do not need any more tests at present. No test is 100% reliable so anyone who is concerned about bowel symptoms should contact their GP, even if their last test was negative.
It is important to note that qFIT tests carried out on patients with symptoms use a different referral threshold to the screening programme. A screening test result should therefore not be used to provide false reassurance to a patient presenting with symptoms.
Bowel cancer screening looks for blood in the bowel motions; however, it is important to note that bleeding is not experienced by everyone who has bowel cancer and bleeding can be intermittent. Therefore some cases of bowel cancer may not be identified through the bowel cancer screening programme.
Is screening for bowel cancer appropriate for everyone?
Bowel cancer screening may not be appropriate for everyone. Individuals may not need to complete the test kit if they:
- Have had their large bowel removed;
- Have had a either a routine colonoscopy or a CT colonoscopy within the last 12 months;
- Are on a bowel surveillance programme;
- Are currently being treated for bowel cancer;
- Are currently awaiting bowel investigations.
For information and advice about the bowel cancer screening programme, contact the freephone helpline on 0800 015 2514.
Bowel cancer screening results
For most people, the result will suggest that no further investigations are needed at this time. In this case, routine screening will continue to be offered to people every two years until a person reaches the age when screening stops.
For about 2 in every 100 people, the result will indicate that further investigations are required. This result does not mean the person has bowel cancer. it means that blood has been detected in the sample and further investigation is needed. The person will be referred to a Specialist Screening Practitioner (SSP) for assessment. This SSP will discuss the result and explain the next step, which is usually a colonoscopy.
For further information you can read the Bowel cancer screening: the next step leaflet by clicking here.
Colonoscopy examination
A colonoscopy is a test where a thin tube (a colonoscope) with a camera at the end is inserted into the rectum to look for signs of bowel cancer and other abnormalities. Sedation may be offered to help the person relax during the procedure.
Polyps are abnormal growths in the lining of the bowel. Although polyps are not cancer, they may develop into cancer over time. Polyps can usually be removed during the colonoscopy.
Any polyps removed or tissue samples (biopsies) taken during the procedure will be sent to the laboratory for examination.
Treatment after the colonoscopy
If polyps are found during the colonoscopy, the individual may be offerered surveillance and invited for a further colonoscopy, usually in three years, depending on the number, size and type of polyps identified.
If the examination detects cancer, the person will be referred to a specialist for further assessment and treatment. The colonoscopy team will explain the findings and answer any questions the individual may have.
Signs and symptoms
Symptoms of bowel cancer can include:
- rectal bleeding
- change in bowel habit, diarrhoea and/or constipation
- abdominal mass
- persistent fatigue
- unexplained weight loss
These symptoms do not necessarily mean that an individual has bowel cancer. However, anyone experiencing these symptoms for three weeks or more should contact their GP, even if they have recently participated in bowel cancer screening or undergone a colonoscopy.
Reducing the risk of bowel cancer
In addition to participating in bowel cancer screening, there are some further steps individuals can take to reduce the risk of bowel cancer:
- Eat a healthy diet. Aim to eat at least five portions of fruit and vegetable each day, and include wholegrains, beans and pulses as sources of fibre. Limit the amount of red and processed meat you eat.
- Be active. Moving more and sitting less can reduce the risk of bowel cancer and other serious illnesses. Aim for at least 150 minutes (2.5) hours of moderate intensity activity each week.
- Maintain a healthy weight. Avoid gaining weight and try losing weight if overweight.
- Limit your alcohol intake. To keep risks low, drink no more than 14 units of alcohol a week.
- Stop smoking.
For further information about the Northern Ireland Bowel Cancer Screening Programme, please use the contact details below:
Public Health Agency
Young Person and Adult Screening Team
9th Floor, Linum Chambers
2 Bedford Square
Bedford Street
Belfast
Tel: 0800 015 2514 Email: screening.bowel@hscni.net