Overview

**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

COVID-19

Resumption of the Bowel Cancer Screening Programme following a temporary pause.

The bowel cancer screening programme was paused in March 2020 in response to the coronavirus pandemic.

Screening colonoscopy services were reintroduced by Trusts from June 2020, for those who had a positive screening result and were on a waiting list for this investigation.

Routine invitations for bowel cancer screening started again from week commencing 17 August 2020, beginning with those who were due to be sent a test in March 2020.

A catch-up exercise is underway for all routine invites that experienced a delay due to the pandemic. For more information on Bowel Screening and Coronavirus, please click here.

The Bowel Cancer Screening Programme was introduced across Northern Ireland from April 2010. The programme aims to detect bowel cancers at an early stage, when there are better chances of effective treatment. It is offered to all individuals aged 60-74 who are currently registered with a GP.

The programme introduced the quantitative faecal immunochemical test (qFIT) as the screening test from January 2021. Prior to this a guaiac faecal occult blood test was used (gFOB). The new screening test is more sensitive and therefore may help detect more bowel cancers and pre-cancerous lesions at an early stage, leading to improved clinical outcomes. The new screening test is also easier for individuals to complete and has been noted to improve screening participation in other regions.

Information for those invited to participate in the screening programme can be found at https://www.nidirect.gov.uk/articles/bowel-cancer-screening

 

Why screen for bowel cancer?

  • Bowel cancer is the third most common type 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.

Regular bowel cancer screening has been shown to reduce the risk of dying from bowel cancer by 16%.

 

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).

  • The qFIT looks specifically for human blood within the bowel motions. The previous test detected blood from any source, and therefore sometimes may have been affected by dietary factors. Because of this, qFIT is considered to be a more sensitive test to identify if someone should have further investigations to assess bleeding within the bowel.
  • The qFIT detects the amount of any blood detected in the stools. Within the bowel cancer screening programme an initial threshold of 150 micrograms Hb/g faeces is being used for referral for further investigations.
  • Individuals who have recently completed a bowel screening test before the introduction of qFIT do not need to repeat their bowel screening 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 tell if an individual has bowel cancer. It simply sorts 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 is advised to 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 everybody. 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.

There is a freephone helpline on 0800 015 2514 which is available to provide information and advice in relation to the bowel cancer screening programme.

 

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 three in every 100 people, the result will show that further investigations are needed. This result does not mean the person has bowel cancer; it means that some blood was detected in the sample and this needs to be investigated. The person will be referred to a specialist screening practitioner (SSP) for assessment. This nurse will discuss the person’s result and give details about 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 bottom to look for signs of bowel cancer. A sedative may be offered to help the person relax.

Polyps are clumps of cells that aren’t cancer but may develop into cancer over a number of years. They can usually be removed without any pain during the colonoscopy.

Any polyps or biopsies which are removed will be sent to the laboratory for examination.

 

Treatment after the colonoscopy

If the colonoscopy finds that the person has polyps, they may be called back for a further colonoscopy in three years’ time to check that they haven’t recurred.

If the examination detects cancer, the person will be referred to a specialist for further treatment. The person who does the colonoscopy will be able to answer any questions the person 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

Please remember that these symptoms don’t necessarily mean that an individual has bowel cancer. It is important that if an individual has any of these symptoms for 3 weeks or more that they speak with their GP, even if they have recently had bowel cancer screening and/or 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. Make sure you get five portions of fruit and vegetable each day, and include wholegrains, beans and pulses for fibre. Limit the amount of red meat you eat, especially processed red meat.
  • Be active. Moving more and sitting less can reduce your risk of serious illness. Aim for at least 2 and a half hours each week.
  • Maintain a healthy weight. Avoid gaining weight and try losing weight if overweight.
  • Drink less. To keep risks to a low level, don’t drink more than 14 units of alcohol a week.
  • Stop smoking

If you require more information about the Northern Ireland Bowel Cancer Screening programme, please get in touch using the contact information 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