Improving uptake of bowel cancer screening (Phase 2)

Bowel screening can detect bowel cancer at an early stage in people with no symptoms when it is easier to treat and there is a significantly greater chance of survival. An effective screening programme can reduce mortality amongst the eligible population by 15%. Wales has the lowest uptake of bowel screening in the UK, with inequities in uptake of bowel screening in Wales present since the programme started in 2008.

Currently, everyone aged between 51 and 74 who is living in Wales is invited to take part in bowel cancer screening every two years. In 2021/22, the uptake rate for bowel screening in Wales was 67.2% with around 238,065 of 354,131 eligible people completing and returning their bowel cancer screening tests. Whilst there was also a narrowing of the inequalities gap between ages, gender and localities, there is still much to do to motivate more people to take part.

As part of the first phase of the Bowel Cancer Programme (2019-20), Bowel Screening Wales piloted a range of interventions aimed at increasing uptake. This included a ‘non-responder’ project that targeted those who initially did not respond to the invitation to participate in bowel screening; this resulted in about 30% of the targeted non-responder group then participating in screening (across 1600 targeted).

Activity during the first phase also involved a bilingual campaign to boost uptake of the new FIT test. This included a TV advert featuring ex-Lions and Wales international rugby player Jamie Roberts, which coincided with the 2020 six nations rugby tournament.

Following the success of phase 1, a second phase of work was undertaken, primarily focused on the introduction of GP endorsed invitation and reminder letters for bowel screening. Evidence has shown that the use of local GP endorsement of screening, by using letters that are issued in the name of the participant’s GP, can improve uptake by up to 6%. As of August 2023, 90% of GP surgeries in Wales opted into the new letters, resulting in an overall, slightly quicker, return rate of FIT tests.

Work was also undertaken to co-produce information for bowel screening participants with learning disabilities. Learning Disability Wales carried out consultations with individuals, their care providers and nurses to understand what was required and help inform design of participant information. As a result of this work, Bowel Screening Wales:

• will pilot a first-line easy read screening invitation within Bowel Screening Wales
• developed two new information booklets, one designed for use by carers, the other for use in care homes and for associated health professionals. Both are currently under quality assurance review.
• developed a learning disabilities good practice standard operating procedure for use within screening endoscopy.
• organised a Specialist Screening Practitioner/screening administration educational day, which dedicated two presentations to improving communication skills, knowledge and awareness of participants with learning disabilities.
• modified its service user questionnaires to include a request for contact details if participants would be willing to share their bowel screening journey with others. These participant experiences will be shared on the Bowel Screening Wales website, included on future programme literature and presented on the Public Health Wales social media channels to demonstrate the positive impact of screening.