What are the common barriers to bowel cancer screening uptake, and how can I address them in my practice?

Common barriers to bowel cancer screening uptake include lower participation among younger eligible adults (especially those aged 50–54), men, and people living in areas of high deprivation. Uptake is generally lower than for other screening programmes, with approximately 59% participation in England and even lower rates in deprived areas. These disparities suggest socioeconomic factors, gender differences, and age-related perceptions affect screening uptake ¹.

Addressing barriers in clinical practice involves primary care teams actively promoting bowel screening by raising awareness of its benefits and encouraging informed participation. This includes providing clear information about the screening process, the need for repeat screening when invited, and the limitations of screening tests (such as the fact that no screening test is 100% effective). Patient information materials like leaflets and posters should be used to support this ¹.

Clinicians should ensure patients understand that a negative screening result does not rule out bowel cancer and advise them to seek urgent medical review if symptoms develop, regardless of recent screening participation. This helps maintain vigilance and encourages timely presentation for symptomatic disease ¹.

Efforts to increase uptake have included the introduction of the faecal immunochemical test (FIT), which has improved participation by about 7%, particularly among men and across all deprivation groups, indicating that easier-to-use tests can help overcome some barriers ¹.

Additionally, primary care can support risk reduction advice, including maintaining a healthy weight, a diet high in non-starchy vegetables, fruit, pulses, and whole grains, limiting red and processed meat, moderating alcohol intake, avoiding smoking, and encouraging regular physical activity, which may motivate participation in screening as part of overall bowel cancer prevention ¹.