Bowel cancer screening

Published:February 08, 2017DOI:


      Colorectal cancer (CRC) is the third most common cancer in both males and females in the UK giving rise to approximately 40,000 new cancer cases per year. It arises from polyps as part of the adenoma-carcinoma sequence. Early detection can aid treatment and improve outcomes. Faecal occult blood (FOBt) and direct imaging using colonoscopy/sigmoidoscopy has been shown to be advantageous in the detection of polyps and earlier cancer. We review the evidence and provide summaries of current strategies as well as future potential developments.


      To read this article in full you will need to make a payment


      1. Cancer research UK, Bowel Cancer statistics available from: (accessed July 2016).

      2. Association of Coloproctologists of Great Britain and Ireland, National Bowel Cancer Audit Report 2015 available from: (accessed July 2016).

        • Walther A.
        • Johnstone E.
        • Swanton C.
        • et al.
        Genetic prognostic and predictive markers in colorectal cancer.
        Nat Rev Cancer. 2009; 9: 489-499
      3. Chapter 3: how does a colorectal cancer develop?.
        in: Rosen P. Young G.P. Levin B. Spann S. Colorectal cancer in clinical practice: prevention, early detection and management. 2nd edn. CRC Press, 2005
        • Cairns S.R.
        • Scholefield J.H.
        • Steele R.J.
        • et al.
        Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002).
        Gut. 2010; 59: 666-689
        • Iannone A.
        • Losurdo G.
        • Pricci M.
        • et al.
        Stool investigations for colorectal cancer screening: from occult blood test to DNA analysis.
        J Gastrointest Canc. 2016; 47: 143-151
      4. Van Ballegooijen M, Habbema JDF, Boer R et al. A comparison of the cost-effectiveness of fecal occult blood tests with different test characteristics in the context of annual screening in the Medicare population. Technology Assessment Report 2003. Available at: (accessed July 2016).

        • Logan R.F.
        • Patnick J.
        • Nickerson C.
        • et al.
        Outcomes of the Bowel Cancer Screening Programme (BCSP) in England after the first 1 million test.
        Gut. 2012; 61: 1439-1446
        • Wardle J.
        • Robb K.
        • Vermon S.
        • et al.
        Screening for prevention and early diagnosis of cancer.
        Am Psychol. 2015; 70: 119-133
        • Moffat J.
        • Bentley A.
        • Ironmonger L.
        • et al.
        The impact of national cancer awareness campaigns for bowel and lung cancer symptoms on sociodemographic inequalities in immediate key symptom awareness and GP attendance.
        Br J Cancer. 2015; 112: S14-S21
        • Cole S.R.
        • Smith A.
        • Wilson C.
        • et al.
        An advance notification letter increases participation in colorectal cancer screening.
        J Med Screen. 2007; 14: 73-75
        • Camilloni L.
        • Ferroni E.
        • Cendales B.J.
        • et al.
        Methods to increase participation in organized screening programs: a systematic review.
        BMC Public Health. 2013; 13: 464
        • Atkin W.S.
        • Edwards R.
        • Kralj-Hans I.
        • et al.
        Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial.
        Lancet. 2010; 375: 1624-1633
        • Vasilyev S.
        • Smirnova E.
        • Popov D.
        • et al.
        A new-generation fecal immunochemical test (FIT) is superior to Quaiac-based test in detecting colorectal neoplasia among colonoscopy referral patients.
        Anticancer Res. 2015; 35: 2873-2880
        • Moss S.
        • Mathews C.
        • Day T.
        • et al.
        Increased uptake and improved outcomes of bowel cancer screening with a faecal immunochemical test: results from a pilot study within the national screening programme in England.
        Gut. 2016; (Jun 7 (E pub ahead of print))
      5. Bowel Cancer UK website, available at: (accessed July 2016).

        • Williams J.G.
        • Pullan R.D.
        • Hill J.
        • et al.
        Management of the malignant colorectal polyp: ACPGBI position statement.
        Colorectal Dis. 2013; 15: 1-38
        • Matsuda T.
        • Fukuzawa M.
        • Uraoka T.
        • et al.
        Risk of lymph node metastasis in patients with pedunculated type early invasive colorectal cancer: a retrospective multicenter study.
        Cancer Sci. 2011; 102: 1693-1697
        • Ruiz-Tovar J.
        • Jimenez-Miramon J.
        • Valle A.
        • et al.
        Endoscopic resection as unique treatment for early colorectal cancer.
        Rev Esp Enferm Dig. 2010; 102: 435-441
        • Bach S.P.
        • Hill J.
        • Monson J.R.T.
        • et al.
        A predictive model for local recurrence after transanal endoscopic microsurgery for rectal cancer.
        Br J Surg. 2009; 96: 280-290