GPAtlas🧭 When to offer screening (and when to suspect bowel cancer)
Bowel (colorectal) cancer is the fourth most common cancer in the UK and a leading cause of cancer death, yet it is highly treatable when caught early. Most early cancers are asymptomatic, which is the whole rationale for population screening: the NHS Bowel Cancer Screening Programme in England invites everyone aged 50 to 74 to complete a home Faecal Immunochemical Test (FIT) every 2 years. People aged 75 and over are not invited automatically but can self-request a kit every 2 years through the screening helpline.
Screening runs alongside the symptomatic pathway. In primary care a quantitative FIT now guides urgent referral for most people with possible colorectal symptoms – and, crucially, a normal screening result never removes the need to investigate symptoms. The core primary-care skills are therefore threefold: promote screening uptake, use symptomatic FIT correctly, and never be falsely reassured by a recent normal screen.
| Element | Detail |
|---|---|
| Eligible population | Men and women aged 50–74 registered with a GP in England |
| Test and interval | Home FIT kit, posted to the patient, repeated every 2 years |
| Aged 75 and over | Not invited automatically; can self-request a kit every 2 years via the helpline (0800 707 60 60) |
| Lynch syndrome | Colonoscopy surveillance every 2 years (not FIT), arranged through the programme |
| Positive ("abnormal") result | ~2% of kits; the programme invites the patient to a Specialist Screening Practitioner, then usually colonoscopy |
| Screening positivity threshold | Higher than the symptomatic threshold – England is lowering it to 80 µg Hb/g |
Screening is delivered entirely by the programme, so GPs cannot refer a patient into it. The GP's screening role is to encourage uptake and to manage symptomatic patients separately, as below.
| When to offer a symptomatic FIT to guide referral |
|---|
|
• An abdominal mass, a change in bowel habit, or iron-deficiency anaemia |
|
• Aged ≥ 40 with unexplained weight loss and abdominal pain |
|
• Aged < 50 with rectal bleeding plus unexplained abdominal pain or weight loss |
|
• Aged ≥ 50 with any unexplained rectal bleeding, abdominal pain or weight loss |
|
• Aged ≥ 60 with anaemia even without iron deficiency |
Refer on a suspected-cancer pathway if the FIT is ≥ 10 µg Hb/g. A rectal mass, an unexplained anal mass, or unexplained anal ulceration should be referred directly, without waiting for FIT. Offer a symptomatic FIT even after a recent normal screening FIT.
Source: NICE NG12 · NICE HTG690 · NHS Bowel Cancer Screening Programme
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