How should I counsel patients about the bowel cancer screening process and what to expect?

Counselling patients about the bowel cancer screening process involves explaining the following key points:

• Screening is offered from age 50 years onwards as part of the NHS Bowel Cancer Screening Programme, which does not directly involve primary care but GPs are informed about invitations and results ¹.
• Patients will receive an invitation to complete a faecal immunochemical test (FIT), which involves collecting a stool sample at home and sending it for analysis to detect hidden blood, a possible sign of bowel cancer ¹.
• It is important to inform patients that no screening test is 100% effective; some cancers may develop between screening rounds (interval cancers), so a negative result does not guarantee absence of cancer ¹.
• Patients should be advised to participate in screening when invited and to continue to attend repeat screening invitations every two years to maximise early detection ¹.
• Explain that if the FIT result is positive, they will be referred for further investigations, usually a colonoscopy, to examine the bowel more closely ¹.
• Patients should be made aware of the key symptoms of bowel cancer such as blood in stools, changes in bowel habits, and abdominal pain, and advised to seek urgent medical review if these develop, even if they have recently had a negative screening test ¹.
• Negative screening results should not be used to rule out cancer if symptoms are present; symptomatic patients require appropriate urgent referral regardless of screening results ¹,³.
• Advise on lifestyle measures to reduce bowel cancer risk, including maintaining a healthy weight, eating a diet high in non-starchy vegetables, fruit, pulses, and whole grains, limiting red and processed meat, avoiding smoking, limiting alcohol intake, and engaging in regular physical activity ¹.

What patients can expect:

• Receiving an invitation by post to complete the FIT kit at home.
• Instructions on how to collect and return the stool sample.
• Notification of the test result by post.
• If positive, referral for colonoscopy with explanation of the procedure, including bowel preparation, sedation, potential discomfort, and risks such as bleeding or perforation ².
• Support and information throughout the screening process, with opportunities to ask questions and discuss concerns ².