Bowel cancer screening care pathway
Published 16 June 2021
Applies to England
© Crown copyright 2021
This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gov.uk.
Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned.
This publication is available at https://www.gov.uk/government/publications/bowel-cancer-screening-care-pathway/bowel-cancer-screening-care-pathway
This flowchart (illustration and text description below) describes the NHS screening pathway for bowel cancer.
1. Send out pre-invitation for screening
The pre-invitation provides information about the process for bowel cancer screening, including the possible benefits and risks. The letter explains that a test kit will be despatched in 2 weeks unless the individual contacts the programme to decline screening.
2. Does the individual decline screening?
Yes: Screening episode ends. The person may be returned to routine recall, ceased for screening if it is not appropriate for them, ceased for screening if they do not want any future invitations, or referred to secondary care. End of pathway.
No: Send out test kit with instructions. Go to question 3.
3. Is the test kit used and returned?
Yes: log and analyse the kit. Go to question 4.
No: Send a reminder after 4 weeks:
- if the kit is returned following the reminder, log and analyse the kit. Go to question 4
- if the kit is not returned following the reminder, return the individual to routine recall. End of pathway
4. Does the kit result show a diagnostic test is needed?
Yes: Make an appointment for the individual to meet with a specialist screening practitioner (SSP). Go to question 5.
No: Return the individual to routine recall. End of pathway.
5. Does the individual attend the SSP appointment?
Yes: Go to question 6.
No: Offer a second SSP appointment:
- if the second SSP appointment is attended, go to question 6
- if the second appointment is not attended, return the individual to routine recall. End of pathway
6. Is the individual medically suitable for a diagnostic test?
Yes: Offer the diagnostic test (usually colonoscopy). Go to question 7.
No: Screening episode ends. The person may be returned to routine recall, ceased for screening if it is not appropriate for them, ceased for screening if they do not want any future invitations, or referred to secondary care. End of pathway.
7. Does the individual attend the diagnostic test?
Yes: Go to question 8.
No: Offer a second appointment for a diagnostic test:
- if the second diagnostic appointment is attended, go to question 8
- if the second diagnostic appointment is not attended, return the individual to routine recall. End of pathway
8. Is cancer detected?
Yes: Refer the individual to the cancer multidisciplinary team (MDT) for discussion and treatment. Return the individual to routine recall. End of pathway.
No: Go to question 9.
9. Is surveillance required?
Yes: Follow British Society of Gastroenterology (BSG) guidance on polyp surveillance. End of pathway.
No: Return to routine recall. End of pathway.