Bowel Cancer Screening Annual Report 2021 to 2022
Published 14 March 2024
Applies to England
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1. Bowel cancer screening standards data report 2021 to 2022
Published 2024
This report focuses on programme performance in England during the screening year 2021 to 2022 (1 April 2021 to 31 March 2022) compared to the national bowel cancer screening programme standards. It also includes trend data from previous years where this is available.
These standards contribute to assessing the quality of the NHS Bowel Cancer Screening Programme (BCSP) across England. Publishing the data ensures stakeholders and the public have access to reliable and timely information on the quality and performance of the screening programme.
The standards focus on some of the important targets that providers have to meet and maintain, to make sure local screening services are high quality, safe and effective.
This report provides data on coverage, uptake, turnaround times for test kit processing, the proportion of effective calls made to the national 0800 telephone helpline, timeliness of first offered and first attended appointments, onward diagnostic tests, turnaround times for pathology samples and endoscopy clinical standards.
Two thresholds, the acceptable threshold and achievable threshold, are specified for each standard, where applicable. Where the data show that standards are not met, providers and commissioners should ensure appropriate action is taken. NHS England works to provide advice and support to this process.
Data for this report were extracted from BCSS, the bowel cancer screening IT system on 8 August 2023.
Throughout this report, consideration should be given to the impact of the COVID pause that occurred in March 2020, and the subsequent restoration period that affected all bowel cancer screening centres and programme hubs. Any decrease in counts associated with the pause may not be apparent in the performance figures, which are usually presented as a percentage.
2. Overview of the NHS Bowel Cancer Screening Programme in England
The NHS Bowel Cancer Screening Programme was introduced in 2006, Initially, people aged 60 to 69 were invited to participate in the scheme. The programme expanded in 2010 to cover those aged 70 to 74, and again, from April 2021, with the roll-out of the screening offer to 50 to 59 year olds. By the end of March 2024, all screening providers are scheduled to have ‘gone live’ for those aged 54 to 59, with work ongoing to complete the expansion to 50 to 53 year olds.
An invite to take part in the programme is made to all eligible people, who are resident in England and are registered with a GP. Screening is carried out via a home testing kit, which participants return for laboratory analysis. The test – known as a faecal occult blood test, or FOBt - looks for the amount of blood in the faecal (poo) samples provided. If that is above a certain level, they will then be invited for further tests.
In this next stage, participants will be assessed by a specially trained nurse, known as a Specialist Screening Practitioner. In the majority of cases, following this appointment, they will be referred for a colonoscopy. This is an examination of the lining of the large bowel, during which any polyps - an abnormal clump of cells – can be removed. Polyps are not cancers, but may develop into cancer over time. Polyps can be easily removed, which reduces the risk of bowel cancer developing. An adenoma is a specific type of polyp found in the bowel. Adenomas (along with other polyp types) have a greater likelihood of developing into cancer over time.
Following the conclusion of the diagnostic tests, participants will either be told that there is no trace of cancer, in which case they will be invited to take part in home testing again in 2 years’ time. Or, if they are given a cancer diagnosis, arrangements will be made to start treatment. Alternatively, they may be placed into surveillance, which means that they will receive a further invite for diagnostic testing at an appropriate time, and will not be offered home testing every 2 years.
In this report the pathway from invitation through to diagnostic testing is referred to as the ‘FOBt bowel cancer screening programme’ or simply the ‘FOBt programme’. People who have been referred to surveillance following participation in the FOBt programme, are described as ‘FOBt programme – surveillance’ patients.
Further details about the programme can be found here.
3. Summary for 2021-22
During 2021-22, the NHS Bowel Cancer Screening Programme in England invited 5,924,232 people to participate in FOBt screening, and of these people 4,083,100 adequately participated (i.e., ‘were screened’), giving an uptake percentage of 68.9%. Of those invited who adequately participated, 80,822 had a test kit result of ‘further tests are needed’ and were automatically referred. This gave a positivity figure of 1.98%. A further 130,917 people self-referred or opted back into the programme within the year (including ‘over-age self-referrals’ and ‘late responder self-referrals’). This meant a total of 84,816 people within the screening year had a test kit result of ‘further tests are needed’ and were referred for onward assessment and diagnostic testing. The programme issued a total of 6,146,434 test kits, and 4,282,680 test kits were returned to one of the five programme hubs within the screening year.
As a whole, the programme carried out a total of 89,713 specialist screening practitioner (SSP) appointments (84,816 of which were first colonoscopy fitness assessment appointments). The programme also carried out a total of 88,392 diagnostic tests (endoscopic and radiological) from both screening and surveillance episodes (this count includes repeat procedures performed as well as those resulting from bowel scope screening and programme surveillance cases). Following endoscopic tests, the programme sent 169,575 resected polyps for pathological analysis within the year.
During the year 2021-22, the programme as a whole diagnosed 6,500 people with cancer, and placed a further 12,034 people into surveillance. People are placed into surveillance when they have an episode result of either ‘high-risk’ or ‘large non-pedunculated colorectal polyp/s’ (usually abbreviated to ‘LNPCP’). A further 12,060 people were given an episode result of ‘intermediate-risk adenoma’ and were subsequently reviewed against new British Society of Gastroenterology (BSG) guidelines, which were introduced into the programme during 2021-22. 34,763 people received an episode result of ‘low-risk adenoma’ or another finding which meant they were returned to routine recall. Only 6,231 people received a normal (nothing abnormal detected - NAD) episode result following attendance at a diagnostic test, which is a false positive rate of less than 9%.
4. BCSP-S01: Coverage
This section covers standard BCSP-S01.
Coverage is measured in the national screening programme to provide assurance that screening is being offered to the eligible population on a timely basis, and to maximise timely attendance of the eligible population (i.e. every 2 years). The eligible population makes an informed choice about whether or not to participate in all screening programmes, including bowel cancer screening. Coverage is defined as the proportion of the eligible population who are up to date with screening, that is to say, of all those eligible for screening, the number who have participated within the last 2.5 years.
Although bowel cancer screening is offered to eligible people every two years, coverage is reported for a 30-month (2.5-year) period, to allow people time to adequately participate in screening. This measure is then reported 6 months in arrears.
Coverage is an important indicator for the programme to achieve its aims of reducing incidence and mortality from bowel cancer.
The programme reports the proportion of eligible people who were screened (adequately participated in FOBt bowel cancer screening) in the 30-month (2.5 year) reporting period. With the cohort defined as the number of people eligible for FOBt bowel cancer screening on the last day of the reporting period.
4.1 FOBt bowel cancer screening coverage
For the 30-month (2.5 year) period ending March 2022, 70.3% (6,454,800 out of the eligible population of 9,180,563 aged 60-74) were screened (adequately participated in FOBt bowel cancer screening).
Table 1: FOBt bowel cancer screening coverage, by reporting period ending each March.
| Date * | No. eligible | No. screened in previous 30 months | 2.5-year coverage % |
|---|---|---|---|
| March 2014 | 8,148,141 | 4,562,303 | 56.0% |
| March 2015 | 8,255,327 | 4,726,719 | 57.3% |
| March 2016 | 8,398,094 | 4,904,971 | 58.4% |
| March 2017 | 8,557,226 | 5,061,657 | 59.2% |
| March 2018 | 8,695,817 | 5,174,400 | 59.5% |
| March 2019 | 8,833,568 | 5,341,562 | 60.5% |
| March 2020 | 8,951,716 | 5,750,327 | 64.2% |
| March 2021 | 9,123,258 | 6,029,159 | 66.1% |
| March 2022 | 9,180,563 | 6,454,800 | 70.3% |
* for the 30-month (2.5-year) period ending in the quoted month
Figure 1: FOBt bowel cancer screening coverage, 30-month (2.5 year reporting period), England, period ending March 2014 to the period ending March 2022.
The line graph above (Figure 1) shows the increase in coverage, for the 30-month (2.5 year) reporting period ending each March. Coverage was first able to be reported for the 2.5-year period ending March 2014 and, as shown in the graph has steadily increased to the period ending March 2019. The graph then shows a more rapid increase in coverage, coinciding with the introduction of FIT during the first half of 2019-20.
5. BCSP-S02: Uptake
This section covers standard BCSP-S02.
An important objective of the NHS Bowel Cancer Screening Programme in England is to maximise uptake in the invited population. Uptake is defined as, of all the people invited, how many participated within the invited screening episode, at time of reporting.
The expected effectiveness of the screening programme in reducing bowel cancer mortality requires a minimum uptake of 52%.
It is important to note that uptake measures do not include people who: late-respond, over-age-self-refer, or who opt-back-in to the programme. This means that whilst an uptake improving initiative may increase participation, this participation may not count towards the calculation of uptake.
The programme reports the proportion of invited people who were screened (adequately participated in FOBt bowel cancer screening), within the invited screening episode, at time of reporting.
Uptake is formally reported monthly for a 1-month period, 6-months in arrears. However, services can review their provisional data more frequently, with shorter initial arrears periods. The data presented below are an aggregate of the monthly data, to present data for the screening year 2021-22 as a whole.
Performance thresholds
Acceptable level: greater than or equal to 52.0%.
Achievable level: greater than or equal to 60.0%.
5.1 FOBt uptake by NHS region
In 2021-22, 68.9% of the invited population (4,083,100 out of 5,924,232) adequately participated in FOBt bowel cancer screening. The invited population includes people aged 60-74 (the standard screening age range), as well as those who have been invited as part of the age extension programme - aged 56 years.
NB: The data presented here may appear very slightly different to those previously published. The uptake data presented here has allowed for longer response times, meaning the figures quoted are a fraction of a percentage higher than those previously published.
Table 2: FOBt uptake by NHS region, 2021-22.
| NHSE Region | Uptake | Quintile 1 (most deprived) | Quintile 2 | Quintile 3 | Quintile 4 | Quintile 5 (least deprived) |
|---|---|---|---|---|---|---|
| East of England | 71.0% | 57.3% | 65.5% | 70.6% | 73.2% | 75.9% |
| London | 58.3% | 50.8% | 53.6% | 58.3% | 62.9% | 68.5% |
| Midlands | 69.2% | 56.0% | 64.6% | 70.6% | 74.0% | 77.2% |
| North East & Yorkshire | 70.6% | 59.8% | 68.2% | 73.1% | 76.3% | 78.7% |
| North West | 68.2% | 57.0% | 65.7% | 71.2% | 74.6% | 77.1% |
| South East | 70.9% | 58.3% | 63.8% | 68.8% | 72.5% | 75.5% |
| South West | 72.8% | 59.7% | 68.4% | 72.5% | 75.1% | 78.1% |
| England | 68.9% | 57.1% | 63.8% | 69.5% | 73.1% | 76.2% |
The table above (Table 2) also shows uptake by index of multiple deprivation quintile ad shows that people who live in the most deprived areas (quintile 1) are less likely to participate in screening than those who live in the least deprived areas (quintile 5). This trend can be seen across all NHS regions.
5.2 FOBt uptake by screening centre
Figure 2: FOBt uptake heat map by screening centre, 2021-22.
The map above (Figure 2) presents FOBt uptake by screening centre for the screening year 2021-22.
Of the 64 bowel cancer screening centres, 58 were on or above the achievable uptake threshold of 60%, 5 centres were between the acceptable and achievable thresholds (between 52% and 60%). Only 1 centre was below the acceptable uptake threshold of 52%, with this centre achieving 51.9% uptake for people invited within the screening year.
5.3 FOBt uptake by year
Figure 3: FOBt uptake by year, England, screening year ending March 2007 to the year ending March 2022.
The line graph above (Figure 3) shows the steady increase in uptake for the invited population since the start of the screening programme in 2006 up to the end of 2018-19. The ‘flip-flop’ or ‘saw tooth’ pattern that can be observed in the yearly data is due to how the screening programme rolled out, leading to different proportions of people who’d taken part before, being invited in alternate years. This affect can be seen to be lessening over time.
A new home testing kit called a faecal immunochemical test (FIT) started to be rolled out across England from April 2019. FIT replaced the guaiac faecal occult blood test (gFOBt kit) which had been in use since the programme began in 2006. Prior to implementation the FIT pilot study suggested that the change in test kit type would lead to an increase in uptake, which can be seen from 2019-20.
5.4 FOBt uptake by invite month and age group
Figure 4: Recent FOBt uptake by invite month and age group, England, January 2021 to March 2022.
An age extension programme also started to be rolled out from early 2021-22, with services beginning to invite 56-year-olds for screening. This change to the programme cohort has resulted in a slight drop in total eligible population uptake (as seen in Figure 3), indicating that younger age groups may be less likely to take up the screening offer - see also chart above (Figure 4). This observation has also been seen in other FOBt bowel cancer screening programmes around the world.
6. BCSP-S03: FOBt kit turnaround time
This section covers standard BCSP-S03.
FOBt kit turnaround time is measured by reporting the proportion of returned test kits that have been processed and read (i.e., ‘resulted’) on or within 3 calendar days of them being logged as returned to the programme hub, out of those that were readable. This is to ensure participants receive their test kit results as soon as possible.
Performance thresholds
Acceptable level: greater than or equal to 80.0%.
Achievable level: greater than or equal to 85.0%.
6.1 FOBt kit turnaround time by programme hub
In 2021-22, 99.5% of all readable test kits (4,261,197) were read within 3 calendar days of being logged as returned to the programme hub. 4,282,680 FIT kits were returned for analysis during the reporting year and 4,282,677 of these were able to be read (3 not readable). These data are reported by programme hub.
Table 3: FOBt kit turnaround time by programme hub, 2021-22.
| Programme Hub | Read Within Target % |
|---|---|
| Eastern | 100.0% |
| London | 99.9% |
| Midlands and North West | 99.2% |
| North East | 100.0% |
| Southern | 99.0% |
| England | 99.5% |
6.2 FOBt test kit turnaround time by year
Figure 5: FOBt test kit turnaround time by year, England, screening year ending March 2007 to the year ending March 2022.
As can be seen in the line graph above (Figure 5), when the programme was using guaiac-based test kits (which were read manually by human eye), achievement of the performance threshold was more variable. Since the introduction of the new FIT kit, which is largely processed and read by machines called ‘analysers’, the proportion of test kits that are read on or within 3 calendar days has increased, with the programme achieving over 99% of all test kits being read within 3 calendar days, for the last 2 consecutive years, with recent outside target cases being mostly read on day 4 or day 5.
7. BCSP-S06: Time to first offered SSP colonoscopy fitness assessment appointment.
This section covers standard BCSP-S06.
An SSP is a specialist screening practitioner. The SSP makes a clinical assessment as to whether a person with a test kit result of ‘further tests are needed’ is fit (healthy enough) to undergo a diagnostic test, usually a colonoscopy.
To reduce anxiety, people who are referred (following an FOBt result of ‘further tests are needed’), should be offered a first SSP colonoscopy fitness assessment appointment in a timely manner, so they can discuss their test kit results and next steps within the screening programme.
The programme monitors this standard by reporting the proportion of first offered SSP colonoscopy fitness assessment appointments where the date of the first offered appointment was on or within 14 days of the FOBt referral date.
Performance thresholds
Acceptable level: greater than or equal to 95.0%.
Achievable level: greater than or equal to 98.0%.
7.1 Time to first offered SSP colonoscopy fitness assessment appointment by NHS region
In 2021-22, 95.4% of all referred people (80,873 in total) were offered an SSP colonoscopy fitness assessment appointment date that was on or within 14 days of their referral date, out of a total of 84,816 people who were referred in the year (following a test kit result of ‘further tests are needed’).
Table 4: Time to first offered SSP colonoscopy fitness assessment appointment by NHS region, 2021-22.
| NHS Region | Within Target % |
|---|---|
| East of England | 95.7% |
| London | 99.9% |
| Midlands | 97.2% |
| North East & Yorkshire | 93.6% |
| North West | 89.9% |
| South East | 99.1% |
| South West | 93.1% |
| England | 95.4% |
7.2 Time to first offered SSP colonoscopy fitness assessment appointment by year, including SSP referral counts
Figure 6: Time to first offered SSP colonoscopy fitness assessment appointment by year including SSP referral counts, England, screening year ending March 2007 to the year ending March 2022.
The line graph above (Figure 6) shows the relatively steady / consistent performance of the programme against this standard, up until the new FIT kit was introduced. The FIT pilot study suggested that the change in test kit type would not only increase uptake, but would also increase positivity (at the employed threshold), and stated that both these factors would increase the number of people with a test kit result of ‘further tests are needed’, and so increase the number of people who would require SSP colonoscopy fitness assessment appointments.
The line graph shows (Figure 6) a drop in performance during the implementation of FIT, where this measure is seen to drop below the achievable level for the first time in many years. This corresponds with the sharp rise in the number of people needing SSP appointments. It then shows the recovery to above the acceptable target in the following years.
8. BCSP-S07: Time to first offered diagnostic test appointment
This section covers standard BCSP-S07.
Following an FOBt result of ‘further tests are needed’ and attendance at an SSP colonoscopy fitness assessment appointment, people who are fit (healthy enough) for onward diagnostic tests are then offered a first diagnostic test appointment date. A first diagnostic test can be either a colonoscopy or a computed tomography colonography (CTC).
To reduce anxiety, people who are referred for a diagnostic test (following an FOBt result of ‘further tests are needed’) should be offered their first diagnostic test appointment in a timely manner. This offer should also be reasonable, offering an appointment that would allow the person the necessary time to prepare for the procedure and take any required bowel preparation medications. The programme monitors this standard by reporting the proportion of first offered diagnostic test appointments, where the date of the first offered appointment was on or within 14 days of the diagnostic test referral date.
Performance thresholds
Acceptable level: greater than or equal to 90.0%.
Achievable level: greater than or equal to 95.0%.
8.1 Time to first offered diagnostic test appointment by NHS region
In 2021-22, 77.3% of people (51,973 in total) referred for a diagnostic test were offered a first diagnostic test that was on or within 14-days of their referral date. This is below the acceptable threshold set by the programme, with considerable regional variation observed within the dataset: the North West can be seen to be offering a timely first diagnostic test in 54.6% of cases, whereas London offered timely appointments in 94.4% of cases. A total of 67,224 people were referred for onward diagnostic tests in the screening year.
Table 5: Time to first offered diagnostic test appointment by NHS region, 2021-22.
| NHS Region | Within Target % |
|---|---|
| East of England | 81.0% |
| London | 94.4% |
| Midlands | 70.1% |
| North East & Yorkshire | 82.3% |
| North West | 54.6% |
| South East | 89.1% |
| South West | 78.4% |
| England | 77.3% |
8.2 Time to first offered diagnostic test appointment by year
Figure 7: Time to first offered diagnostic test appointment by year, England, screening year ending March 2007 to the year ending March 2022.
The line graph above (Figure 7) shows that other than a short period of time during 2013-14, nationally, the screening programme has rarely been able to achieve the acceptable threshold of offering ??? 90% of people a timely first diagnostic test appointment. The graph also shows a significant dip in performance during the FIT test kit implementation year, coinciding with additional demand. The percentage of people being offered a first appointment on or within 14 days of their referral date appears to increase in subsequent years.
9. BCSP-S08: Time to attendance for first diagnostic test
This section covers standard BCSP-S08.
Evidence shows that the first offered diagnostic test date (reported in standard BCSP-S07) and the first attended diagnostic test date (reported in this standard - BCSP-S08) can vary significantly, due to a number of reasons.
People can reject their first offered diagnostic test appointment date and can request a more suitable (often later) date.
Offered appointments indicate screening centre capacity. Attended appointments represent patient experience / patient choice, (as well as screening centre capacity). Reviewing both measures together provides a picture of centre capacity and patient choice / patient behaviour.
This standard is monitored by reporting the proportion of people who attended their first diagnostic test appointment on or within 14 days of their referral for diagnostic testing.
9.1 Time to attendance for first diagnostic test by NHS region
In 2021-22, 44.8% of people (29,266 in total) attended a first diagnostic test on or within 14 days of their onward referral (following an SSP colonoscopy fitness assessment). A total of 65,263 people attended for a first diagnostic test in the screening year.
Table 6: Time to attendance for first diagnostic test by NHS region, 2021-22.
| NHS Region | Within Target % |
|---|---|
| East of England | 47.5% |
| London | 64.6% |
| Midlands | 41.3% |
| North East & Yorkshire | 44.5% |
| North West | 31.7% |
| South East | 49.9% |
| South West | 43.8% |
| England | 44.8% |
9.2 Time to attendance for first diagnostic test by year
Figure 8: Time to attendance for first diagnostic test by year, England, screening year ending March 2008 to the year ending March 2022.
The line graph above (Figure 8) shows the proportion of people attending their diagnostic test on or within 14 days, over time. It should be noted that any delays in first offered diagnostic test appointments (such as those seen in BCSP-S07 during the introduction of FIT), will also affect this measure.
10. BCSP-S05: CTC usage within the FOBt screening programme
This section covers standard BCSP-S05.
A computed tomography colonography (‘CTC’) is a test that uses CT scans to examine the large bowel. This type of test is sometimes also called a ‘virtual colonoscopy’. It is important that people who require a diagnostic test receive a quality procedure. Whilst colonoscopy is the gold standard diagnostic test within the FOBt bowel cancer screening programme, a CTC may be performed for a small proportion of patients who have specific clinical reasons. It is important that the proportion of CTCs is monitored, to ensure CTCs are being performed appropriately within the FOBt bowel cancer screening programme.
The programme reports the proportion of CTCs performed, out of all the diagnostic tests carried out in the programme, in order to monitor the use of this type of diagnostic test.
Performance thresholds
Monitoring statistic only – SQAS to investigate screening centre outliers, as necessary.
10.1 Proportion of CTCs performed within the programme by NHS region
In 2021-22, 6.3% (5,413 out of 86,129) of all diagnostic test procedures carried out in the year were CTCs. Regional variation in the proportional usage of CTCs can be observed across England, with London having the highest percentage usage, and the North West having the lowest percentage usage.
Table 7: Proportion of CTCs performed within the programme by NHS region, 2021-22.
| NHS Region | CTC % |
|---|---|
| East of England | 6.6% |
| London | 8.5% |
| Midlands | 6.6% |
| North East & Yorkshire | 5.2% |
| North West | 5.0% |
| South East | 6.3% |
| South West | 7.1% |
| England | 6.3% |
10.2 Proportion of CTCs performed within the programme by year
Figure 9: Proportion of CTCs performed within the programme by year, England, screening year ending March 2017 to the year ending March 2022.
The use of CTC has increased over the years, as use of the test and access to facilities has improved. Detailed CTC data for bowel cancer screening (in its current format), started to be captured at the beginning of 2016. No programme data is available for this measure before this date.
11. BCSP-S11: Diagnostic test uptake
This section covers standard BCSP-S11.
It is important that people who receive an FOBt result of ‘further tests are needed’, go on to have a diagnostic test, where appropriate for them.
This standard is monitored by reporting the proportion of people who go on to have a diagnostic test (one or more within the episode), out of all those who received an FOBt result of ‘further tests are needed.
Performance thresholds
Acceptable level: greater than or equal to 81.0%.
Achievable level: greater than or equal to 90.0%.
11.1 Diagnostic test uptake by NHS region
In 2021-22, 75.6% (64,440 out of 85,183) of people who received a test kit result of ‘further tests are needed’, went on to have a (one or more) diagnostic test (colonoscopy or CTC) within the bowel cancer screening programme. Whilst there is variation between the regions, all are below the acceptable performance threshold.
Table 8: Diagnostic test uptake by NHS region, 2021-22.
| NHS Region | Diagnostic Test Uptake % |
|---|---|
| East of England | 75.5% |
| London | 72.4% |
| Midlands | 77.4% |
| North East & Yorkshire | 74.5% |
| North West | 71.3% |
| South East | 78.3% |
| South West | 79.4% |
| England | 75.6% |
11.2 Diagnostic test uptake by year
Figure 10: Diagnostic test uptake by year, England, screening year ending March 2009 to the year ending March 2022.
The line graph above (Figure 10) shows the gradual decline in diagnostic test uptake over the years since the programme started, with a more abrupt drop observed when FIT kits were introduced into the screening programme. NHS England are currently carrying out investigations into this observation, including: reviewing changes over time to the make-up of the invited population (as the programme has matured), inequalities and the existing health conditions and medical history of people now participating in FIT.
It is important to note that a person can only be referred for a diagnostic test if they are assessed as fit (i.e., healthy enough) to have a procedure (colonoscopy or CTC). It is then their choice whether or not to take part in this portion of the screening pathway.
12. BCSP-S12: Adenoma detection rate (FOBt)
This section covers standard BCSP-S12.
Adenoma detection is an important quality measure for individual endoscopists working in the bowel cancer screening programme. This measure indicates the endoscopist’s ability to remove (resect) and retrieve ‘novel’ (not seen before) polyps, which are then histologically confirmed (in a laboratory) to be adenomas.
This standard is monitored by reporting the proportion of first (known as ‘index’) complete screening colonoscopies where at least one histologically confirmed adenoma was resected and retrieved, out of all the complete screening index colonoscopies performed.
Reviewing complete screening index colonoscopies provides a ‘level playing field’ for the reporting of this standard. If subsequent procedures were included, polyps could have already been removed, meaning there would be fewer to find, reducing the detection rate. Similarly, the subsequent procedure could be being performed as there is known pathology which requires removal, thereby artificially increasing the detection rate. This is particularly relevant when reviewing data at clinician level.
Performance thresholds
Acceptable level: greater than or equal to 40.0%.
Achievable level: greater than or equal to 50.0%.
12.1 Adenoma detection rate by NHS region
In 2021-22, the national adenoma detection rate was 63.3%, which was above the acceptable and the achievable performance thresholds, with all regions above the achievable target. This was a total of 37,994 out of a total of 59,978 complete screening index colonoscopies performed in the screening year.
Table 9: Adenoma detection rate by NHS region, 2021-22.
| NHS Region | Adenoma Detection % |
|---|---|
| East of England | 63.8% |
| London | 63.8% |
| Midlands | 63.0% |
| North East & Yorkshire | 64.3% |
| North West | 65.4% |
| South East | 62.1% |
| South West | 61.2% |
| England | 63.3% |
12.2 Adenoma detection rate by year
Figure 11: Adenoma detection rate by year, England, screening year ending March 2008 to the year ending March 2022.
The line graph above (Figure 11) shows the gradual increase in adenoma detection over the lifetime of the screening programme, followed by a more recent jump in the detection percentage during 2019-20, following the introduction of FIT. As FIT is known to be a more sensitive test, this percentage increase was expected, following the change in test kit type.
This measure is also monitored locally at endoscopist level, to assure individual clinician performance.
13. BCSP-S09: Polyp pathology turnaround time
This section covers standard BCSP-S09.
To reduce anxiety, it is important that any removed polyps are reported in a timely manner, so definitive polyp pathology results can be given to the person as soon as possible. This standard is monitored by reporting the proportion of polyps where the elapsed time between date received in the laboratory and date reported is on or within 7 days.
Performance thresholds
Acceptable level: greater than or equal to 90.0%.
Achievable level: greater than or equal to 95.0%.
13.1 Polyp pathology turnaround time by NHS region
In 2021-22, 91% of all polyps (154,226 out of 169,528) received into the laboratory were reported on or within 7 calendar days, which is above the acceptable performance threshold.
Table 10: Polyp pathology turnaround time by NHS region, 2021-22.
| NHS Region | Within Target % |
|---|---|
| East of England | 92.3% |
| London | 95.5% |
| Midlands | 91.5% |
| North East & Yorkshire | 89.4% |
| North West | 90.0% |
| South East | 89.7% |
| South West | 90.4% |
| England | 91.0% |
13.2 Polyp pathology turnaround time by year
Figure 12: Polyp pathology turnaround time by year, England, screening year ending March 2014 to the year ending March 2022.
The line graph above (Figure 12) shows national performance of this target over the last 9 years. The graph shows a drop in performance during the FIT implementation year, coinciding with the additional workload seen in pathology. The additional workload occurred not only because of the increase in test kit uptake and positivity (meaning more people attended for endoscopic tests where polyps were removed) but also the increase in pathology yield that the new FIT test brings. The FIT kits have a lower false positive rate than guaiac test kits (that is, the FIT kit refers fewer people for a diagnostic test who go on to have a ‘nothing abnormal detected’ outcome), meaning more polyps are found in those people attending for endoscopic tests. The graph shows some recovery in 2020-21, and another dip during 2021-22, coinciding with when the population increased again due to the start of age extension, extending the screening offer to people aged 56 years.
Pathology turnaround time data for bowel cancer screening started to be captured during 2013. No data is available for this measure before this date.
14. BCSP-S13: Caecal intubation rate
This section covers standard BCSP-S13.
Caecal intubation (reaching the caecum with the scope) is an important quality marker for individual endoscopists working in the bowel cancer screening programme.
Where possible it is important that people attending for colonoscopy have the whole of their bowel examined, in order to maximise the detection of cancers as well as other significant findings. Reaching the caecum should be documented with a photograph or a video.
Caecal intubation should not be strived for at the detriment of patient comfort or safety.
This standard is monitored by reporting the proportion of colonoscopies where caecal intubation was achieved with photographic or video evidence taken.
Performance thresholds
Acceptable level: greater than or equal to 92.0%.
Achievable level: greater than or equal to 97.0%.
14.1 Caecal intubation rate with photo / video evidence by NHS region
In 2021-22 the national caecal intubation rate within the screening programme was 95.1%, with all regions above the acceptable target, but below the achievable target. This was 70,598 out of a total of 74,241 colonoscopies performed within the screening year.
Table 11: Caecal intubation rate with photo / video evidence by NHS region, 2021-22.
| NHS Region | Caecal Intubation % * |
|---|---|
| East of England | 96.3% |
| London | 95.7% |
| Midlands | 94.7% |
| North East & Yorkshire | 94.4% |
| North West | 94.5% |
| South East | 95.8% |
| South West | 95.1% |
| England | 95.1% |
* with photo / video evidence taken
14.2 Caecal intubation rate with photo / video evidence by year
Figure 13: Caecal intubation rate with photo / video evidence by year, England, screening year ending March 2009 to the year ending March 2022.
The line graph above (Figure 13) shows a rapid increase in caecal intubation rates from the start of reporting to 2010-11, largely due to improvements in access to photography and video equipment. Lower performance of this standard prior to 2010-11 does not necessarily indicate a lower completion rate, but indicates that fewer endoscopy suites had access to photographic or video equipment to capture evidence of completion. In the early years, visualisation of anatomical landmarks was more often used as completion proof.
This measure is also monitored locally at endoscopist level, to assure individual clinician performance.
15. BCSP-S14: Scope withdrawal time
This section covers standard BCSP-S14.
Scope withdrawal time is an important quality measure for individual endoscopists working in the bowel cancer screening programme. The time taken to withdraw the scope (from caecum to extubation) for colonoscopies where no abnormalities were found (often written as a ‘normal’ result or ‘nothing abnormal detected’ – NAD), needs to be of sufficient duration to allow for a thorough inspection of the bowel. Tests with a ‘non-normal’ finding cannot be included in this measure, as polyp resections and biopsies are often taken on withdrawal, elongating the withdrawal time taken.
This standard is monitored by reporting the average (mean) time in minutes (whole minutes) taken to withdraw the scope (from caecum to extubation), for all complete colonoscopies where the procedure outcome was normal (no abnormalities found).
Performance thresholds
Acceptable level: greater than or equal to 6 minutes.
Achievable level: greater than or equal to 10 minutes.
15.1 Scope withdrawal time (in minutes) for all normal (NAD) colonoscopies by NHS region
In 2021-22 the mean withdrawal time in minutes for all normal (NAD) colonoscopies was 11 minutes, and all regions reached the achievable performance threshold of 10 minutes.
Table 12: Scope withdrawal time (in minutes) for all normal (NAD) colonoscopies by NHS region, 2021-22.
| NHS Region | Mean scope withdrawal time (in mins) * |
|---|---|
| East of England | 11 |
| London | 10 |
| Midlands | 11 |
| North East & Yorkshire | 11 |
| North West | 11 |
| South East | 11 |
| South West | 11 |
| England | 11 |
* for all normal (nothing abnormal detected) colonoscopies
15.2 Scope withdrawal time (in minutes) for all normal (NAD) colonoscopies by year
Figure 14: Mean scope withdrawal time (in minutes) for all normal (NAD) colonoscopies by year, England, screening year ending March 2008 to the year ending March 2022.
The line graph above (Figure 14) shows the national mean number of minutes taken to withdraw the scope for all programme performed colonoscopies where nothing abnormal was detected (i.e., the procedure had a ‘normal - NAD’ outcome). This measure is also monitored locally at endoscopist level, to assure individual clinician performance.
16. BCSP-S15: Polyp retrieval rate
This section covers standard BCSP-S15.
In order to maximise the programme’s detection of cancers as well as other significant findings, all resected polyps should be retrieved, so they can undergo pathological analysis.
Polyp retrieval is an important quality measure for individual endoscopists working in the bowel cancer screening programme. The retrieval of some resected polyps can be quite complex, especially when using gas (CO2 or O2 / air) for colonic insufflation. The proportion of polyps that are resected but not retrieved should be small.
This standard is monitored by reporting the proportion of polyps retrieved, out of those resected during an endoscopic procedure.
Performance thresholds
Acceptable level: greater than or equal to 90.0%.
Achievable level: greater than or equal to 95.0%.
16.1 Polyp retrieval rate by NHS region
In 2021-22 the national polyp retrieval rate was 97.7%, with all regions above the 95% achievable performance threshold. This equates to 169,575 out of a total of 173,491 resected polyps during the screening year.
Table 13: Polyp retrieval rate by NHS region, 2021-22.
| NHS Region | Polyp Retrieval % |
|---|---|
| East of England | 98.3% |
| London | 98.0% |
| Midlands | 97.6% |
| North East & Yorkshire | 97.5% |
| North West | 96.9% |
| South East | 98.4% |
| South West | 97.8% |
| England | 97.7% |
16.2 Polyp retrieval rate by year
Figure 15: Polyp retrieval rate by year, England, screening year ending March 2006 to the year ending March 2022.
The line graph above (Figure 15) shows programme improvement in performance against this standard over the years, suggesting that endoscopists have become more adept and skilled at retrieving the polyps they resect during an endoscopic procedure. This measure is also monitored locally at endoscopist level, to assure individual clinician performance.
17. BCSP-S10: Effective calls received by the BCSP helpline
This section covers standard BCSP-S10.
As initial bowel cancer screening is carried out using a home testing kit which is sent and returned via the post, the programme offers a telephone helpline for people to ask questions about the programme, including their suitability for screening, or for advice regarding test kit completion. It is important that callers are able to get through to a helpline operator (i.e., that the call is ‘effective’), as any barriers to accessing help may reduce participation and/or result in a loss of confidence in the programme.
The bowel cancer screening helpline is a single 0800 telephone number used across the whole of the NHS Bowel Cancer Screening Programme in England. The service is supplied to NHS England by BT. Calls are routed to the appropriate programme hub using the caller’s geographic location or by a selection made by the caller.
The proportion of ‘ineffective calls’ should be small. Ineffective calls are those which do not reach the programme hub’s host telephone system. These calls are classified by BT as calls where: ‘called number busy’, ‘equipment engaged tone’, ‘ring tone no reply’, ‘out of service’, ‘caller early release’, ‘unknown’, ‘blank’ or ‘other’.
17.1 Effective calls received by the telephone helpline by programme hub
In 2021-22, 98.5% (510,088 out of a total of 517,715) of calls made to the bowel cancer screening 0800 telephone helpline number within the screening year were ‘effective’.
Table 14: Effective calls received by the telephone helpline by programme hub, 2021-22.
| Programme Hub | Effective Call % |
|---|---|
| Eastern | 98.4% |
| London | 99.4% |
| Midlands and North West | 98.8% |
| North East | 97.5% |
| Southern | 98.4% |
| England | 98.5% |
17.2 Effective calls received by the telephone helpline by programme hub by year
Figure 16: Effective calls received by the telephone helpline by programme hub by year, April 2021 to March 2022.
The line graph above (Figure 16) shows each hub’s effective call % by month, for the reported screening year. Whilst discrete drops in the effective proportion of calls can be seen for individual hubs during specific months, the overall proportion of effective calls remained high.