Screening more men for bowel cancer

In July 2006, the first invitations were sent out for the NHS Bowel Cancer Screening Programme (NHSBCSP) for England.   By the end of 2009 the programme was offering a self-administered test at home to all people aged between 60 and 69.  The age range of invitations will be extended to 74 from 2010.

The NHSBCSP employs a faecal occult blood test (FOBt); each person in the qualifying age group receives by post a kit that enables him or her to collect a tiny sample from each of three separate bowel movements.  These samples, smeared on to a specially prepared card, are returned in a post-paid envelope to one of the five regional NHSBCSP hub laboratories.  At the laboratory they are subject to a chemical process which detects the presence of minute quantities of blood in the stool.  Blood in the stool is an “occult” (hidden) symptom that might indicate early stage bowel cancer.  The FOBt is capable of detecting this symptom, in many cases, long before a person taking the test would have become aware of it.

The introduction of the NHSBCSP was preceded by a lengthy pilot screening programme which took place in two “rounds” during 2001 - 2003, and 2003 – 2005. During both rounds of the pilot programmes, men were significantly less likely than women to take part at all stages of the process.  The most basic measure of participation was the proportion of people completing the FOBt and returning stool samples for analysis.  During the first round, 52% of men returned samples compared with 61% of women .  During the second round, 48% of men returned samples compared with 56% of women .  If proportions of men taking up the offer of screening had equalled those of women, then around 10,000 more men would have been screened in the first round and over 5,000 men in the second round.

In 2006, the MHF was commissioned by the Department of Health, with additional funding from the National Cancer Screening Programme, to develop a project whcih explored why men were less likely to take part in screening and ways in which they might be encouraged to do so in greater numbers amongst the target group.  This project has encompassed three stages : 

• An analysis of what is already known about male attitudes to bowel cancer and cancer in general, and what is known about men’s participation in mass public health initiatives
• Using the knowledge from Stage1, a process of research and discussion with “ordinary” men exploring some of the most important issues and seeking ways of overcoming the perceived barriers to male participation in screening
• Make recommendations, based on the research, on how the NHSBCSP might more effectively target men and increase uptake

David Wilkins, policy officer at the MHF, said "This has been a fascinating programme of research analysing both men's and women's (who were included in part of the research as a control group) attitudes towards cancer and screening.  Our findings suggest that there would be benefits to both sexes of considering gender-specific emphases in information campaigns with a very significant majority (of 90% of both sexes) expressing a preference for information written specifically for men and women".

It is hoped that the research findings can lead to the development of a model content, structure and to produce guidance for use both by the NHSBCSP and by PCTs and public health departments. The project will report later in 2010.  Visit Malehealth for more information on bowel cancer or here for more information about the NHSBCSP.