Bowel Screening Wales (BSW) aims to reduce the number of people dying from bowel cancer in Wales through early identification of cancer when treatment is more likely to be successful and through the removal of pre-cancerous growths. As part of a programme of optimisation, the eligible age range has changed, from 55 to 74 years at the point of publication (August 2023) to 50 to 74 years over the coming years.
Following the pause in screening programmes in March 2020, bowel screening participants were invited as part of a phased restart from the end of July 2020. The programme “recovered”, catching up with all those invitations that were delayed and getting back on schedule, in October 2021. From March 2021 to March 2022 a total of 354,131 people were invited to take part in bowel screening with 238, 065 people taking up the offer of a screening test.
Uptake of bowel screening is reported as the proportion of invited participants who were screened within six months of invitation, making this the latest data available as of October 2022. The minimum standard for uptake across the programme is 60%. Across Wales in 2021/22, uptake was 67.2%. This is very similar to the uptake in 2020/21 where uptake was 67.1% and shows a marked increase from the years prior (61.5% in 2019/20 and 57.3% in 2018/19).
There is little geographical variation in uptake across Wales at health board level with uptake ranging from 66.5% in Swansea Bay University Health Board to 68.3% in Hywel Dda University Health Board (table 3).
Table 3: Uptake (%) of bowel screening by health board of residence, 2021/22
|
Health board |
Invited (n) |
Screened (n) |
Uptake (%) |
|
Aneurin Bevan UHB |
64790 |
43807 |
67.6 |
|
Betsi Cadwaladr UHB |
83852 |
56016 |
66.8 |
|
Cardiff & Vale UHB |
46744 |
31405 |
67.2 |
|
Cwm Taf Morgannwg UHB |
48073 |
32054 |
66.7 |
|
Hywel Dda UHB |
50027 |
34165 |
68.3 |
|
Powys Teaching HB |
18791 |
12775 |
68.0 |
|
Swansea Bay UHB |
41807 |
27806 |
66.5 |
|
All-Wales |
354131 |
238065 |
67.2 |
However, greater geographical variation in uptake is noted at local authority area ranging from 62.3% in Merthyr Tydfil to 72.5% in Monmouthshire (Figure 5). The local authorities with the highest and lowest uptakes remain unchanged from the previous year.
Figure 5: Uptake (%) of bowel screening by local authority of residence, 2020/21
Description of Figure 5: Bar chart showing the pattern of uptake in each of the 22 local authorities. This ranges from 72.5% in Monmouthshire to 62.3% in Merthyr Tydfil, with all areas over the 60% standard.
Across Wales in 2020/21, uptake of bowel screening was highest in the least deprived areas at 73.4%, with lowest uptake in the most deprived areas at 57.9%.
The absolute difference between uptake in the most and least deprived areas is 15.9% (73.8-57.9). Compared to 2020/21 this gap has increased, from a difference of 14.5% (73.4-58.9).
Figure 6: Uptake of Bowel Screening by deprivation quintile – all Wales 2021/22
Description of figure 6: Bar chart showing how bowel screening uptake decreases as level of deprivation increases. Uptake in the least deprived group is 73.8% but 57.9% in the most deprived group.
This association between uptake and deprivation is seen across all health board areas in Wales, with uptake of bowel screening highest in the least deprived areas and lowest in the most deprived areas. The inequity gap ranged from 19.9% in CVUHB to 11.3% in HDUHB (Figure 6).
Figure 7: Uptake of Bowel Screening by deprivation quintile by health board 2021/22
Description of Figure 7: Clustered Bar chart showing the pattern of bowel screening uptake by deprivation in each of the seven health boards. The overall pattern is generally that uptake decreases as deprivation increases.
There also is a social gradient for uptake of bowel screening for all the local authority areas in Wales, with highest uptake in the least deprived areas and lowest uptake in the most deprived areas.
Across Wales in 2021/22, uptake of bowel screening is lowest in the youngest age group (58-59 year olds) at 62.6%, compared to 69.5% in the oldest age group of 70-74 year olds. The difference in uptake between the oldest and youngest invited has increased this year, but that is because the lower age limit changed from 60 to 58 in October 2021. Comparing like with like, the difference between uptake in those ages 60-74 and those ages 70-74 has increased slightly as uptake in those aged 70-74 increased by 1.4% and uptake in those aged 60-64 decreased very slightly by 0.2%.
Figure 8: Uptake (%) of Bowel Screening by age group – all Wales 2021/22
Description of Figure 8: Bar chart comparing bowel screening uptake by age groups showing that uptake is lowest in the youngest age group and increases as participants get older.
A difference in uptake by age is seen across all health boards in Wales.
Although 58 and 59 year olds only started to be invited part of the way through the year, the number invited was 26,808 so large enough to see a pattern.
In 2021/22, uptake of bowel screening was highest amongst those people who had previously taken part in screening, at 90.7%. Uptake for people invited for the first time was still above the 60% standard at 64.2%. However, uptake was significantly lower in people who had been invited before but not responded, at 22%.
|
Type of Invitation |
Invited |
Screened |
Uptake |
|
First |
68961 |
44283 |
64.2 |
|
Recall, not previously responded |
94478 |
20809 |
22.0 |
|
Recall, previously responded |
190692 |
172973 |
90.7 |
There is little variation across health boards.
Uptake for those who had previously been invited but non-responded has fallen from 25.5% in 2020/21, but remains almost the same for those who previously responded (90.8% in 2020/21). Uptake for first round has fallen from 65.9% in 2020/21, influenced by the youngest age group being included for the first time.
Bowel Screening Wales invites people of any gender to take part in bowel screening every two years. Across Wales, there is a 2.8% difference in uptake of bowel screening between males and females with uptake in men lower at 65.8% compared to uptake in women at 68.6%.
The gap has widened by 0.8% compared to 2020/21, driven by a 0.5% increase in uptake in women and smaller drop in uptake for men.
There is some variation by health board with the gap ranging from 2% in Aneurin Bevan and Swansea Bay UHBs, to 5.1% in Powys THB. However, Powys has closed the gap by 0.4% this year.
Table 7: Uptake (%) of bowel screening by gender, 2020/21
|
Health board |
Male |
Female |
Inequity Gap |
Inequity Gap 20/21 |
|
Aneurin Bevan UHB |
66.6 |
68.6 |
2.0 |
1.9 |
|
Betsi Cadwaladr UHB |
65.3 |
68.3 |
3.0 |
2.6 |
|
Cardiff and Vale UHB |
65.5 |
68.8 |
3.3 |
2.8 |
|
Cwm Taf Morgannwg UHB |
65.8 |
67.6 |
1.8 |
0.2 |
|
Hywel Dda UHB |
66.6 |
69.9 |
3.3 |
2.1 |
|
Powys Teaching HB |
65.4 |
70.5 |
5.1 |
5.5 |
|
Swansea Bay UHB |
65.5 |
67.5 |
2.0 |
0.5 |
|
All-Wales |
65.8 |
68.6 |
2.8 |
2.0 |
Uptake by gender of bowel screening varied across local authority areas in Wales in 2021/22. Uptake was higher in women compared to men in all local authority areas with the largest inequity gap between men and women in Powys at 5.1% and the smallest in Cwm Taf at 0.9%. (Last year, uptake was higher for men in CTMUHB, the only health board to have shown that pattern).