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    A Problem with Poo

    By Siu Hing Lo, on 1 July 2013

    The NHS in England invites all adults aged 60 to 69 (currently being extended to 74) for bowel cancer screening. Eligible individuals are sent a test kit which requires them to take three samples from their bowel motions. Unlike breast and cervical screening, the test can be completed at home and sent back to the laboratory in an envelope. This process ensures privacy and avoids potential scheduling difficulties.

    Nevertheless, only about one in two return their bowel cancer screening test kit. In comparison, 74-79% of women attend their appointments for breast and cervical screening. Suggested reasons for lower participation in bowel cancer screening include low perceived risk of bowel cancer, the risk of procrastination with a home-based test and the unpleasantness of stool sampling. What we do not know, however, is whether similar reasons are equally barriers to other types of cancer screening.

    To address this question, we compared reasons women gave for not participating in bowel, breast and cervical screening in our most recent study. Rather surprisingly, few differences emerged. For example, we did not find that low perceived risk or procrastination stood out as barriers specific to bowel cancer screening. However, we did observe that women who did not participate in bowel cancer screening were more likely to cite ‘not liking the idea of test’. This lends further support to previous research showing that stool-sampling is off-putting.

    It seems that many have a problem with poo. Aversion against stool sampling should therefore be tackled for bowel cancer screening to gain the same level of acceptance as other established screening programmes.


    Chapple, A., Ziebland, S., Hewitson, P. & A. McPherson (2008), ‘What affects the uptake of screening for bowel cancer using a faecal occult blood test (FOBt): a qualitative study’, Social Science and Medicine, 66, 2425–35.

    Consedine, N., Ladwig, I., Reddig M.K. & E.A. Broadbent (2011), ‘The many faeces of colorectal cancer screening embarrassment: Preliminary psychometric development and links to screening outcome. British Journal of Health Psychology, 16, 559-579.

    Lo, S.H., Waller, J., Wardle, J. & C. von Wagner (2013), ‘Comparing barriers to colorectal cancer screening with barriers to breast and cervical screening: a population-based survey of screening-age women in Great Britain’, Journal of Medical Screening, published Online First 10th June 2013, doi: 10.1177/0969141313492508.

    O’Sullivan I. & S. Orbell (2004), ‘Self-sampling in screening to reduce mortality from colorectal cancer: a qualitative exploration of the decision to complete a faecal occult blood test (FOBT)’, Journal of Medical Screening, 11, 16–22.

    von Wagner C., Good A., Smith S., & J. Wardle (2012), ‘Responses to procedural information about colorectal screening using Faecal Occult Blood testing: the role of consideration of future consequences’, Health Expectations, 15, 176–86.