Bowel cancer awareness: Why early detection and appropriate surveillance matter

March marked Bowel Cancer Awareness Month, an important opportunity to highlight a disease that is common, often slow growing, and highly treatable when detected early.

Bowel cancer (also known as colorectal cancer) is the fourth most common cancer in the UK, with more than 44,000 people diagnosed each year. Importantly, more than nine in ten people survive the disease when it is caught at its earliest stage.

Recent changes to England’s bowel cancer screening programme reflect growing recognition that earlier detection saves lives - particularly for those at higher risk.

Why bowel cancer can be missed

Unlike some cancers, bowel cancer often develops slowly over many years. Early symptoms can be vague or easily dismissed, including:

• Changes in bowel habits
• Blood in the stool
• Abdominal discomfort
• Unexplained weight loss or fatigue

Because symptoms may be mild or absent in the early stages, many cases are only diagnosed once the disease has progressed, when treatment becomes more complex and outcomes poorer. 

This is why screening and surveillance are so critical. As of January 2025, everyone aged 50 to 74 in England is eligible for NHS bowel cancer screening and will automatically be sent a home FIT test every two years.

Who is at higher risk of bowel cancer?

While bowel cancer can affect anyone, certain groups face a significantly higher lifetime risk and may require enhanced surveillance or earlier intervention.

These include people with:

• Ulcerative colitis
• Crohn’s disease affecting the colon
• A strong family history of bowel cancer
• Hereditary conditions such as Lynch syndrome

Long term inflammatory bowel disease (IBD), particularly when it affects a large portion of the colon, increases bowel cancer risk due to chronic inflammation over time.

Surveillance for patients with inflammatory bowel disease

Updated British Society of Gastroenterology (BSG) guidelines emphasise that people with IBD should not be managed under routine population screening alone.

Key recommendations include:

• Regular colonoscopic surveillance, typically every 1–3 years, depending on individual risk
• Use of high definition colonoscopy and chromoendoscopy to improve detection of precancerous changes
• Escalation to surgical intervention where high risk dysplasia is identified

Failure to appropriately enrol patients in surveillance programmes - or delays in investigation - can lead to missed or late diagnoses.

When delayed diagnosis may raise concerns

Although bowel cancer can still occur despite appropriate care, avoidable delays in diagnosis may give rise to clinical negligence concerns, particularly where:

• Screening invitations were not sent or followed up appropriately
• Symptoms were repeatedly dismissed without investigation
• High risk patients were not offered specialist surveillance
• Abnormal test results were not acted upon promptly
• Referral thresholds or guidance were incorrectly applied

Earlier diagnosis often means less invasive treatment, better prognosis and significantly improved quality of life.