Screening can detect early signs of cancer in people who are not experiencing symptoms. Early detection is important because treatment is more likely to be successful and the chances of survival are much better. In the UK, there are national screening programmes for breast, cervical and bowel cancer. These services save almost 9,000 lives each year.
In November 2018, NHS England commissioned an independent review of the National Cancer Screening programmes in England, which was later extended to cover other adult screening programmes (e.g. the abdominal aortic aneurysm screening programme). The final report of the review was published in October 2019, and recommendations included developing new IT systems for screening programmes, implementing evidence-based initiatives to improve screening uptake, and investing in screening equipment and facilities. The findings of the review will be taken forward as part of the implementation of the NHS Long Term Plan.
Women between the ages of 50 and 70 are invited for regular breast screening (every three years) under the NHS Breast Screening Programme. X-ray images of the breast (mammograms) are taken and assessed for any abnormalities. Coverage is measured as the percentage of women in the population who are eligible for screening who have been screened within the last three years. The national efficiency standard (the point at which programme delivery is considered to become efficient) is 70% and the optimal performance standard (the point at which programme delivery is considered to begin to operate optimally) is 80%.
Breast screening coverage in England increased from 64% in 2001/02 to 77% in 2009/10, then remained stable until 2012/13 when it gradually began to decrease. In 2019/20, breast screening coverage was 72%.
During the Covid-19 pandemic, breast screening services were officially paused in Scotland, Wales and Northern Ireland, and locally paused in England from March to June 2020. Estimates suggest that up to one million women in the UK may have missed breast screening appointments during the pandemic. Consequently, in 2020/21, breast screening coverage in England fell to 64%, dipping below the efficiency standard for the first time since 2004/05. In 2021/22, this improved slightly to 65%; over six million women were eligible for screening and 4.1 million women had been screened within the last three years. Coverage was highest in the 65–69 age group (67%) and lowest in the 50–52 age group (45%). Lower coverage in the younger age category could be because screening only begins at the age of 50. There was also regional variation, with the East Midlands reporting the highest coverage at 69% and London reporting the lowest coverage at 56% (data not shown).
Women between the ages of 25 and 64 are invited for regular cervical screening under the NHS Cervical Screening Programme. Cervical screening samples are taken and tested for the human papilloma virus (HPV). It was announced in 2016 that HPV primary screening would be integrated into the NHS Cervical Screening Programme and it was rolled out fully across England in December 2019. HPV screening is a more sensitive diagnostic tool than primary cytology (the previously used method for cervical cancer screening), which means that it identifies more women at risk for cervical cancer. Coverage is measured as the percentage of women in the population who are eligible for screening who were screened adequately within the last three and a half years (for women aged 25–49) and five and a half years (for women aged 50–64). The efficiency standard is set at 75% and the optimal performance standard is 80%.
Cervical screening coverage for the total target age group (25 to 64 years) fell from 76% in 2010/11 to 70% in 2021/22. 15.9 million women were eligible for cervical screening in 2021/22 and 11 million women were screened within the specified target period. Coverage was consistently higher in the older age group (50-64 years) than the younger age group (25-49 years). Coverage among women aged 25 to 49 years decreased from 74% in 2010/11 to 68% in 2021/22. For women aged 50 to 64 years, coverage fell from 80% in 2010/11 to 75% in 2021/22.
In England, invitations for cervical screening were suspended in April 2020 due to the Covid-19 pandemic and resumed from June 2020. This short-lived disruption caused screening rates to decrease slightly in 2020/21 when compared with 2019/20.
Bowel cancer screening in the form of a home-testing kit is offered to men and women aged 60 to 74 every two years. From June 2019, the faecal immunochemical test (FIT) replaced the faecal occult blood (FOB) test. An additional one-off bowel scope screening test was introduced in England at the age of 55. In August 2018, it was announced that bowel cancer screening in England would begin at the age of 50, and this would be implemented across four years beginning from April 2021. Coverage is measured as the percentage of men and women who are eligible for screening who were screened adequately within the last two and a half years. The efficiency standard is 55% and the optimal performance standard is 60%.
Bowel screening coverage in England increased from 35% in 2009/10 to 70% in 2021/22. Performance against the bowel screening standards is improving, but from a lower starting point than the other screening programmes. The efficiency standard has been met since 2013/14, and the optimal performance standard has been met since 2018/19.
The bowel screening programme was not officially paused in England during the Covid-19 pandemic, but services were suspended locally. An estimated one million bowel cancer screening invitations were not sent out in England due to the pandemic. Despite this, screening rates increased in 2020/21. Improved participation could have been a result of the use of home-testing kits during the pandemic, as face-to-face appointments were not required for screening as they are with breast and cervical cancer.
Breast screening across different countries
The Organisation for Economic Co-operation and Development (OECD) collects international data on breast cancer screening (mammography) for women aged 50–69. Some countries supply survey data (denoted by ^ in the chart) and others supply programme data (denoted by *).
Across England, Wales and Northern Ireland, breast screening coverage has remained relatively steady over time up until 2019, with an average of 76%. While this country group outperforms many OECD countries, including France and Germany, breast screening coverage is highest in Sweden and Portugal.
About this data
Data on screening coverage in England is collected by the NHS Cancer Screening Programmes. Coverage is defined as the percentage of people in the population who are eligible for screening at a particular point in time, who have had a test with a recorded result at least once within the screening round.
Breast screening coverage is assessed using the 53–70 age group as women may first be called at any time between their 50th and 53rd birthdays. Caution should be used in interpreting the bowel screening data as not all CCGs had full implementation of the programme in the recorded period.
OECD breast cancer screening data: Number of women aged 50–69 who have received a bilateral mammography within the past two years (or according to the specific screening frequency recommended in each country) divided by the number of women aged 50–69 answering survey questions on mammography (for survey-based data) or eligible for an organised screening programme (for programme-based data).
For information about limitations in comparability of OECD data, please see Health at a Glance: OECD Indicators.
^ = Survey data
* = Programme data