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 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 2002 to 77% in 2009, where it remained stable until 2012 when it gradually began to decrease. In 2019, breast screening coverage was 75%; six million women were eligible for screening and 4.5 million women had been screened within the last three years. Coverage was highest in the 65-69 age group (76%) and lowest in the 53-54 age group (72%). There was also regional variation, with the North East reporting the highest coverage at 78% and London reporting the lowest coverage at 67% (data not shown).
The national review of screening programmes identified opportunities for improving the uptake, coverage and functioning of the breast screening programme. These include targeting breast screening on the basis of an individual’s risk and offering women the opportunity to attend screening at times and places they find convenient.
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 implemented into the NHS Cervical Screening Programme and it was rolled out fully across England in December 2019. Coverage is 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 2011 to 72% in 2019. 15 million women were eligible for cervical screening in 2019 and 10.9 million women were screened within the specified target period. Coverage is 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 2011 to 70% in 2019. For women aged 50 to 64 years, coverage fell from 80% in 2011 to 76% in 2019. At a regional level, coverage for the total target age group ranged from 65% in London to 75% in the East Midlands (data not shown).
The incidence of cervical cancer is expected to decrease as the effects of the HPV vaccination emerge. In March 2019, Public Health England launched a national cervical screening campaign with the aim of helping women understand and be less fearful of cervical screening to improve uptake.
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 is being introduced in England at the age of 55. In August 2018, it was announced that bowel cancer screening in England will in the future start at the age of 50. NHS England and Public Health England are now considering how to lower the screening age as part of the NHS Long Term Plan.
This indicator measures the coverage of men and women who were eligible for FOB test 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 61% in 2018/19. 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 was met for the first time in 2018/19.
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 *).
In England, Wales and Northern Ireland (grouped), breast screening coverage has remained relatively steady over time with an average of 76%. While this country group outperforms many OECD countries, including France and Germany, breast screening coverage is higher in the Netherlands and Finland.
The OECD also collects international data on cervical cancer screening for women aged 20-69. Again, some countries supply survey data (denoted by ^ in the chart) and others supply programme data (denoted by *).
Compared to other countries, the UK has one of the highest cervical cancer screening rates. However, there has been a gradual decrease in the proportion of women screened over time from 79% in 2010 to 75% in 2018.
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 to 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).
OECD cervical cancer screening data: Number of women aged 20-69 who have been screened for cervical cancer within the past three years (or according to the specific screening frequency recommended in each country) divided by the number of women aged 20-69 answering the survey question (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 2019: OECD Indicators.
^ = Survey data
* = Programme data