Simple text reminders could help close London’s bowel cancer screening gap

The project compared two approaches to encourage people who didn’t respond to their initial invitation to complete their cancer screening. 

Surrey’s researchers worked with colleagues from University College London and Queen Mary University of London to test both text message reminders and personalised telephone support with more than 3,000 people across eight London boroughs. Both approaches tripled screening uptake among initial non-responders compared with no follow-up, with text messages proving highly cost-effective at £1.82 per additional person screened. 

London’s bowel cancer screening uptake stands at 63.8 per cent, eight percentage points below the national average. Early detection through screening can significantly improve cancer outcomes, but many people don’t complete their test kits after receiving them. 

The randomised controlled trial found that simple automated text reminders sent at 19, 21, 23 and 25 weeks increased uptake among initial non-responders from 2.0 per cent to 6.5 per cent. If this approach were rolled out across London, the increased uptake would equate to an additional 18,000 people being screened for bowel cancer each year – which would lead to an average of 50 extra bowel cancers being detected at an earlier and therefore usually more treatable stage. Telephone support from trained navigators, who helped people overcome specific barriers to screening, increased uptake to 7.5 per cent overall. 

The study has been published in the British Journal of Cancer. 

The study, conducted between June and July 2025, randomised 3,129 people who had not returned their screening kits within 18 weeks. One group received no further contact, a second received automated text reminders and a third received an initial text followed by telephone calls from patient navigators trained to address common barriers. 

Common reasons people gave for not screening included thinking they were already up to date (19.4 per cent), not receiving their test kit (19.4 per cent) and being too busy (13.4 per cent). The navigators found that men who thought they were up to date were particularly responsive to telephone support, with 39.6 per cent completing screening after the call compared with 20.4 per cent of women reporting the same reason. 

All participants who answered the phone rated their experience highly. Less than 1 per cent of people opted out of receiving text messages. 

The research was funded by NHS England and the National Institute for Health and Care Research Policy Research Unit for Cancer Awareness, Screening and Early Diagnosis. The findings suggest that text message reminders could be rolled out across London to help reduce regional inequalities in screening uptake. Telephone calls could be used more selectively, targeting groups for whom they prove most effective and cost-effective, particularly men. 

The NHS Bowel Cancer Screening Programme offers faecal immunochemical test (FIT) screening to adults aged 50–74 in England. The NHS sends a home test kit directly to eligible adults every two years. The kit contains a small plastic stick and a collection tube. To complete the test, you wipe the stick across a bowel movement, place it in the tube and post it back using the prepaid envelope provided. The sample is then tested for tiny traces of blood, which can be an early sign of bowel cancer or growths called polyps. Most people receive a normal result within two weeks. Those whose samples show blood are invited for further investigation, usually a colonoscopy, to find the cause. The whole process takes just a few minutes at home and requires no preparation or appointment. 

If you are aged 50–74 and have not taken part in the screening programme, and would like to learn more, please visit https://www.nhs.uk/tests-and-treatments/bowel-cancer-screening/. Alternatively, you can call 0800 707 6060. 

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Notes to editors 

• Dr Robert Kerrison is available for interview. For more information, please contact the University of Surrey’s media office via mediarelations@surrey.ac.uk. 
• Dr Kerrison is supported by a Cancer Research UK Population Research Fellowship.