ObjectivesTo identify the reasons why some people do not participate in bowel cancer screening so that steps can be taken to improve informed decision-making.DesignQualitative study, using focus groups with thematic analysis of data to identify, analyse and report patterns. Transcripts were repeatedly read and inductively coded using a phenomenological perspective, and organised into key themes.SettingBelfast and Armagh, two areas of Northern Ireland with relatively low uptake of bowel cancer screening.ParticipantsTen women and 18 men in three single-gender focus groups (two male and one female), each with 9–10 participants. Study participants were recruited by convenience sampling from the general public and were eligible for, but had not taken part in, the Northern Ireland Bowel Cancer Screening Programme.ResultsKey themes identified were fear of cancer; the test procedure; social norms; past experience of cancer and screening; lack of knowledge or understanding about bowel cancer screening; and resulting behaviour towards the test. Fear about receiving bad news and reluctance to conduct the test themselves were reactions that participants seemed willing to overcome after taking part in open discussion about the test.ConclusionsWe identified barriers to participation in bowel cancer screening and used these insights to develop new materials to support delivery of the programme. Some of the issues raised have been identified in other UK settings, suggesting that knowledge about barriers, and strategies to improve uptake, may be generalisable.

Contributors the report was devised and drafted by MBL. GI and HGC performed data analysis. WD and tAO contributed to data interpretation. All authors approved the final version. Funding HGC is funded by a Cancer research UK Career establishment Award (reference:C37703/ A25820). *These 609 high-risk cases under 2020 guidance (see ref. 1 for definitions) comprise: 371 cases with advanced polyp (AP) plus 1-3 other premalignant polyps (PMP) but total <5; 114 cases with ≥5 PMPs but no APs; 101 cases with ≥5 PMPs and at least 1 AP; 23 cases with an isolated large (≥20 mm), large non-pedunculated colorectal polyp and no other PMPs.

The £ for lb. Challenge was an effective, low-cost health improvement intervention with meaningful weight loss for many participants, particularly male workers. With high levels of engagement and ownership, and successful collaboration between public health, voluntary bodies, private companies and public organisations, it is a novel workplace-based model with potential to expand.

AimsWe report pathology findings from the first 10 years of the faecal–occult blood‐based Northern Ireland Bowel Cancer Screening Programme, presenting summary data and trends in pathology diagnoses and clinicopathological features of screen‐detected cancers.Methods and resultsData were analysed from a comprehensive polyp‐level pathology database representing all endoscopy specimens from programme inception in 2010 until 2021. A total of 9800 individuals underwent 13 472 endoscopy procedures, yielding 25 967 pathology specimens and 32 119 diagnoses. Index specimen diagnoses (4.1%) and index colonoscopies (10.4%) yielded a diagnosis of colorectal cancer, representing 1045 cancers from 1020 individuals (25 with synchronous cancers). A further 13 index cancers were identified via computed tomography colonography; 65.3% of cancer diagnoses were in males; 41.7% were stage I, 23.1% stage II, 25.8% stage III and 1.8% stage IV (7.6% unstaged). Of 233 pT1 cancers diagnosed within local excision specimens, 79 (33.9%) had completion surgery. Ten‐year trends showed a steady decline in the proportion of index colonoscopies that yielded a diagnosis of cancer (14.7% in year 1; 4.8% in year 11) or advanced colorectal polyp. There was a strong upward trend in diagnoses of sessile serrated lesions, which overtook hyperplastic polyps in proportions of total index diagnoses by the end of the study time‐frame (8.7% compared to 8.5%).ConclusionsOver the first 10 years of a population colorectal cancer screening programme, ‘real world’ pathology data demonstrate success in the form of reduced diagnoses of cancer and advanced colorectal polyp with passage of successive screening rounds. Interesting trends with respect to serrated polyp diagnoses are also evident, probably related to pathologist and endoscopist behaviour.

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