Review says that offering bowel cancer screenings to 50-54-year-olds would be cost effective, but may cause long waiting lists for tests and procedures if more resources aren’t also made available
Capacity issues in health services must be addressed before expanding the eligibility for bowel cancer screening to people aged 50-54, an assessment has found.
The HIQA report concluded that beginning the screening service from the age of 50 has been shown to reduce the number of deaths from colorectal cancer.
The health technology assessment also said it would likely be a cost-effective measure. However, it warned that staffing and resource levels would need to change so that additional tests and procedures would not lead to longer waiting lists for essential care.
Currently, BowelScreen is open to people aged between 57 and 71, with plans to expand eligibility to everyone aged 55-74 in the coming years.
More than 192,000 people completed the at-home test for BowelScreen in 2025, representing an uptake rate of 52 per cent.
Those who receive abnormal results after screening are expected to be scheduled for a colonoscopy within 20 working days under HSE key performance indicators.
However, last year 1,212 people were left longer than this recommended timeframe for this care, more than twice the 559 people in breach of this target in 2024.
Meanwhile, almost twice as many people were left waiting longer than four weeks for an urgent colonoscopy last year compared to 2024.
“Our assessment examined the available evidence and we have advised NSAC (National Screening Advisory Committee) that there are clear clinical benefits to expanding the programme to those aged 50-54 years old,” said HIQA’s Deputy CEO Dr Máirín Ryan.
“However, we also highlighted capacity issues that currently exist within the services required for bowel screening.”
“By lowering the age, the population eligible for screening would be increased by 27 per cent. Therefore, we advised that an extension of the BowelScreen programme to those aged 50 to 54 must be done in a way that does not negatively impact the current screening programme or the wider symptomatic services.
“This would require a phased approach to implementation, and significant forward planning and investment in staffing and training to ensure sufficient resources are in place for the extension of screening to those aged 50 to 54.”
Around 2,750 people are diagnosed with bowel cancer in Ireland each year. It is the third leading cause of cancer death here, leading to around 1,000 mortalities annually.
The disease is generally more common in people aged 50 years and older. While the number of new cases of bowel cancer diagnosed each year in older adults has decreased over time, it has stayed the same in those aged 50 to 54 for the last number of years.
Bowel cancer screening is already available for people aged 50 and older in a number of countries, including United States, Canada, Australia, and New Zealand.
The Irish Cancer Society welcomed HIQA’s assessment, saying that it would bring hundreds of thousands of people into the BowelScreen programme and save more lives.
“Three in five bowel cancers detected through screening are caught at Stage 1 or 2, when there is a better chance of cure, compared to just two in five non-screening detected bowel cancers,” said the charity’s director of advocacy Steve Dempsey.
“Four years ago, the Irish Cancer Society’s submission to the National Screening Advisory Committee called for HIQA to investigate the lowering of BowelScreen to begin at 50 years old. On the back of these calls, HIQA was tasked with exploring this and its report published today makes the very welcome recommendation that BowelScreen should be expanded to 50-74 year olds.
“This announcement, while hugely welcome, does not mean BowelScreen will be expanded overnight. We are hopeful that Government will accept HIQA’s recommendation and at the same outline a clear plan as to how it will urgently investment in endoscopy, histopathology and diagnostic radiology services so that this proposed BowelScreen expansion can become a reality.”
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