# data[].attributes.headline
Cancer care and screening for people with a learning disability in primary care

# data[].attributes.subject
Cancer care and screening for people with a learning disability in primary care

# data[].attributes.attachment_link.title
NHS bowel cancer screening: helping you decide

# data[].attributes.attachment_link.description
You can choose if you take part in bowel cancer screening. This leaflet aims to help you decide.

# data[].attributes.headline
Video instruction on using Bowel Cancer Screening

# data[].attributes.subject
Video instruction on using Bowel Cancer Screening

# data[].attributes.attachment_link.title
Using your bowel cancer screening kit on Vimeo

# data[].attributes.attachment_link.description
Join the web’s most supportive community of creators and get high-quality tools for hosting, sharing, and streaming videos in gorgeous HD with no ads.

# data[].attributes.body
Your Guide to NHS Breast Screening

# data[].attributes.attachment_link.readable_text
Public Health England ( PHE) created this information on behalf of the NHS. In this information, the word 'we' refers to the NHS service that provides screening.

It is your choice whether to have breast screening or not. This leaflet aims to help you decide.

Why the NHS offers breast screening

The NHS offers screening to save lives from breast cancer. Screening does this by finding breast cancers at an early stage when they are too small to see or feel. Screening does not prevent you from getting breast cancer.

Breast screening does have some risks. Some women who have screening will be diagnosed and treated for breast cancer that would never otherwise have been found or caused them harm.

Why you have been invited for breast screening

All women aged 50 up to their 71st birthday are invited for breast screening every 3 years. We send out first invitations to screening some time between your 50th and 53rd birthdays.

If you are aged 71 or over, you are still at risk of breast cancer. Although you will no longer receive screening invitations after your 71st birthday, you can still have breast screening every 3 years. You will need to ask your local breast screening unit for an appointment. Find details of your local unit on the NHS.UK website.

Some local breast screening services may send you SMS (text) appointment reminders for breast screening.

Breast cancer

Breast cancer starts when cells in the breast begin to grow in an uncontrolled way and build up to form a lump (also known as a tumour). As the cancer grows, cells can spread to other parts of the body and this can be life-threatening.

Breast cancer is the most common type of cancer in the UK. About 12,000 women in the UK die of breast cancer every year. Survival from the disease has been improving over time, and now about 3 out of 4 women diagnosed with breast cancer are alive 10 years later.

Your risk of getting breast cancer goes up as you get older. About 4 out of 5 breast cancers are found in women over 50 years old. Most women with breast cancer do not have a family history of the disease.

Breast screening

Breast screening uses an X-ray test called a mammogram to check the breast for signs of cancer. It can spot cancers that are too small to see or feel.

Choosing to have breast screening

When you arrive at the breast screening unit, the staff will check your details and ask you about any breast problems you have had. If you have any questions, please ask.

Mammograms are carried out by women called mammographers. The mammographer will first explain what will happen. She will then place your breast onto the mammogram machine and lower a plastic plate onto it to flatten it. This helps to keep your breast still and get clear X-rays.

The mammographer will usually take 2 X-rays of each breast, one from above and one from the side. She will go behind a screen while the X-rays are taken. You have to keep still for several seconds each time.

The whole appointment takes less than 30 minutes and the mammogram only takes a few minutes.

You may be asked if you want to take part in a clinical trial

These are medical research studies. Any trial you are offered will gather information about the best types of breast cancer tests or treatments so we can help women more effectively in the future. You can choose whether to take part or not.

Preparing for your mammogram

To have a mammogram, you need to undress to the waist. So it may be easier to wear a skirt or trousers instead of a dress.

Please do not use a spray deodorant or talcum powder as this may show up on your mammogram. You can use roll-on deodorant.

What having a mammogram feels like

Having a mammogram can be uncomfortable, and some women find it painful. Usually, any pain passes quickly.

Please phone your breast screening unit before coming for your appointment if you:

need information in another format

need additional support to attend screening, for example if you have a learning disability or mobility problems

have breast implants

have a pacemaker or any other implanted medical device

are pregnant or breastfeeding

are under the care of a breast consultant

have had a mammogram in the last 6 months

Breast screening results

You will receive a letter with your breast screening results within 2 weeks of your appointment. The results will also be sent to your GP.

Occasionally women will need another mammogram before they get their result. Sometimes technical problems mean that the mammogram is not clear enough to read. If this happens, you will be asked to have another mammogram to get a clearer picture of your breast.

Most women will have no sign of cancer

In about 96 out of every 100 women screened the mammogram will show no sign of cancer, and no further tests are needed.

Cancer can still develop between mammograms. Remember to check your breasts and tell your GP straight away if you notice any unusual changes.

Some women will need more tests

The results letter may say you need more tests because the mammogram looks abnormal. About 4 in every 100 women are asked to come back for more tests after screening.

Out of these 4 women, 1 will be found to have cancer. The rest will not have cancer and will go back to having screening invitations every 3 years.

If you are called back for more tests, you may have a breast examination, more mammograms and ultrasound scans. You may also have a biopsy, which is when a small sample is taken from your breast with a needle to be checked under a microscope. You will usually get your results within a week.

If you are found to have breast cancer, it could be either non-invasive or invasive

Non-invasive breast cancer

About 1 in 5 women diagnosed with breast cancer through screening will have non-invasive cancer. This means there are cancer cells in the breast, but they are only found inside the milk ducts (tubes) and have not spread any further. This is also called ductal carcinoma in situ ( DCIS). In some women, the cancer cells stay inside the ducts. But in others they will grow into (invade) the surrounding breast in the future.

Doctors cannot tell whether non-invasive breast cancers will grow into the surrounding breast or not.

Invasive breast cancer

About 4 in 5 women diagnosed with breast cancer through screening will have invasive cancer. This is cancer that has grown out of the milk ducts and into the surrounding breast. Most invasive breast cancers will spread to other parts of the body if left untreated.

Diagram showing the development of breast cancer in a milk duct

Breast cancer treatment

Whether the cancer is invasive or non-invasive, you will be offered treatment and care from a team of breast cancer specialists. The treatment is likely to include surgery (which may mean a mastectomy), radiotherapy, hormone therapy and possibly chemotherapy. These treatments can cause long-term side effects.

Making a choice: the possible benefits and risks of breast screening

It is your choice whether or not you have breast screening. There are many different reasons why women decide whether or not to have screening. To help you decide, we have included information on the possible benefits and risks.

Screening saves lives from breast cancer.
Lives are saved because cancers are diagnosed and treated earlier than they would have been without screening.

Screening finds breast cancers that would never have caused a woman harm.
Some women will be diagnosed and treated for breast cancer that would never otherwise have been found and would not have become life-threatening. This is the main risk of screening.

Doctors cannot always tell whether a breast cancer that is diagnosed will go on to be life-threatening or not, so they offer treatment to all women with breast cancer. This means that some women will be offered treatment that they do not need.

Weighing up the possible benefits and risks of breast screening

There is debate about how many lives are saved by breast screening and how many women are diagnosed with cancers that would never have become life-threatening. The numbers below are the best estimates from a group of experts who have reviewed the evidence.

Saving lives from breast cancer

Screening saves about 1 life from breast cancer for every 200 women who are screened. This adds up to about 1,300 lives saved from breast cancer each year in the UK.

Finding cancers that would never have caused a woman harm

About 3 in every 200 women screened every 3 years from the age of 50 up to their 71st birthday are diagnosed with a cancer that would never have been found without screening and would never have become life-threatening. This adds up to about 4,000 women each year in the UK who are offered treatment they did not need.

Overall, for every 1 woman who has her life saved from breast cancer, about 3 women are diagnosed with a cancer that would never have become life-threatening.

Researchers are trying to find better ways to tell which women have breast cancers that will be life-threatening and which women have cancers that will not.

Other risks of breast screening

Most women who need more tests after breast screening are found not to have breast cancer. These women experience unnecessary worry and some feel distress which affects their ability to do their normal day-to-day activities at the time.

X-rays can very rarely cause cancer. Having mammograms every 3 years for 20 years very slightly increases the chance of getting cancer over a woman's lifetime.

Mammograms do not find all cancers. Sometimes they cannot be seen on the mammogram, and very occasionally mammogram readers will miss a cancer on the X-ray. Your breasts may change between screening appointments so it is important to check your breasts regularly to know what is normal for you. Please talk to your GP if you have any concerns.

Symptoms of breast cancer

If you get to know how your breasts normally look and feel, you will be more likely to spot any changes that could be signs of breast cancer. This is important even if you have been for breast screening. Look out for:

a lump or thickening in the breast

a swelling or lump in the armpit

a change in the nipple, which might be pulled back into the breast, or change shape - you might have a rash that makes the nipple look red and scaly, or have blood or another fluid coming from the nipple

a change in how the breast feels or looks - it may feel heavy, warm or uneven, or the skin may look dimpled; the size and shape of the breast may change

pain or discomfort in the breast or armpit

If you have any change to your breast, you should make an appointment to see your GP straight away. You may not have cancer. But if you do, being diagnosed and treated at an early stage may mean you are more likely to survive breast cancer.

What happens to your mammograms after screening

The NHS Breast Screening Programme will keep your mammograms for at least 8 years. These are saved securely. The programme regularly checks records to make sure the service is as good as possible. Staff in other parts of the health service may need to see your records for this, but your records will only be shared with people who need to see them.

We will review your previous screening results if you are diagnosed with breast cancer between screening appointments. You can see the results of this review if you wish.

Confidentiality

The NHS screening programmes use personal information from your NHS records to invite you for screening at the right time. Public Health England also uses your information to ensure you receive high quality care and to improve the screening programmes. Find out more about how your information is used and protected, and your options.

More information

If you have questions about screening, please contact your local breast screening unit.

If you would like to talk to someone about whether to have breast screening, your GP can help. Together, you can weigh up the possible benefits and risks, to help you decide.

Information about breast screening can be found on the NHS website, including details of your local breast screening unit.

Find out how to opt out of screening.

# data[].attributes.attachment_link.title
NHS breast screening: helping you decide

# data[].attributes.attachment_link.description
Public Health England ( PHE) created this information on behalf of the NHS. In this information, the word 'we' refers to the NHS service that provides screening. It is your choice whether to have breast screening or not. This leaflet aims to help you decide. The NHS offers screening to save lives from breast cancer.

# data[].attributes.headline
Check your breasts regularly and always get checked if something isn't right. 

# data[].attributes.subject
Check your breasts regularly and always get checked if something isn't right. 

# data[].attributes.headline
Guidance on how to collect your poo and complete the FIT

# data[].attributes.subject
Guidance on how to collect your poo and complete the FIT

# data[].attributes.headline
Guidance for NHS population screening: information for trans and non-binary people

# data[].attributes.subject
Guidance for NHS population screening: information for trans and non-binary people

# data[].attributes.body
This information is for trans (transgender) and non-binary people in England. It tells you about the adult NHS screening programmes that are available in England and explains who we invite for screening.

# data[].attributes.attachment_link.title
NHS population screening: information for trans and non-binary people

# data[].attributes.attachment_link.description
This information is for trans (transgender) and non-binary people in England. It tells you about the adult NHS screening programmes that are available in England and explains who we invite for screening.

# data[].attributes.headline
Information on Cancer risk and screening for people who are transgender, non binary and gender diverse by OUTpatients the UK's LGBTIQ+ cancer charity

# data[].attributes.subject
Information on Cancer risk and screening for people who are transgender, non binary and gender diverse by OUTpatients the UK's LGBTIQ+ cancer charity

# data[].attributes.headline
Video of a trans man attending cervical screening

# data[].attributes.subject
Video of a trans man attending cervical screening

# data[].attributes.headline
NHS England South West - Health Inequalities Screening Flowchart 

# data[].attributes.subject
NHS England South West - Health Inequalities Screening Flowchart 

# data[].attributes.body
Video made by people with a learning disability for people with a learning disability explaining breast screening

# data[].attributes.attachment_link.description
Taking the fear out of going for breast screening. A film by and for women with learning disabilities.

A biggerhouse film production for Avon Breast Screening.

# data[].attributes.headline
Macmillan Easy Read information on Breast Screening

# data[].attributes.subject
Macmillan Easy Read information on Breast Screening

# data[].attributes.body
An Easy Read Guide to Bowel Screening

# data[].attributes.headline
Bowel cancer leaflet designed for people with a learning disability

# data[].attributes.subject
Bowel cancer leaflet designed for people with a learning disability

# data[].attributes.attachment_link.title
CS57603 NHSE SW Bowel Cancer A5 leaflet (1)

# data[].attributes.headline
Video explaining bowel screening for people with a learning disability

# data[].attributes.subject
Video explaining bowel screening for people with a learning disability

# data[].attributes.attachment_link.description
Maggie has done the bowel screening test and thinks that other people with a learning disability should do the same.

# data[].attributes.body
Easy ready information on cervical screening

# data[].attributes.body
Macmillan Easy read information on Cervical Screening

# data[].attributes.attachment_link.title
Bowel cancer screening: having a colonoscopy

# data[].attributes.attachment_link.description
This information is for people invited for colonoscopy after bowel screening. You can choose if you have a colonoscopy. This leaflet aims to help you decide.

# data[].attributes.attachment_link.description
It is your choice whether to have a cervical screening test or not. This guidance aims to help you decide. Cervical screening used to be called a ‘smear test’.

# data[].attributes.headline
Timeline of what screening is offered to people. Please note as on July 2025 all women are now offered cervical screening every 5 years. 

# data[].attributes.subject
Timeline of what screening is offered to people. Please note as on July 2025 all women are now offered cervical screening every 5 years. 

# data[].attributes.body
This leaflet is sent with invites to cervical screening.

# data[].attributes.attachment_link.title
Your Guide to NHS Cervical Screening July 25

# data[].attributes.headline
An NHS video explaining what screening is.

# data[].attributes.subject
An NHS video explaining what screening is.

# data[].attributes.attachment_link.description
Find out about the different types of screening offered by the NHS in England.

# data[].attributes.headline
Screening offered to women - Please note the age of Bowel Screening is now 50 and all women are now offered cervical screening every 5 years.

# data[].attributes.subject
Screening offered to women - Please note the age of Bowel Screening is now 50 and all women are now offered cervical screening every 5 years.

# data[].attributes.attachment_link.title
Female lifetime screening pathway (English)

# data[].attributes.headline
Screening available for men. Please note bowel screening is now offered to everyone from the age of 50.

# data[].attributes.subject
Screening available for men. Please note bowel screening is now offered to everyone from the age of 50.

# data[].attributes.attachment_link.title
Male lifetime screening pathway (English)

# data[].attributes.headline
The Eve Appeal Website information on cervical cancer screening

# data[].attributes.subject
The Eve Appeal Website information on cervical cancer screening

# data[].attributes.attachment_link.description
Information on cervical screening tests- what they are, what to expect at your appointment and tips on how to make your appointment easier.

# data[].attributes.headline
How to spot cervical cancer - Getting checked early

# data[].attributes.subject
How to spot cervical cancer - Getting checked early

# data[].attributes.headline
Cervical Screening - A guide for survivors of rape, sexual assault and sexual abuse

# data[].attributes.subject
Cervical Screening - A guide for survivors of rape, sexual assault and sexual abuse

# data[].attributes.headline
Beyond words guide to cervical screening

# data[].attributes.subject
Beyond words guide to cervical screening

# data[].attributes.headline
Cervical Screening video - full programme

# data[].attributes.subject
Cervical Screening video - full programme

# data[].attributes.headline
Tips for cervical screening for trans men and non binary people.

# data[].attributes.subject
Tips for cervical screening for trans men and non binary people.

# data[].attributes.attachment_link.title
Tips for your screening appointment - The Eve Appeal

# data[].attributes.attachment_link.description
Tips to help make cervical screening tests easier for trans men, non-binary and intersex people with a cervix.

# data[].attributes.headline
Cervical screening support for people who feel anxious about screening

# data[].attributes.subject
Cervical screening support for people who feel anxious about screening

# data[].attributes.attachment_link.readable_text
This information is for women and people with a cervix who find it difficult to attend cervical screening.

You may feel understandably anxious or worried about attending, this could be for many reasons and may include:

a mental health condition

previous cervical screening experience(s)

previous traumatic experience(s)

sexual and/or domestic violence

This information talks about what support is available if you are worried, feel anxious or think it may be painful when attending your cervical screening. You can use this information to help decide whether to attend and to find support to make it easier for you if you would like it.

Cervical screening

Cervical screening tests for human papillomavirus ( HPV).

HPV is very common. Most people will get the virus at some point in their life. It is spread through close skin to skin contact during any type of sexual contact. There are many different types of HPV, some types can cause abnormal cell changes, but only some types can lead to cancer, these types do not cause any symptoms. In most cases, your immune system can get rid of the virus without you ever knowing you had it.

Sometimes HPV can stay in the body for many years at undetectable levels without causing any problems. This is called 'dormant' HPV. Dormant HPV can become active and is then found at screening. This means the HPV infection can become active again years after you have it. HPV can cause abnormal cell changes in your cervix.

Your cervix is the lowest part of your uterus (or womb), and it is found at the top of your vagina.

Diagram showing the female reproductive system.

Your body can usually get rid of the abnormal cells and your cervix returns to normal. But sometimes this doesn't happen, and the abnormal cells can go on to develop into cancer. This is usually a slow process taking over 10 years.

Going for cervical screening when invited is the best way to protect yourself against cervical cancer. It is your choice whether to have a cervical screening test or not. Please read the leaflet about cervical screening available at: Cervical screening: leaflet for women considering screening - GOV.UK (www.gov.uk). This leaflet will help you decide whether to have the test and provide more information about HPV and cervical cancer.

You will get an invitation for cervical screening through the post if:

your contact details are up to date

you are between 25 and 64 years old

you are registered as female on your NHS records*

In some areas, you may be able to arrange your appointment at a sexual health clinic instead of your GP practice.

If you are not registered at a GP practice and would like to have screening at a GP practice, you will need to register first; more information about registering is available at: How to register with a GP surgery - NHS (www.nhs.uk)

In some areas, local sexual health clinics may also offer screening. More information about finding a sexual health clinic local to you is available at: Find a sexual health clinic - NHS (www.nhs.uk).

If you are not sure if you are due for cervical screening, you can ask your GP or health professional.

*If you have a cervix but are not registered as female with your GP you will need to ask for a cervical screening appointment. You can talk about this with your GP, practice nurse, at a sexual health clinic or transgender health clinic. More information is available at: NHS population screening: information for trans and non-binary people

Booking your appointment

Before you book your appointment, it might help to think about what would make screening easier for you. You might already know what can help or you may want to discuss this with a nurse or health professional who can make some suggestions. Here are some tips that might help:

If you get anxious sitting in waiting rooms, let the receptionist know. You can ask to book the first appointment of the day, so that you do not have to wait long.

If you would prefer to be seen by a woman, ask for a female health professional.

Tell the receptionist if you would like a chaperone. This is a usually another health professional. You might also want a friend, relative or carer present.

You may feel you need more time for your cervical screening appointment. Ask the receptionist if you can book a longer appointment to give you more time during and after.

You may also wish to consider asking for an appointment just to talk about what happens during the screening first (you do not have to have the test at this appointment).

If you find screening painful a doctor may be able to prescribe creams or medications to help you feel more relaxed.

Before your appointment

You may find it helpful to:

plan your journey

listen to music or watch something on your phone to help you relax, or bring something to read

consider what to wear to your appointment; if you feel more comfortable wearing a skirt, dress or long top, it may help you feel more covered (you can keep these clothes on during your test and only take off your underwear)

speak to the health professional beforehand to discuss your concerns if you think the test may be uncomfortable as they can offer support

ask someone you trust to go with you, such as a friend, relative or carer/mental health worker, who can also be with you after your appointment

Questions to ask the health professional

It might be helpful to think of any questions you want to ask the health professional before your appointment.

We want to make you feel at ease so you have the best possible experience - you can ask for extra support for any reason, including if you:

have a mental health condition

take medication that makes you shake

find it hard to leave your house

sometimes find it hard to process information

do not like to feel exposed by removing your clothes

are embarrassed by showing your body

have scars

feel like you might be judged

feel like a burden

are afraid it will hurt

may start to cry or freeze up

may pass out or faint

may have a panic attack

get distressed during a physical examination

have had a negative cervical screening experience in the past

have experienced trauma

are a survivor of sexual violence

are a survivor of female genital mutilation or cutting (FGM/C)

want to be warned before the health professional touches you

find that waiting rooms make your symptoms worse

find that certain words, actions or positions trigger anxiety attacks or flashbacks

You may want to print out and fill in the extra support checklist to take with you to your screening test.

During your appointment

The cervical screening test takes a few minutes - here's what to expect at your appointment:

The health professional will explain the test at the start of your appointment.

1. You will have a private space to undress from the waist down and you will have a modesty sheet to cover you - remember you can wear a long top or dress/skirt to help you feel less exposed.

2. There may be different positions that could make the test more comfortable for you, like lying on your side. Your healthcare professional will work with you to make sure you are in the most comfortable position.

3. A speculum (usually plastic) will be gently put into your vagina. It opens so the health professional can see your cervix. Speculums come in a range of sizes. Talk to your health professional to discuss the size that is most appropriate for you.

4. The health professional will use a small, soft brush to take a sample of cells from your cervix.

5. Your test could feel uncomfortable but remember, you are in control during the test. It may help to agree a word or hand signal, so the health professional knows to stop immediately if you want them to.

After the test

The sample of cells is sent to the laboratory for testing.

We will send your screening result to you by post. The nurse or doctor who does your screening test will tell you when you can expect to get your result letter, and they will also get a copy. Please make sure you tell your GP practice or healthcare professional about any changes to your address.

You may feel anxious while waiting for your results. It may help to speak with someone you trust about how you are feeling.

Cervical screening results

HPV negative

Most people get an HPV negative result. This means no further tests are needed and you will be called back for screening when your next test is due.

HPV positive, no abnormal cells

If your sample is HPV positive, we also test it for abnormal cells. If none are found, your result will say you have HPV, but no abnormal cells. We will ask you to come for screening again sooner than usual. Your result letter will explain when.

HPV positive, abnormal cells

There are several 'grades' of abnormal cells as some are more serious than others. Your result letter will explain what your results mean. If you have HPV and any grade of abnormal cervical cells we will refer you for colposcopy (see information below).

Further information about having a colposcopy is available at: NHS cervical screening - having a colposcopy.

Occasionally a sample may be called 'unavailable' or 'inadequate'. This means that we were not able to get a result from your screening sample. This sometimes happens when there are not enough cells in the sample to get a result or due to a technical problem at the laboratory.

We will send you a letter inviting you for a repeat test in 3 months. Waiting 3 months gives your body enough time to make new cells, meaning it is less likely to happen again.

Looking after your health

You will get another invitation through the post when you are due for cervical screening again.

If you have any unusual symptoms, please tell your GP as soon as possible. These might include:

vaginal bleeding that is unusual for you; bleeding between your periods, during or after sex, after the menopause or having heavier periods than usual

pain during sex

changes to vaginal discharge

pain in your lower back, between your hip bones (pelvis), or in your lower tummy (abdomen)

These symptoms are often caused by other things, but it is important to get them checked. In rare cases cervical cancer can develop in between screening tests. But if you are found to have cancer, getting it diagnosed and treated early can mean you are more likely to survive.

Screening is not a test for investigating symptoms. If you have any of these changes, don't wait for your next cervical screening appointment. See your GP as soon as possible. Your GP can examine you and refer you to a gynaecology clinic if necessary.

Getting support

If you need support, you:

can talk to a trusted friend, relative or health professional

may find it helpful to seek spiritual support from a religious or spiritual leader

may want to talk to someone at The Havens, Samaritans or SANE

The Havens

The Havens are specialist centres in London for people who have been raped or sexually abused. Telephone 020 3299 6900 for urgent advice or an appointment.

My Body Back (London and Glasgow)

My Body Back offers support to people to reclaim control of their body after sexual violence. It runs specialist clinics offering cervical screening and sexually transmitted infection (STI) testing in London and Glasgow for women, transgender and non-binary people who have experienced sexual violence.

Email: info@mybodybackproject.com

Samaritans

Samaritans is available round the clock, every single day of the year. You can talk to them any time you like, in your own way, about whatever's getting to you.

Call free, any time: 116 123

Email: jo@samaritans.org

SANE

SANE is a national mental health helpline offering specialist emotional support to anyone affected by mental illness.

SANEline: 0300 304 7000 (every day, 4.30 to 10pm).

Support for victims of sexual violence and abuse

Advice and support for those who are experiencing or feel at risk of sexual violence and abuse is available at: Support for victims of sexual violence and abuse - GOV.UK (www.gov.uk)

National FGM Support Clinics

National FGM Support Clinics (NFGMSCs) are community-based clinics that offer a range of support services for women with female genital mutilation (FGM)

More information and clinic locations can be found at: National FGM Support Clinics - NHS - NHS (www.nhs.uk)

Acknowledgement

This information is adapted from a leaflet developed by Dr Frederique Lamontagne-Godwin, which was based on research with users of mental health services and was supported by:

NHS Dorset Healthcare University Foundation Trust

University of Surrey

University of West London

West London NHS Trust

We are grateful to all the patients, service user groups, professionals and frontline staff who helped in the making of that leaflet.

# data[].attributes.attachment_link.title
Cervical screening: support for people who feel anxious about attending

# data[].attributes.attachment_link.description
This information is for women and people with a cervix who find it difficult to attend cervical screening. You may feel understandably anxious or worried about attending, this could be for many reasons and may include: a mental health condition previous cervical screening experience(s) previous traumatic experience(s) sexual and/or domestic violence This information talks about what support is available if you are worried, feel anxious or think it may be painful when attending your cervical screening.

# data[].attributes.headline
Video made by a women with a learning disability regarding cervical screening. - Please note it was not possible to link directly to the video so you need to scroll down a bit. 

# data[].attributes.subject
Video made by a women with a learning disability regarding cervical screening. - Please note it was not possible to link directly to the video so you need to scroll down a bit. 

# data[].attributes.attachment_link.title
Further help and support for cervical screening

# data[].attributes.attachment_link.description
Find out where to get further help and support with cervical screening.

# data[].attributes.headline
Greater Manchester Cancer Alliance Video of a woman with learning disabilities and autism attending cervical screening

# data[].attributes.subject
Greater Manchester Cancer Alliance Video of a woman with learning disabilities and autism attending cervical screening

# data[].attributes.attachment_link.title
Cervical screening films for women with learning disabilities and autistic women

# data[].attributes.attachment_link.description
A short collection of films co-produced by women with learning disabilities and / or autistic women. Find out everything you need to know about smear tests,…

# data[].attributes.headline
Supporting access and tackling barriers to breast screening - Cancer Research UK

# data[].attributes.subject
Supporting access and tackling barriers to breast screening - Cancer Research UK

# data[].attributes.body
Interventions addressing barriers to accessing screening

# data[].attributes.attachment_link.title
Supporting access and tackling barriers to breast screening

# data[].attributes.attachment_link.description
How interventions that address barriers to accessing breast screening services can tackle inequalities in uptake and access.

# data[].attributes.headline
A selection of videos for people with SMI regarding screening

# data[].attributes.subject
A selection of videos for people with SMI regarding screening

# data[].attributes.attachment_link.title
Cancer and serious mental illness :: South East London Cancer Alliance

# data[].attributes.attachment_link.description
Cancer is a worrying topic for anyone. If you’ve got a serious mental illness, cancer might seem particularly scary, isolating or overwhelming.

# data[].attributes.headline
Primary care good practice guide for Bowel Cancer Screening

# data[].attributes.subject
Primary care good practice guide for Bowel Cancer Screening

# data[].attributes.headline
Cancer Research UK Bowel Cancer Screening Information 

# data[].attributes.subject
Cancer Research UK Bowel Cancer Screening Information 

# data[].attributes.attachment_link.title
Bowel Cancer Screening | Cancer Research UK

# data[].attributes.attachment_link.description
Information and resources to help healthcare professionals support people to make an informed decision about participating in bowel cancer screening.

# data[].attributes.headline
CRUK Supporting access and engagement with Bowel Screening and evidence review

# data[].attributes.subject
CRUK Supporting access and engagement with Bowel Screening and evidence review

# data[].attributes.attachment_link.readable_text
Understanding the barriers to participation

When looking for ways to support informed bowel screening uptake, it's important to understand who is not engaging with the programme and the barriers that prevent them. Evidence shows some of the common barriers include:

Groups with lower participation

Some groups of people face more significant or frequent barriers to participating in screening. In the UK, although there are gaps in data availability, there's evidence that the following groups are less likely to participate in bowel cancer screening:

Taking part in bowel cancer screening is an individual choice, but one that should be equally available to everyone.

The bowel grid

Our tool to help assess interventions to address inequalities

We've developed a practical tool for health system professionals - that can be used alongside local uptake data and insights - to help you identify which interventions are most likely to improve bowel screening uptake among groups with lower participation across the UK. The tool brings together evidence on the effectiveness of different interventions and can support you to:

Prioritise and target interventions based on their potential to improve uptake in specific groups or across multiple underserved populations.

Understand the barriers or enablers to participation for different groups and which interventions are best placed to address these (using behaviour change models).

Plan implementation and evaluation by considering practical steps to embed and assess your chosen intervention(s).

We recommend watching the introductory video for a walk-through of the tool and how it can be used in practice.
Download the bowel grid tool
We welcome feedback on this tool and insights into how you're using it in your role via our survey.

Interventions for improving uptake

Below are some of the primary-care level interventions that have been shown to improve participation in bowel cancer screening. Other interventions may be implemented at a national level e.g., implementing FIT return deadlines - see the above tool for a more holistic list of interventions.

Call for kit health promotion: phone and in-person support

A study found that offering non-responders a phone or face-to-face consultation with a health promoter can boost screening uptake by up to 15.3%

. These sessions explain how to do the test, address common concerns and barriers, and offer replacement kits.

GP-endorsed letters

GP endorsement via a letter has been shown to increase uptake by up to 6%, and up to 12% when combined with enhanced patient information

.

The Practice Endorsed Additional Reminder Letter (PEARL)  project also found GP-endorsed reminder letters to improve uptake. Patients who hadn't returned a test kit after the standard 28-day reminder were sent a second reminder - this time on GP letterhead and signed by the GP, which increased uptake by 3%

.

Text reminders

Text reminders may increase uptake amongst first-time invitees

, though overall impact is mixed. Ongoing projects, like the  iPLATO and Small Business Research Institute (SBRI) initiative, are exploring how texts can reduce inequalities and improve uptake.

Text reminders have also been shown to be effective at improving uptake in other cancer screening programmes

Download our bowel cancer screening primary care good practice guide(PDF, 1.1 MB) for templates and scripts for GP-endorsed calls, texts and letters.

Supporting attendance to follow-up tests

People with a positive FIT result will be offered follow-up investigation, usually a colonoscopy or sometimes a computer tomography colonography (CTC) or a colon capsule endoscopy (CCE). Recent figures show that around 1 in 4 people with a positive FIT result in Scotland (2022-24)

and England (2023-24) did not attend their follow-up colonoscopy. Barriers to attendance may include anxiety about the procedure and the potential of a cancer diagnosis and surgery. Much like bowel cancer screening, there's evidence that these barriers are more common or persistent for some groups of people, including people from non-white ethnic minorities and from areas of higher deprivation.

Usually, people with a positive FIT are offered an appointment with a specialist nurse or a specialist screening practitioner (SSP). Here, the patient's fitness for a follow-up test is assessed, and they're provided information and counselling to help them make informed decisions about attending further tests. You can play an important role in supporting people to attend their SSP appointment and further tests.

Actions you can take:

Read more

# data[].attributes.attachment_link.title
Access and inequalities | Bowel cancer screening | Cancer Research UK

# data[].attributes.attachment_link.description
Read about inequalities in access to bowel cancer screening, common barriers to participation, and our tool to help you assess interventions for improving informed uptake.

# data[].attributes.headline
Cancer Research UK - Key things to know about FIT for healthcare professionals

# data[].attributes.subject
Cancer Research UK - Key things to know about FIT for healthcare professionals

# data[].attributes.headline
Cancer Research UK - Spot breast cancer early information

# data[].attributes.subject
Cancer Research UK - Spot breast cancer early information

# data[].attributes.attachment_link.description
Read our in-depth guide to breast cancer symptoms. Plus, what to check for, how to check your breasts, and what will happen when you see your GP.

# data[].attributes.headline
Cancer Research UK information on spotting Bowel Cancer early

# data[].attributes.subject
Cancer Research UK information on spotting Bowel Cancer early

# data[].attributes.attachment_link.description
Spot bowel cancer early by knowing the signs. Learn about symptoms, risk factors, and screening options.

# data[].attributes.headline
Cancer Research UK information on spotting Cervical Cancer early

# data[].attributes.subject
Cancer Research UK information on spotting Cervical Cancer early

# data[].attributes.attachment_link.description
Spot cervical cancer early by knowing the signs. Learn about symptoms, risk factors, and screening options.

# data[].attributes.headline
Breast Cancer Now leaflet on knowing your breasts and checking your breasts

# data[].attributes.subject
Breast Cancer Now leaflet on knowing your breasts and checking your breasts

# data[].attributes.headline
Breast Cancer Now leaflet - a guide to breast awareness and screening. 

# data[].attributes.subject
Breast Cancer Now leaflet - a guide to breast awareness and screening. 

# data[].attributes.headline
A practical guide to cervical screening in primary care.

# data[].attributes.subject
A practical guide to cervical screening in primary care.

# data[].attributes.body
For the use of primary care.

# data[].attributes.headline
Health care professional guidance regarding Cervical Screening for transgender and non binary people

# data[].attributes.subject
Health care professional guidance regarding Cervical Screening for transgender and non binary people

# data[].attributes.body
Improving access to cervical screening for transgender and nonbinary people: A practical guide for non clinical staf

# data[].attributes.attachment_link.title
20250401 Transgender Non Binary Opt In_Non-Clinical Guide v1.0

# data[].attributes.headline
Cancer care and screening for people with a learning disability in primary care

# data[].attributes.subject
Cancer care and screening for people with a learning disability in primary care

# data[].attributes.headline
A guide for GP Surgeries on Cervical Screening for physically disabled and autistic people

# data[].attributes.subject
A guide for GP Surgeries on Cervical Screening for physically disabled and autistic people

# data[].attributes.attachment_link.readable_text
This clinical guidance provides resources for registered nurses, midwives and nursing associates who are responsible for providing cervical screening in any setting. The main intention is to encourage and facilitate the uptake of cervical screening for women and those with a cervix who have a physical disability and/or are autistic.

Some of our publications are also available in hard copy, but this may entail a small charge. For more information and to order a hard copy please call 0345 772 6100 and select option five. The line is open Monday-Friday (excluding bank holidays) between 10am-4pm.

You can download all electronic publications from the RCN free of charge.

Page last updated - 03/05/2025

# data[].attributes.attachment_link.title
Cervical Screening for Physically Disabled Women and Autistic Women | Publications | Royal College of Nursing

# data[].attributes.attachment_link.description
Clinical guidance for registered nurses, midwives and nursing associates who are responsible for providing cervical screening in any setting.

# data[].attributes.headline
Fair Advice - Easy read guide to cervical screening

# data[].attributes.subject
Fair Advice - Easy read guide to cervical screening

# data[].attributes.attachment_link.title
Fair advice_Easy read guide to having a smear test

# data[].attributes.headline
Cornwall people first - Easy read leaflet for cervical screening

# data[].attributes.subject
Cornwall people first - Easy read leaflet for cervical screening

# data[].attributes.headline
Videos explaining AAA Screening for people with a learning disability

# data[].attributes.subject
Videos explaining AAA Screening for people with a learning disability

# data[].attributes.attachment_link.description
All men living in England are invited for abdominal aortic aneurysm (AAA) screening the year they turn 65. AAA screening is recommended for anyone assigned m...

# data[].attributes.headline
The South East London Cancer Alliance, has collaborated with the Baked Bean Charity and the Guys Cancer Academy to create a training module on supporting people with a learning disability regarding cancer care and screening

# data[].attributes.subject
The South East London Cancer Alliance, has collaborated with the Baked Bean Charity and the Guys Cancer Academy to create a training module on supporting people with a learning disability regarding cancer care and screening

# data[].attributes.attachment_link.title
Cancer care and screening for people with a learning disability in primary care

# data[].attributes.headline
Toolkit for health checks with people with LD 

# data[].attributes.subject
Toolkit for health checks with people with LD 

# data[].attributes.body
Health Checks are really good opportunities to discuss screening

# data[].attributes.headline
Checklist for patients to identify that extra form is required and why

# data[].attributes.subject
Checklist for patients to identify that extra form is required and why

# data[].attributes.attachment_link.title
Cervical screening extra support checklist

# data[].attributes.headline
Cervical Screening information and guidance to reduce the number of rejected samples

# data[].attributes.subject
Cervical Screening information and guidance to reduce the number of rejected samples

# data[].attributes.attachment_link.title
Cervical Screening - Information and guidance to reduce the number of rejected samples

# data[].attributes.headline
Cancer Research UK - Reducing inequalities in cancer screening

# data[].attributes.subject
Cancer Research UK - Reducing inequalities in cancer screening

# data[].attributes.headline
Overview of the three programme processes

# data[].attributes.subject
Overview of the three programme processes

# data[].attributes.headline
Forms questionnaire for feedback on understanding of screening and barriers

# data[].attributes.subject
Forms questionnaire for feedback on understanding of screening and barriers

# data[].attributes.attachment_link.description
Easily create surveys and polls to collect customer feedback, measure employee satisfaction, and organize team events.

# data[].attributes.headline
Printable version of cancer screening questionnaire

# data[].attributes.subject
Printable version of cancer screening questionnaire

# data[].attributes.headline
Fact sheet for promotion of cervical cancer prevention week

# data[].attributes.subject
Fact sheet for promotion of cervical cancer prevention week

# data[].attributes.attachment_link.title
Eliminating Cervical Cancer – Awareness & Prevention

# data[].attributes.body
This explains what AAA screening is and who is eligible for this screening.

# data[].attributes.attachment_link.title
Abdominal aortic aneurysm (AAA) screening, a free test for men aged 65 and over

# data[].attributes.headline
Videos explaining AAA Screening for people with a learning disability

# data[].attributes.subject
Videos explaining AAA Screening for people with a learning disability

# data[].attributes.attachment_link.description
All men living in England are invited for abdominal aortic aneurysm (AAA) screening the year they turn 65. AAA screening is recommended for anyone assigned m...

# data[].attributes.attachment_link.readable_text
An abdominal aortic aneurysm (AAA) is a bulge or swelling in the aorta, the main blood vessel that runs from the heart down through the chest and tummy.
An AAA can be dangerous if it is not spotted early on.

It can get bigger over time and could burst (rupture), causing life-threatening bleeding.

Men aged 65 and over are most at risk of AAAs. This is why men are invited for screening to check for an AAA when they're 65.

Symptoms of an abdominal aortic aneurysm (AAA)

AAAs do not usually cause any obvious symptoms, and are often only picked up during screening or tests carried out for another reason.

Some people with an AAA have:

a pulsing sensation in the tummy (like a heartbeat)

tummy pain that does not go away

lower back pain that does not go away

If an AAA bursts, it can cause:

Call 999 for an ambulance immediately if you or someone else develops symptoms of a burst AAA.

When to get medical help

Make an appointment to see your GP as soon as possible if you have symptoms, especially if you're at a higher risk of an AAA.

An ultrasound scan of your tummy may be done to check if you have one.

Call 999 for an ambulance immediately if you or someone else develops symptoms of a burst AAA.

Who's at risk of an abdominal aortic aneurysm (AAA)

An AAA can form if the sides of the aorta weaken and balloon outwards. It's not always clear why this happens, but there are things that increase the risk.

People at a higher risk of getting an AAA include:

men aged 65 or over - AAAs are up to 6 times more common in men than women, and the risk of getting one goes up as you get older

people who smoke - if you smoke or used to smoke, you're up to 15 times more likely to get an AAA

people with high blood pressure - high blood pressure can double your risk of getting an AAA

people with a parent, sibling or child with an AAA - you're about 4 times more likely to get an AAA if a close relative has had one

Speak to your GP if you're worried you may be at risk of an AAA. They may suggest having a scan to check if you have one and making healthy lifestyle changes to reduce your risk of an AAA.

Treatments for an abdominal aortic aneurysm (AAA)

The recommended treatment for an AAA depends on how big it is.

Treatment is not always needed straight away if the risk of an AAA bursting is low.

Treatment for a:

small AAA (3cm to 4.4cm across) - ultrasound scans are recommended every year to check if it's getting bigger; you'll be advised about healthy lifestyle changes to help stop it growing

medium AAA (4.5cm to 5.4cm) - ultrasound scans are recommended every 3 months to check if it's getting bigger; you'll also be advised about healthy lifestyle changes

large AAA (5.5cm or more) - surgery to stop it getting bigger or bursting is usually recommended

Ask your doctor if you're not sure what size your AAA is.

Reducing your risk of an abdominal aortic aneurysm (AAA)

There are several things you can do to reduce your chances of getting an AAA or help stop one getting bigger.

These include:

If you have a condition that increases your risk of an AAA, such as high blood pressure, your GP may also recommend taking tablets to treat this.

Screening for AAAs

In England, screening for AAAs is offered to men during the year they turn 65. This can help spot a swelling in the aorta early on, when it can be treated.

The test involves a quick and painless ultrasound scan to see how big your aorta is.

If you're a man over 65 and you have not been screened, you can request a test by contacting your local AAA screening service directly.

Women and men under 65 are not routinely invited for screening. But if you think you might have a higher risk of an AAA, talk to your GP about the possibility of having a scan.

Read more about screening for an AAA.

# data[].attributes.attachment_link.description
An abdominal aortic aneurysm (AAA) is a bulge or swelling in the aorta, the main blood vessel that runs from the heart down through the chest and tummy. An AAA can be dangerous if it is not spotted early on. It can get bigger over time and could burst (rupture), causing life-threatening bleeding.

# data[].attributes.headline
CoppaFeel Information page for Trans and non binary people regarding Breast Cancer

# data[].attributes.subject
CoppaFeel Information page for Trans and non binary people regarding Breast Cancer

# data[].attributes.attachment_link.title
Resources for trans and non-binary people

# data[].attributes.headline
Video explaining what to expect when attending diabetic eye screening

# data[].attributes.subject
Video explaining what to expect when attending diabetic eye screening

# data[].attributes.headline
Learning disability storyboard poster for diabetic screening

# data[].attributes.subject
Learning disability storyboard poster for diabetic screening

# data[].attributes.attachment_link.title
1609 IH - Learning disabilities storyboard poster

# data[].attributes.headline
Learning  Disability storyboard for slit lamp appointments

# data[].attributes.subject
Learning  Disability storyboard for slit lamp appointments

# data[].attributes.attachment_link.title
2064 IH - LD storyboard for slit lamp appointments

# data[].attributes.headline
Leaflet for AAA, Breast, Bowel and Cervical screening services in South Devon and Torbay

# data[].attributes.subject
Leaflet for AAA, Breast, Bowel and Cervical screening services in South Devon and Torbay

# data[].attributes.headline
Referral Form for Specialist Health Learning Disability Service

# data[].attributes.subject
Referral Form for Specialist Health Learning Disability Service

# data[].attributes.body
Produced by OUTPATIENTS and Coppa Feel.