Surrey trial: automated text reminders raised bowel cancer screening uptake from 2.0% to 6.5% in London

Researchers at the University of Surrey, together with University College London and Queen Mary University of London, tested two ways of prompting people who had not responded to a bowel cancer screening invitation. The randomized controlled trial ran in eight London boroughs in June and July 2025 and included 3,129 people who had not returned their test kits within 18 weeks, news-medical.net reports on the paper in the British Journal of Cancer news-medical.netnews-medical.netnews-medical.netOpen source ↗. Both approaches tripled screening uptake compared with no follow-up news-medical.netnews-medical.netnews-medical.netOpen source ↗.

Trial design and results

Participants were randomized into three groups. The first received no further contact, the second received automated text reminders, and the third received an initial text followed by calls from patient navigators trained to address common barriers. Texts sent at 19, 21, 23 and 25 weeks raised uptake among initial non-responders from 2.0% to 6.5% news-medical.netnews-medical.netnews-medical.netOpen source ↗. The authors put the cost at £1.82 per additional person screened. Telephone support raised uptake to 7.5% overall news-medical.netnews-medical.netnews-medical.netOpen source ↗.

Less than 1% of participants opted out of text messages, and all who answered the phone rated their experience highly. The most common reasons for not screening were thinking they were already up to date (19.4%), not receiving the kit (19.4%) and being too busy (13.4%). Among people who thought they were up to date, 39.6% of men completed screening after the call, compared with 20.4% of women. According to project lead Dr Robert Kerrison, neither approach widened existing inequalities, and both worked as well in deprived areas as elsewhere.

Screening context

Bowel cancer screening uptake in London is 63.8%, eight percentage points below the national average news-medical.netnews-medical.netnews-medical.netOpen source ↗. The authors estimate that rolling out text reminders across London would mean about 18,000 more people screened each year and, on average, 50 extra cancers detected at an earlier stage. They suggest using telephone calls more selectively, for groups where they are most effective and cost-effective, particularly men.

The NHS Bowel Cancer Screening Programme offers fecal immunochemical test (FIT) screening to adults aged 50–74 in England. A home kit is mailed every two years; the user wipes a small stick across a stool sample, places it in a tube and posts it back. The sample is tested for traces of blood, and those with a positive result are invited for further investigation, usually a colonoscopy.