Public acceptability and anticipated uptake of risk-stratified bowel cancer screening in the UK: An online survey

Objective: This study aimed to quantify public acceptability and anticipated uptake with risk stratification incorporated at three points on the bowel cancer screening pathway, compared with current screening in England. Methods: We conducted an online population-based survey of 1,203 UK adults in 2024. The main outcome measures were overall acceptability of three strategies where risk stratification is introduced at 1) the point of eligibility, 2) the referral threshold and 3) the screening interval, compared with the current programme (screening as usual), and the acceptability of high- and low-risk screening practices at each point. Other outcomes included anticipated uptake of screening and the acceptability of data collection methods. Results: Acceptability of risk-stratified eligibility and referral thresholds was significantly greater than for screening as usual (p < 0.001). There was no difference for stratified intervals. At all three points, more intense screening for those at high-risk was more acceptable and less intense screening for those at low-risk less acceptable when compared with screening as usual (p < 0.0001). The anticipated likelihood of taking up screening was also significantly higher if at high-risk and significantly lower if at low-risk, compared with screening as usual for all strategies (p < 0.0001). Conclusions: Participants expressed strong acceptability for risk-stratified bowel cancer screening, particularly for risk-stratified eligibility and thresholds for referral. However, acceptability for less intense screening for those at low-risk was lower than for the current programme and may negatively impact uptake. This suggests that the design and framing of risk groups requires careful consideration and communication with the public.