Simple text reminders could help close London's bowel cancer screening gap
· Medical Xpressedited by Sadie Harley, reviewed by Andrew Zinin
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As low-cost and straightforward an intervention as automated text messaging could make a significant contribution to tackling London's below-average bowel cancer screening rates, according to a study led by the University of Surrey. The project compared two approaches to encourage people who didn't respond to their initial invitation to complete their cancer screening.
Surrey's researchers worked with colleagues from University College London and Queen Mary University of London to test both text message reminders and personalized telephone support with more than 3,000 people across eight London boroughs. Both approaches tripled screening uptake among initial nonresponders compared with no follow-up, with text messages proving cost-effective at £1.82 per additional person screened.
London's bowel cancer screening uptake stands at 63.8%, eight percentage points below the national average. Early detection through screening can significantly improve cancer outcomes, but many people don't complete their test kits after receiving them.
The randomized controlled trial found that simple automated text reminders sent at 19, 21, 23 and 25 weeks increased uptake among initial nonresponders from 2.0% to 6.5%.
If this approach were rolled out across London, the increased uptake would equate to an additional 18,000 people being screened for bowel cancer each year—which would lead to an average of 50 extra bowel cancers being detected at an earlier and therefore usually more treatable stage. Telephone support from trained navigators, who helped people overcome specific barriers to screening, increased uptake to 7.5% overall.
The study has been published in the British Journal of Cancer.
Dr. Robert Kerrison, project lead from the School of Health Sciences at the University of Surrey, said, "A simple text message at the right time can prompt someone to complete a test that could save their life, and it costs less than a cup of coffee per person. We were particularly struck by how well telephone support worked for men.
"When we could actually speak to them, they were much more likely to take action—especially if they had simply forgotten or thought they were already up to date. This is valuable insight when we are designing services.
"Perhaps most importantly, neither approach made existing inequalities worse. They worked just as well for people in deprived areas as anywhere else. When you're trying to close gaps in screening uptake, that matters enormously."
The study, conducted between June and July 2025, randomized 3,129 people who had not returned their screening kits within 18 weeks. One group received no further contact, a second received automated text reminders and a third received an initial text followed by telephone calls from patient navigators trained to address common barriers.
Common reasons people gave for not screening included thinking they were already up to date (19.4%), not receiving their test kit (19.4%) and being too busy (13.4%). The navigators found that men who thought they were up to date were particularly responsive to telephone support, with 39.6% completing screening after the call compared with 20.4% of women reporting the same reason.
All participants who answered the phone rated their experience highly. Fewer than 1% of people opted out of receiving text messages.
The findings suggest that text message reminders could be rolled out across London to help reduce regional inequalities in screening uptake. Telephone calls could be used more selectively, targeting groups for whom they prove most effective and cost-effective, particularly men.
Kerrison added, "Bowel cancer is the UK's second-biggest cancer killer, but when caught early it is treatable and curable. An absolute increase of 4.5 to 5.5 percentage points among nonresponders in London would translate to 18,000 more people being screened each year. That is significant when we are trying to close an eight-percentage-point gap with the national average. These interventions give us practical, evidence-based tools to do that."
The NHS Bowel Cancer Screening Program offers fecal immunochemical test (FIT) screening to adults aged 50–74 in England.
Publication details
Which Is More Effective at Improving Uptake of Bowel Cancer Screening: Text Message Reminders or Patient Navigation? Results from a Three-Arm RCT, British Journal of Cancer (2026). DOI: 10.1038/s41416-026-03645-1
Journal information: British Journal of Cancer
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OncologyCommon illnesses & PreventionPreventive medicine Provided by University of Surrey Who's behind this story?
Sadie Harley
BSc Life Sciences & Ecology. Microbiology lab background with pharmaceutical news experience in oil, gas, and renewable industries. Full profile →
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Master's in physics with research experience. Long-time science news enthusiast. Plays key role in Science X's editorial success. Full profile →
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